Objective To investigate the effect of artifictal circadian rhythm of melatonin on the postoperative cellular immune function in patients undergoing gynecological operation Methods Eighteen ASA Ⅰ or Ⅱ patients,aged 25-50 yr,weighing 45-80 kg,scheduled for elective gynecological operation,were randomly divided into 3 groups (n =6 each):control group (group C),placebo control group (group P) and melatonin group (group M).In group M.melatonin 6 mg was given orally at 10 min before lights-out (21:00) on 1 day before operation,on the day of operation and on 1 day after operation,while placebo was given orally instead of melatonin in group P.The operation was performed under epidural anesthesia.Patient-controlled epidural analgesia with ropivacaine was used for postoperative analgesia.VAS score was maintained ＜ 5.Blood samples were collected from the peripheral vein at 1 day before operation (baseline),the end of operation and 1 day after operation to measure CD4+,CD8+ and CD3+ cell count by flow cytometry.The ratio of the number of CD4+ cells to the number of CD8+ cells was calculated.Results There were no significant differences in the number of CD4+,CD8+ and CD3 + cells and ratio of the number of CD4 + cells to the number of CD8 + cells between groups C,P and M (P ＞0.05).Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular immune function in patients undergoing gynecological operation.

[Summary] Regional cerebral oxygen saturation ( rSO2 ) can be used to monitor the changes of cerebral oxygen demand and supply, and postoperative cognitive dysfunction ( POCD ) is a relatively common adverse effect following cardiac surgery. The intraoperative rSO2 decrease may associate with the incidence of POCD. Real-time intraoperative monitoring of rSO2 and necessary interventions performed to correct cerebral rSO2 desaturation may reduce the incidence of POCD of cardiac surgery.

Objective:To investigate the influences of repeated propofol anesthesia on the hippocampal apoptosis and the long-term learning and memory abilities of neonatal rats.Methods: In the study,45 male Sprague-Dawley rats,aged 7 days,were randomly divided into 3 group (n=15 each): control group (C group) that received intralipid 7.5 mL/kg intraperitioneal (IP) once a day×7 days;group propofol 1 (P1) that received propofol 75 mg/kg IP once a day×7 days;group propofol 2 (P2) that received intralipid 7.5 mL/kg IP once a day×6 days+propofol 75 mg/kg IP on the 7th day.In each group,5 animals were chosen and arterial blood samples were obtained immediately after the animals were fully awake for blood gas analysis.Learning and memory abilities were assessed using Morris water maze when the other rats were 4 weeks old.The animals were decapitated after the tests.The hippocampi were isolated for detection of neuron-specific nucleoprotein (NeuN) expression by immunohistochemistry method and the expression of caspase-3 using the Western blot.Results: There was no significant difference in the indexes of blood gas analysis among the 3 groups.Morris water maze test: compared with group C,the escape latency and the length of searching on the 5th day were significantly prolonged,and the searching time in target quadrant and platform crossing on the 6th day were significantly decreased in group P1 (P<0.05) but not in group P2.Compared with group C,NeuN-positive neurons were decreased,and the expression of caspase-3 was increased in the rats of group P1 (P<0.05) but not in group P2.Conclusion: Repeated propofol anesthesia may destroy long-term learning and memory abilities by inducing apoptosis of hippocampal neurons in neonatal rats,while single dose of propofol has no obvious effect on the hippocampal apoptosis and long-term learning and memory of neonatal rats.

