BACKGROUND:Positive total knee replacement surgery greatly improved the quality of life in patients with knee joint degenerative disease, but widespread perioperative acute pain increases the probability of complications and hinders the rehabilitation exercises of patients; therefore perioperative pain processing has become an important topic of the current knee replacement.
OBJECTIVE:To compare the efficacy and safety of preemptive analgesia of parecoxib sodium, periarticular analgesia and their combination in the total knee arthroplasty, and explore reasonable and effective analgesic scheme.
METHODS:60 patients undergoing knee replacement were randomly selected in Xuzhou Central Hospital from May 2012 to December 2014, and then they were divided with a random number table into four groups: preemptive analgesia with parecoxib sodium, periarticular analgesia, combination and blank control, with 15 cases in each group. Different programs were used in each group during total knee arthroplasty.
RESULTS AND CONCLUSION:At 6, 12, 24 and 36 hours after operation, rest pain scores, activity pain scores and drug dose were significantly lower in the combination group than other three groups (P < 0.05). Time interval of anesthetic use was significantly longer in the combination group than other three groups (P < 0.05). At 3 days after replacement, active leg-raising time and active genuflex 90° time were significantly shorter in the combination group than other three groups (P < 0.05), and range of motion of the knee was good. The incidence of adverse reaction was lowest in the combination group (P < 0.05). These results indicate that preemptive analgesia of parecoxib sodium combined with periarticular analgesia is a safe and effective analgesic option, can obviously reduce pain after replacement, the amount of anesthetics and adverse reactions, improve range of motion of the knee and promote early rehabilitation of patients.

Objective To investigate the effect of hypertonic saline (HS) on the permeability of blood-brain barrier in a rat model of intracerebral hemorrhage (ICH).Methods Sixty healthy male Sprague-Dawley rats, aged 8 weeks, weighing 260-300 g, were randomly divided into 4 groups (n=15 each) using a random number table: sham operation group (group S), sham operation+HS group (group HS) ,ICH group, and ICH+HS group.ICH was commonly induced in anesthetized rats by intraparenchymal injection of autologous blood 50 μ1.The equal volume of normal saline was given instead in group S.The neurologic deficits were scored on a five-point scale, and a score of 1-3 indicated successful establishment of the model.At 48 h after establishment of the model, the rats were sacrificed, and brains were removed for determination of brain water content, expression of occludin in brain tissues (by Western blot) , and Evans blue content.Results Compared with group S, the brain water content and Evans blue content were significantly increased, and the expression of occludin was down-regulated in ICH and ICH+HS groups, and no significant change was found in the indices mentioned above in group S+HS.Compared with group ICH,the brain water content and Evans blue content were significantly decreased, and the expression of occludin was up-regulated in group ICH +HS.Conclusion HS can inhibit increase in the permeability of bloodbrain barrier, and reduce the cerebral edema in a rat model of ICH.

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 observe the clinical effect of preoperative intranasal dexmedetomidine on sedation and preventing postoperative agitation in children inguinal hernia operation .Methods Forty children patients ,aged 1-s5 years old ,ASA Ⅰ ,were selected and equally randomized into 2 groups ,receiving intranasally dexmedetomidine 1 μg/kg(group Dex) and the same volume of normal saline (group NS) at preoperative 30 min respectively .The sedation score ,emotion score when separating from their par‐ents ,mask inhalation induction resistance score were evaluated at 30 min after medication ,furthermore the agitation scores were ob‐served and recorded at postoperative 30 min ,1 ,2 h .Results The sedation score ,emotion score when separating from their parents and mask inhalation induction resistance score in the Dex group were superior to the NS group ,moreover the agitation score at each points were lower than those in the NS group(P<0 .05) .Conclusion Preoperative intranasal dexmedetomidine can be safely used in children inguinal hernia operation ,has better sedative effect ,meanw hile reduces the postoperative agitation occurrence .

Objective To evaluate the effect of hyperbaric oxygen (HBO) therapy on postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia.Methods A total of 112 patients,aged 65-75 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective non-cardiac surgery with general anesthesia,were randomly divided into control group (C group,n =54) and HBO group (n =58).Patients were exposed to hyperbaric oxygen in a hyperbaric oxygen chamber once a day from day 3 to day 12 after surgery in both groups.Pressure was slowly increased to 2 atmosphere absolute within 20 min,pure oxygen was inhaled for 35 min by mask,5 min later pure oxygen was inhaled for another 35 min,oxygen inhalation was then stopped and pressure was slowly increased to 1 atmosphere absolute in HBO group.Patients inhaled air at 1 atmosphere absolute for 70 min in C group.Cognitive function score was assessed using Mini-Mental State Examination,language ability test,visual identification function test,digit span backwards task and Hasegawa's Dementia Scale (HDS) at 2 days before surgery and 7 and 13 days after surgery.The development of POCD was recorded.Results Compared with the baseline at 2 days before surgery,language ability test,digit span backwards task and HDS scores were significantly decreased at 7 and 13 days after surgery in C group,and digit span backwards task scores were significantly decreased at 7 days after surgery in HBO group (P＜0.05 or 0.01).The language ability test and HDS scores were significantly higher,and the incidence of POCD was lower at 7 and 13 days after surgery in HBO group than in C group (P＜0.05).Conclusion HBO therapy can reduce POCD in elderly patients undergoing general anesthesia.

Objective The purpose of this study was to assess the safety of carbon dioxide pneumoperitoneum on patients during robotic rectectomy.Methods 50 patients [American Society of Anesthesiologists (ASA) physical status Ⅱ,18 and 65 years of age] underwent rectal cancer surgery were selected in our study.According to whether or not robotic assisted surgery was performed,they were divided into a robotic surgery group (group RS) and a laparoscopic surgery group (group LS) by surgical approach,25 patients in each group.All participants were given the same anesthesia protocol.Arterial blood samples 1 ml was obtained from the left radial artery for blood gas analysis to measure the partial pressure of arterial carbon dioxide (PaCO2) and and calculate the arterial-to-end-tidal carbon dioxide pressure difference (Pa-ETCO2) just 10 min after endotracheal intubation (T0),at 30 min(T1),1 h(T2),2 h(T3) after pneumoperitoneum and 30 minutes after release (T4).Meanwhile,the airway peak pressure was monitored.Blood samples (4 ml) extracted at T0,T3 and T4 were centrifuged and measured the serum levels of interleukin (IL)-6 and IL-10 by enzyme linked immunosorbent assay (ELISA).The time to resuscitation,extubation time,intraoperative medication and perioperative adverse events were all recorded.Results Compared with group LS,PaCO2 in the RS group was increased significantly at T1,T2 and T3 after pneumoperitonum and the IL-6 was lower at T4 (P ＜ 0.05).There were no statistically significant differences in Pa-ETCO2,airway peak pressure,IL-10,time to resuscitation,extubation time and the incidence of adverse events between the two groups (P ＞ 0.05).Conclusions It is safe for normal adult patients performed by intravenous anesthesia during robotic-assisted rectal surgery and the inflammatory response is small,which is beneficial to the patient's postoperative recovery.