Objective To investigate the effects of different degrees of hemodilution on neurological injury and amino acid content in different brain areas after deep hypothermic circulatory arrest (DHCA) . Methods Forty-eight male adult SD rats weighing 400-450 g were randomly divided into 4 groups ( n = 12 each); group 1 Hct 10% (H1); group II Hct 20% (H2); group III Hct 30% (H3) and control group (C). All animals except those in control group underwent DHCA at 18 ℃ for 90 min (including cooling and rewarming) under general anesthesia with fentanyl, ketamine and droperidol. Different degrees of hemodilution were accomplished by changing the composition and volume of priming solution used in cardiopulmonary bypass (CPB) . Hct was determined before, at the initiation of CPB and beginning of rewarming. PaO2, pH and blood lactate of arterial blood and SO2 of venous blood from internal jugular vein (SjvO2 ) were determined at the beginning and end of cooling and rewarming. The animals were killed and brains removed after recovery of circulatory function for the count of injured neurons and determination of glutamate (Glu), aspartate (Asp), glycine (Gly), ?-aminobutyric acid (GABA) and taurine (Tau) contents in cortex, hippocampus and thalamus. Results The number of injured neurons in hippocampus and parietal cortex was significantly smaller in Hct 30 % group than in the other two groups (P

Aim To compare the different effect of intracarotid and intravenous injection of propofol on the neuronal apoptosis of hippocampus in rats undergoing cardiopulmonary bypass.Methods Fifty rats were randomly assigned to five groups. Shame group (Group Non-CPB,n=10); group cardiopulmonary bypass(group CPB,n=10);group intravenous injection of propofol 2 mg?kg -1?h -1 (group P_ 2V,n=10);group intravenous injection of propofol 10mg.kg -1?h -1 (group P_ 10V,n=10);group intracarotid injection of propofol 2 mg?kg -1?h -1 (group P_ 2a,n=10).Mean arterial pressure(MAP)and heart rate(HR) were monitored. Changes of the neuronal apoptosis of hippocampus were observed with TUNEL staining, Bax and bcl-2 mRNA and protein expressions were measured by RT-PCR and Western blot. In addition,neuronal ultrastructures were observed. Results Neuronal apoptosis and changes of neuronal ultrastructures of hippocampus were attenuated in group P_ 2a and P_ 10V,but the apoptosis of neurons was not attenuated in group P_ 2v. Bcl-2 and Bax mRNA expression increased undergoing CPB. Bax mRNA expression decreased after CPB in group P_ 2a and P_ 10V. Bcl-2 mRNA expression increased in group P_ 2a and P_ 10V. But Bcl-2 and Bax mRNA expression in group P_ 2V was not significantly different compared with that of group CPB. Bcl-2 and Bax protein expression measured by Western blot showed the same trend with mRNA expressions. Compared with baseline values, MAP and HR in group P_ 2V and P_ 2a remained unchanged. But the MAP and HR in group P_ 10V changed compared with group CPB and baseline value.Conclusions intracarotid injection of propofol attenuated the injury of brain at a fraction of the intravenous dose and with less adverse systemic and cerebrovascular side effects.

