Objective To investigate the application of small dose of ketamine during induction of anesthesia in patients after coronary artery bypass grafting neutrophil superoxide generation effect .Methods 30 patients undergoing elective coronary artery bypass grafting operation were randomly divided into 2 groups ,in the fentanyl induced respectively based on combined with small dose of ketamine (ketamine group) or normal saline (control group) ,a blood sample collection time points :before ,immediately after extracorporeal circulation operation ,operation after 1-6 days .Neutrophil function by using (12-) fourteen acid and phorbol ester (-13-) acetate (PMA) ,yeast polysaccharide or formyl-methylthio-light-phenylalanine after stimulation of superoxide production de-termination method .Results During general anesthesia combined with low dose ketamine inhibits superoxide anion increases .In ad-dition ,ketamine reduces perioperative 2 -6 days of the neutrophil percentage .Conclusion Ketamine can reduce the activation of neutrophils after cardiopulmonary bypass .

Objective To investigate the effect of L-N6-(1-iminoethyl) Lysine(L-NIL) on ischemia-reperfusion (I/R) -induced lung injury in a rat model of lung transplantation. Methods Pathogen free male SD rats weighing 250-350g were used as donor and recipient rats in this study. The animals were randomly divided into 3groups (n = 6 each): sham operation group (group S); lung tratsplantation group (group L) and lung transplantation + L-NIL (selective iNOS inhibitor) group (group L-NIL). In group L and L-NIL orthotopic left lung allograft transplantation was performed. In group L-NIL 3 mg/kg was injected iv at the beginning of reperfusion. The donor lungs were removed from live donor rats and placed in Euro-collins solution at 4 ℃. The lung transplantation was performed under microscope and non-suture cuff technique was used. The implanted donor lungs were ventilated and reperfused. 0.5% Evans blue 0.2 ml was injected iv during reperfusion. The donor lungs were removed after being implanted, ventilated and reperfused for 2 h for microscopic examination and determination of iNOS, endothelial NOS (eNOS) and myeloperoxidase (MPO) activity and malondialdehyde (MDA) and Evans blue content in the lung tissue and W/D lung weight ratio. Results Lung transplantation significantly inceased W/D ratio, iNOS and MPO activity, and Evans blue and MDA content in the lung tissue and decreased eNOS activity in group L as compared with group S. L-NIL iv significantly attenuated the increase in the variables mentioned above and ameliorated capillary congestion and inflammatory cell infiltration in the lung. Conclusion Intravenous L-NIL administered at the beginning of reperfusion can reduce I/R injury to the transplanted donor lungs.

Objective To explore the method of anesthesia and intra-operative management for robotic thoracic surgery. Methods Twelve patients who underwent robotic thoracic surgery using the Da Vinci surgical system were anesthetized with general anesthesia combined with T4-8 paravertebral block. After induction of anesthesia, a double-lumen endotracheal tube was positioned by bronchofibroscope to allow onelung ventilation during intra-operative procedure. Hemodynamics and respiratory function were routinely monitored and arterial blood gas (ABG) were tested during operation. Results All patients could tolerate the anesthesia for robotic thoracic surgery and there was no hospital mortality. The arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after induction were (35.2 ± 3.6) mm Hg( 1 mm Hg =0.133 kPa) and (213.3 ± 57.5) mm Hg respectively; PaCO2 and PaO2 30 min after one -lung ventilation were (37.9 ± 4.8) mm Hg and ( 125.3 ± 36.5) mm Hg respectively. When the one-lung ventilation started about 58% (7/12) of the patient developed temporarily low SpO2 (over 0.90) and recovered to 0.95 soon when using 3 - 5 cm H2O( 1 cm H2O = 0.098 kPa) positive end expiratory pressure (PEEP). The anesthesia time was ( 291.5 ± 99.4) min, the time for one-lung ventilation was (206.3 ± 93.4) min, the volume of blood loses in operation was ( 171.7 ± 110.3 ) ml and the tracheal catheter extration time was ( 16.3 ± 4.5 ) min, all the patients left ICU on the second day after surgery. Conclusions The anesthesia for robotic thoracic surgery with Da Vinci surgical system is multiplicity, the hemodynamics and respiratory function can be instable, it is a new challenge for the technology and management of anesthesia. Good one-lung ventilation is important for this surgery, ventilation parameter need to be adjusted when hypoxia occurred and PEEP could be used to the ventilated lung. General anesthesia combined with paravertebral block will be a good option for postoperative pain control and minimal hemodynamics disturb ance.

