Study of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block to prevent pain syndrome by evaluating ccl2 gene expression after radical mastectomy.

This study aimed to investigate the clinical effect of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block in preventing postoperative pain syndrome of breast cancer. For this purpose, 100 women treated for breast cancer from April 2018 to July 2019 were enrolled as research objects. Surgical procedures included local sentinel lymph node biopsy, mastectomy, sentinel lymph node biopsy for mastectomy, modified radical mastectomy, and implantation. The selected patients were randomly divided into two groups: control group (routine operation anesthesia; n = 50) and observation group (ultrasound-guided thoracic paravertebral block before induction of ropivacaine+butorphanol anesthesia; n = 50). The Real-time PCR technique was performed to evaluate CCL2 gene expression. VAS scores were recorded during the postoperative period. Compared with the control group, the observation group had lower VAS scores at six h, 24h, and 48h (P<0.05). The pain effect of the observation group was less than that of the control group. The observation group had better analgesic effects after anesthesia. The observation group had a lower incidence of pain syndrome at the 6th, 8th, and 12th months (P<0.05), and the incidence of pain syndrome in the two groups decreased with the extension of time. The observation group had lower levels of related factors (P<0.05), and the observation group had lower traumatic stress responses. The protein expression of IL-6, IL-17, and CRP in the observation group was lower than that in the control group (P<0.05). The results of CCL2 gene expression also showed that gene expression in the control group increased significantly (P=0.0047). Since the expression of this gene is one of the factors that stimulate pain signals in the body, the method used in the present study was able to reduce the amount of pain significantly. Therefore, the combination of ropivacaine combined with butorphanol ultrasound-assisted paravertebral block can reduce the intensity of postoperative pain in patients with breast cancer surgery, decrease the incidence of pain syndrome, and increase pain tolerance.

Effect of Positive End-Expiratory Pressure (PEEP) Titration in Elderly Patients Undergoing Lobectomy.

BACKGROUND Currently, one-lung ventilation in thoracoscopic lobectomy adopts mostly a protective ventilation mode, which includes low tidal volume (a tidal volume of 6 mL/kg predicted body weight), positive end-expiratory pressure (PEEP), and intermittent lung inflation. However, there is no clear conclusion regarding the value of PEEP in elderly patients undergoing lobectomy. MATERIAL AND METHODS Fifty patients who underwent video-assisted thoracoscopic unilateral lobectomy, aged 65 to 78 years, with a body mass index of 18 to 29 kg/m² and ASA grades I to III, were randomly divided into 2 groups (n=25 each): optimal oxygenation titration group (group O) and optimal compliance titration group (group C). Mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were recorded in both groups at different time points. The radial artery blood samples were collected at 3 time points for blood gas analysis, and the void volume/tidal volume ratio was calculated. The peak airway pressure and PEEP values were recorded at 4 min after the completion of one-lung ventilation titration (T2), and the driving pressure was calculated. RESULTS The best PEEP value of titration in the best compliance group was lower than that of the best oxygenation method, the peak was lower, and the dynamic lung compliance was higher; however, this had no effect on MAP and HR. The CVP was lower than optimal oxygenation at T2. CONCLUSIONS Dynamic lung compliance-guided PEEP titration improved lung function in elderly patients undergoing lobectomy.

Effect of Pressure-Controlled Ventilation-Volume Guaranteed on One-Lung Ventilation in Elderly Patients Undergoing Thoracotomy.

BACKGROUND Volume-controlled ventilation (VCV) in one-lung ventilation (OLV) is most commonly used in thoracotomy, but pressure-controlled ventilation-volume guaranteed (PCV-VG) is used in elderly patients to improve arterial oxygenation, reduce inflammatory factors, and decrease acute lung injury (ALI). The purpose of this study was to investigate the effects of these 2 different ventilation modes - VCV versus PCV-VG - during OLV in elderly patients undergoing thoracoscopic lobectomy. MATERIAL AND METHODS Sixty patients undergoing thoracoscopic lobectomy from September 2018 to February 2019 at Cangzhou Central Hospital, Hebei, China were randomly assigned to a VCV group or a PCV-VG group. Pulmonary dynamic compliance (Cdyn), peak inspiratory pressure (PIP), arterial blood gas, and inflammatory factors were monitored to assess lung function. The Clinical Trial Registration Identifier number is ChiCTR1800017835. RESULTS Compared with the VCV group, PIP in the PCV-VG group was significantly lower (P=0.01) and Cdyn was significantly higher at 30 min after one-lung ventilation (P=0.01). MAP of the PCV-VG group was higher than in the VCV group (P=0.01). MAP of the PCV-VG group was also higher than in the VCV group at 30 min after one-lung ventilation (P=0.01). The concentration of neutrophil elastase (NE) in the PCV-VG group was significantly lower than in the VCV group (P=0.01). CONCLUSIONS Compared with VCV, PCV-VG mode reduced airway pressure in patients undergoing thoracotomy and also decreased the release of NE and reduced inflammatory response and lung injury. We conclude that PCV-VG mode can protect the lung function of elderly patients undergoing thoracotomy.