Objective To observe the distribution and origins of the nitrergic perivascular nerves in rat cerebral arteries with a histochemical method for reduced nictinamide adenine dinucleotid phosphate(NADPH) diphorase activity, after resecting the membraneous structure at the ethmoidal formen. Methods Health adult SD rats were randomly distributed to three groups:sham operation group(group A), unilateral (right) operation group(group B), and bilateral operation group (group C). Both group B and C were further divided into two groups: group of resection of membraneous structure and nasociliary nerve (group BⅠ,CⅠ), and group of only removing membraneous structure (group BⅡ, CⅡ). On the seventh day after operation, the pterygopalatine ganglia and otic ganglia of group A were taken, and striped the cerebral arteries of three groups. With the method of NADPH d we investigated the positive cells in pterygopalatine ganglia, otic ganglia, and the changes of positive perivascular nerve fibers. Results A great deal of NADPH d positive cells were found in both pterygopalatine ganglia and otic ganglia. After unilateral operation, the NADPH d positive nerves in the ipsilateral middle cerebral artery(MCA) completely disappeared, but it did not change on the contralateral MCA. The positive nerves on basal artery(BA) and bilateral posterior cerebral artery(PCA), internal carotid artery(ICA), and anterior cerebral artery (ACA), obviously decreased. After bilateral operation, the positive nerve fibers in all arteries except ACA disappeared. There were no significant difference between group BⅠ and BⅡ; CⅠ and CⅡ.Conclusion There were nitrergic nerve fibers in all major cerebral arteries, and the density of positive nerve fibers in the anterior circulation of the cerebral artery was higher than that of posterior one. Different cerebral arteries have different origins of nitrergic nerve. The nitrergic nerve in BA, PCA and ICA completely originated from ipsilateral pterygopalatine ganglia; the nitrergic nerves of MCA were completely originated from ipsilateral pterygopalatine ganglion; ACA have more sources of nitrergic nerves other than bilateral pterygopalatine ganglia. Nasociliary nerve from trigeminal ganglion did not involve in the origins of nitrergic perivascular nerves in rat cerebral arteries. [

Aim To investigate the protective effects of high concentration fentanyl on the brain slice injury induced by oxygen glucose deprivation(OGD).Methods Rat brain slices were made and randomly assigned to four groups:control(n=10),OGD(n=10),fentanyl 50 ?g?L~(-1)(F_(50),n=10) and fentanyl 500 ?g?L~(-1)(F_(500),n=10).Changes of the neuron injury and apoptosis were observed with TTC staining,LDH releases,TUNEL staining,immunohistochemistry and electromicroscope.In addition,changes of intracellular calcium were measured with confocal laser-scanning microscopy.Results F_(50) and F_(500) attenuated the decrease of TTC staining and the increase of LDH release induced by OGD in brain slices.Neuronal apoptosis and changes of neuronal ultrastructures were attenuated by F_(50) and F_(500).Bcl-2 and Bax protein expressions were increased after OGD.Bax protein expression was decreased by F_(50) and F_(500),while Bcl-2 protein expression was increased by F_(50)and F_(500).Intracellular calcium concentration was increased by OGD and then it was lowered by F_(50) and F_(500).The protective effects of F_(50) were more obvious than that of F_(500).Conclusions High concentrations of fentanyl have neuron protective effects against OGD injury in rat brain slices,and fentanyl 50 ?g?L~(-1) has more obvious protective effects than fentanyl 500 ?g?L~(-1).

Objective To evaluate the outcome of long-term cognitive function after liver transplan-tation in children and the role of age factor.Methods Ninety-five pediatric patients,aged 2 yr and 6 months to 6 yr and 11 months at test,at least 1 yr after liver transplantation,were selected.The children's cognitive function was assessed using Chinese Wechsler Intelligence Scale for Children.The patients were divided into 2 groups according to the age at transplantation: ≤1 yr group(L1 group,n＝65)and > 1 yr group(M1 group,n＝22).Results Compared with the normal value,the scores of verbal comprehension and total intelligence quotient(IQ)were significantly decreased,and the proportion of children who had a-bove-average IQ was decreased 1 yr after liver transplantation,the scores of verbal comprehension were de-creased,and the proportion of children who had above-average IQ was decreased in group L1,and the scores of verbal comprehension,visual space and total IQ were significantly decreased,the proportion of children who had above-average IQ was reduced,and the proportion of children who had below-average IQ was increased in group M1(P＜0.05).Compared with L1 group,the total IQ score was significantly de-creased,the proportion of children who had above-average IQ was reduced,and the proportion of children who had below-average IQ was increased in group M1(P＜0.05).Conclusion The long-term cognitive function of children after liver transplantation is lower than that of normal children,and the long-term cogni-tive function of children ≤1 yr is better than that of children >1 yr.

