In the teaching of central venous catheterization in graduate students of Institute of Anaesthesiology, teachers use traditional teaching method, multimedia method, simulation method and clinical training. It can not only make teaching contents richer and more vivid, but also increase students' interest, thus greatly enhancing teaching results.

Objective To compare the effects of combined general-epidural anesthesia (CGEA) and general anesthesia (GA) on energy metabolism and oxygen cost of breathing.Methods Forty patients (25 male, 15 female) aged 42-61 yr weighing 42-75 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups : group CGEA (Ⅰ, n = 20) and group GA (Ⅱ, n = 20) . The patients were premedicated with midazolam 0.05 mg?kg-1 and scopolamine 0.3 mg i.m. . In groupⅠepidural catheter was placed at T9-10 A. test dose of 4ml of 2 % lidocaine was given. When the height of block was confirmed general anesthesia was started. In both groups anesthesia was induced with etomidate 0.3 mg?kg-1 , fentanyl 8 ?g?kg-1 and tracheal intubation was facilitated with atracurium 0.8 mg?kg-1 . Anesthesia was maintained with propofol in both group and intermittent epidural lidocaine in CGEA group and intermittent i. v. boluses of fentanyl in GA group. Muscle relaxation was maintained with atracurium infusion at 8 ?g?kg-1 ? min-1 during operation. Oxygen consumption ( VO2 ), CO2 production (VCO2 ) , energy expenditure ( EE) and respiratory quotient (RQ) were measured before anesthesia, during and after operation using indirect calorimetry (Datex, Deltatrac MBM-200) . Postoperative oxygen cost of breathing (OCB) was calculated during spontaneous breathing and controlled ventilation. Results VO2 , VCO2 , EE were significantly lower and RQ was significantly higher during operation than those before anesthesia in both groups (P

Objective To study the changes in oxygen consumption ( VO2 ) and oxygen cost of breathing(OCB) in postoperative patients and the effects of various kinds of assisted ventilatory support on OCB.Methods Twenty patients (13 male, 7 female), aged 43-70 years, undergoing thoracic surgery were divided into two groups: (A) pulmonary disease(PD) group in which patients had chronic pulmonary disease and abnormal pulmonary function( n = 10); non-pulmonary disease (NPD) group in which patients had no chronic pulmonary disease and their pulmonary function was normal ( n = 10). Operation were performed under combined intravenous-inhalation anesthesia or general-epidural anesthesia. Metabolism of the patients was measured before anesthesia. After operation the patients were mechanically ventilated in ICU and PaCO2 was maintained between 4.6-6.0 kPa. Metabolism was measured 12h after operation when anesthesia had worn off, the patients were fully awake and breathing spontaneously. Their hemodynamics was stable. Body temperature was maintained at 37℃?0.5℃ . VO2 was measured using indirect colorimetry (Datex Deltatrac MBM-200). VO2, VCO2, energy expenditure(EE) and respiratory quotient (RQ) were recorded every minute for 30 min. OCB was calculated by deducting VO2 measured during controlled ventilation from VO2 measured during spontaneous breathing( OCB = VO2 spontaneous breathing - VO2 controlled ventilation) and expressed by OCB/VO2 spontaneous breathing ( % ) . During mechanical ventilation FiO2 was set

ObjectiveTo investigate the incidence and the cause of chronic pain in maintenance hemodialysis(MHD) patients,and the effect of chronic pain on quality of life.Methods Seventy MHD patients in dialysis centre of our hospital were enrolled in the study and divided into 2 groups according to pain symptoms.There were 32 patients with chronic pain in pain group,and 38 patients without chronic pain in painless group.Pain degree was evaluated by numerical rating scale (NRS,1 to 10) in pain group.Parathyroid hormone (PTH),β2-microglobulin (β2-MG) and bone mineral density(BMD) of all the patients were measured.Depression and insomnia degrees were examined by Beck depression index (BDI) and Pittsburgh sleep quality index (PSQI) respectively.Correlations were performed among parameters.Results The incidence of chronic pain in MHD patients was 45.7％ and the mean pain intensity of NRS was 5.71±1.86(95％ CI,5.04-6.38).There were significant differences of PTH,BMD,β2-MG,BDI score and PSQI score between two groups(all P＜0.01).The painful degree was positively correlated with levels of PTH and β2-MG,and the scores of PSQI and BDI,and was negatively correlated with BMD in pain group.Conclusion Chronic pain is common in MHD patients with different location and moderate degree,which can aggravate the depression and insomnia and may be associated with the changes of PTH,β2-MG and BMD.

