Objective To investigate the peri operative changes and anesthetic management during orthotopic liver transplantation (OLT) Methods General anesthesia or general anesthesia combined with epidural anesthesia was applied During the anhepatic phase, extracorporeal veno venous bypass (EVVB) was established Hemodynamics, respiratory function, blood gas, biochemistry, blood coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored According to the different characteristics of the pre anheptic phase, anheptic phase and neoheptic phase during OLT, the corresponding anesthetic management was supplied Results Applying EVVB during the anheptic phase could keep hemodynamics stable, but in 15 min of the primary anheptic and neoheptic stages a transient circulatory instablity occurred,and the rapid blood volume expansion was required Through comprehensive management, there was no obvious acid base disturbance during the phases The hypocalcemia, hypokalemia and hyperglycemia occurred and thebody temperature changed greatly,to require timly corrective measures Certain coagulative disturbances occurred, to require the supplement of coagulation factors, proper hemostatic drugs and protamine for neutralizing heparin Intraoperatively, anti rejection drugs were required Peri operatively, the blood glucose levels were higher than normal Conclusions Utilizing EVVB during the anheptic phase can be helpful to maintain hemodynamics stable, prevent obvious acidosis and hyperkalemia The anesthetic management during the neoheptic phase should be required to correcte hypothermia, hypocalcemia, hypokalemia, hyperglycemia and disturbence of coagulation

Objective To observe the changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation Methods During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was utilized in 20 patients undergoing live transplantation Systemic and pulmonary hemodynamics were monitored through Swan-Ganz catheter during whole procedures Results As compared with the preoperative values , MAP remained unchanged in normal range during perioperative period;CO,CI,LVSW and RVSW decreased significantly during anhepatic phase and increased markedly 15 min after hepatic reperfusion (P

Objective To investigate the effect of astragalus membranaceus on the ultrastructure of small intestinal epithelial cells in rabbits with hemorrhagic shock. Methods Twenty-four New Zealand white rabbits of both sexes weighing 2-3 kg were randomly divided into 3 equal groups : (A) control group received normal saline iv ( n = 8); (B) group HI received astragalus membranaceus 20 mg? kg-1 iv ( n = 8); ( C) group H2 received astragalus membranaceus 10 mg?kg-1 iv ( n = 8 ). Animal model of hemorrhagic shock-resuscitation was established according to Wigger's. A strip of small intestine, 10 cm in length was taken from distal end of ileum for electron microscopic examination. The two-dimensional structural parameters and three-dimensional structural parameters of mitochondria were calculated. Results (1) Morphological changes of small intestine : in group H1 epithelial cells were orderly arranged, with relatively normal mitochondria and intestinal villi were slender and orderly; in group H2 the nuclei in epithelial cells were dwindled, the intestinal villi were thin and short and unorderly arranged with slightly swelled mitochondria and blurring ridges. Endoplasmatic reticulum was dilated; in group C the gaps between epithelial cells widened. There were a lot of apoptotic cells. Microvilli were thin and short and swelled. Mitochondria were swelled with broken ridges. Endoplasmatic reticulum was severely dilated. (2) Structural parameters of mitochondria : in group C there were least mitochondria and the swelling of mitochondria was severe; in group H1 there were plenty of mitochondria and the swelling was slightest; in group H2 the changes in mitochondria were between group C and H1. Conclusion Astragalus membranaceus can protect small intestine from ischemia/reperfusion injury in a dose-dependent manner.

0.05), but pretreatment with yohimbine 10 ug significantly reduced the antinociceptive effect of tramadol ( 10ug) at 35 min and 40 min and the nociception score increased by 56% and 41 % respectively ( P 0.05). Scatchard analysis of the saturation isotherms showed that H-yohimbine was bound to a single binding site with a Kd value of 1.79 nM. The competition curve of tramadol was sigmoidal with a Ki value of 34.14 uM and an IC50 value of 68.25 uM. Tramadol was 19 000-fold less potent for binding to a2-adrenoceptor of the spinal cord as compared to H-yahimbine. Conclusion Intrathecal tramadol produces time-dependent antinociception. Tramadol has very low affinity with a2-adrenoceptor of the spinal cord. A part of its intrathecal antinociceptive effect was related to indirect a2-adrenoceptor effect of the spinal cord.

Objective To study the transformation of myosin isoforms and the effect of verapamil on the transformation after burn. Methods Wistar rats were randomly divided in four groups: the burn group(BG, inflicted with 30% TBS third degree burn), the verapamil group(VG), the fluid replacement group(RG) and the control group(CG). The transformation of myosin was observed by SDS PAGE. Results The transformation of myosin from V1 to V3 in three experimental groups was found at the 12 th hour(at 24 th hour in verapamil group)after burn, which was significantly different from that in the control group( P 0.05). Conclusion Burn can induce the transformation of myocardial contractile protein myosin isoforms from V1 to V3, which can be partially prevented by verapamil.

This paper reports a cases of cervical root chylous cyst and reviews related literatures.This disease is rare in the root of neck. Clinical and imaging diagnosis of the disease is very important for treatment.Surgical excision is the main treatment,conservative treatment can be used as a aductive therapy.

