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.

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.

Objective To investigate the alleviative effects of lidocaine postconditioning on pulmonary injury following ischemia reperfusion.Methods Seventy-two adult SD rats were randomized to 4 groups:sham group,ischemia-reperfusion(I-R) group,ischemic postconditioning(IPC) group and lidocaine postconditioning group. The pulmonary ischemia-reperfusion model was established by occlusion of the left hilum of lung for 45 min and the reperfusion was taken by removing the clamp for 2 h. At the moment of reperfusion,lidocaine 4 mg/kg was injected as a priming dose following a continuous rate of 4 mg/(kg?h). PaO2,TNF-?,W/D of left lung,the level of MDA of left lung tissue were measured. At the end of reperfusion left lung was removed for microscopy. Results After reperfusion PaO2 of lidocaine group was much higher than that of I-R group(P

Objective: This trial was designed to study the profile of the pharmacokinetics of desflurane in balance anesthesia. Method:Forty ASA physical status Ⅰ and Ⅱ patients undergoing abdominal surgery were admitted to this study. All patients were anesthetized with balance anesthesia technique,which received delivered concentration(FD)of 6% desflurane in a fresh gas(O_2: N_2O=1:2)inflow of 3L/min until end-tidal target concentration(FA)of 3% des flurane was obtained, then the FD was adjusted to maintain the target concentration, 30 min later the inflow was decreased to 1.5L/min. As well as nitrous oxide,oxygen and carbon dioxide concentrations were measured at the common gas outlet and the endotracheal tube connector respectively. At same time fentanyl and atracurium were given as necessary. The SpO_2,BP,and HR were also measured. We observed the time of target concentration reached during wash-in period, and also the time of FA: FAO = 1/2 during wash-out period at the end of operation. Result: During the first 30 min of 3L/min flow administration,the target concentration was obtained at 2.9 min,and was kept stable during the whole procedure,even during low flow(1.5L/min)it was not required to increase the FD to maintain FA at the target concentration. The wash-out time of FA:FAO= 1/2 was 2.0 min from stopping adminstration. The time of spontaneous breath recovery, open eye, extubation.reciting of name and birthday and discharge from recovery room was 6, 5.8.6,9.0,12.0 and 30 min respectively. The parameters of cardiac function were stable during operation. Con clusion: During the balance anesthesia with desflurane.even at relative low flow.the FD of desflurane provides a reasortable surrogate of FI and FA. The lower solubility of desflurane favors its safe use in low-flow technique.and the anesthesia depth can be controlled more easy.

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 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.

[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.

[Summary] Postoperative cognitive dysfunction ( POCD) is a common central nervous system complication after anesthesia and surgery.The mechanisms of POCD are not clear yet.The article reviewed several potential mechanisms that have been reported. Further researches are needed to identify the pathophysiologic progress of POCD, which have great clinical and economic values.