Objective To investigate the effects of inhalation of isoflurane (Iso) on pulmonary and systemic inflammatory response through the changes in the plasma and pulmonary levels of IL-1β and IL-10 in rats. Methods Thirty-two adult male Wistar rats were randomly divided into 4 groups (n=8 each): group control (group C), group Iso-4 h, group Iso-8 h and group R. Group C inhaled air only. Group Iso-4 h and Iso-8 h inhaled in 40% O2 + 1.5% Iso for 4 and 8 h respectively. Group R inhaled 40% O2 + 1.5% Iso for 8 h and then withdrew and only inhaled 40 % O2 for 2 h. Blood samples were taken from femoral artery for measurement of plasma concentrations of IL-1β and IL-10 by ELISA. Then the rots were sacrificed to collect bronchoalveolar lavage fluid (BALF) for measurement of IL-1β and IL-10 concentrations. The right lung tissues were obtained for determination of the expression of IL-1β mRNA and IL-10 mRNA by RT-PCR. Results The BALF concentration of IL-1β and IL-1β mRNA expression in lung tissues were significantly higher in group Iso-4 h, and the concentrations of plasma and BALF IL-1β and IL-10, and the expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly higher in group Iso-8 h than in group C (P<0.05), but there were no significant differences in the concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues between group R and group C (P>0.05). The plasma and BALF IL-10 concentrations and IL-10 mRNA expression in lung tissues were significantly higher in group Iso-8 h than in group Iso-4 h (P<0.05). The concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly lower in group R than in group Iso-8 h (P<0.05). Conclusion Isollurane inhalation can induce transient pulmonary and systemic inflammatory response in rats.

0.05).Conclusions Combined spinal and epidural anesthesia combined with target controlled infusion of midazolam has slight side effects and serum cortisol changes,suitable for gynecological operations.

Objective:To examine the effects of different concentrations of Isoflurane on the level of surfactant protein A(SP-A) and the expression of SP-A mRNA in the lung of rats.Methods: Thirty-two male Wistar rats were randomly divided into 4 groups: control group received 40%(volume fraction) O_2 inhalation(40% O_2,n=8);0.7% isoflurane group(n=8),1.5% isoflurane group(n=8).They and 2.0% isoflurane group(n=8).They were treated with 40%O_2 with 0.7%,1.5% and 2.0% isoflurane respectively.In each group,the rats inhaled experimental gas for 8 hours,and then were put to death immediately.Morphological changes of type Ⅱ pneumocytes were observed by transmission electron microscopy.Surfactant protein content in broncho-alveolar lavage fluid(BALF) was measured with Western Blotting.The level of intracellular SP-A was examined with immunohistochemistry(IHC).To assess the relative levels of SP-A mRNA in lung tissue,reverse transcriptase-polymerase chain reaction(RT-PCR) was used with the co-amplification of the "housekeeping" gene GAPDH as internal control.Results: Morphological changes of type Ⅱ pneumocytes were distinct in 1.5% isoflurane and 2.0% isoflurane groups.Isoflurane,after three doses,significantly reduced the SP-A content in BALF.Control group,(437 112)?25 654;0.7%Isoflurane group,355 789?28 116;1.5%Isoflurane group,238 554?31 531;(2.0%) Isoflurane group,223 632?25 710(P

Objective To investigate the effects of 1% ropivacaine injected epineurally or intraneurally on the recovery of sciatic nerve from acute injury in rats. Methods Seventy-two healthy male Wistar rats weighing 220-250 g were xandomly assigned into 4 groups ( n = 18 each): group Ⅰ epineural injection of normal saline(NS)(group C1); group Ⅱ intraneural injection of NS (group C2); group Ⅲ epineural injection of 1% ropivacaine (group Epi-R) and group Ⅳ intraneural injection of 1% ropivacaine (group Intra-R). The animals were anesthetized with intraperitoneal 3% pentobarbital 60 mg/kg. The sciatic nerve was exposed and crushed with blood vessel clamp for 2 min. NS or 1% ropivacaine 0.2 ml was injected epineurally or intraneurally after release of the clamp.Sciatic nerve function was measured and sciatic nerve function index (SFI) was calculated at day 1, 3, 7, 14, 21and 28 after operation. Six animals in each group were anesthetized on the 14th and 28th day after operation and the nerve conduction velocity (NCV) of the sciatic nerve was measured. The sciatic nerve was then removed for histologic examination. Results There was no significant difference in SFI and NCV at all time points among group C1 , C2 and Epi-R. SFI was almost normal on the 28th day after operation in the 3 groups. The NCV was significantly slower at day 14 and 28 after operation in intra-R group than in the other 3 groups. Conclusion Intra-neural injection of ropivacaine can significantly delay the recovery of sciatic nerve from acute injury.