To compare the effects of desflurane, sevoflurane, isoflurane and enflurane on cardiovascular response to surgical procedures and recovery from anesthesia. Method: The 40 patients scheduled for abdominal hysterectomy under balanced anesthesia were randomly divided into desflurane (D), sevoflurane (S), isofluane(I)and enflurane(E)groups. After induction of anesthesia and endotracheal intubation, 6% of desflurane, 2% of sevoflurane,1. 15% of isoflurane and 1.7% of enflurane in oxygen and nitrous oxide(1:2) were inhaled in D,S,I and Egroups, respectively. The fractional end tidal alveolar concentration of inhaled anesthetics(Fa) was adjusted to 1MAC during the maintenance of anesthesia. 2?g?kg~(-1)?h~(-1) of fentanyl was infused simultaneously, and the rate of infusion was decreased by 50 percent after infusion for half an hour. Heart rate(HR), systolic pressure(SP), diastolic pressure(DP), SpO_2, and P_(ET)CO_2 were monitored continuously. Volume of minute ventilation(Ve)was observed before induction of anesthesia and 5, 15, 30, 45min after extubation. The recovery parameters of conciousness were also observed. Result: There was no significant difference among the four groups in hemodynamics. Within 30rain after extubation, Ve in I and E groups were lower than that before inductoin of anesthesia and that in D and S groups. The recovery time in D and S groups were significantly shorter thanthat in E and I groups. Conclusion: In balanced anesthesia,desflurane can effectively inhibit the cadiovascular response to surgical procedures and the recovery from anesthsia is faster than any other vaporized anesthetics.

Objective To investigate the relationship between bispectral index (BIS) and cerebrospinal fluid (CSF) concentrations of propofol or effect-site concentrations during target-controlled infusion (TCI) of propofol and evaluate the accuracy of the infusion system targeting at effect-site concentration.Methods Twelve healthy mongrel dogs weighing (17.04? 1.53) kg were anesthetized with intramuscular ketamine 5 mg?kg-1 followed by enflurane inhalation. A catheter was inserted into subarachnoid space and advanced to the base of skull for the collection of CSF. BIS, hemodynamics and PETCO2 were monitored continuously during the experiment. Target effect-site propofol concentration was set at 3 ?g?ml-1 and infusion was continued for 15 min. CSF was collected at 1, 3, 5, 10, 15, 20, 30, 45 and 60 min after infusion was started for determination of propofol concentration by high performance liquid chromatography with fluorescence detection. Results The equilibrium between predicted plasma and effect-site concentration was reached at 10.9 min and the target effect-site concentration was maintained at 3 ?g?ml-1 .The peak CSF concentration of propofol was (0.29? 0.14)?g?ml-1 .CSF concentrations were much lower than the effect-site concentrations at all sampling times (about 18.7% of the effect-site concentration on average) . BIS was consistent with the CSF concentrations of propofol. Both of them reached the lowest or peak values at 5 min after infusion was started, while the peak effect-site concentration was reached relatively later. BIS was found to be better correlated with CSF concentration (? = 0.9195) than with the effect-site concentration (? = 0.554) . The dogs developed hypotension as expected but no other severe adverse effect was observed. Conclusion The inconsistency of BIS with effect-site concentration during TCI of propofol may result from its pharmacokinetic parameters. Good correlation between BIS and CSF concentration indicates that CSF concentration can reflect the pharmacokinetic profileof propofol at effect-site more accurately than the plasma concentration during TCI of propofol targeting at effect-site concentration.

Objective To investigate the clinical features of multiple endocrine neoplasia ( MEN) associated with pheochromocytoma and anesthetic management during perioperative period. Methods Medical records of 12 patients who were operated upon for MEN associated with pheochromocytoma in our hospital from April 1977 to April 2001 were reviewed retrospectively. The demographic data, clinical manifestation, family history, biochemical examinations, type of MEN, the order of different surgical procedures for patients who had multiple operations and changes in hemodynamics were collected and analyzed. Results The 12 patients accounted for 5.6% (12/213) of the patients with pheochromocytoma admitted in the same period. Nine of the 12 patients had a diagnosis of MEN Ⅱa (Sipple syndrome) and three mixed MEN. Four patients with MEN type II a had a positive familial history. Five patients with other coexistent endocrine disorders underwent the excision of pheochromocytoma first, and only two of them had hypertensive symptoms when they were admitted. Seven patients without a history of hypertensive episodes received surgical treatment for pheochromocytoma as a second operation. The excision of pheochromocytoma was performed under general anesthesia ( in 8 patients ) or epidural anesthesia (in 4 patients). Marked hemodynamic fluctuations were recorded in 8 patients. There was no death.Conclusion Pheochromocytoma associated with other endocrine disorders in MEN may manifest itself as the main clinical symptom or most frequently as an occult tumor. Recognition of this feature is of importance to the improvement of diagnosis and treatment of both pheochromocytoma and MEN.