Effect of lung protective ventilation on perioperative pulmonary infection in elderly patients with mild to moderate COPD under general anesthesia.

OBJECTIVE: The research aims to explore the effects of different ventilation time on postoperative pulmonary infection in elderly patients with the mild and moderate chronic pulmonary obstructive disease (COPD), so as to provide evidence for reducing postoperative pulmonary infection complications in patients with COPD. METHODS: 120 elderly patients with mild and moderate COPD were selected as the research objects. First, the general information of patients with COPD before surgery and the difference between healthy population and lung forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEV1/FVC and maximum midexpiratory flow (MMEF) functional indexes were analyzed and detected. Patients with COPD were operated on with single lung ventilation and general anesthesia. Patients with mild and moderate COPD were divided into two groups according to lung ventilation time (ventilation time 1.0-2.0h group, ventilation time >2.0h group). The inflammatory factors of IL-6, IL-21, TNF-α, and CXCL13 as well as inflammatory indicators of polycaprolactam (PCT), C-reactive protein (CRP) and white blood cell (WBC) in serum of all patients were detected after the operation. The probability of pulmonary infection after COPD was diagnosed and analyzed. Finally, the regression analysis of postoperative pulmonary infection in COPD patients was analyzed. RESULTS: (1) The results showed that the smoking rate of mild and COPD patients was significantly higher than that of healthy people (P<0.05). (2) The lung function indexes of the mild and moderate groups were significantly lower than those of the control group (P<0.01), while the lung function indexes of the moderate group were significantly lower than those of the mild group (P<0.05). (3) All the inflammatory indicators of moderate COPD patients were significantly higher than those of mild COPD patients (P<0.05). (4) All inflammation-related indicators in patients with mild and moderate COPD with ventilation time of >2.0h were significantly higher than those in the 1.0-2.0h group (P<0.05). (5) The probability of postoperative pulmonary infection in moderate patients was significantly higher than that in mild patients (P<0.01). The probability of postoperative pulmonary infection in >2.0h group was significantly higher than that in the 1.0-2.0h group (P<0.01). (6) Multivariate Logistic regression analysis results showed that lung function, duration of lung ventilation and smoking were independent risk factors for postoperative pulmonary infection in COPD patients. CONCLUSION: It is important to detect pulmonary function before surgery, maintain single lung ventilation protection for no more than 2.0h during surgery, and quit smoking to improve pulmonary infection in patients with COPD after surgery. In addition, the incidence of postoperative pulmonary infection in patients with moderate COPD was higher than that in patients with mild COPD, suggesting that early treatment in patients with COPD was also of great significance in reducing the incidence of postoperative pulmonary infection.

Vitexin improves neuron apoptosis and memory impairment induced by isoflurane via regulation of miR-409 expression.

BACKGROUND: Anesthetics, such as isoflurane, sevoflurane, ketamine, and desflurane, are commonly used in clinics. Specifically, isoflurane is one of the most commonly used inhalational anesthetics, which can be used in surgery patients of all ages, including children. OBJECTIVES: The aim of the study was to investigate the mechanisms of vitexin against isoflurane-induced neurotoxicity. MATERIAL AND METHODS: Reference memory testing was performed for 5 days (4 trials, 2 per day) before anesthesia. Reversal testing was performed on the 3rd day after anesthesia. The cell viability and apoptosis of PC-12 cells were detected using MTT and TUNEL assays, respectively. Enzyme-linked immunosorbent assay (ELISA) kits were used to measure serum tumor necrosis factor α (TNF­α), interleukin 6 (IL­6), glutathione (GSH), and superoxide dismutase (SOD) concentrations. The concentration of reactive oxygen species (ROS) was detected using ROS measurement. Expression of miR-409 was determined using quantitative reverse-transcription polymerase chain reaction (qPT-PCR). Protein expression levels were detected using western blotting. RESULTS: Rats treated with isoflurane showed significant increases in the escape latency periods (ELP) and the apoptosis of hippocampus neuron cells; this effect was reversed by 3 mg/kg or 10 mg/kg of vitexin (p < 0.05). Further testing showed that isoflurane could significantly decrease the cell viability and increase the apoptosis of PC-12, the expression of inflammatory cytokines (TNF­α and IL­6) and ROS (p < 0.05). However, these results were reversed by 10/100 µM of vitexin. In addition, vitexin could significantly increase the expression of miR-409 (p < 0.05). Further studies showed that overexpression of miR-409 could significantly promote the effect of vitexin on isoflurane-induced neurotoxicity (p < 0.05). Finally, overexpression miR-409 could significantly increase the expression of p-AMPK/t-AMPK and p-GSK3ß/t-GSK3ß. CONCLUSIONS: Vitexin has protective effects against isoflurane-induced neurotoxicity by targeting miR-409 and the AMPK/GSK3ß pathway.