Objective To investigate the effects of inhalation of different concentrations of sevoflurane on pulmonary inflammatory response in rats. Methods One hundred and twenty adult Wistar rats of both sexes weighing 200-250 g were randomly divided into 4 groups: Ⅰ control group breathing room air (group C, n = 12);Ⅱ oxygen group breathing 40% O2(group O, n = 36);Ⅲ and Ⅳ sevoflurane groups breathing 1.5% and 3.0% sevoflurane in 40% O2 respectively (group S1, S2, n = 36). Group Ⅱ was further divided into 3 subgroups according to the duration of 40% O2 inhalation 4 h, 8 h and 10 h. Group Ⅲ and Ⅳ were further divided into 3 subgroups ( n = 12 each) breathing sevoflurane for 4 h, 8 h and 8 h followed by 2 h O2 (40%) inhalation. The animals were sacrificed at the end of O2 or/and sevoflurane inhalation. Broncho-alveolar lavage was performed in 6 animals in each subgroup. The TNF-α concentration in broncho-alveolar lavage fluid was determined. The TNF-α mRNA expression and MPO activity in the lung tissue were measured in the other 6 animals in each subgroup. Results Inhalation of 1.5% or 3.0% sevoflurane for 4 or 8 h did not induce inflammatory response in the lung as compared with animals breathing room air or 40% O2 . Conclusion Exposure to sevoflurane does not induce pulmonary inflammatory response in rats breathing spontaneously.

The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.

Objective To discuss the management of anesthesia for video-assisted laser operation under rigid bronchoscopy.Methods A retrospective review was made on anesthetic records of 15 cases of video-assisted operation under rigid laser bronchoscopy in this hospital from September 2002 to December 2006.According to the ASA classification,there were 7 cases of class Ⅱ,7 cases of class Ⅲ,and 1 case of class Ⅳ.The diagnosis included 13 cases of tumor and 2 cases of cicatricial stricture.All the patients had a forced expiratory volume in 1 second(FEV1) predicted lower than 70%. By using intravenous fast induction,the propofol,fentanyl,and vecuronium or rocuronium were injected successively.Then a rigid bronchoscope was inserted into the trachea under orthoptic laryngoscope.During the operation a total intravenous anesthesia(TIVA) was maintained.Before induction and 5～10 min after operation,we monitored artery blood gas(ABG) levels.Immediately following the operation the end-tidal CO2 pressure(PETCO2) was measured.Results Hemodynamics parameters were not significantly different between preoperatively and intraoperatively.During the operation,the pH value was 45 mm Hg in 5.All the patients presented normal blood pressures and heart rates. Conclusions During video-assisted laser operation under rigid bronchoscope,anesthesia with normal frequency jet-ventilation and artery blood gas monitoring is safe and reliable.

Objective To determine the difference between the measured(Cm) and the target rocuronium plasma concentration(Cp) in geriatric patients given by target-controlled infusion(TCI) during laparoscopic rectectomy or colectomy,and to evaluate the performance of the rocuronium TCI system(Szenohradszkay model).Methods Twenty-four ASA I～II patients aged 65～81 years old received selective laparoscopic rectectomy or colectomy.After induction,all patients received rocuronium by TCI system.The beginning Cp was 1000 ng/ml,then increased to 1300,1600,1900,2200,and 2500 ng/ml,according to the neuromuscular transmission response.The endpoint of Cp was determined when the T1 was maintained at 5%～10%.Radial arterial blood samples were taken before anesthesia and before the adjustment of Cp each time,to determine the plasma concentration of rocuronium by using HPLC/MS.We used parameters of bias,precision,and wobble to evaluate the performance of the TCI system. Results The endpoint Cp(when the T1 was maintained at 5%～10%) was 1600 ng/ml in 2 patients,1900 ng/ml in 5 patients,2200 ng/ml in 9 patients,and 2500 ng/ml in 8 patients.The bias,precision,and wolbble of the rocuronium TCI system were 4.69%,14.93%,and 17.24%,respectively. Conclusions The rocuronium TCI system with Szenohradszkay pharmacokinetic model is clinically acceptable for Chinese geriatric patients.

