Objective To evaluate the influence of different methods of anesthesia on the glucose metabolism of leukocytes in elderly patients undergoing colorectal cancer surgery. Methods Fifty ASA Ⅰ or Ⅱ patients, aged≥65 yr, with body mass index 18-25 kg/m2, scheduled for elective colorectal cancer surgery, were randomly divided into 2 groups ( n = 25 each) : sevoflurane anesthesia group (Sevo group) and sevoflurane anesthesia combined with epidural block group ( S + E group) . The patients in S + E group underwent epidural catheterization, and 2% lidocaine 3 ml was given via the epidural catheter. If no signs of spinal anesthesia were confirmed 5 min later, the mixture of 1% lidocaine and 0.2% tetracaine 8-10 ml was given, and an increment of the mixture 4-5 ml was given every 50 min. During the operation, the end-tidal concentration of sevoflurane was maintained at 0.7 MAC in S + E group and at 1.0 MAC in Sevo group. The depth of anesthesia was adjusted according to the BIS value in both groups. Venous blood samples were taken at 10 min before operation (T1 ), and 60 min, 24 h.and 5 days after the end of operation (T2-4 ) for WBC count and measurement of activities of pyruvate kinase (PK)and glucose-6-phosphate dehydrogenase (G6PD) in the leukocytes. Results Compared with T1, the WBC count at T3 in both groups, the PK activity at T, in group S+E and G6PD activity at T, in group Sevo and at T3,4 in group S + E were significantly increased ( P ＜ 0.01) . Compared with group Sevo, the PK activity at T, and G6PD activity at T3,4 were significantly increased in group S+E ( P ＜ 0.05) . There was no significant difference in the WBC count between the two groups ( P ＞ 0.05) . Conclusion There is no significant change in the WBC count when the two methods of anesthesia are used in elderly patients undergoing colorectal caner surgery, however, sevoflurane anesthesia combined with epidural block enhances the leukocyte function in elderly patients compared with sevoflurane anesthesia alone.

Objective To evaluate the effects of dexmedetomidine on the expression of neuronal nitric oxide synthase (nNOS) and c-fos in the lcuos cruleus (LC) in a rat model of endotoxic shock.Methods Twentyeight male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were randomly divided into 4 groups (n =7 each):control group (group C),endotoxic shock induced by lipopolysaccharide (LPS) group (group L),lowdose dexmedetomidine group (groupLD) and high-dose dexmedetomidine group (group HD).Normal saline 0.5 ml/kg was injected via the tail vein in C and L groups.Dexmedetomidine 0.5 and 4.5μg/kg were injected via the tail vein in group LD and group HD,respectively.Normal saline 0.5 ml/kg was injected via the tail vein 10 min later in C,while LPS 5 mg/kg was injected intravenously 10 min later in the other groups.The rats were sacrificed and their brains were removed for determination of brain water content,the number of nNOS and c-fos positive cells and expression of nNOS and c-fos in the LC by immuno-histochemistry.Results Compared with group C,the brain water content was significantly increased,the number of nNOS and c-fos positive cells in the LC was enlarged,and the expression of nNOS and c-fos in the LC was up-regulated in group L (P ＜ 0.05).The brain water content was significantly lower,the number of nNOS and c-fos positive cells in the LC was smaller,and the expression of nNOS and c-fos in the LC was lower in LD and HD groups than in group L (P ＜ 0.05).The number of nNOS and c-fos positive cells in the LC was significantly smaller,and the expression of nNOS and c-fos in the LC was lower in HD group than in group LD (P ＜ 0.05).Conclusion Dexmedetomidine can down-regulate the expression of nNOS and c-fos in the LC,which may be one of brain-protective mechanisms of dexmedetomidine in a rat model of endotoxic shock.