Dexmedetomidine reduces ventilator-induced lung injury via ERK1/2 pathway activation.

Mechanical ventilation (MV) can contribute to ventilator­induced lung injury (VILI); dexmedetomidine (Dex) treatment attenuates MV­related pulmonary inflammation, but the mechanisms remain unclear. Therefore, the present study aimed to explore the protective effect and the possible molecular mechanisms of Dex in a VILI rodent model. Adult male Sprague­Dawley rats were randomly assigned to one of seven groups (n=24 rats/group). Rats were euthanized after 4 h of continuous MV, and pathological changes, lung wet/dry (W/D) weight ratio, the levels of inflammatory cytokines (IL­1ß, TNF­α and IL­6) in the bronchoalveolar lavage fluid (BALF), and the expression levels of Bcl­2 homologous antagonist/killer (Bak), Bcl­2, pro­caspase­3, cleaved caspase­3 and the phosphorylation of ERK1/2 in the lung tissues were measured. Propidium iodide uptake and TUNEL staining were used to detect epithelial cell death. The Dex pretreatment group exhibited fewer pathological changes, lower W/D ratios and lower expression levels of inflammatory cytokines in BALF compared with the VILI group. Dex significantly attenuated the ratio of Bak/Bcl­2, cleaved caspase­3 expression levels and epithelial cell death, and increased the expression of phosphorylated ERK1/2. The protective effects of Dex could be partially reversed by PD98059, which is a mitogen­activated protein kinase (upstream of ERK1/2) inhibitor. Overall, dexmedetomidine was found to reduce the inflammatory response and epithelial cell death caused by VILI, via the activation of the ERK1/2 signaling pathway.

Effects of Permissive Hypercapnia on Laparoscopic Surgery for Rectal Carcinoma.

BACKGROUND: Permissive hypercapnia has been recommended during the treatment of chronic diseases; however, there are insufficient clinical data to investigate the feasibility of permissive hypercapnia in relatively long-term surgeries such as laparoscopic surgery for rectal carcinoma. This prospective study is aimed at investigating the efficacy and safety of permissive hypercapnia under different CO2 pneumoperitoneum pressures during the laparoscopic surgery for rectal carcinoma. METHODS: A total of 90 patients undergoing laparoscopic surgery for rectal carcinoma were recruited from July 2016 to March 2017. They were randomly assigned to high hypercapnia group (n = 30), low hypercapnia group (n = 30), or control group (n = 30), whose PaCO2 levels were maintained at 56-65 mmHg, 46-55 mmHg, or 35-45 mmHg, respectively. The primary endpoint was peak pressure. Plateau pressure, dynamic compliance, arterial blood analysis, and hemodynamic measures were collected as secondary outcomes. Adverse events were monitored. RESULTS: High hypercapnia group were reported to be associated with significantly lower peak pressure and plateau pressure, but higher dynamic compliance compared to low hypercapnia and control group (all P < 0.01). Moreover, patients in the high hypercapnia group had higher postoperation oxygenation index values compared to those in the low hypercapnia and control group (all P < 0.01). There is no significant difference in the pH, Spo2, MAP, heart rate, and adverse events among the three groups. CONCLUSION: Permissive hypercapnia with a PaCO2 level of 56-65 mmHg was able to improve respiratory function after laparoscopic surgery in rectal cancer patients.

Effects of bronchial blockers on one-lung ventilation in general anesthesia: A randomized controlled trail.

BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied. METHODS: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively. RESULTS: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups. CONCLUSIONS: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.

Impact of local administration of various doses of dexmedetomidine on ropivacaine-induced lumbar plexus-sciatic nerve block.

The present study aimed to investigate the impact of various doses of dexmedetomidine (DEX) on ropivacaine (ROP)-induced lumbar plexus-sciatic nerve block (LSB). A total of 80 patients who underwent ankle surgery under LSB were divided into group R (applied with 30 ml 5% ROP), Dex1 (30 ml 0.5% ROP + 1 µg/kg DEX), Dex2 (30 ml 0.5% ROP + 1.5 µg/kg DEX) and Dex3 (30 ml 0.5% ROP + 2 µg/kg DEX), with 20 cases in each group. The onset time and duration of sensory and motor block, mean arterial pressure (MAP), heart rate (HR), oxygen saturation, Ramsay score, serum vascular endothelial growth factor (VEGF) level and adverse reactions in the four groups were observed. Results demonstrated that the durations of sensory and motor block in group R were shorter than those in groups Dex1-3 (P<0.01), followed by the sequence of group Dex1

Protective mechanism of sulforaphane in Nrf2 and anti-lung injury in ARDS rabbits.

