The characteristics of respiratory parameters in patients with different body mass index during general anesthesia with tracheal intubation / 实用医学杂志

Objective To explore the characteristics of respiratory parameters in patients with different body mass index during general anesthesia with tracheal intubation. Methods 102 patients scheduled for otitis me-dia surgery were divided into low weight group(B1,n=32),normal weight group(B2,n=36)and overweight or obese group(B3,n = 34 ). After general anesthesia with tracheal intubation,the tidal volume of anesthetic ma-chine wasadjusted to maintain the end tidal carbon dioxide partial pressure between 35 - 45 mmHg. At 10 min (T1),30min(T2)and 60 min(T3)after adjustment,arterial PH,arterial partial pressure of oxygen(PaO2),arte-rial carbon dioxide pressure(PaCO2),inspiratory tidal volume(VTi),expiratory tidal volume(VTe),end tidal carbon dioxide partial pressure(PETCO2),peak airway pressure(Ppeak),plateau airway pressure(Pplat)and dy-namic lung compliance(Cdyn)were recorded. Results PH and PaO2 were not significantly different at T1-3 among the three groups(P>0.05). As compared with group B1 and B2,PaCO2 was lower in group B3. In comparison with group B2,VTi,VTe and Cdyn were higher in group B1 and lower in group B3(P < 0.05). Ppeak and Pplat were lower in group B1 but higher in group B3(P<0.05). PETCO2 was higher in group B1(P>0.05)while lower in group B3 (P < 0.05). Conclusions With the increase in BMI during general anesthesia with tracheal intubation ,the VTi,VTe,Cdyn,PETCO2 and PaCO2 decrease significantly,but Ppeak and Pplat elevate markedly. BMI is a refer-ence index for setting respiratory parameters.

Effects of propofol sedation on psychological stress in surgical patients under epidural / 南方医科大学学报

OBJECTIVE@#To explore the effects of propofol sedation on psychological stress in patients undergoing surgery under epidural anesthesia.@*METHODS@#Sixty patients scheduled to undergo elective ileostomy closure under epidural anesthesia were randomized into propofol sedation group and control group (=30). The patients in the sedation group received a loading dose of propofol of 0.6 mg·kg· h followed by a maintenance dose with continuous infusion of 3 mg·kg· h given after the Observer's Assessment of Alertness/Sedation (OAA/S) score reached 2-3. An equivalent volume of normal saline was administered in patients in the control group. The patients' preoperative and intraoperative anxiety scores were assessed with the State Anxiety Inventory (SAI) on the day before and on the first day after the surgery, respectively. The mean blood pressure (MBP), heart rate (HR), SpO, OAA/S, and the indicators of psychological stress of brain functional state of the patients (including the wavelet index [WLi], anxiety index [ANXi], comfortable index [CFi] and pain index [Pi]) were recorded at 5 min after entering the operating room (T), at the time of lumbar puncture (T) and change to supine position after the puncture (T), at 20 s (T), 40 s (T), and 60 s (T) after intravenous administration, and at 2 min (T), 4 min (T), 6 min (T), 8 min (T), 10 min (T) and 40 min (T) after skin incision. The patient's satisfaction with anesthesia was assessed with the Visual Analog Scale (VAS) score on the first day after the operation. Serum cortisol level was measured before anesthesia and at the end of operation to calculate the changes in cortisol level.@*RESULTS@#The two groups of patients were comparable for preoperative SAI scores (>0.05); The patients in the sedation group appeared to have lower intraoprative SAI scores, but this difference was not statistically significant (=0.05). MBP, HR, and SpO at the time points from T to T and OAA/S, WLi, ANXi, CFi, and Pi at the time points from T to T were significantly lower in the sedation group (all < 0.05), and these parameters were not significantly different between the two groups at the other time points (all >0.05). The patient satisfaction scores were significantly higher in the sedation group (Z=2.07, < 0.05). Compared with the preoperative levels, serum cortisol level at the end of the operation was increased in the sedation group but lowered in the control group, and the variations of serum cortisol level differed significantly between the two groups (=4.75, < 0.01).@*CONCLUSIONS@#Intraoperative propofol sedation can alleviate the patients' anxiety, improve the comfort level, and lessen physiological stress during surgeries under epidural anesthesia.

Clinical analysis of perioperative electrolyte imbalance in 999 patients undergoing gastrointestinal surgery / 中华胃肠外科杂志