Objective To evaluate the effects of therapy with small volume of different fluids on renal blood flow in endotoxemia rats.Methods Thirty parthogen-free SD rats weighing 180-250 g were randomly divided into 5 groups (n = 6 each):group Ⅰ control; group Ⅱ LPS; group Ⅲ LPS + 7.5 % hypertonic saline (HS);group Ⅳ LPS + hydrozyethly starch (HES) 130/0.4 and groupⅤ LPS + hypertonic saline plus hydroxyethly starch (HS-HES) 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 40 mg/kg. Left carotid artery was cannulated for BP and HR monitoring and fluid administration. In groupⅡ-Ⅴ LPS 1 mg/kg was administered via arterial cannula. In group Ⅲ, Ⅳ and V 4 ml/kg of 7.5% HS, HES 130/0.4 AND HS-HES 40 were administered via arterial cannula respectively at 30 min after LPS administration.In groupⅠ and Ⅱ normal saline 4 ml/kg was given insteadt. Renal blood flow was measured with Doppler ultrasound before LPS (T1 ,baseline), at 30 min after LPS (T2), 10, 30 and 60 min after fluid therapy (T3, T4, T5). The animals were then sacrificed and both kidneys were removed for microscopic examination with light microscope. Results Renal blood flow was significantly decreased and was significantly recovered to some extent by therapy with different fluids especially with HS-HES 40 in group Ⅴ. Conclusion Therapy with small volume of HS,HES or HS-HES could increase renal blood flow and inprove renal microcirculation especially HS-HES.

Objective To study the effect of transcutaneous electrical acupoint stimulation (TEAS) on emergence agitation in children undergoing cochlear implantation.Methods Sixty patients (age range,1-4 years) scheduled to undergo pediatric cochlear implantation were enrolled and randomized into the TEAS group (group T,n =30) that received continuous TEAS and the control group (group C,n =30) that did not receive TEAS.Anesthesia time,operation time,change in blood flow dynamics during the perioperative period,extubation time,and PACU stay time were recorded.The incidence of emergence agitation and postoperative nausea and vomiting (PONV) was monitored.Results No significant intergroup differences were observed in age,sex,weight,operation time,and PACU stay time (P ＞ 0.05).The MAP and HR in group T were lower than those in group C at different time points such as 30 min after the start of surgery,the end of the surgery,the extubation and 5 min after extubation,and the difference was statistically significant (P ＜ 0.05).The FPS-R,FLACC,and PAED scores in group T were lower than those in group C at different time points within 30 min after exmbation (including the time of extubation),and the difference was statistically significant (P ＜ 0.05).Extubation time,anesthesia time,and incidence of PONV were lower in group T than in group C,and the difference was statistically significant (P ＜ 0.05).Conclusion TEAS combined with general anesthesia significantly reduces the incidence of emergence agitation in children undergoing surgery for congenital hearing loss;it also helps control hypotension,reheve dramatic hemodynamic changes during the waking period,and reduce the incidence of PONV.

Objective To evaluate the effect of lipo-alprostadil on lung injury in patients undergoing orthotopic liver transplantation.Methods Forty-eight ASA Ⅱ-Ⅳ patients of both sexes,aged 45-64 yr,weighing 45-70 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =24 each):control group (group C) and lipo-alprostadil group (group A).Anesthesia was induced with midazolam,propofol,fentanyl and vecuronium and maintained with sevoflurane,sufentanil and vecuronium.The patients were tracheal intubated and mechanically ventilated.Lipo-alprostadil 5 μg in 10 ml of normal saline was infused intravenously and slowly over 30 min before induction of anesthesia and at 1 h of neohepatic phase in group A.Lipoalprostadil was not administrated in group C.Peak inspiratory pressure (PIP),mean inspiratory pressure (Pmean),dynamic lung compliance (Cd),oxygenation index (OI),respiratory index (RI) and the concentrations of inflammatory cytokines in exhaled breath condensate (EBC) were recorded immediately before operation,at the end of operation,and at 24 h after operation.The occurrence of pulmonary complications was recorded within 7days after operation.Results Compared with group C,PIP,Pmean,RI,and TNF-α and IL-8 concentrations in EBC were significantly decreased,while Cd and OI were increased at the end of operation and 24 h after operation,and the incidence of acute lung injury and pulmonary infection were decreased within 7 days after operation (P ＜0.05),and no significant change in the other indexes was found in group A (P ＞ 0.05).Conclusion Lipo-alprostadil has protective effect on lung in patients undergoing orthotopic liver transplantation.

Objective To investigate the administration of antibiotics in the treatment of infection of burns based on bacteriological surveillance from burn wound.Methods A retrospective analysis of bacterial culture and drug-sensitivity results from burn wound and subeschar tissues in 581 patients during 1999 to 2004 was carried out.Results Eight hundred and eighty-seven strains of bacteria were isolated from burn wound and subeschar tissues in 581 patients,among which 481 strains were gram negative(54.23%),and 406 strains were gram positive(45.77%).Among the bacteria of gram negative,the most majority was Pseudomonas and then was the Enterobacteriaceae.Among the bacteria of gram positive,Staphylcoccus aureus was the majority,and MRSA accounted for 71.48% in the Staphylcoccus aureus.The resistance of Pseudomonas to Netilmicin was decreased from 20.1% to 4.9%,and the resistance of Enterobacteriaceae to Imipenem was still in a low level.All bacteria of gram positive were sensitive to Vancomycin.Conclusion The majority of the bacteria of burn infection is gram negative.The isolated bacteria show multiple resistance to antibiotic.The analysis of bacteria from burn wound and resistance of bacteria to antibiotic is very important to experiential treatment of antibiotic for burn infection.