Objective To investigate the risks and anesthetic management of scar uterus undergoing cesarean section.MethodsOne hundred pregnant women(aged 24-43 years old)with scar uterus underwent cesarean section.Epidural anesthesia was used in 90 cases(group A)and general anesthesia in 10 cases(group B).The monitorings included ECG,BP,HR and SpO_2.CVP was measured in the high risk cases.The time from skin incision tO neonatal delivery(I-D).the time from uterine incision to delivery(U-D),and Apgar scores of neonates were recorded.Results Incomplete blockade was seen in 20 cases(22％).The I-D time was shorter in group B than that in group A[(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).Intraoperative hypotension occurred in 32 cases (32％).Neonatal asphyxia happened in 21 cases(21%).Apgar scores of 11 neonatals werc less than 3,of whom 5 neonates died.Apgar scores were 4 to 7 in 10 cases,8 to 10 in 79 cases.Subtotal uterectomy was performed in 2 cases.Repair of injuried bladder had to be done in one case.Intraoperative huge bleeding took place in 15 cases.Conclusion The scar uterus undergoing cesarean section has a high risk for mothers and neonates.The incidence of incomplete epidural blockade is higher.Effectively preventing and managing the risk factors are the keys for reducing maternal and neonatal complications and mortality.

AIM: To study the effectiveness of urapidil and nitroglycerine on controlling the cardiovascular responses to tracheal intubation/extubation in patients with essential hypertension. METHODS: 45 patients with essential hypertension undergoing general anesthesia were divided randomly into control (C, without depressor, n=15), urapidil (U, 0.5 mg?kg -1 , n=15), and nitroglycerine (N, 1 ?g?kg -1 , n=15) groups. The SBP, DBP, MAP, HR and RPP were measured during intubation and extubation and at the induction of anesthesia and the end of operation respectively. RESULTS: The SBP, DBP, MAP, HR and RPP increased markedly (P

Twenty-eight children with laryngeal papilloma aged 10 months -3.5 yr weighing 8-15 kg received CO2 laser treatment under serf-retaining laryngoscope from May 2003 to May 2007. There were 17 patients without laryngeal obstruction, 7 patients with 1st degree laryngeal obstruction and 4 patients with 2rid or 3rd degree laryngeal obstruction. Different techniques of anesthesia were used for patients with different degrees of laryngeal obstruction. In patients without laryngeal obstruction anesthesia was induced with intramuscular ketamine 5 mg/kg. After the patients lost consciousness midazolam 0.1 mg/kg, ketamine 1-2 mg/kg or fentanyl 2 μg/kg was given iv. Tracheal intubation was facilitated with succinyl-cboline 1.5 mg/kg. In patients with 1st degree laryngeal obstruction, ketamine 5 mg/kg was given ira. The patients kept spontaneous breathing. Tracheal intubaiion was pedormed under topical anesthesia with 1% tetracaine. In patients with 2nd and 3rd degree laryngeal obstruction tracheal intubation was performed awake without any premedication under topical anesthesia with 1% tetracaine. The trachea was intubated with the tracheal tube 1 size smaller than the regular size. Anesthesia was maintained with propofol 3-5 mg·kg1·h-1 and intermittent iv boluses of ketamine 1-2 mg/kg and vecuronium 0.05-0. 1 mg/ kg. Dexamethasone 0.2-0.3 mg/kg was given iv at the end of operation. The patients were extubated when the patients regained consciousness and SpO2≥ 96% on air. In one patient with Ist degree laryngeal obstruction emergency tracheotomy was performed during induction of anesthesia. Anesthesia was otherwise smooth and recovery was uneventful.

