Objective To analyse the cognitive dysfunction early after non-cardiac surgery in elderly. MethodsEighteen elderly patients undergoing selective non-cardiac surgery were investigated. General anesthesia was used in 11 patients and combined epidural-spinal anesthesia in 7 cases. The operations involved orthopedic, thoracic, abdominal and urologic surgeries. The patients were premedicated with phynoharbital 0. 1g and scopolamine 0. 3mg. Results All patients suffered from typical POCD that occurred during 1 to 3 days after operation. The symptoms were more severe at night. The patients with POCD were treated effectively with intravenous injection of midozolam and muscle injection of haloperidol in 15 cases. The symptoms of POCD were attenuated by injection of pethidine in 2 cases. One case had to be given intravenous infusion of propofol continually for 16 hours. All patients were cured without psychological complications before discharge Conclusion POCD is a common complication in the elderly and should be treated actively.

Objective To determine the distribution of flurbiprofen axetil in the muscle tissue in the surgical field after intravenous administration in rats. Methods Forty pathogen-free male SD rats weighing 240-260 g were randomly divided into 5 groups (n=8 each) : Ⅰ control group (group C) and Ⅱ-Ⅴ flurbiprofen groups received iv flurbiprofen axetil 2, 4, 8, 16 mg/kg respectively (group F_1, F_2, F_3, F_4). An 1 cm long incision was made in the right plantar surface from the heel to the toes according to the method described by Brennen under isoflurane anesthesia. The muscle was cut through in the incision but not severed. Flurbiprofen axetil was injected iv via the vein in the tail at 20 min after plantar incision was made in group Ⅱ-Ⅴ . At 2 h after iv flurbiprofen axetil administration, the animals were anesthetized with intraperitoneal 3% pentobarbital 100 mg/kg. The muscles of both hindpaws were dissected, homogenized and centrifuged. The supernatant was separated for determination of flurbiprofen content (by RP-HPLC) and PGE_2 content ( by ELISA). Results The flurbiprofen content in the muscle of hindpaw on the operated side was significantly increased dose-dependently compared with that on the non-operated side and was significantly higher than that on the non-operated side. The flurbiprofen content in the muscle of hindpaw on the non-operated side was significantly higher in group F_4 than in the other 4 groups. There was no significant difference in the flurbiprofen content in the paw muscle on the non-operated side among group C, F_1 F_2 and F_3. The PGF_2 content was significantly higher in the hindpaw muscle on the operated side than that on the non-operated side, and was significantly decreased by flurbiprofen dose-dependently. Conclusion The content of flurbiprofen is significantly higher in the muscle tissue in the surgical field after iv administration than that on the non-operated side, indicating that flurbiprofen axtei has target-analgesic effect.

Objective Calcitonin gene-related peptide (CGRP), neurotensin (NT) and atrial natriuretic polypeptide (ANP) have strong vaso-dilating and positive inotropic action, whereas neuropeptide Y (NPY) and endothelin (ET) have vaso-constricting effect. They all have profound effects on hemodynamics. The purpose of this study was to examine the changes in the 5 neuropeptides in elderly hypertensive patients under general anesthesia.Methods The control group comprised eight men and six women without hypertension with a mean age of (69?8)yr. The hypertension group included nine men and five women with a mean age of (71?9)yr. The patients in the hypertension group had different degrees of myocardial hypertrophy and ST-T changes. All 28 patients underwent upper abdominal surgery. Anesthesia was induced with propofol 2mg?kg -1 and fentanyl 2?g?kg -1 and intubation was facilitated with succinylcholine 2mg?kg -1. The patients were mechanically ventilated after intubation. Anesthesia was maintained with 50% N 2O and enflurane or isoflurane inhalation supplemented with intermittent doses of vecuronium. Venous blood samples were taken before anesthesia, 3min after intubation, 60 min after start of surgery, at the end of surgery and 24 h after operation for determination of plasma levels of CGRP, NT, ANP, NPY and ET by radioimmunoassay.Results In hypertension group plasma level of ANP decreased and NPY increased significantly at the end of operation and 24 h after operation (P

