Objective Meta-analysis was performed to compare the myocardial protection of sevoflurane versus propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Electronic databases were searched to identify all randomized controlled trials (RCTs) published to September 2008 which compared sevoflurane with propofol in patients undergoing CABG surgery. Two authors independently assessed the quality of each study to meet the inclusion criteria and extracted perioperative data, including patients' preoperative information (baseline characteristics, heart function, disease history and situation of medication), surgical variables (number of grafts and iachemia time) and outcome data such us cardiac index after CPB, postoperative cardiac troponin Ⅰ (cTnⅠ) levels, mechanical ventilation time, positive inotropic drugs, intensive care unit (ICU) and hospital stay length, postoperative mortality, myocardial infarction, myocardial ischemia and atrial fibrillation. Then Meta analysis was performed using RevMan 5.0 software. Results A total of 696 patients from 13 prospective RCTs were inchided in the Meta analysis, 402 out of 696 patients were allocated into sevoflurane group, and 294 into propofol group. There were no significant differences in postoperative mechanical ventilation time, usage rate of positive inotropic drugs, postoperative mortality, incidence of myocardial infarction and atrial fibrillation between the two groups ( P > 0.05 ). Cardiac index after CPB was significantly higher, postoperative cTnl level and incidence of postoperative myocardial ischernia lower, and ICU and hospital stay length shorter in the sevoflurane group than in the propofol group ( P < 0.05 ). Conclusion Sevoflunme has better myocardial protection than propofol in patients undergoing CABG surgery.

Objective To access the analgesia effect and side effect of flurbiprofen axetilcombined with sufentanil.Methods Thirty-eight patients underwent cardiac surgery were randomlydivided into two groups with nineteen cases each.Group S was given sufentanil 250μg diluted to 125ml via PCIA after surgery.Group F was given sufentanil 125 gg plus flurbiprofen axetil 150 mgdiluted to 125 ml via PCIA after surgery.The PCIA pump was set at a rate of 0.2 ml/h,bellus dosewas 0.8 ml.lockout time interval was 10 min. Analgesia grade was accessed,vital sign and sideeffects were recorded.Results 'Fhere was no significant difference in analgesia grade between tWOgroups.The side effects were lower in group F than those in group S.Conclusion Flurbiprofen axetilcombined with sufentanil can obtain similar analgesia effects to sufentanil alone,but can reduce sideeffects and fever temperature.

Ojective To study the anesthesia technique for video-assisted thoracoscopic coronary artery bypass surgery (VATCABS). Methods The anesthesia of 14 VATCABS were reviewed retrospectively. Results The average dose of Fentanyl was (13.3?7 3)?g/kg Six (42.9%) of 14 cases were extubated at the operating room, while other 8 cases (57.9%) were extubated (4.71?2.21) hours after operation. The time of ICU stay was (45.2?35.5) hours. No anesthesia related complications were found perioperatively. Conclusions "Fast track" anesthesia technique is suitable for VATCABS.

Objective To investigate the volume kinetics of 6% hydroxyethyl starch 130/0.4 in healthy volunteers.Methods Seven healthy volunteers aged 18-32 yr weighing 46-84 kg were selected in this study. 6% hydroxyethyl starch 130/0.4 30 ml/kg was infused over 60 min. Volume kinetics analysis of 6% hydroxyethyl starch 130/0.4 was performed with Matlab 6.0 software, compartment model was determined by F test.Results One-compartment model parameters: basic clearance, clearance and distribution volume of one-compartment model were (3.5 ± 1.3) ml/min,(19± 11) ml/min and (5746 ± 1371) ml respectively. Two-compartment model parameters: clearance, K1, the volume of central compartment, the volume of peripheral compartment, distribution volume of two-compartment model were (63 ±29) ml/min,(11 ±4) ml/min, (1551 ± 995) ml, (908 ±398) ml,(2460 ± 1332) ml respectively. There was no difference between the distribution volume of one-compartment model and blood volume of healthy volunteers ( P ＞ 0.05) .The distribution of infused 6% hydroxyethyl starch 130/0.4 was accordant with one-compartment model (F value was 3.81, P ＞ 0.05)and 4 h clearance was (75 ± 10)% .Conclusion The distribution of infused 6% hydroxyethyl starch 130/0.4 for volume expansion is accordant with one-compartment model, and the effective duration of plasma volume expansion is 4 h.

Fifty-two patients with chronic thrombeembolism (41 male, 11 female) aged 33-67 yr underwent pulmonary endarterectomy between 1997-2008. Anesthesia was induced with etomidate, fentanyl/ sufentanil and rocuronium/vecuronium and maintained with large doses of narcotics supplemented with low concentrations of isoflurane/sevoflurane if necessary. Swan-Ganz catheter was placed after induction of anesthesia. Trausesophageal echocardiography was monitored. Bilateral pulmonary thromboembolism was performed using profound hypothermia with circulatory arrest. After operation, 35 patients still had sustained pulmonary hypertension (67%). Nervous system complications occurred in 7 patients ( 14% ). Six patients developed lung bleeding (12%) during and after operation and 4 patients infection (8%). The mortality was 15%.

