The application of transesophageal echocardiography (TEE) in perioperative monitoring was introduced,and its involvement in non-cardiac surgery was described.The advantages and disadvantages of TEE were analyzed when applied to cardiac and non-cardiac operations for congenital heart disease,coronary disease,vascular heart disease,aorta disease and etc.The abuse of vasoactive drug or fluid is avoided due to subjective evaluation on cardiac function and volume load.TEE facilitates the anesthetist in diagnosis and evaluation of the patient with heart diseases,and the surgeon in immediate assessment of the operation,which can be used for real-time monitoring of cardiac function and hemodynamics.

Objective To investigate the effects of combined general and epidural anesthesia on intestinal barrier function in patients with obstructive jaundice after surgery.Methods Forty patients with obstructive jaundice,male 1 5 cases,female 25 cases,aged 26-65 years,of ASA Ⅰ-Ⅲ,with TBIL >100 μmol/L were randomly divided into two groups (n =20):the general intravenous anes-thesia group (group GA)and the combined general and epidural anesthesia group (group GE).Pa-tients of group GA with oxygen mask rapid intubate induction of endotracheal after general anesthesia. Patients of group GE take left side line of T8~9 or T9 ~1 0 segmental epidural puncture and insert cathe-ter,after changing the hypothesis to be 2% lidocaine 5 ml for test quantity,confirm without anesthe-sia complications and other abnormalities after general anesthesia 5 minutes later.Peripheral venous blood was sampled when entering the operating room (T1 ),and at the end of operation (T2 ),24 hours after operation(T3 )and 48 hours after operation (T4 ).The concentration of D-lactate (D-LA) was measured using ELISA method.Also polymerase chain reaction (PCR)was performed for quali-tative detection of Escherichia coli specific beta galactosidase gene BG.Results Compared with T1 , Plasma D-LA level in two groups at T2-T4 were increased gradually and it was significantly higher in group GA than in group GE at T2-T4 with significant difference (P <0.05).The Escherichia coli DNA test was negative at T1 ,the positive rate of Escherichia coli DNA gradually increased,and it was significantly higher in group GA than in group GE at T4 with significant difference(P <0.05).Conclusion Compared with the general intravenous anesthesia, general anesthesia combined with epidural anesthesia may relieve the intestinal barrier injury in patients with obstructive jaundice after surgery.

Objective To evaluate the effect of dexmedetomidine on liver injury in the rats with ob?structive jaundice. Methods Forty?five healthy male Sprague Dawley rats, weighing 250-300 g, aged 8-9 weeks, were divided into 3 groups ( n=15 each) using a random number table: sham operation group ( S group) , obstructive jaundice group ( OJ group) and dexmedetomidine group ( D group) . Obstructive jaun?dice was induced in rats by division and double ligation of the common bile duct in OJ and D groups. Dexmedetomidine 100 μg∕kg was injected intraperitoneally at 72 h after establishment of the model in group D. At 3, 5 and 24 h after administration, blood samples were collected from hearts for determination of the plasma alanine aminotransferase (ALT) and C?reactive protein (CRP) levels. After blood sampling at each time point, the specimens from the external right lobe of the liver were obtained for detection of the expres?sion of Toll?like receptor 4 ( TLR4) mRNA ( by real?time polymerase chain reaction) and TLR4 content ( by enzyme?linked immunosorbent assay) in liver tissues and for pathological examination of liver tissues ( with light microscope) . Results Compared with group S, the plasma ALT and CRP levels were significantly increased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly up?regulated, and TLR4 content in liver tissues was significantly increased in OJ and D groups ( P<0?05) . Compared with group OJ, the plasma ALT and CRP levels were significantly decreased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly down?regulated, and TLR4 content in liver tissues was significantly decreased in group D ( P<0?05) . The degree of damage to liver tissues was significantly attenuated in group D compared with group OJ, and was aggrava?ted in group D compared with group S. Conclusion Dexmedetomidine can reduce liver injury in the rats with obstructive jaundice.