Objective To investigate the effects of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 20010.5 on serum S-100B protein concentration and cerebral oxygen metabolism at 37℃ in rabbits.Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups (n = 8each) : Ⅰ control group underwent no ANH and Ⅱ , Ⅲ , Ⅳ ANH group underwent ANH with hematocrit (Hct)reduced to 24%, 18% and 12% respectively. The animals were anesthetized with iv 20% urethane 5 ml/kg,tracheostomized and mechanically ventilated (VT = 15 ml/kg, RR = 30 bpm). The body temperature was maintained at 37℃. Left carotid artery and jugular vein were cannulated for BP monitoring, blood gas analysis and blood sampling. Right jugular vein was cannulated for CVP monitoring. Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Hemodynamics parameters, were recorded and blood gases were analyzed and serum S-100B protein concentration and cerebral O2 metabolic rate (CERO2) were determined before (baseline) and at 2, 4 and 8 h after ANH. Brain water content was measured by wet/dry brain weight ratio. Results There were no significant differences in serum S-100B protein concentration, CERO2 and pH value between group Ⅰ and group Ⅱ (Hct 24%). Serum S-100B protein concentration and CERO2 were significantly increased at 8 h after ANH as compared with the baseline before ANH in group Ⅰ (Her 18%). Serun S-100B protein concentration and CERO2 were significantly increased at 2, 4 and 8 h after ANH as compared with the baseline before ANH in group Ⅳ (Hct 12%). There was no significant difference in brain water content among the 4 groups. Conclusion ANH does not affect cerebral O2 metabolic when Hct is reduced to 24%. CERO2 can not be sustained and ischemic cerebral injury may occur when Hct is reduced to≤18%.

Objective To investigate the effect of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 200/0.5 on mucous membrane of small intestine in rabbits. Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups ( n = 8 each): Ⅰ control group underwent no ANH, and Ⅱ, Ⅲ, Ⅳ group underwent ANH with hematocrit (Hct) reduced to 24%, 18% and 12% respectively (group H1-3 ). The animals were anesthetized with 20% urethane 4 ml/kg, thracheostomized and mechanically ventilated (VT = 8 ml/kg, RR = 50 bpm). The body temperature was maintained at 36.5-37.6 ℃. Left carotid artery was cannulated for MAP monitoring and blood sampling. Right jugular vein was cannulated for CVP monitoring. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Blood samples were obtained from superior mesenteric vein (SMV)for determination of plasma concentrations of TNF-α before ANH(T0) and at 8 h after ANH (T1). Small intestinal mucosal tissues were obtained at T1 to observe the pathological changes by electron microscopy. Results Compared with those at T0, plasma concentrations of TNF-a in SMV were significantly increased at T1 in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). Compared with group C, plasma concentrations of TNF-α in SMV were significantly increased in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). No injury was found in mucous membrane of small intestine in group H1 . The injury to mucous membrane of small intestine was mild in group H2 and severe in group H3 . Conclusion ANH with 6% HES 200/0.5 does not affect mucous membrane of small intestine when Hct is reduced to 24% The injury to mucous membrane of small intestine occurs when Hct is reduced to≤ 18%.

