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 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

Objective To compare the effects of desflurane, enflurane and isoflurane on onset time,duration of action and recovery time of pipecuronium. Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-60yr weighing40-80 kg were randomly divided into 3 groups: (1) desflurane group (n = 10); (2) enflurane group(n = 10) and(3) isoflurane group (n = 10). The patients were premedicated with intramuscular pethidine 1 mg?kg~(-1) andatropine 0 .01 mg?kg. Anesthesia was induced with midazolam 0. 03 mg?kg~(-1), propofol 0.5-1 .0 mg?kg~(-1)andfentanyl 2?g?kg~(-1) .When the patients fell asleep neuromuscular function was monitored by accelerography usingTOF stimulation. Pipecuronium 0.045 mg?kg~(-1) was given i. v. as soon as T_1 was 100 % blocked (T_1= 0), anotherdose of propofol was given, making the total dose of propofol amount to 2.5 mg' kg?kg~(-1).Tracheal intubation wasperformed. The patients were mechanically ventilated and P_(ET) CO_2 was maintained at 35-45 mm Hg. Desflurane oreaflurane or isoflurane was inhaled with N_2O-O_2(2: 1) .The end-tidal desflurane, enflurane or isofluraneconcentration was maintained at 0. 65 MAC(desflurane= 3. 9 %, enflurane = 1. 1 %, isoflurane = 0. 75 % ). Duringoperation when deeper anesthesia was needed intermittent i. v. blouses of fentanyl were given. The onset time, thetime needed for T_1 to return to 5 %, 10 %,25 %, 50 %,75 % of control and recovery index were recouled andcompared among the three groups.Results The demographic data including age, weight, sex and types ofoperation were not significantly different among the 3 groups. Three were no significant differences in onset time,recovery time (time for T_1 to return to 5 %, 10 %,25 %,50 % and 75 % of control) and recovery index amongthe 3 groups. Conclusion Desflurane can prolong the duration of action and recovery time of pipecuronium justlike enflurane and isoflurane but there were no significant differences among the 3 groups.

Objective To investigate the relationship between circadian rhythm of perioperative melatonin secretion and neuropsychological status in patients undergoing coronary artery bypass grafting (CABG) .Methods Forty male ASA Ⅱ-Ⅲ patients aged 45-60yr scheduled for elective CABG under hypothermic cardiopulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated to CPB group ( n = 20) or off-pump group (n - 20). Blood samples were taken before induction of anesthesia (T1 ), 10 min after tracheal intubation (T2), 10 min after heparinization (T3) , 2h after skin incision (T4), immediately before neutralization of heparin with protamine (T5 ), at the end of surgery after skin suture (T6 ) and every 3h after operation for 24h for determination of plasma melatonin concentration using enzyme-linked immunosorbent. Degree of depression was assessed by Self-Rating Depression Scale; anxiety by the State-Trait Anxiety Inventory and cognitive function by neuropsychological tests respectively, the day before operation, 7-10 days after surgery and 3 months postoperatively. Results In the 24 hours after operation the circadian secretion pattern of melatonin was kept in 2 patients in CPB group and 6 patients in off-pump group, but disturbed in the remaining patients in both groups. Postoperative depression scores were significantly higher than the preoperative baseline values in both groups. Anxiety scores at 7-10 days after operation were significantly higher in CPB group than those in off-pump group (P

5) who were conscious and had no obvious cardio-respiratory and hepato-renal dysfunction were enrolled in this study. The patients received intravenous PCA with morphine for the first 48 hours. The PCIA morphine solution contained morphine 2-6mg?ml-1 and droperidol 1-2 mg?30 ml-1 . PCIA included a bolus dose of morphine 1-3 mg with a 5 min lockout. No background infusion was given. Morphine PCIA was then combined with transdermal fentanyl. The initial dose of transdermal fentanyl was 25?g ? h-1 in the first two to three days. The dose was then gradually increased in 25 ?g?h-1 increments according to VAS scores and the amount of Ⅳ morphine needed to reduce the persistent pain until transdermal fentanyl alone could provide sufficient relief of persistent pain and Ⅳ morphine was given only for breakthrough pain. Pain intensity (VAS scores) before and after treatment, daily consumption of morphine (mg?d-1) and transdermal fentanyl (?g?h-1), vital signs and side effects were recorded.Results The 13 patients included 6 males and 7 females. Their mean (?SD) age was 54?15 yrs and body weight 53? 8 kg. There was positive correlation between the titrated dose of transdermal fentanyl (??k-1) and the initial need of Ⅳ morphine (mg?day-1). Y= 1.3606 X + 6.5088. Persistent pain intensity and breakthrough pain intensity evaluated by VAS scores were significantly reduced during the treatment ( 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.

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 investigate the effect of ketamine pretreatment on acute tolerance to morphine in rats with chronic inflammatory pain.Methods Twenty-four adult male SD rats weighing 180-200 g were randomly divided into 3 groups (n=8 each): group Ⅰ morphine (M) ,group Ⅱ ketamine (K) and group Ⅲ ketamine + morphine (KM). Chronic inflammatory pain was induced by subcutaneous injection of Freund's adjuvant 0.125 ml into the plantar surface of left hindpaw. Three days after Freund's adjuvant injection, the animals received intraperitoneal (IP) morphine 5 mg/kg in group M, IP ketamine 10 mg/kg in group K or IP ketamine 10 mg/kg 10 min before IP morphine 5 mg/kg in group KM once a day for 3 consecutive days respectively. The paw withdrawal threshold to yon Frey hair stimulation (PWT) and paw withdrawal latency to noxious thermal stimulation(PWLT) using the hot plate test were measured before Freund's adjuvant injection (T0, baseline), and every day before (T1) and at 15 (T2), 30 (T3), 60 (T4) and 120 min (T5) after medication for 3 days (D1,2,3).Results PWT was significantly increased after medication on D1,2,3 in group KM but only on D1,2 in group M. PWLT was significantly prolonged after medication on D1,2,3 in group KM but only on D1 in group M. Conclusion Ketamine 10 mg/kg pretreatment can decrease the acute tolerance to morphine in rats with chronic inflammatory pain.