Objective To evaluate the effect of 6% hydroxyethyl starch (HES) 200/0.5 on the pulmonary capillary permeability in oleic acid induced acute lung injury (ALI) and investigate the possible mechanism of the therapeutic effect of HES. Methods Forty male SD rats weighing 280-370 g were randomly divided into four groups: group I balanced solution (control); group II 6% HES 200/0.5; group III gelatin and group IV dextran 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 30-40 mg?kg-1 . Right external jugular vein was cannulated. Oleic acid 0.06 ml?kg-1 was given iv.10 ml?kg-1 of the above-mentioned different solutions was infused over 1.5 h in the four groups. Then 0.5% Evan's blue 1ml was injected iv. Four hours later the animals were sacrificed and lungs removed for pathologic examination under microscope, and determination of lung water content [ (wet weight -dry weight)/wet weight ? 100% ] . Lung Evan's blue content was determined by formamide extracting method. Lung MDA content and MPO activity were also determined.Results Lung water and Evan's blue contents were significantly lower in group II than those in any other groups. MPO activity and MDA level in group II were lowest among the four groups. Conclusions HES can decrease pulmonary capillary permeability, attentuate pulmonary edema and lung injury, and depress MPO activity and MDA level. The underlying mechanism may be due to its depressant effect on PMN aggregation and lipid peroxidation.

Objective To evaluate the effects of different doses of compound Xuelian capsule on bone cancer pain (BCP) in rats.Methods Fifty pathogen-free adult female Sprague-Dawley rats,weighing 200-220 g,aged 7-8 weeks,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S),group BCP,and compound Xuelian capsule 50,100 and 200 mg · kg-1 · d-1 groups (group CX50,group CX100 and group CX200).BCP was produced by injecting Walker256 mammary gland carcinoma cells into the intramedullary space of the right femur bone.At 11-21 days after inoculation of the tumor ceils,normal saline containing compound Xuelian capsule 50,100 and 200 mg · kg 1 · d 1 was injected through a tube into stomach once a day in CX50,CX100 and CX200 groups,respectively.The mechanical paw withdrawal threshold (MWT) and limb use score were measured at 1 day before inoculation of the tumor cells (baseline) and 4,7,11,14,17,19,and 21 days after inoculation of the tumor cells.Results Compared with group S,the MWT at 4-21 days after inoculation of the tumor cells was significantly decreased,and limb use score was significantly decreased at 11-21 days after inoculation of the tumor cells in BCP,CX50,CX100 and CX200 groups (P＜0.05).Compared with group BCP,the MWT was significantly increased at 19-21 days after inoculation in group CX50,at 17-21 days after inoculation in group CX100 and at 14-21 days after inoculation in group CX200,and limb use score was significantly increased at 14-21 days after inoculation in group CX100 and at 17-21 days after inoculation in group CX200 (P＜0.05).Conclusion Compound Xuelian capsule 50,100 and 200 mg· kg 1 · d 1 (for 11 consecutive days) can reduce BCP in a dose-dependent manner in rats.

From August 2006 to June 2011 among consecutive 18 294 patients underwent thoracic surgery from Shanghai Chest Hospital,41 developed adverse events during peri-anesthesia period and the incidence was 0.224％,and the constituent ratios of the predictable and unpredictable events were 15％ and 85％,respectively.Cardiac arrest and massive hemorrhage were the main clinical manifestation of the adverse events and the constituent ratios were 37％ and 24％,respectively.Among the inducements for adverse events,patient's factor,surgical factor,anesthesia factor,patient-surgery factor,patient-anesthesia factor and patient-surgery-anesthesia factor accounted for 12.2％,48.8％,12.2％,7.3％,7.3％ and 12.2％,respectively.The ratio of death from adverse events was 17％ (7 cases),and among the inducements for adverse events causing death,surgical factor,patient-surgery factor and patient-surgery-anesthesia factor accounted for 43％,43％ and 14％,respectively.The incidence of adverse events was 1.093％ in the patients underwent operation on trachea,which was significantly higher than that in the patients underwent operation on lung (0.223％),mediastinum (0.236％) and esophagus (0.194％).In conclusion,although the adverse events which occurred during peri-anesthesia period in the patients underwent thoracic surgery were rare,they threatened the safety of patients.Surgical factor was not only the main inducement,but also the risk factor for death,and cardiac arrest and massive hemorrhage were the main clinical manifestation of the surgery-related adverse events.For cardiac arrest,as long as it was found in time and treated appropriately,the serious consequences could be avoided.For massive hemorrhage,more attention should be paid due to be the main reason of death,and the prevention depended on the surgeon's improvement of diagnosis and surgery.It was difficult to predict patient-related the adverse events and careful monitoring was required.For the anesthesia-related adverse events,they were mostly due to the poor airway management,so preoperative airway assessment should be strengthened.

The strategy of optimizing anesthetic management was carried out in all the patients un?dergoing thoracic surgery in our hospital from January 1, 2012: the patients were monitored using routine electrocardiogram combined with invasive arterial blood pressure monitoring, double?lumen central venous catheter pathway was established, and when severe bradycardia ( heart rate<40 beats∕min) occurred, inter?vention was carried out immediately, and chest compression was performed timely. Medical records of 15 212 patients from July 1, 2006 to December 31, 2011 ( before optimizing anesthetic management) as well as medical records of 17 078 patients from January 1, 2012 to January 15, 2015 ( after optimizing an?esthetic management) were reviewed. The data including baseline patient characteristics as well as the time period and causes of cardiac arrest, rescue time, rescue measures, successful resuscitation and prognosis in the patients developing intraoperative cardiac arrest were collected. Before optimizing anesthetic manage?ment, 28 patients developed cardiac arrest, the incidence was 0?184%, successful resuscitation was found in 25 cases, the success rate of resuscitation was 89%, and there were 3 cases in whom resuscitation failed due to massive hemorrhage?induced cardiac arrest. After optimizing anesthetic management, 17 patients de?veloped cardiac arrest, the incidence was 0?109%, massive hemorrhage?induced cardiac arrest was not found in patients, and the success rate of resuscitation was 100%. Prognosis was good after surgery in suc?cessfully resuscitated patients. Compared with the values before optimizing anesthetic management, the in?cidence of cardiac arrest was significantly decreased (P=0?05), and no significant change was found in the other parameters after optimizing anesthetic management ( P>0?05) , and the incidence of cardiac arrest was decreased by 45% after optimizing anesthetic management. In conclusion, the strategy of optimizing anesthetic management is helpful in decreasing the occurrence of cardiac arrest during thoracic surgery.

