Objective To evaluate the clinical intubation of Bonfils intubation fiberscope in difficult airway of acromegaly patients.Methods Fifteen acromegaly patients who have one of the following criteria of preoperative airway assessment,Mallampati score ≥3,thyromental distance (≤6 cm),mouth opening(≤3.5 cm).After routine anesthetic induction the patients were intubated with Bonfils intubation fiberscope.Haemodynamic changes were observed and handling of the Bonfils intubation fiberscope was evaluated in terms of the ease of insertion into oropharynx,visualization of epiglottis,advancement into glottis aperture and slide down the tracheal tube.Intubating time and success rate were also recorded.Postoperatively,sore throat or hoarseness were followed up for all patients.Results After intubation systolic pressure and heart rate increased as compared with pre-intubation((P

Objective To compare the GlideScope video-laryngoscope and Macintosh laryngoscope for double-lumen tube (DLT) intubation.Methods Seventy ASA Ⅰ-Ⅲ patients,aged 18-75 yr,scheduled for thoracic surgery and requiring one-lung ventilation,were randomly divided into 2 groups (n =35 each):Macintosh laryngoscope group (group M) and GlideScope video-laryngoscope group (group G).Anesthesia was induced with propofol,fentanyl and rocuronium.The exposure of glottis obtained with Macintosh laryngoscope and GlideScope video-laryngoscope was assessed using Cormack-Lehane grade.DLT intubation was assisted with Macintosh laryngoscope or GlideScope video-laryngoscope.The Cormack-Lehane grade,difficulty of DLT placement,and reverse DLT placement were recorded.The success rate of DLT placement at first attempt and intubation time were also recorded.Blood pressure and heart rate were recorded before intubation and at 0 and 3 min after intubation.The postoperative side effects were recorded.Results Compared with M group,the intubation time was significantly prolonged,the difficulty of DLT placement and blood pressure at 0 and 3 min after intubation were increased in G group (P ＜ 0.05).There was no significant difference in the success rate of DLT placement at first attempt,rate of reverse DLT placement,Comark-Lehene grade and heart rate at each time point between the two groups (P ＞0.05).The Comark-Lehene grade obtained with GlideScope video-laryngoscope was superior to that obtained with Macintosh laryngoscope in G group (P ＜ 0.05).Conclusion GlideScope video-laryngoscope can provide a better exposure of glottis and improvement in the intubating conditions,but the method is more complex and the response to intubation is stronger than Macintosh laryngoscope for DLT intubation.

Objective To investigate the safety and feasibility of anesthesia for patients with myasthenia gravis using target controlled infusion without muscle relaxant.Methods Thirty-one patients with myasthenia gravis were recruited into study.A target controlled infusion was started with targeting effect-site concentration of propofol 3 μg/mL and remifentanil 4 ng/mL.Intubation was performed when patients were unconsciousness and target concentrations of both drugs were reached.No muscle relaxant was used during anesthesia.Blood pressure,heart rate,performance of intubation and respiratory recovery including extubation and wake time were observed.Results All patients were intubated successfully in one attempt.38.7% patients had mild cough when the endotracheal tube past through the vocal cord during intubation.Blood pressure and heart rate at post-intubation increased significantly as compared with pre-intubation (P＜0.01).After cease of drugs,time of spontaneous breathing recovery was (6.5±2.9) min.Extubation and wakeup time were (9.8±3.6) and (7.4±3.1) min respectively.No adverse event was noted.Conclusion Target controlled infusion without muscle relaxant was safe and effective anesthesia for myasthenia gravis patients undergoing thymectomy.