Objective To compare the effects of different anesthetic and postoperative analgesic methods on the immune function of helper T lymphocytes and tumor metastasis after orthotopic liver cancer resection in rats.Methods Orthotopic liver cancer was induced by intrahepatic tumor implantation (IHTI) with Morris hepatoma 3924A.Thirty male ACI rats receiving IHTI,aged 12-18 weeks,weighing 240-300 g,were randomized into 3 groups (n =10 each) using a random number table:control group (group C),general anesthesia combined with epidural block-postoperative epidural analgesia group (group GE + EA),and general anesthesia-postoperative intravenous analgesia group (group G + IA).The liver cancer resection was performed on 14th day after IHTI,group G + IA inhaled 5％ sevoflurane for induction of anesthesia and inhaled 2％-3％ sevoflurane and received intraperitoneal injection of morphine 20 μg/100 g for maintenance of anesthesia.In group GE + EA,general anesthesia was performed as the method previously described in group G + IA,and epidural block was performed with 0.25 ％ bupivacaine 25 μl after tracheal intubation.Within 3 days after operation,0.125 ％ bupivacaine 150 μl + morphine 20 μg were injected daily via an epidural catheter once every 4 h (25μl per time) for postoperative analgesia in group GE + EA,and postoperative analgesia was performed with intraperitoneal morphine 240 μg injected daily once every 4 h (40 μg per time) in group G+ IA.Before surgery (T1) and on 2nd,7th and 30th days after sugery (T2-4),blood samples were collected to detect the levels of plasma interferon-γ (IFN-γ),interleukin-4 (IL-4),IL-17,IL-10 and tumor growth factor-β1 (TGF-β1).IFN-γ/IL-4 ratio was calculated.The rats were sacrificed after collecting blood samples at T4,and the development of abdominal lymph node metastasis,malignant ascites,implantation metastasis to abdominal wall and visible pulmonary metastasis nodules were observed.Results Compared with C group,the incidence of pulmonary metastasis,abdominal lymph node metastasis,and malignant ascites was significantly decreased,the plasma IFN-γ and IL-17 levels at T2 and IL-4 and TGF-β at T2,3 were increased,and IFN-γ/IL-4 ratio was decreased at T2,3 in group G+ IA,and the incidence of pulmonary metastasis,abdominal lymph node metastasis,malignant ascites and implantation metastasis to abdominal wall was significantly decreased,the plasma levels of IFN-γ,IL-4,IL-17,IL-10 and TGF-β1 were increased at T2(P ＜ 0.05),and no significant change was found in IFN-γ/IL-4 ratio in GE + EA group (P ＞ 0.05).Compared with G + IA group,the incidence of pulmonary metastasis and abdominal lymph node metastasis was significantly decreased,the plasma levels of IFN-γ and IL-17 at T2 and IL-4 and IL-10 at T3 were decreased,the plasma levels of IFN-γ at T4 and TGF-β1 at T2 and IFN-γ/IL-4 ratio at T3,4 were increased in GE + EA group (P ＜ 0.05).Conclusion The inhibitory degree of the immune function of helper T lymphocytes is decreased and development of tumor metastasis is reduced after orthotopic liver cancer resection in rats when general anesthesia combined with epidural block-postoperative epidural analgesia is applied as compared with those when general anesthesia-postoperative intravenous analgesia is applied.

Background and purpose:Obvious pulmonary dysfunction may exsist preoperatively in part of the patients undergoing pulmonary lobectomy. Volume-controlled ventilation (VC) during one-lung ventilation (OLV) may lead to lung injury in lung cancer patients with preoperative pulmonary dysfunction. However, pressure-regulated volume-controlled (PRVC) ventilation mode is a new type of ventilation mode, and can alleviate ventilation-induced lung injury. This study explored the effect of PRVC on respiratory mechanics, oxygenation index, pulmonary inlfam-matory response, and clinical outcomes in patients undergoing pulmonary lobectomy during OLV compared with VC mode.Methods:Forty ASAⅡ-Ⅲ patients with moderate to severe pulmonary dysfunction undergoing pulmonary lobectomy were randomly divided into group VC and group PRVC (n=20).PRVC ventilation mode was performed for patients in group VC during the ifrst 5 minutes after OLV, and then ventilation mode was switched to VC ventilation mode till the end of surgery. In the other group, ventilation modes were performed in reverse order. Ventilation settings remained unchanged when ventilation mode was switched. Respiratory mechanics, static lung compliance, hemody-namic parameters and arterial blood gas were obtained during the surgery. Blood samples and bronchoalveolar lavage (BALF) in ventilated lung were collected to determine the level of TNF-α, IL-1β, IL-6 and IL-8 at the end of surgery.Results:Both the peak expiratory pressure and static lung compliance in group PRVC were signiifcantly lower than those in group VC (P<0.01). However, there were no statistical difference in hemodynamic parameters (heart rate and blood pressure) and arterial blood gas analysis (pH,paO2andpaCO2) between the two groups during OLV, as well as postoperative pulmonary complications and length of hospital stay. The levels of TNF-α, IL-1β and IL-6 in BALF in group PRVC were signiifcantly lower than those in group VC (P<0.05), while there was no difference in blood sample. Conclusion:PRVC mode during OLV may relieve the extravagant airway pressure and then reduce the release of inlfammatory factors in ventilation lung, which might prevent acute lung injury induced by lung barotraumas, especially for those patients with pulmonary dysfunction preoperatively. Therefore, PRVC mode is a safe and effective ventilation mode for high-risk patients undergoing pulmonary lobectomy.