Objective To investigate the relationship between circadian rhythm of perioperative melatonin secretion and neuropsychological status in patients undergoing coronary artery bypass grafting (CABG) .Methods Forty male ASA Ⅱ-Ⅲ patients aged 45-60yr scheduled for elective CABG under hypothermic cardiopulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated to CPB group ( n = 20) or off-pump group (n - 20). Blood samples were taken before induction of anesthesia (T1 ), 10 min after tracheal intubation (T2), 10 min after heparinization (T3) , 2h after skin incision (T4), immediately before neutralization of heparin with protamine (T5 ), at the end of surgery after skin suture (T6 ) and every 3h after operation for 24h for determination of plasma melatonin concentration using enzyme-linked immunosorbent. Degree of depression was assessed by Self-Rating Depression Scale; anxiety by the State-Trait Anxiety Inventory and cognitive function by neuropsychological tests respectively, the day before operation, 7-10 days after surgery and 3 months postoperatively. Results In the 24 hours after operation the circadian secretion pattern of melatonin was kept in 2 patients in CPB group and 6 patients in off-pump group, but disturbed in the remaining patients in both groups. Postoperative depression scores were significantly higher than the preoperative baseline values in both groups. Anxiety scores at 7-10 days after operation were significantly higher in CPB group than those in off-pump group (P

Objective To determine the changes in perioperative plasma melatonin, cortisol and neuron-specific enolase (NSE) and neuropsychological function in patients who developed CNS complications after coronary artery bypass grafting (CABG) .Methods Three patients developed CNS complications (cerebral infarction, motor aphasia, motor and sensory aphasia) after CABG performed under hypothermic cardiopulmonary bypass (CPB) were studied. Blood samples were taken before induction of anesthesia (T1) , 10 min after tracheal intubation (T2), 10 min after heparinization (T3), at 30 min of CPB (T4) , immediately after discontinuation of CPB (T5), at closure of chest (T6), immediately after returning to ICU (T7) and every 3 h in ICU for 24 h (T8-15) for determination of plasma concentrations of NSE, cortisol and melatonin using enzyme-linked immunosorbent assay and radioimmunoassay. Cognitive function was measured before and 10 to 20 days after operation using a battery of tests, while depression and anxiety were assessed by self-rating depression scale and state-trait anxiety inventory respectively. Results The plasma NSE concentration was increased after operation in all 3 patients. The circadian rhythms of melatonin and cortisol were disturbed in patient 1 and 2 during the 24h after operation but were retained in patient 3. In patient 1 and 3 the performance of the trailing making test, the digit symbol subtest of WAIS-R and the stroop color word interference test were poor, meanwhile they became more depressed and less anxious. Conclusion In patients who develop CNS complication after CABG, there are cognitive decline, sentimental disorders and disrupted circadian rhythm of melatonin and cortisol secretion.

The concept of the health promoting hospital, a modern mode of medical service that has turned from the formerly unitary pattern of medical treatment to the health promoting and life quality improving pattern of medical treatment, prevention and health care, was proposed by modern medical institutions so as to keep up with the change in medical modes and medical socialization. In recent years, many countries in the world have adopted the advanced service ideas of the health promoting hospital and conducted active research on various specific subjects. The paper gives an account of the concept, basic theories, development history, and latest progress both at home and abroad of the health promoting hospital so as to give an impetus to health education and health promotion in China.

Objective To analyze the clinical data and features of malignant hyperthermia (MH) in Mainland China and address the problems associated with diagnosis and treatment of MH.Methods Thirty-four cases of MH which occurred in Mainland China from January 1978 to March 2004 were reviewed and analyzed. Results MH syndrome occurred more frequently in adolescents with more males than females and developed very often during oral surgery ( especially cleft lip and palate repair), orthopedic surgery and pediatric surgery for congenital anomalies. The main clinical manifestations included hypercapnia, high body temperature and muscle rigidity. In most cases diagnosis of MH was made based on clinical manifestations only without'in vitro contracture test the golden standard for diagnosis of MH. No specific treatment was available and no epidemiological study was done. Conclusion The report of MH has been increasing recently in Mainland China. Studies on MH should be intensified by establishing the standard of laboratory diagnosis of MH.