Objective To evaluate the effect of mild hypothermia on the recovery from cisatracurium blockade during the recovery from anesthesia in patients .Methods Thirty ASA physical status Ⅰ or Ⅱ patients , aged 18-64 yr , with body mass index 18-25 kg/m2 , scheduled for elective abdominal surgery under general anesthesia ,were enrolled in the study .The patients were divided into 2 groups according to the body temperature recorded when cisatracurium infusion was stopped at the end of surgery .The body temperature 36.0-36.9 ℃served as normothermia group (group N , n=14 ) and 34.0-35.9 ℃ served as mild hypothermia group (group H , n= 16 ) . The body temperature was measured by a thermocouple placed in the nasopharynx . Neuromuscular function was monitored by measuring the evoked mechanical response of the adductor pollicis muscle to supramaximal train-of-four (TOF) stimulation (frequency 2 Hz ,wave length 0.2 ms ,intensity 50 mA ,interval 15 s) of the ulnar nerve at the wrist using TOF-Watch SX? .Cisatracurium was intravenously infused at 1-3μg·kg-1 ·min-1 during surgery to maintain neuromuscular block with 1%

Objective To investigate the changes of stress responses and fibrinolysis under three anesthesia techniques undergoing elective hysterectomy during perioperative period. Methods Thirty ASA Ⅰ or Ⅱ patients aged 31-57yr weighing 45-70 kg undergoing elective hysterectomy were divided randomly into 3 groups ( n = 10 each): group Ⅰ continuous epidural anesthesia (E); group Ⅱ general anesthesia combined with continuous epidural anesthesia (G + E) and group Ⅲ general anesthesia (G) . The patients in the 3 groups were all premedicated with midazolam 0.05 mg?kg-1 i.v. . In group G and G + E the patients received an additional scopolamine 0.3 mg i.v. . In group E and G + E an epidural catheter was placed through L1-2 interspace and 2% lidocaine 5 ml was given as test dose. The spinal segments blocked was extended from L3 to T6 using 0.75 % bupivacaine. In group G and G + E general anesthesia was induced with fentanyl 2-3 ?g ? kg-1, propofol 1.5-2.0 mg?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of vecuronium. The patients were mechanically ventilated after tracheal intubation. BIS, ECG, BP, HR, SpO2 , PETCO2 and end-tidal isoflurane concentration were continuously monitored during operation. BIS value was maintained below 60. PCEA or PCIA was started as soon as the patients were awake. VAS scores were maintained below 3-4. Venous blood samples were taken before anesthesia (T0 baseline) at the end of operation (T1) and 24 and 72 h after operation (T2 , T3) for determination of plasma adrenaline (A) and noradrenaline (NA), D-dimer level (DD), tissue type plasminogen activator (t-PA ) and plasminogen activator inhibitor ( PAI-1) concentrations. Results The plasma NA and A concentrations in group G were significantly increased at T1-3 as compared to the baseline value at T0 and were significantly higher than those in group E and G + E. There was no significant difference in plasma NA concentration between group E and G + E. The DD level was significantly increased at T2 as compared to the baseline value at T0 in all 3 groups and remained high at T3 in group E and G + E. The t-PA and PAI-1 activities were significantly increased at T1 as compared to the baseline values at T0 in all three groups and then gradually decreasing at T2 and T3 . In group E the PAI-1 activity returned to baseline level at T3 . Conclusion Epidural anesthesia helps in maintaining fibrinolytic activity by attenuating the responses to surgical stress and inhibiting the increase in PAI-1 activity.