OBJECTIVE@#To investigate the perioperative electrolyte imbalance in patients undergoing gastrointestinal surgery.@*METHODS@#Retrospective case analysis was used in this study. Patients who underwent gastrointestinal surgery under general anesthesia at the Sixth Affiliated Hospital of Sun Yat-sen University from January to April 2018 were selected through electronic medical records system. Blood gas analysis during surgery must be carried out in the enrolled patients. Patients with excessive fluid infusion, critical conditions or patients who had been enrolled in other clinical trials were excluded. A total of 999 patients were enrolled. The preoperative, intraoperative and postoperative concentrations of serum sodium, potassium and calcium were collected by the last biochemical examination before surgery, arterial blood gas analysis within 1 h after anesthesia and another biochemical examination within 24 hours after surgery respectively. The type and incidence of electrolyte imbalance were then analyzed, and logistic regression analysis was used to investigate the risk factors.@*RESULTS@#In the 999 patients, 683 cases were male (63.9%) and 361 cases were female(36.1%), with an average age of (56.9±14.6) years old. Fifty-eight patients (5.8%) underwent emergency surgery and 941 patients (94.2%) underwent elective surgery; Sixty-two patients were treated with laxatives at least 3 times and 115 patients were treated with enema at least 3 times before operation. The incidence of hypokalemia was 49.6%(496/999) intraoperatively and decreased to 15.2%(152/999) postoperatively. No hyperkalemia cases were found. The incidence of hypocalcemia was 53.8%(537/999) intraoperatively and increased to 79.7% (796/999) postoperatively. The incidence of hypokalemia in ileus patients was 33.3%(17/51) before surgery, which was higher than that in patients with colorectal cancer [12.3%(86/703)], patients with gastric cancer [7.8%(8/104)] and patients with other gastrointestinal diseases[10.6%(15/141)] (all P<0.05). Similarly, the preoperative and intraoperative incidence of hyponatremia in ileus patients were both 15.7%(8/51), which were higher than those in patients with colorectal cancer [3.0% (21/703) and 2.3% (16/703)] and patients with gastric cancer [2.9%(3/104) and 1.9%(2/104)]. The incidence of hypocalcemia in ileus patients was 31.4%(16/51) preoperatively, which were also higher than those in patients with colorectal cancer [7.4%(52/703)] and patients with gastric cancer [8.7%(9/104)] (all P<0.05). Logistic regression analysis showed that ileus and emergency surgery were risk factors for patients with preoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for intraoperative electrolyte imbalance; intraoperative electrolyte imbalance was a risk factor for postoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for postoperative imbalance of sodium and potassium.@*CONCLUSIONS@#The incidence of electrolyte imbalance is high in patients undergoing gastrointestinal surgery, especially hypocalcemia and hypokalemia. It is necessary to recognize the electrolyte abnormality timely and give active intervention and correction.

Perioperative fluid management in gastrointestinal surgery / 中华胃肠外科杂志

Perioperative fluid management in gastrointestinal surgery is one of the key points to maintain sufficient blood perfusion and oxygen delivery for the organs, tissues and cells. Different strategies of fluid management have different influences on postoperative complications and mortality. After systematic review of related literature, we found that compared with the conventional liberal liquid administration, restricted liquid management and goal directed liquid management would benefit patients in general. With the guidance of cardiac output (CO), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV) and pulse perfusion variation index (PVI), which can dynamically monitor the reactivity to volume, individualized goal-directed liquid management was more likely to maintain the perioperative hemodynamic stability, guarantee adequate tissue and organ blood perfusion and oxygen delivery, reduce perioperative complications, and shorten the postoperative hospital stay. In addition, the potential risk of tissue hypoperfusion caused by restricted liquid management should draw the clinicians' attention. More researches are needed to explore the right timing, the appropriate type of liquid and the reasonable amount of liquid to maintain the best functional state of tissues and organs perioperatively.

Reliability of pressure cuff induced transient limb ischemia in conscious rabbits / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The protective effects of transient limb ischemia (TLI) induced by several cycles of intermittent pressure cuff inflation and deflation for a period have been widely investigated, however the reliability of this protocol has not been clearly verified. Our study aimed to investigate the reliability of pressure cuff induced TLI in conscious rabbits.</p><p><b>METHODS</b>Eight New Zealand rabbits were subjected to TLI without anesthesia. TLI consisted of 3 cycles of ischemia and reperfusion induced by inflating the cuff placed on the left lower limb to 200 mmHg for 5 minutes followed by deflating the cuff for 5 minutes. Skin color, pulse oxygen saturation (SpO2), pulse rate (PR), plethysmogram waveform (Pleth), and ultrasound detection of the blood flow in the extremity distal to the ischemic segment were observed to confirm ischemia and reperfusion during TLI. The frequency of severe limb movement during TLI was also recorded to assess the amenability of this protocol in conscious rabbits.</p><p><b>RESULTS</b>The skin color of the extremity distal to the ischemic segment changed from bright red to dark purple after inflating the cuff to 200 mmHg, and returned to normal after cuff deflation. Pleth, PR and SpO2 disappeared during ischemia and restored during reperfusion in the monitor. Blood flow of the left posterior tibial artery was completely blocked by a pressure of 200 mmHg during ischemia, and recovered immediately after cuff deflation. The frequency of severe limb movement in supine position was higher than that in prone position (P < 0.05), but there was no severe limb movement that could result in disturbance to ischemia when the rabbits were placed in prone position.</p><p><b>CONCLUSION</b>Pressure cuff inflating to 200 mmHg for 5 minutes and deflating for 5 minutes is a reliable regimen to induce TLI in conscious rabbits.</p>

High-cholesterol diet with or without corn oil for establishing atheroscle-rotic model in rabbits / 中国病理生理杂志