Objective To retrospectively compare the postoperative recovery and medical cost of pediatric patients underwent fast track cardiac anesthesia(FTCA,extubated in operating room)or regular anesthesia(extubated out of operating room).Methods From January 2005 to January 2006,108 children with congenital heart disease were operated under FTCA,108 patients who received regular anesthesia were set as a control group.The general characteristics,anesthetic method,postoperative treatments,recovery,and medical cost of the two groups were compared.Results The mean body weight of FTCA group was significantly higher than that in the control [(13.8?4.2)kg vs(10.9?3.8)kg,t=5.321,P=0.000].The patients received sevoflurane for anesthesia induction in the FTCA group were more than those in the control(58 vs 16,?2=36.260,P=0.000).The mean dosage of fentanyl used during operation in FTCA group was significantly lower than that in the control [(10.9?7.3)?g/kg vs(18.0?5.7)?g/kg,t=-7.697,P=0.000].In addition,fewer patients in FTCA group used more than one kind of sedative after the operation(7 vs 19,?2=6.296,P=0.012).95 patients in FTCA group returned to their ward without extubation-related complications.No significant difference in length of hospital stay was found between the two groups,however,the medical cost of FTCA group was significantly lower than that in the control(P

From June 2004 to December 2005 anesthesia was done for 43 patients undergoing orthotopic heart transplantation (OHT) in Fuwai Hospital. Most patients were premedicated with oral diazepam 5-10 mg, and intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.1-0.3 mg. Radial artery was cannulated and Swan-Ganz catheter was placed. ECG, direct BP, HR, CVP, PAP, CO, SpO2, SvO2, PETCO2 were monitored before and during operation. Anesthesia was induced with midazolam 1-3 mg, etomidate 0.2-0.3 mg?kg-1 , fentanyl 5-15?g?kg-1 or sufentanil 50-100?g, vecuronium 0.1 mg?kg-1 or rocuronium 0.6 mg?kg-1 , and maintained with isoflurane inhalation and propofol infusion and intermittent i. v. boluses of fentanyl or sufentanil and vecuronium. Hemodynamic suppression was mild during anesthesia. The average duration of aortic cross-clamping and CPB was 57-133 min and 123-230 min. The cardiovascular support used for weaning the patients from CPB included dopamine, ephedrine and isoproterenol. Nitroglycerin, NO and iloprost were administered for pulmonary artery vasodilation. Pacing was started at the termination of CPB because of bradycardia in 1 of 43 patients. Sinus rhythm appeared after the patients were weaned from CPB and the function of the transplanted heart was satisfactory. Basiliximab, cyclosporine A, cellcept and methyl prednisolone were administered for immunosuppression during perioperative period. Forty-two of the 43 patients were discharged from hospital without any rejection episodes or other complications. One patient died of multiple organ failure after heart-kidney transplantation.

Objective To investigate the effects of propofol on the survival rate of and the expression ofinducible nitric oxide synthase (iNOS) in the cultured hippocampal neurons.Methods Hippocampal neuronsisolated from new-born SD rats were dispersed and cultured in B27 culture medium for 9-10days.The culturedhippocampal neurons were randomized to one of 4 groups: (1)control group; (2) anoxia group; (3)propofol 4?g?ml~(1) + anoxia group; (4) propofol 12 ?g?ml~(-1)+ anoxia group. For anoxia the cultured hippocampal neurons wereplaced in a tightly closed vessel filled with 95 % N_2～5% CO_2 at 37℃ for 4h,followed by 24 h reoxygenation. Inthe propofol groups (group 3 and 4) propofol was added before anoxia. Survival rates were measured by MTTassay The levels of iNOS expression were determined by immunocytochemistry method.Results In the twopropofol groups (group 3 and 4) propofol attenuated the levels of iNOS expression in the cultured hippocampalneurons and increased the survival rates as compared with anoxia group (group 2). Depofol reduced the levels ofiNOS expression in a concentration-dependent manner.Conclusion Propofol can decrease the level of iNOSexpression in cultured hippocampal neurons induced by anoxia-reoxygenation and increase the survival rate ofhippocampal neuron after anoxia-reoxygenation. Inhibition of iNOS expression may explain partly the mechanism ofcerebral protective effects of propofol.

Objective To evaluate the effect of ropivacaine and bupivacaine on L-type calcium current (ICa-L) in ventricular myocytes of guinea pigs and to identify the probable mechanism of their negative inotropic effect on myocardium. Methods Single ventricular myocytes were enzymatically isolated from adult male guinea pigs weighing 300-350 g using the enzymatic dissociation method as described by Liu et al. The whole-cell patch clamp technique was used to record ICa-L Results 100 ?mol?L-1 ropivacaine and bupivacaine decreased the peak current of ICa-L by 37% ? 3% and 42% ? 5% respectively ( P

Objective To study the effect of ketamine on L-type calcium currents (ICa-L) in guinea pig ventricular myocytes. Methods Adult guinea pigs of both sexes were anesthetized with pentobarbital. The hearts were immediately removed and ventricular myocytes were prepared by the technique described by Liu et al. The whole-cell patch clamp technique was used to study the ICa-L in isolated guinea pig ventricular myocytes. The changes in ICa-L produced by ketamine 100 ?mol?L-1 with different holding potentials or by different concentrations of ketamine with holding potential of + 10 mV were analyzed. Results Ketamine dose-dependently inhibited ICa-L evoked by a voltage step from a holding potential of - 40 mV to + 10 mV. The 4 concentrations of ketamine (100, 500, 1 000, 5 000 ?mol?L-1) reduced 1Ca-L by 28.7%?5.7% , 34.7%?1.4%, 58.7%?6.4% and 81.7%?6.7% respectively, with a mean IC50 concentration of 926.6 ?mol?L-1 . When the cells were exposed to ketamine 100 ?mol?L-1, the steady-state activation curve was not significantly affected, while the steady-state inactivation curve was shifted to more negative potentials.V1/2 decreased from ( - 14.8?0.8 ) mV to ( - 19.6?0.7) mV (P0.05) in control and drug-affected cells respectively. Ketamine slowed the rate of recovery from inactivation. Conclusion Ketamine can inhibit ICa-L in guinea pig ventricular myocytes in a concentration-dependent manner. This inhibitory effect of ketamine may explain its negative inotropic effect. Ketamine inhibits L-type calcium channel in its inactivated state.