Objective To investigate the effects of nitric oxide (NO) inhalation on the expression of TNF-?,IL-8 and CD11b mRNA in lung tissue during acute respiratory distress syndrome (ARDS) induced by intravenous injection of endotoxin in dogs.Methods Twelve pure bred beagle dogs of both sexs weighing 8-12.5 kg were randomly divided into 2 groups: NO group received mechanical ventilation with NO inhalation (n = 6) and control group received only mechanical ventilation ( n = 6) . Sepsis and ARDS were induced by intravenous injection of endotoxin as described in detail in our previous paper. Hemodynamics and pulmonary oxygenation were monitored and shunt fraction was calculated. At the end of experiment the animals were sacrificed and lung tissue was obtained aseptically and stored in the liquid nitrogen at - 180℃ . The total RNA was extracted. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of TNF-?,IL-8 and CD11b mRNA. The total RNA was reversely transcripted to cDNA. Then the cDNA was amplified by PCR. The product of PCR was scanned by gel-image analysis system.?-action was used as internal control. Semi-quantitative method was adopted for measurement of TNF-? ,IL-8 and CD11b mRNA expression. Results The expression of TNF-?, IL-8 and CD11b mRNA in lung tissue was significantly decreased in NO group compared with those in control group.Conclusion NO inhalation reduces expression of TNF-?, IL-8 and CDllb mRNA in lung tissue during ARDS induced by intravenous endotoxin.

Objective To investigate the changes in pharmacokinetics of propofol and propofol concentration in the brain induced by normovolemic hemodilution ( NHD) . Methods Thirteen healthy male mongrel dogs weighing 10-15 kg were randomly divided into 2 groups: control group ( n = 7) and NHD group ( n = 6). The animals were anesthetized with intravenous diazepam 0.5 mg?kg-1 and ketamine 5 mg?kg-1 . The femoral artery and vein were cannulated. Lactated Ringer's solution was infused at 5-7 ml ? kg-1 ? h-1 . 30 min after induction of anesthesia NHD was conducted by removing blood from femoral artery and replacing it with 6% hydroxyethyl starch (HES) until Hct was reduced to 25% . Propofol was then infused at 10 mg?kg-1 ?h-1 for 30 min after NHD. Arterial blood samples were taken immediately before and at 1, 2, 5 , 10, 15, 20, 30, 31, 32, 35, 40, 50, 70, 90, 120, 150, 180, 240 and 300 min after propofol infusion was started for determination of plasma propofol concentrations. One week later the same NHD was repeated. Propofol was administered by TCI via Graseby 3500 infusion pump incorporated with Stanpump TCI software. Target plasma propofol concentration was set at 5 ?g?ml-1 . Arterial blood and CSF samples were obtained at 5, 15, 30, 45 and 60 min after the start of propofol infusion for determination of plasma propofol concentration ( bound and free) , plasma free propofol concentration and CSF propofol concentration. At the end of 60 min, after the collection of blood and CSF samples, brain tissue was obtained from the cerebral cortex of right frontal lobe for determination of brain propofol content. ECG, BP, arterial blood gases and body temperature were monitored during experiment.Results The plasma propofol concentrations were significantly lower during and after propofol infusion at 10 mg? kg-1 ? h-1 in NHD group than in control group ( P