Objective To investigate the relationship between bispectral index (BIS) and cerebrospinal fluid (CSF) concentrations of propofol or effect-site concentrations during target-controlled infusion (TCI) of propofol and evaluate the accuracy of the infusion system targeting at effect-site concentration.Methods Twelve healthy mongrel dogs weighing (17.04? 1.53) kg were anesthetized with intramuscular ketamine 5 mg?kg-1 followed by enflurane inhalation. A catheter was inserted into subarachnoid space and advanced to the base of skull for the collection of CSF. BIS, hemodynamics and PETCO2 were monitored continuously during the experiment. Target effect-site propofol concentration was set at 3 ?g?ml-1 and infusion was continued for 15 min. CSF was collected at 1, 3, 5, 10, 15, 20, 30, 45 and 60 min after infusion was started for determination of propofol concentration by high performance liquid chromatography with fluorescence detection. Results The equilibrium between predicted plasma and effect-site concentration was reached at 10.9 min and the target effect-site concentration was maintained at 3 ?g?ml-1 .The peak CSF concentration of propofol was (0.29? 0.14)?g?ml-1 .CSF concentrations were much lower than the effect-site concentrations at all sampling times (about 18.7% of the effect-site concentration on average) . BIS was consistent with the CSF concentrations of propofol. Both of them reached the lowest or peak values at 5 min after infusion was started, while the peak effect-site concentration was reached relatively later. BIS was found to be better correlated with CSF concentration (? = 0.9195) than with the effect-site concentration (? = 0.554) . The dogs developed hypotension as expected but no other severe adverse effect was observed. Conclusion The inconsistency of BIS with effect-site concentration during TCI of propofol may result from its pharmacokinetic parameters. Good correlation between BIS and CSF concentration indicates that CSF concentration can reflect the pharmacokinetic profileof propofol at effect-site more accurately than the plasma concentration during TCI of propofol targeting at effect-site concentration.

Objective To compare the efficacy and safety of anesthetizing patients with propofol-remifentanil given by TCI targeting effect-site vs plasma. Methods Forty-four ASA Ⅰ - Ⅱ patients aged 20 -65 yr undergoing laparascopic cholecystectomy were randomly divided into two groups : group P targeting plasma concentration (n = 22) and group E targeting effect-site concentration ( n - 22) . The patients were given midazolam 1 mg and scopolamine 0.3 nig i. v. in the operating room before anesthesia. Auditory evoked potential, BP, HR and SpO2 monitoring were started before induction of anesthesia. Anesthesia was induced with propofol and remifentanil given by TCL using two Graseby 3500 infusion pumps. The target concentration of propofol was set at 4 ?g ? ml-1 and remifentanii at 2 ng ? ml -1 . Remifentanil infusion was started 2 min before propofol infusion. When the patients lost consciousness (no response to patting and request for eye-opening), succinylcholine 2 mg?kg-1 was given i. v. to facilitate intubation. Intubation score was assessed. The time required for loss of consciousness after TCI of propofol was started (TLOC), the amount of propofol and remifentanil infused and auditory evoked potential index (AAIs) when the patients lost consciousness were recorded. The patients were mechanically ventilated (VT 8-10 ml, RR 10 bpm) and PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with N2O inhalation, TCI of propofol - remifentanil and intermittent i.v. boluses of vecuronium. Propofol -remifentanil target concentrations were titrated against AAIs value below 20 during maintenance of anesthesia. At the end of operation quality of anesthesia was evaluated. The total amount of propofol and remifentanil consumed were recorded. Aldrate post anesthetic recovery score and postoperative pain score were also assessed. Results TLOC was significantly shorter in group E [(0.45 ?0.1) min] than that in group P (0.86 ? 0.3 min) ( P

AIM: To investigate if pregabalin could depress the acute tolerance induced by morphine when curing the chronic inflammatory pain of rats.METHODS: 24 adult male Sprague-Dawley rats weighing 180-200 g were randomly divided into three groups(8 in each group).Freund's adjuvant was injected subcutaneously in left hind-paw of the rat to establish the chronic inflammatory pain model.3 days later,rats received 3 daily intragastrical(p.o.) morphine 8 mg/kg(M group),pregabalin 3 mg/kg(P group) or morphine 8 mg/kg+pregabalin 3 mg/kg(MP group) administrations respectively.The rats' pressure-withdrawal threshold(PWT) and paw withdrawal thermal latency(PWTL) were determined with Von-Frey hair test and rat hot-plate test respectively.The results of PWT and PWTL before and 15,30,60,120 min after medication were recorded.RESULTS: PWT and PWTL of the rats in M group increased after medication on all the time points of the first day and 15 min of the second day(P