Safe airway management is the primary task of anesthesiologists.Anesthesiologists must have good airway management skills including dealing with all kinds of difficult airway in time and effectively to ensure the ventilation and oxygenation of patients and to avoid regurgitation and aspiration.The second World Airway Management Meeting held in Netherlands in November 2019 discussed fourteen topics related to airway management.This article will focus on six hot issues in this session, namely, 1.Human factors and safe airway management; 2.Management of patients with full stomach; 3.Difficult Airway Society (DAS) Awake Tracheal Intubation (ATI) guidelines; 4.Whether awake tracheal intubation can solve all the difficult airway, and whether succinylcholine is out of date; 5.The Universal Management of Airways Guidelines; 6.Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE). The purpose of interpreting and analyzing the above hot issues is to timely update the knowledge of airway management for anesthesiologists, and to improve the understanding and mastery of airway management, especially difficult airway management.

Objective:To evaluate the relationship between decreased atrial myoelectric conduction and gap junction protein 40 (Cx40) and Cx43 in rats with reperfusion atrial arrhythmia.Methods:Sixteen Langendorff-isolated heart perfusion models were randomly divided into control group (group C) and ischemia-reperfusion group (group IR), with 8 rats in each group.According to whether the atrial arrhythmia occurred after reperfusion, group IR was further divided into reperfusion non-atrial arrhythmia subgroup (group R-NAA) and reperfusion atrial arrhythmia subgroup (group R-AA). Group C was balanced perfusion with K-H solution (37 ℃) for 120 min.In group IR, hearts were perfused with K-H solution (37 ℃) for 30 min, perfusion was then stopped, Thomas solution (4 ℃, 20 ml/kg) was injected to induce cardiac arrest for 60 min, the surrounding of the heart was protected with 4 ℃Thomas solution, and hearts were perfused with Thomas solution (4 ℃, 10 ml/kg) again after 30 min of cardiac arrest and then with K-H solution 37 ℃ for 30 min.At 120 min of equilibration or 30 min of reperfusion, the effective refractory period (ERP) and conduction velocity (CV) of the right atrium were measured, the expression of Cx40 and Cx43 in the right atrial myocardium was detected by Western blot, and ratio of Cx40 to Cx40+ Cx43 and the ratio of Cx43 to Cx40+ Cx43 were calculated.Results:The incidence of reperfusion atrial arrhythmia was 38% in group IR.Compared with group C, ERP was significantly prolonged, CV was decreased, the expression of Cx40 and Cx43 was down-regulated, the ratio of Cx40 to Cx40+ Cx43 was increased, and the ratio of Cx43 to Cx40+ Cx43 was decreased in R-NAA and R-AA groups ( P<0.05). Compared with group R-NAA, ERP was significantly prolonged, CV was decreased, the expression of Cx40 and Cx43 was down-regulated, the ratio of Cx40 to Cx40+ Cx43 was increased, and the ratio of Cx43 to Cx40+ Cx43 was decreased in group R-AA ( P<0.05). Conclusion:The decreased atrial myoelectric conduction may be related to the down-regulation of Cx40 and Cx43 expression in rats with reperfusion atrial arrhythmia.

Objective To evaluate the relationship between different levels of central venous pres-sure (CVP) and blood loss during pediatric living donor liver transplantation (LDLT). Methods Pediat-ric patients underwent LDLT in Renji Hospital from 2006 to August 10, 2016 were retrospectively reviewed. The patients were divided into 2 groups according to the different CVP levels before peritoneum closure:central venous pressure<10 mmHg group ( group L) and CVP≥10 mmHg group ( group H) . The primary outcome measure was intraoperative blood loss. The secondary outcome measures were duration of mechani-cal ventilation in intensive care unit (ICU), duration of ICU stay, length of postoperative hospital stay, intraoperative blood loss, intraoperative blood transfusion, intraoperative volume of liquid infused, opera-tion time and anesthesia time. Results A total of 442 pediatric patients were enrolled in this study, with 209 cases in group L and 233 cases in group H. Compared with group H, the intraoperative blood loss was significantly decreased, the anesthesia time, operation time and length of postoperative hospital stay were shortened ( P<0. 05) , and no significant change was found in intraoperative blood transfusion, intraopera-tive volume of liquid infused, duration of mechanical ventilation in ICU or duration of ICU stay in group L ( P>0. 05) . Conclusion Maintaining intraoperative CVP<10 mmHg can markedly reduce the blood loss during LDLT and is helpful for postoperative recovery in pediatric patients.