The effect of sulforaphane on nuclear factor erythroid 2-related factor 2 (Nrf2) and its protective mechanism for lung injury in rabbits with acute respiratory distress syndrome (ARDS) were investigated. Thirty rabbits were randomly divided into control (n=10), model (n=10) and experimental groups (n=10). Rabbits in model group and experimental group were treated with femoral venous injection of oleic acid to establish the ARDS model, while those in control group were injected with the same volume of normal saline. The experimental group received intravenous injection of sulforaphane. Twelve hours after modeling, the clinical manifestations and deaths of rabbits in each group were recorded and compared, including blood gas indexes, lung index (LI), alveolar damage coefficient, serum Nrf2 expression, as well as messenger ribonucleic acid (mRNA) and protein expression of Nrf2 in lung tissues. Pink frothy sputum and death were observed in rabbits in model group and experimental group, but the number of such cases in experimental group was smaller than that in the model group (p<0.05). Compared with those in control group, LI and IQA in model group and experimental group were increased, but LI and IQA in the experimental group were significantly decreased compared with those in the model group. Compared with those in the model group, the blood gas indexes (PaO2, PaCO2 and SaO2) in the experimental group were significantly increased (p<0.05). Nrf2 in serum and lung tissues of rabbits in experimental group was significantly increased compared with that in model group (p<0.05). Sulforaphane significantly inhibits ARDS in rabbits and plays a protective role in ARDS through upregulating Nrf2.

Neuroprotective effects of vitexin against isoflurane-induced neurotoxicity by targeting the TRPV1 and NR2B signaling pathways.

Vitexin is a bioactive compound extracted from hawthorn leaves, which reduces blood pressure and has anti­inflammatory and potential anticancer effects. However, the mechanisms underlying the protective effects of vitexin against isoflurane­induced neurotoxicity remain elusive. Therefore, the aim of the present study was to investigate these mechanisms further. Sprague Dawley rats received 1.4% isoflurane in a 100% oxygen environment for 2 h. Human PC12 pheochromocytoma neurosecretory cells were exposed to 2% isoflurane for 12 h before they were treated with 1, 10 or 100 µM vitexin for a further 24 h. Vitexin inhibited the isoflurane-induced cell cytotoxicity and weakened isoflurane-induced neuroinflammation and oxidative stress pathways in PC12 cells. In addition, treatment with vitexin suppressed isoflurane­induced caspase­3 activation and increased ß-secretase 1 levels in PC12 cells. Furthermore, vitexin treatment decreased the levels of isoflurane­induced cytosolic calcium and reactive oxygen species, and downregulated the expression of transient receptor potential cation channel subfamily V member 1 (TRPV1) and glutamate ionotropic receptor NMDA type subunit 2B (NR2B) protein expression in isoflurane-treated PC12 cells. These results suggest that vitexin mediates its protective effects against isoflurane-induced neurotoxicity by targeting the TRPV1 and NR2B signaling pathways.

Dezocine for anesthesia and stress reduction in induced abortion.

BACKGROUND: The purpose of this study was to evaluate the efficacy of dezocine with regard to analgesic and stress reduction outcomes in women undergoing induced abortion. METHODS: A total of 126 women in early pregnancy (up to 14 weeks' gestation) who underwent induced abortion at Cangzhou Central Hospital from May 2012 to May 2013 were randomly assigned to a control (propofol) group (n=63) or an intervention (propofol + dezocine) group (n=63). Wake-up time, orientation force recovery time, incidence of adverse reactions, postoperative visual analog scale (VAS) score, analgesic effect, and respiratory and circulatory monitoring before the operation, 5 minutes into the operation, and 5 minutes after the operation were compared between the two groups. RESULTS: The surgical procedure and anesthesia were performed successfully in all patients. Systolic and diastolic blood pressure and oxyhemoglobin saturation in the intervention group were significantly higher than in the control group; however, heart rate was significantly lower in the intervention group than in the control group 5 minutes into the operation (all P<0.05). There were no statistically significant differences in these parameters before surgery and after recovery. The postoperative VAS score (2.82±0.72), Ramsay score (2.65±0.65), and anesthetic effect in the intervention group were better than in the control group (3.90±0.84 and 2.21±0.49, respectively), and all differences were statistically significant (P<0.05). The wake-up time (3.41±0.79 minutes) and orientation force recovery time (4.28±0.92 minutes) were all significantly shorter (P<0.05) in the intervention group than in the control group, as was the incidence of adverse reactions (7.94% versus 26.98%, respectively). CONCLUSION: Adverse reactions of propofol combined with dezocine in painless induced abortion are less while the analgesic effect is better.