Objective To investigate the effect of flurbiprofen axetil(FA)on the acute lung injury(ALI)induced by LPS in rats.Methods Forty male SD rats weighing 190-220 g were nmdomly divided into 3 groups:group Ⅰ control(C,n=8);groupⅡ LPS(n=16)and group Ⅲ FA+LPS(n=16).In group Ⅱ and Ⅲ LPS 5 mg/kg in 1 ml of normal saline(NS)w88 given iv.In group Ⅲ FA 6 mg/kg in NS 1 ml was given Ⅳ 0.5 hbefore LPS administration.In group Ⅱ and Ⅲ 8 animals were killed at 2 h(T1)and 4 h(T2)after LPS administration respectively.Blood samples were obtained at T1 and T2 for blood gas analysis and determination of serum TXB2,6-keto PGF1α(by radio-immuno assay),TNF-α,IL-1β,IL-6 and IL-10 concentrations(by ELISA).Lungs were removed for determination of W/D lung weight ratio,lung water content(LC)and microscopic examination.ResultsCompared with group C,LPS signitlcanfly decreased PaO2,PaO2/FiO2 and increased PaCO2,W/D lung weight ratio,LC,serum TXB2,6-keto-PGF1α concentrations,TXB2/6-keto-PGF1α ratio and serum IL-1β,TNF-α,and IL-6 concentrations in LPS group.Pulmonary edema and hemorrhage were observed in LPS group.FA pretreatment significantly attenuated LPS-induced blood gas,bio-chemical and pulmonary histological changes in group Ⅲ.Conclusion Flurbiprofen axetil pretreatment can protect the lungs against LPS-induced acute injury by down-regulating TXB2/6-keto-PGF1α ratio and inhibiting inflammatory response.

95 mmHg , P300, P

Objective To evaluate the effects of penehyclidine hydrochloride pretreatment on the expression of nitric oxide synthase (NOS) and cell apoptosis in lung tissues in rats with endotoxin-induced acute lung injury (ALI).Methods Forty adult male Sprague-Dawley rats,weighing 220-270 g,were randomly divided into 5 groups (n =8 each) using a random number table:control group (group C),endotoxin-induced ALI group (ALI group),and penehyclidine hydrochloride 0.03,0.10,0.30 mg/kg groups (Pi-3 groups).ALI was induced with lipopolysaccharide (LPS) 5 mg/kg which was injected via the caudal vein.In P1-3 groups,penehyclidine hydmchloride 0.03,0.10 and 0.30 mg/kg were injected intraperitoneally,respectively,at 1 h before LPS injection,while the equal volume of normal saline was administered in C and ALI groups.The animals were sacrificed at 4 h after ALI models were successfully established and pulmonary specimens were obtained for determination of the cell apoptosis (by TUNEL),expression of NOS mRNA (using PT-PCR),and Bcl-2 and Bax protein (by Western blot),NOS activity (using chemical colorimetry) and NO content (by using nitrate reductase method) and for examination of pathological changes (by light and electron microscopes).Apoptotic index (AI) and the ratio of Bcl-2/Bax was calculated.Results Compared with group C,NOS mRNA and Bax protein expression was significantly up-regulated,NOS activity,NO content and AI were increased,Bcl-2 protein expression was down-regulated,the ratio of Bcl-2/Bax was decreased (P ＜ 0.01),and the degree of pathological changes of the lung was aggravated in ALI and P1-3 groups.Compared with ALI and P1 groups,NOS mRNA and Bax protein expression was significantly down-regulated,NOS activity,content of NO and AI were decreased,Bcl-2 protein expression was up-regulated,the ratio of Bcl-2/Bax was increased (P ＜ 0.01),and the degree of pathological changes of the lung was alleviated in P2-3 groups.There was no significant difference in the indexes mentioned above and results of pathological changes of the lung between group ALI and group P1,and between group P2 and group P3 (P ＞ 0.05).Conclusion Penehyclidine hydrochloride pretreatment ameliorates endotoxin-induced ALI by inhibiting NOS expression and cell apoptosis in rat lung tissues.

Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the pulmonary protection of dexmedetomidine in combination with parecoxib in pa?tients undergoing thoracotomy with one-lung ventilation. Methods Eighty patients undergoing elective resection of esopha?geal or lung cancer, including both sex, aged 40-70 yr, ASAⅠ-Ⅲ, were randomly divided into four groups (n=20), dexme?detomidine group (D group), parecoxib group (P group), dexmedetomidine in combination with parecoxib group (DP group) and control group (C group). Dexmedetomidine 1μg/kg was infused in ten minutes and then continued infusion at the rate 0.6μg·kg-1·h-1 until the chest was closed in group D. Parecoxib 40 mg was infused 10 min before the induction of anesthesia in group P. DP group was given parecoxib 40 mg and parecoxib 40 mg 10 min before the induction of anesthesia. The equal volume of normal saline was given in group C. Blood samples were collected for determination of blood gas analysis and the serum concentration of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 immediately after the induction of anes?thesia (T1), 30 min (T2) and 60 min(T3) after one-lung ventilation, and at the end of the operation (T4). Oxygenation index (OI) was calculated. The serum levels of TNF-α, IL-6 and IL-8 were detected by ELISA. Results Compared with time T0, the serum concentrations of TNF-α, IL-6 and IL-8 (except IL-8 at the time T2 in DP group) were significantly increased, and OI was decreased in all groups at the time T2-4 (P<0.05). Compared with group C, concentrations of TNF-α, IL-6 and IL-8 decreased and OI increased significantly at the time T2-4 in D group, P group and DP group (P<0.05). There were no obvious differences in concentrations of TNF-α, IL-6, IL-8 and OI value between D group and P group (P > 0.05). Conclusion Combination of dexmedetomidine and parecoxib can further mitigate inflammatory response, improve lung oxygenation dur?ing one-lung ventilation, and provide pulmonary protection in patients undergoing thoracotomy.

Objective To investigate the effect of flurbiprofen axetil on perioperative plasma levels of prostaglandin E2 (PGE2) and β-endorphine (β-EP) in patients after remifentanil-based anesthesia.Methods Sixty ASA Ⅱ patients of both sexes,aged 40-64 yr,weighing 50-75 kg,undergoing resection of esophageal cancer,were randomly divided into 3 groups (n =20 each):intralipid group (group A),flurbiprofen axetil pretreatment + postoperative analgesia with flurbiprofen axetil group (group B) and flurbiprofen axetil pretreatment group (group C).Anesthesia was induced with propofol,remifentanil and rocuronium and maintained with propofol,remifentanil and intermittent iv boluses of rocuronium.In group A,intralipid 0.2 ml/kg was injected intravenously at 30 min before operation and patient-controlled intravenous analgesia (PCIA) with fentanyl 15μg/kg + intralipid 0.2 ml/kg was used for postoperative analgesia.In group B,flurbiprofen axetil 2 mg/kg was injected intravenously at 30 min before operation and PCIA with fentanyl 15 μg/kg + flurbiprofen axetil 2 mg/kg was used for postoperative analgesia.In group C,flurbiprofen axetil 2 mg/kg was injected intravenously at 30 min before operation and PCIA with fentanyl 15 μg/kg + intralipid 0.2 ml/kg was used for postoperative analgesia.PCIA solution contained fentanyl 15 μg/kg,flurbiprofen axetil 2 mg/kg and intralipid 0.2 ml/kg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose,a 10 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of 5 ml starting from 30 min before the end of operation.VAS score was maintained ＜ 3 after operation,and tramadol 50 mg was injected intravenously when VAS ≥ 4 after operation.The amount of remifentanil used during operation and the number of successfully delivered doses and the number of attempts,requirement for tramadol,apnea and severer hypotension were recorded within 48 h after operation.Blood samples were taken immediately before induction of anesthesia,at the end of operation,24 and 48 h after operation (T1-4) for determination of plasma β-EP and PGE2 concentrations.Results There was no significant difference in the amount of remifentanil used among the three groups (P ＞ 0.05).Compared with group A,the number of successfully delivered doses,the number of attempts and the requirement for tramadol were decreased,and the concentration of plasma PGE2 at T2,3 were significantly decreased in groups B and C,and the concentrations of plasma β-EP at T3,4 in group B and at T4 in group C were significantly increased (P ＜ 0.05).Compared with group B,the number of successfully delivered doses,the number of attempts and requirement for tramadol were significantly increased,and the concentration of plasma β-EP at T3,4 wassignificantly decreased in group C (P ＜ 0.05).Compared with the baseline value at T1,the concentrations of PGE2 were significantly increased at T2,3,and the concentration of plasma β-EP was significantly increased at T2,but decreased at T4 in group A,and the concentrations of β-EP at T3,4 were significantly increased in group B (P ＜ 0.05).There was no significant difference in the concentrations of PGE2 and β-EP between the four time points in group C (P ＞ 0.05).Apnea and severer hypotension were not found in the three groups.Conclusion The mechanism by which flurbiprofen axetil reduces postoperative opioid tolerance in patients after remifentanil-based anesthesia may be related to the decrease in PGE2 levels and increase in β-EP levels.