Objective: To evaluate the outcome of long-term cognitive function after liver transplantation in children and the role of age factor. Methods: Ninety-five pediatric patients, aged 2 yr and 6 months to 6 yr and 11 months at test, at least 1 yr after liver transplantation, were selected.The children′s cognitive function was assessed using Chinese Wechsler Intelligence Scale for Children.The patients were divided into 2 groups according to the age at transplantation: ≤1 yr group (L1 group, n=65) and > 1 yr group (M1 group, n=22). Results: Compared with the normal value, the scores of verbal comprehension and total intelligence quotient (IQ) were significantly decreased, and the proportion of children who had above-average IQ was decreased 1 yr after liver transplantation, the scores of verbal comprehension were decreased, and the proportion of children who had above-average IQ was decreased in group L1, and the scores of verbal comprehension, visual space and total IQ were significantly decreased, the proportion of children who had above-average IQ was reduced, and the proportion of children who had below-average IQ was increased in group M1(P<0.05). Compared with L1 group, the total IQ score was significantly decreased, the proportion of children who had above-average IQ was reduced, and the proportion of children who had below-average IQ was increased in group M1 (P<0.05). Conclusion The long-term cognitive function of children after liver transplantation is lower than that of normal children, and the long-term cognitive function of children ≤1 yr is better than that of children >1 yr.

Objective: To evaluate the electrophysiological changes of atrial myocardium in a rat model of hypothermic ischemia-reperfusion (I/R). Methods: Sixteen isolated Sprague-Dawley rat hearts successfully perfused in the Langendorff apparatus were divided into control group (group C) and hypothermic I/R group (group IR) using a random number table method, with 8 heats in each group.Heats in group IR were further divided into reperfusion-non-atrial arrhythmia subgroup (group R-NAA) and reperfusion-atrial arrhythmia subgroup (group R-AA) depending on whether atrial arrhythmia occurred after reperfusion.In group C, the heart was perfused with K-H solution at 37 ℃ for 120 min.In group IR, the heart was perfused with K-H solution at 37 ℃ for 30 min and then perfusion was stopped, cardiac arrest was induced for 60 min through injecting Thomas solution (4 ℃, 20 ml/kg), the area around the heart was protected with low temperature (4 ℃) Thomas solution, and hearts were resuscitated with 4 ℃ Thomas solution (10 ml/kg) at 30 min after cardiac arrest and with 37 ℃ K-H solution for 30 min staring from 60 min after cardiac arrest.At 30 min of equilibration (T₀), 105 min of equilibration/15 min of reperfusion (T₁), and 120 min of equilibration/30 min of reperfusion (T₂), right atrial monophasic action potentials, maximal velocity of phase zero, monophasic action potential amplitude (MAPA) and MAP duration at 50% and 90% of repolarization (MAPD₅₀ and MAPD₉₀) were measured.Right-atrium conduction velocity and effective refractory period were recorded at T₂, and the ratio of ERP to MAPD₉₀ (ERP/MAPD₉₀) was calculated.Atrial fibrillation was induced by programmed electrical stimulation, and the maximum pacing cycle length of inducing atrial fibrillation (AF-PCL_max) was recorded. Results: Compared with C and R-NAA groups, the maximal velocity of phase zero was significantly decreased and MAPD₉₀ was increased at T₁, the right-atrium conduction velocity and ERP/MAPD₉₀ ratio were decreased and MAPD₉₀, effective refractory period and AF-PCL_max were increased at T₂ in group R-AA (P<0.05). Conclusion The decrease in depolarization velocity, prolongation of repolarization duration and decrease in conduction velocity, excitability and electrical stability may be the electrophysiological mechanism of reperfused atrial arrhythmia in rats.