Objective To investigate the role of p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Sixty male SD rats weighing 180-230 g were randomly divided into 4 groups: control group (group C, n = 6), ALI group ( n = 24),p38MAPK specific inhibitor SB203580 + ALI group (group SB + ALI, n = 24), SB203580 group (group SB,n =6). LPS 5 mg/kg was injected intravenously via tail vein in group ALI and SB + ALI, while the equal volume of normal saline was given instead in group C. Group SB + ALI received iv injection of SB203580 10 mg/kg via tail vein 30 min before LPS administration. Group SB received injection of SB203580. The rats were sacrificed at 1, 3 and6 h agter LPS administration (T1-3) in group ALI and SB + ALI (8 rats at each time point) andat 1 h after administration in C and SB groups. The lungs were immediately removed for microscopic examination and determination of phosphorylated p38MAPK (p-p38MAPK) expression, the concentration of protein in bronchoalveolar lavage fluid (BALF) and apoptotic index (AI). Another 32 rats were selected and randomly divided into 2 groups for survival study: ALI group and SB + ALI group ( n = 16 each), and then they were treated as mentioned above and observed for 48 h. Results The concentration of protein in BALF, AI and p-p38MAPK expression were significantly increased in group ALI and SB + ALI compared with group C, while decreased in group SB + ALI compared with group ALI ( P ＜ 0. 05 ). LPS-induced pulmonary histological changes were significantly attenuated in group SB + ALI compared with group ALI. The survival rate was significantly decreased in group ALI compgred with group SB + ALI ( P ＜ 0.01 ). Conclusion p38 MAPK signal transduction pathway is involved in LPS-induced ALI, which may be related to the apoptosis in the cells in the lung.

Objective To investigate the role of neurokinin-1 receptor (NK-1R) in the anti-nociceptive effect of enflurane, isoflurane and sevoflurane in mice. Methods Three hundred and twenty Kunming mice of both sexes weighing 20-25 g were randomly divided into4 groups (n =80 each): group normal saline (group NS);group enflurane (group E); group isoflurane (group I) and group sevoflurane (group S). Normal saline (NS) 1.0ml/kg, erflurane 0.5 ml/kg, isoflurane 0.4 ml/kg and sevoflurane 2.0 ml/kg were injected intraperitoneally in NS,E,I and S groups respectively. Each group was further divided into 4 subgroups receiving intrathecal NS 5 μl and Sar-SP (NK-IR agonist) 20, 40 and 80 ng respectively at 5 min after intraperitoneal injection of inhalation anesthetics. The anti-nociceptive effect of the inhalation anesthetics was assessed by tail flick latency (TFL) (the latency for removal of the tail from the path of heat source) and paw-licking time (PLT) after intraplantar formalin injection. Results lntraperitoneal enflurane, isoflurane and sevoflurane significantly prolonged TFL and shortened PLT. Intrathecal Sar-SP 20, 40 and 80 ng significantly shortened TFL dose-dependently but had no significant effeet on PLT as compared with control subgroup. Conclusion NK-1R is involved in the anti-nociceptive effect of enflurane, isoflurane and sevofluran on thermal pain but not chemical and inflammatory pain.

Objective The purpose of this study was to compare the whole body oxygen consumption determined by reverse Pick method and indirect calorimetry in mechanically ventilated patients after cardiac surgery. Methods Eight NYHA II-III patients (2 male, 6 female ) aged 43-68 yr, undergoing aortic valve replacement, mitral valve replacement or coronary artery bypass grafting(CABG) under CPB. Swan-Ganz catheter was placed via right internal jugular vein. Anesthesia and operation were carried out uneventfully. The patients were placed in ICU after operation and mechanical ventilation was continued (IPPV, FiO2 40%-50% , PEEP 5 cm H2O) . PaCO2 was maintained at 35-45 mm Hg by adjustment of VT and RR. T was maintained at 37.0 1C+0.5C .Total body oxygen consumption was measured by the reverse Fick method and indirect calorimetry simultaneously at 2h and 6h after operation. Results The mean oxygen consumption (VO2 ) value determined by indirect calorimetry( 162 + 30 mlmin-1m-2) was significantly higher than that determined by reverse Fick method (127+23 ml min-1m-2)(P