Background and purpose:Many patients may suffer from acute pain after radical mastectomy un-der general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anes-thesia on analgesia after radical mastectomy for breast cancer.Methods:Ninety-six patients underwent modiifed radical mastectomy for breast cancer were randomized with random number into group C (intercostal nerve block coupled with general anesthesia) and group G (general anesthesia), with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general an-esthesia was the same between the two groups. During the surgery, 10 μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 (T1), 12 (T2) and 24 h (T3) after surgery. The incidence of postoperative nausea and vomiting was also observed.Results:Sufentanil amount used intra- and post- operation were signiifcantly lower in group C [(25.2±3.5) and (3.3±1.2) μg] than that in group G [(40.5±4.3) and (8.4±2.2) μg] (P<0.01). The VAS scores on 2, 12 and 24 h after surgery in group C(0.45±0.15,1.75±0.08 and 2.05±0.12), were signiifcantly lower than those in group G (4.32±0.21, 4.88±0.13 and 4.78±0.16) (P<0.01). The incidences of nausea and vomiting on 2 and 24 h after surgery in group C (6.25% and 16.66%) were signiifcantly lower than those in group G (20.8% and 41.66%). There was no adverse complication related with intercostal nerve block in group C.Conclusion:Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modiifed radical mastectomy for breast cancer, which may improve postoperative pain control and reduce the usage of opioids and incidence of nausea and vomiting. Intercostal nerve block under ultrasound is quite safe and effective for patients.

Objective To investigate the effectiveness of target-controlled infusion (TCI) of etomidate and remifentanil for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixtynine ASA Ⅰ or Ⅱ patients of both sexes,aged 35-71 yr,weighing 41-83 kg,scheduled for elective EBUS-TBNA,were randomly divided into 3 groups ( n =23 each).In group Ⅰ,anesthesia was induced with TCI of propofol and iv injection of fentanyl 4 μg/ml,and the target plasma concentration (Cp) of propofol was set at 3-4 μg/ml.In group Ⅱ ,anesthesia was induced with TCI of propofol ( Cp 3-4 μg/ml) and remifentanil ( Cp 5 ng/ml).In group Ⅲ ,anesthesia was induced with TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml).After the patients lost consciousness,laryngeal mask airway was inserted to perform mechanical ventilation.PETCO2 was maintained at 30-40 mm Hg.BIS value was maintained at 40-60.The use of vasoactive agents (perdipine,ephedrine,atropine and esmolol) and occurrence of bucking during operation,emergence time,and the occurrence of nausea and vomiting within 24 h after operation were recorded.Blood samples were collected from the femoral vein at 30 min before induction,at the end of operation and at 24 h after operation for determination of the plasma cortisol concentration.Results The incidence of bucking and nausea and vomiting was significantly lower,the emergence time was significantly shorter,and the number of patients who needed vasoactive agents during operation was significantly smaller in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜ 0.05).The number of patients who needed vasoactive agents during operation was significantly smaller in group Ⅲ than in group Ⅱ (P ＜0.05).Compared with groups Ⅰ and Ⅱ,the plasma cortisol concentration was significantly decreased at the end of operation in group Ⅲ (P ＜ 0.05).There was no significant difference in the plasma cortisol concentration at each time point between groups Ⅰ and Ⅱ (P＞0.05).Conclusion TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml) can provide satisfactory anesthesia for EBUS-TBNA with few adverse effects.

Objective To study the best multiple concentration of target controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia. Methods Fifty elderly patients were randomized into five groups, according to the effect site concentration of remifentanil (0, 2, 4, 6, 8 ng/mL). We started the effect site concentration of propofol (PEC) at 2 μg/mL, and added 1 μg/mL every 2 min until bispectral index (BIS) was stable at 40±5. During the induction,we recorded the effect site concentration of remifentanil (REC) and propofol (PEC), heart rate (HR), arterial blood pressure (ABP), BIS, AAI, and isolated forearm technique (IFT). After statistic analysis, the best multiple concentration was judged. Results There was no significant difference (P<0.05) in the changes of hypertension and hypotension among these five groups during intubation. The most smooth hemodynamic conditions were found in group B, i.e. 20% and 10%, respectively. When consciousness was lost, there was a negative correlation between PEC and REC. Group B was the minimum on the change of IFT and the cardiovascular system among these five groups at tracheal intubation. Conclusions It is safe and stable to use REC 2 μg/mL for TCI, combined with propofol in elderly patients under general anesthesia. PEC is (3.5±0.8)μg/mL when the patients' consciousness is lost. And PEC is 5.3 μg/mL at tracheal intubation.

Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.