Objective To establish a rat model of bone cancer pain by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Methods Sixty female Wistar rots weighing 180-200 g were randomly divided into 4 groups (a=15each):groupⅠ normal control; group Ⅱsham operation; group Ⅲtumor cell inoculation + normal saline (NS) and group Ⅳtumor cell inoculation + flurbiprofen. NS 0.2 nd and flurbiprofen 10 mg/kg in 0.2 ml were injected IV at 2 h before determination of pain threshold on 14 and 17 d after inoculation oftumor cells in groupⅢand Ⅳ respectively. On day 0, 4, 7, 10, 14, 17 and 21 after inoculation pain threshold was measured after determination of body weight. X-ray examination of the tibia was performed on day 14 after inoculation. The animals were killed on day 21 after inoculation for microscopic examination of the inoculated tibia. Results The animals started losing weight and the threshold to yon Frey hair stimulation was decreased from dhy 10 after inoculation in group Ⅲand Ⅳ. X-ray examination showed destruction of bone and microscopic examination showed tumor growing in tibia. Flurbiprofen significantly decreased mechanical hyperalgesia in group Ⅳ. There was no significant difference in paw withdrawal latoney to radiant heat among the 4 groups. Conclusion A model of bone cancer pain can be made by inoculation of Walker 256 mammary gland carcinoma cells into tibia characterized by mechanical hyperalgesia.

Objective To evaluate the ventilation modes and factors influencing the tidal volume(VT)in the nonventilated lung during one-lung ventilation(OLV)in patients undergoing thorascopic surgery using electrical impedance tomography.Methods Thirteen American Society of Anesthesiologists physical statusⅠ or Ⅱ patients of both sexes,aged 45-64 yr,weighing 45-80 kg,undergoing elective pulmonary surgery performed via video-assisted thoracoscope,were enrolled in the study.After anesthesia induction,a double lumen tube was placed,and correct tube placement was confirmed with a fiberoptic bronchoscope.Two-lung ventilation and OLV were performed sequentially when in supine position with a fixed VT of 8 ml/kg and respiratory rate(RR)of 12 breaths/min.When the patients were turned to lateral position(with the operated lung on the upper side),correct placement of the tube was reconfirmed with a fiberoptic bronchoscope.Bilateral lungs were ventilated with VT of 8 ml/kg and RR of 12 breaths/min,and unilateral lungs were then ventilated in the following modes in sequence:VT 8 ml/kg and RR 12 breaths/min for the lung on the upper side;VT 8 ml/kg and RR 12 breaths/min for the lung on the lower side;VT 8 ml/kg,RR 12 breaths/min and positive end-expiratory pressure(PEEP)4 cmH2O for the lung on the lower side;VT 6 ml/kg and RR 16 breaths/min for the lung on the lower side;VT 4 ml/kg and RR 24 breaths/min for the lung on the lower side.Each ventilation mode stabilized for 2 min.At 2 min of OLV in each mode,electrical impedance tomography was used to record the ventilation mode in the nonventilated lung,anesthesia machine was used to record VT in the nonventilated lung,and the percentage of VT on nonventilated side in VT on ventilated side(VT-non/VT-ven%)was calculated.When the unilateral lung on the lower side was ventilated in lateral position,logistic regression analysis was used to analyze the correlation between VT on ventilated side(no PEEP)and that on nonventilated side.Results Opposite ventilation was found in the nonventilated lung during OLV.VT-non/VT-ven% was significantly higher in lateral position than in supine position(P<0.05).VT-non/VT-ven% was significantly higher when the lung on the lower side was ventilated than that when the lung on the upper side was ventilated(P<0.05).Four cmH2O PEEP exerted no effect on VT-non/VT-ven%.When the lung on the lower side was ventilated in lateral position,there was a linear positive correlation between VT on ventilated side(no PEEP)and that on nonventilated side(r=0.899,P<0.05).Conclusion During OLV in patients undergoing thorascopic surgery,there is opposite ventilation in the nonventilated lung,and VT is influenced by body positions and VT in contralateral lungs.

Objective To detect the spreading scope of rectal cancer to mesorectum by RT PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. Methods Forty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT PCR using CEA as a marker. Results Nine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages,the infiltrated depth of bowel wall, tumor differentiation and tumor type( P 0.05). Conclusion The excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.