Objective To investigate the effects of different ventilation modes on PaCO 2 and PaO 2 during laparoscopic surgery in the Trendelenburg position.Methods Forty cases of laparoscopic resection of rectal cancer were randomly divided into group A (n =20)and group B (n =20).Under general anesthesia,all the cases were in volume-controlled ventilation mode (VCV,tidal volume=10 ml/kg)before pneumoperitoneum.After ventilating in VCV mode for 20 minutes with a lower tidal volume (8 ml/kg),group A was converted to PCV mode for 20 minutes and then back to the VCV mode for 20 minutes again.Next we switched to PCV combined with PEEP (5 cm H 2 O)mode (PCV+PEEP)for 20 minutes.In group B,we only alternated PCV with PCV combined with PEEP.Arte-rial blood-gas analysis was obtained at each time when ventilating mode changed.Results In both group A and B,PaO 2 in VCV mode was less than that in PCV mode and PCV+PEEP mode (P <0.05),PaO 2 in PCV mode was also less than that in mode PCV+PEEP mode (P <0.05).PaCO 2 in PCV and PCV combined with PEEP mode was less than that in VCV mode (P <0.05 ),and there was no difference of PaCO 2 in PCV mode and PCV+PEEP mode.The pH value in VCV mode was less than that in PCV mode and PCV+PEEP mode (P < 0.05).There was no difference in pH value between PCV mode and PCV+PEEP mode.Conclusion PCV combined PEEP mode is beneficial ei-ther in increasing or decreasing of PaCO 2 during laparoscopic surgery in the Trendelenburg position comparing with single VCV mode or PCV mode.

Objective To study target-distribution of flurbiprofen axetil in operative incision tissue in incision-induced rats. Methods Thirty-two-250 g-weight rats were randomly divided into 4 groups. The incision pain model was established by being operated according to Brennan's method. Two hours after vena caudalis injection, all the rats were anesthetized deeply by pentobarbital sodium-perito injection 100 mg/kg,muscles of both hind paws were dissected, homogenated, centrifuged and supernatant fluids were dissociate. The concentration of flurbiprofen were detected by reversed phase high peformance liquid chromatography(RP-HPLC). Results In these groups of different dosage, the concentration of flurbiprofen in operative incision notably increased compared to that in the non-operative incision, especially in group K16. The concentration of flurbiprofen in operative incision of different dosage increased in dose-dependent manner. The difference of concentration of flurbiprofen in non-operative incisions of K2, K4, K8 was statistically insignificant, but the concentration of flurbiprofen in non-operative incision of K6 increased compared to that of K2, K4 and K8. Conclusion The distribution of flurbiprofen axeti in operative incision was targeted. When rats were injected flurbiprofen axetil at 16 mg/kg by vena caudalis, The concentration of flurbiprofen in the non-operative incision increased notably.

Objective To compare the accuracy of Marsh model and Schnider model for propofol target?controlled infusion ( TCI) system. Methods Eighty patients, aged 20-60 yr, of American Society of Anesthesiologists physical status ⅠorⅡ, with body mass index of 17?5-28?0 kg∕m2 , scheduled for e?lective gynecological operation under general anesthesia, were equally and randomly divided into either Marsh model group ( group M) or Schnider model group ( group S) using a random number table. The target plasma concentration was set at 3 μg∕ml in both groups. During TCI and at different time points after the end of TCI, the blood samples were collected for determination of blood propofol concentrations by high per?formance liquid chromatography with fluorescence detector. The difference between measured and predicted concentrations (△C) at each time point was calculated. The median performance error ( MDPE) , median absolute performance error ( MDAPE) , and wobble of propofol TCI system were calculated in each group. Results In M and S groups, the MDPE was 9. 90% and 14?00%, respectively; the MDAPE was 11?43% and 14?49%, respectively;the wobble was 7?77% and 7?79%, respectively. There was no sig?nificant difference in △C at each time point during TCI between group M and group S (P>0?05). After TCI was stopped, △C at each time point was significantly lower in group M than in group S ( P<0?05) . Conclusion Marsh model provides higher accuracy than Schnider model for propofol TCI system in the pa?tients undergoing gynecological operation.