AIM:To compare the reliability and plaque area between using high-cholesterol diet and high-cho-lesterol diet with corn oil to establish a rabbit atherosclerotic model .METHODS:Eighteen New Zealand rabbits were ran-domly divided into 3 groups (6 rabbits each):normal diet group (group C), high-cholesterol diet group (group H1) and high-cholesterol diet containing 6%corn oil group (group H2).All rabbits were fed for 12 weeks, and their body mea-sured was weighed at the end of every weeks .The serum levels of high-density lipoprotein cholesterol ( HDL-C) , low-den-sity lipoprotein cholesterol ( LDL-C) , total cholesterol ( TC) and triglyceride ( TG) were measured by automatic chemistry analyzer at 0 week and 12 weeks.At the end of 12 weeks, the thoracic aorta of 8-cm length since aortic root was isolated from the rabbit after anesthesia , and stained with Sudan IV or oil red O to verify the existence of plaque .The percentage of plaque area (PA/IA) in the intima area was further calculated by ImageJ 2x software.RESULTS:At the end of 12-week feeding, the serum levels of HDL-C, LDL-C and TC in both group H1 and group H2 were significantly higher than those in group C, and serum TG in group H2 was significantly higher than that in group C .Serum HDL-C in group H2 was signifi-cantly higher than that in group H1, but no significant difference of serum LDL-C, TC and TG between group H1 and group H2 was found .There was no plaque in the intima in group C , and plaques were observed in the intima of all rabbits in group H1 and group H2.Rabbit atherosclerotic models in both group H 1 and group H2 were established with a success rate of 100%.The values of PA/IA in group H1 [(49.74 ±18.78)%] and group H2 [(56.95 ±26.74)%] were both sig-nificantly higher than that in group C (0%), and no significant difference of PA/IA between group H1 and group H2 was observed.CONCLUSION:High-cholesterol diet with or without corn oil can establish a rabbit atherosclerotic model with a success rate of 100%after 12-week feeding , and the percentage of plaque area in the total aortic intimal area is not differ-ent in the 2 feeding methods .

The effects of propofol combined with fentanyl on metabolic rate of energy expenditure during anesthesia / 中华麻醉学杂志

To observe the effects pf propofol combined with fentanyl on metabolic rate of energy cxpen diture in anesthesia. Method: Thirty-one elective neurosurgical adult patients, ASA class Ⅰ-Ⅱ, received tolal intravenous anesthesia with propofol combined with fentanyh Oxygen consumption (VO_2), carbon dioxide production (VCO_2), respiratory quotient(RQ), metabolic rate(MR)were measured. Resuh: VO_2 and MR increased when patients' posture changed or there existed strong operative stimulation. VO_2 and MR during post induction were 91.09% and 91.29% of the level before anesthesia respectively(P

Comparison of cold blood and cold crystalloid cardioplegia on myocardial protection effects in valve replacement surgery / 中国医师杂志

Objective To compare the myocardial protection effects of cold blood cardioplegia and cold crystalloid cardioplegia in patients undergoing valve replacement surgery.Methods One hundred adult patients with cardiac function Ⅱ～Ⅲ class undergoing primary elective valve replacement surgery due to rheumatic heart disease were retrospectively analyzed.For patients with cardiac arrest,cold blood cardioplegia was applied to 50 cases(Group B),and cold crystalloid cardioplegia to the others(group C).The process of heart resuscitation,the postoperative need of dopamine,the blood pressure and heart rate,the postoperative level of serum myocardial enzyme,the intensive care unit(ICU) stay after operation were collected and statistically analyzed.All the cardioplegic solution was perfused in a similar manner and topical cooling was employed simultaneously.Results There were less cases in group B than in group C who needed isoprenaline for cardiac resuscitation after clamp removal(P0.05).Conclusion The cold blood cardioplegia and cold crystalloid cardioplegia have similar myocardial protection effects on rheumatic heart disease patients with cardiac function Ⅱ～Ⅲ class undergoing valve replacement surgery.

Granulocyte colony-stimulating factor mobilized bone marrow stem cells treat the acute myocardial infarction / 中国病理生理杂志

AIM: To investigate the effects of granulocyte colony-stimulating factor (G-CSF)-mobilized bone marrow stem cells on treatment of the myocardial infarction in experimental rats. METHODS: Three hours after injected with isoprenaline(ISO) interaperitoneally to develop acute ischemic model, rats' bone marrow stem cells were mobilized by G-CSF and migrated to the site of myocardial infarction. The hearts were harvested from 24 hours to 2 weeks after administration of ISO for histopathological examination. RESULTS: 24 hours after administration of ISO , myocardial infarct zones scattered in the pallium of the control group ,there were a large amoumt of inflammatory cells infiltration around the infarct zones and majority of them were neutrophils. The infarction in the G-CSF treatment group was milder, majority of the infiltrative cells were monocytoid; 48 hours after administration of ISO, infarct zones expanded greatly in control group, while that of the G-CSF treatment group increased just mildly; 2 weeks after administration of ISO, there was no significant scar in the G-CSF treatment group. We also found the regeneration of myocytes in the pallium. CONCLUSION: G-CSF treatment protected the ischemic myocardium and it may be used to treat the acute myocardial infarction.