Objective To determine the changes in perioperative plasma melatonin, cortisol and neuron-specific enolase (NSE) and neuropsychological function in patients who developed CNS complications after coronary artery bypass grafting (CABG) .Methods Three patients developed CNS complications (cerebral infarction, motor aphasia, motor and sensory aphasia) after CABG performed under hypothermic cardiopulmonary bypass (CPB) were studied. Blood samples were taken before induction of anesthesia (T1) , 10 min after tracheal intubation (T2), 10 min after heparinization (T3), at 30 min of CPB (T4) , immediately after discontinuation of CPB (T5), at closure of chest (T6), immediately after returning to ICU (T7) and every 3 h in ICU for 24 h (T8-15) for determination of plasma concentrations of NSE, cortisol and melatonin using enzyme-linked immunosorbent assay and radioimmunoassay. Cognitive function was measured before and 10 to 20 days after operation using a battery of tests, while depression and anxiety were assessed by self-rating depression scale and state-trait anxiety inventory respectively. Results The plasma NSE concentration was increased after operation in all 3 patients. The circadian rhythms of melatonin and cortisol were disturbed in patient 1 and 2 during the 24h after operation but were retained in patient 3. In patient 1 and 3 the performance of the trailing making test, the digit symbol subtest of WAIS-R and the stroop color word interference test were poor, meanwhile they became more depressed and less anxious. Conclusion In patients who develop CNS complication after CABG, there are cognitive decline, sentimental disorders and disrupted circadian rhythm of melatonin and cortisol secretion.

Objective To evaluate the feasibility of tracheal intubation without muscle relaxant after induction of anesthesia with propofol-remifentanil given by target controlled infusion (TCI) .Methods Twenty-eight ASA Ⅰ or Ⅱ patients of both sexes (15 males, 13 females) aged 18-67 yrs weighing 43-89 kg scheduled for elective operation under general anesthesia were studied. Midazolam 0.03 mg?kg-1 was given i. v. as premedication. Anesthesia was induced with propofol and remifentanil and both of them were given by TCI. The target effect site concentration of propofol was set at 3 ?g?ml-1 and that of remifentanil at 4 ng?ml-1. BP, HR and bispectral index (BIS) were monitored during induction and intubation. The results of tracheal intubation were graded as satisfactory, average and poor baaed on intubation conditions and intubation response including easiness of ventilating the patients via face mask, jaw relaxation, easiness of inserting laryngoscope and visualization of larynx, the vocal cord position and patients response to intubation such as cough, limb movement and response to cuff inflation.Results HR and BP were significantly increased within 1 min after intubation as compared to the baseline values before intubation ( P

Objective A 23-year-old female patient who had a past history of sexual - precocity and fracture developed hyperhyroidism 8 months ago. Radiological examination revealed enlargement of sella turcica and a adrenal gland nodule. The patient was diagnosed to have McCune -Albright syndrome and scheduled for resection of left subtotal adrenalectomy under general anesthesia. The patient was taking (1) thiamazole 5 mg t. i. d. and propranolol 10 mg q. d. for hyperthyroidism; (2) adalat 10 mg t. i. d. and potassium citrate 20 ml t. i. d. for Cushing syndrome and (3) calcium tablets for osteoporosis. Anesthesia was induced with intravenous midazolam 1 mg, fentanyl 50 ?g and vecuronium 1 mg followed by propofol 150 mg and succinyl choline 100 mg. The patient was intubated and mechanically ventilated (VT = 500 ml, RR =10 bpm, I: E = 1 :2) . PET CO2 was maintained between 35 - 45 mm Hg. Anesthesia was maintained with inhalation of isoflurane and N2O - O2 (1:2) and intermittent i.v. boluses of fentanyl and vecuronium. The BP was increased to 180/110 mm Hg after induction of anesthesia. Urapidil 10 mg was given intermittently i.v. During the exploration of adrenal gland BP was again increased to 200/140 mm Hg. Nitroglycerin was infused i.v. and BP was decreased to 120-130/80-90 mm Hg and was kept at this level till the end of operation. Hydrocortisone succinate 100 mg was infused i.v. slowly after operation. The operation went smoothly. The patient was extubated and the postoperative course was uneventful.

Gabapentin may bind the ? 2? subunit of the voltage -dependent calcium ion channels at the postsynaptic dorsal horn and interrupt t he series of events possibly leading to the experience of a neuropathic pain sen sation. Many clinical studies have clearly demonstrated the efficacy of gabapent in in the treatment of diabetic neuropathy and postherpetic neuralgia. Gabapenti n is considered an effective drug with its minimal side effects and drug interac tions in the management of neuropathic pain syndromes.