Objective To compare the development of postoperative cognitive dysfunction ( POCD) under total inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-77 yr, weighing 43-78 kg, with preoperative Mini?Mental State Examination ( MMSE) score≥25, scheduled for elective surgery for oral and maxillofacial carcinoma, were divided into 2 groups ( n=30 each) using a random number table: total inhalation anesthesia with sevoflurane group ( group S) and total intravenous anesthesia with propofol?based anesthesia group ( group P ) . The patients were tracheally intuba?ted under local infiltration anesthesia. In group S, anesthesia was induced with inhalation of 8% sevoflurane (oxygen flow rate 8 L∕min), rocuronium 0?9 mg∕kg was injected intravenously when the bispectral index ( BIS) value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with inhalation of sevoflurane with the end?tidal concentration of 2%-3%. In group P , anesthesia was induced with iv propofol 2 mg∕kg and sufentanil 0?3μg∕kg, rocuronium 0?9 mg∕kg was injected intravenously when the BIS value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with target?controlled infusion of propofol ( target plasma concentration 3-5μg∕ml) and remifentanil ( target plas?ma concentration 3-5 ng∕ml). In both groups, intermittent iv boluses of cisatracurium 0?04 mg∕kg were given to maintain muscle relaxation during operation, and BIS value was maintained at 40-60 during opera?tion. Before intubation ( T1 ) , immediately after onset of intubation ( T2 ) , at 10 min of intubation ( T3 ) , immediately after begninning of skin incision ( T4 ) , while operating on the base of tongue or sawing the low?er jaw ( T5 ) , at the end of operation ( T6 ) and on the morning of the postoperative day 1 ( T7 ) , blood sam?ples from the elbow vein were collected for determination of plasma norepinephrine and epinephrine concen?trations by high?performance liquid chromatography and electrochemistry. At T1?7 and on the morning of the postoperative day 3 ( T8 ) , blood samples from the elbow vein were collected for measurement of plasma cor?tisol concentrations by radioimmunoassay. MMSE was used to assess the cognitive function on the postopera?tive day 7. MMSE score< 24 was defined as POCD, and the occurrence of POCD was recorded. Results Compared with group S, the plasma concentrations of norepinephrine and epinephrine were significantly de?creased at T4 and T5 , the plasma cortisol concentration was significantly decreased at T4?7 ( P<0?05) , and no significant change was found in the incidence of POCD on the postoperative day 7 in group P ( P>0?05) . Conclusion Although the probability of the development of POCD is low when the two anesthetic methods are used, total intravenous anesthesia with propofol?based anesthesia induces a marked decrease in periop?erative stress responses when compared with total inhalation anesthesia with sevoflurane.

Objective To investigate the effects of exogenous pulmonary surfactant(PS)on the inflammatory response in rats with ventilator-induced lung injury(VILI).Methods Twenty-eight adult male Wistar rats weighing 310-388 g were randomly divided into 4 groups(n =7 each):normal control group(group C),group VILI,group PS and air control group(group A).VILI was produced by high-pressure ventilation(HPV)with peak inspiratory pressure(PIP)40 cm H2 O,respiratory rate(RR)20 hpm and without positive end-expiratory pressure(PEEP)for 20 min.The rats were sacrificed by exsanguination immediately after anesthesia and after VILI in groups C and VILI,respectively.In groups PS and A,PS 100 mg/kg(50 mg/ml)and the equal volume of air were injected into the trachea via the airway after the tracheal edema fluid was removed respectively,and the rats were mechanically ventilated(Vr 10 ml/kg,RR 45 bpm and PEEP 7.5 cmH2O)for 120 min and then sacrificed by exsanguination.The blood samples were taken from femoral artery for determination of the plasma levels of IL-6,IL-10,MIP-2 and TNF-α by ELISA.The tracheal edema fluid was collected to determine the protein concentration by Bradford method.The lungs were removed for microscopic examination and the number of neutrophils was counted under microscope.Results There was no significant difference in the plasma levels of TNF-α among the four groups(P ＞ 0.05).Compared to group C,the plasma levels of MIP-2,IL-10 and IL-6 were significantly increased and the number of neutrophils was significantly enlarged in group VILI(P ＜ 0.05).The number of neutrophils was significantly smaller in group PS than in group A(P ＜ 0.05).There was no significant difference in the plasma levels of MIP-2,IL-10 and IL-6 between groups PS and A(P ＞ 0.05).The inflammatory damage in lung tissues was observed obviously in groups VILI,A and PS.Conclusion When exogenous PS is used to treat the rats with VILI,PS reduces neutrophil recruitment,but can not inhibit the release of inflammatory cytokines.