Currently,the environment for establishing anesthesiologic undergraduate education no longer exists,and the side-effects of its narrow professional content are more and more apparent,so canceling undergraduate education of anesthesiology is becoming imperative.The education of anesthesia must be reformed.However,the direction of reform is not clear.Anesthesia long-term system education and Anesthesia and preoperative medical education are two optical reform directions with its own advantages and disadvantages.Comparing these two directions,the Anesthesia and preoperative medical education seems to be the better one.

Objective To evaluate the role of MLK3-MKK3/6-p38MAPK signal transduction pathway in lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. Methods Seventy-eight healthy adult male SD rats weighing 200-250 g were randomly divided into 4 groups: control group (group C, n = 6), ALI group ( n =24), MLK3 inhibitor K252a group (group MK, n = 24) and p38MAPK specific inhibitor SB203580 group (group MS, n = 24). ALI was induced by iv injection of LPS 5 mg/kg via tail vein, while the equal volume of normal saline was given instead in group C. K252a 75 μg/kg and SB203580 10 mg/kg were injected intravenously via tail vein 30 min before LPS administration in group MK and MS respectively. The rats were killed at 1, 3, 6 and 12 h (T1-4) after LPS administration in group ALI, MK and MS (6 rats at each time point) and immediately after normal saline administration in group C. The lungs were removed for microscopic examination. The left lung was lavaged.The broncho-alveolar lavage fluid (BALF) was collected. The concentration of TNF-α in the BALF was determined by ELISA. W/D lung weight ratio was calculated. The expression of p-MLK3, p-MKK3/6 and p-p38MAPK were determined by Western blot. Results The concentration of TNF-α in the BALF, W/D lung weight ratio, and expression of p-MLK3, p-MKK3/6 and p-p38MAPK were significantly higher in the other three groups than in group C (P ＜ 0.01). The parameters mentioned above were significantly lower in group MK, and the concentration of TNF-α in the BALF, W/D lung weight ratio, and p-p38MAPK expression were significantly lower in group MS than in group ALI (P ＜ 0.05). The microscopic examination showed that LPS-induced ALI was less severe in group MK and MS than in group ALI. Conclusion MLK3-MKK3/6-p38MAPK signal transduction pathway plays an important role in LPS-induced ALI in rats.

Objective To investigate the effects of RO20-1724 on repetitive ketamine administration-induced learning and memory impairment in immature rats.Methods Forty-eight 21-day-old SD rats of both sexes weighing 45-55 g were randomly divided into 4 groups (n =12 each):control group(group C); ketamine group (group K); ketamine + RO20-1724 group (group K+ R) and ketamine + vehicle (ethanol) group (group K+ A).Ketamine 70 mg/kg was injected intraperitoneally (IP) once a day for 7 consecutive days in groups K,K+ R and K+ A.RO20-1724 0.5 mg/kg and equal volume of ethanol were injected IP at 30 min after IP ketamine once a day for 7 consecutive day in groups K + R and K + A respectively.Morris water maze test was used to assess learning and memory ability.The escape latency and the number of times of passing the safe zone were recorded.The animals were killed after water maze test and their brains removed for microscopic examination of hippocampus and determination of p-CREB protein expression in hippocampus (by Western blot).Results Repetitive ketamine administration significantly prolonged the escape latency,decreased the number of times of passing the safe zone and down-regulated the expression of p-CREB protein in hippocampus on the 3rd and 4th day in group K as compared with group C.RO20-1724 significantly attenuated the above changes induced by repetitive ketamine administration in group K + R as compared with group K.Electron microscopic examination showed that RO20-1724 significantly ameliorated repetitive ketamine administration-induced hippocampal neuronal damage.Conclusion RO20-1724 can ameliorate cognitive dysfunction induced by repetitive ketamine administration.Up-regulation of cAMP /CREB signaling pathway is involved in the mechanism.