Objective To compare the effects of dexmedetomidine and propofol on intestinal ischemia-reperfusion (I/R) injury in rats.Methods Forty male SPF Wistar rats, aged 2-3 months, weighing 185-230 g, were randomized into 4 groups (n=10 each) using a random number table: sham operation group (S group), intestinal I/R group (I/R group), propofol group (P group) and dexmedetomidine group (D group).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 20 min followed by reperfusion.In P and D groups, propofol 10 mg/kg and dexmedetomidine 5 μg/kg were injected, respectively, via the femoral vein at 20 min before occlusion.At the end of 2 h reperfusion, the blood samples were collected from the inferior vena cava for determination of serum diamine oxidase (DAO) activity.A segment of the intestine of 5 cm in length was removed for microscopic examination with light microscope.The degree of damage to intestinal mucous membrane was scored according to Chiu.Results Compared to S group, the activity of DAO and Chiu' s score were significantly increased in I/R, P and D groups.Compared to I/R group, the activity of DAO and Chiu' s score were significantly decreased in P and D groups.Compared to P group, the activity of DAO and Chiu' s score were significantly decreased in group D.Conclusion Anesthetic dose of dexmedetomidine pretreatment reduces intestinal I/R injury in rats, and the effect is superior to that produced by propofol.

Objective To evaluate the effects of ABO blood group factors on perioperative coagulation in patients following epidural anesthesia.Methods One hundred and twenty ASA I or Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective operations expected to cause small volume of blood loss during operation under epidural anesthesia,were divided into 4 groups according to the blood group (n =30 each):blood group A group (A group),blood group B group (B group),blood group AB group (AB group) and blood group O group (O group).Blood samples were taken from the central vein before anesthesia (baseline,T1),at 30 min after beginning of operation (T2),at the end of operation (T3),and at 1,8 and 24 h after operation (T4-6) for determination of prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib) concentration,thrombin time (TT),prothrombin activity (PTA),hematocrit (Hct),and platelet (Plt) count.Results The parameters of coagulation were within the normal range at T1-6 in each group.Compared with the baseline value at T1,Fib concentration was significantly decreased,and PT,TT and APTT were increased at T2-6 in O group (P ＜0.05),however,no significant change in all parameters was found at T2-6 in the other three groups (P ＞ 0.05).Fib concentration was significantly lower,and PT,APTT and TT were longer at T1-6 in O group than in A,B and AB groups (P ＜ 0.05 or 0.01).Conclusion Although perioperative coagulation is in the normal range under epidural anesthesia in patients of different ABO blood groups,the coagulation is decreased in patients of blood group O as compared with the other blood groups.

Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass(CPB)-induced intestinal barrier injury in patients undergoing cardiac surgery.Methods Ninety NYHA Ⅰor Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective cardiac surgery with CPB,were randomly divided into 3 gnoups(n =30 each):control group without CPB(group Ⅰ),control group with CPB(group Ⅱ)and administration of methylprednisolone before CPB group(group Ⅲ).Anesthesia was induced with midszolam,fentanyl,etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium.The patients were mechanically ventilated after tracheal intubation.In group Ⅲ,methylprednisolone 10 mg/kg was injected intravenously before operation and CPB.While in groups Ⅰ and Ⅱ,the equal volume of normal saline was injected instead.The blood samples were taken from the central vein before induetion of anesthesia(T1),before CPB(T2),at 30 min after the beginning of CPB(T3),at 30 rin afier the end of CPB(T4)and at 120 min after operation(T5)for determination of the plasma endotoxin concentration.Infection was recorded within 7 days after operation.Results The plasma endotoxin concentrations at T1 were within the normal range in all groups,without significant difference among the three gnoups(P ＞0.05).The plasma endotoxin concentration at T3-5 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ,while higher than those in group Ⅰ(P ＜ 0.05).Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal harrier function in patients undergoing cardiac surgery.

Objective To evaluate the efficacy of parecoxib sodium for prevention of post-thoracotomy pain syndrome.Methods Ninety ASA physical status Ⅰ or Ⅱ patients,aged 40-64 yr,weighing 50-80 kg,scheduled for elective thoracotomy,were equally and randomly divided into 3 groups using a random number table:control group (group C) and two different treatments with parecoxib sodium groups (P1 and P2 groups).At 20 min before skin incison,parecoxib sodium 40 mg was injected intravenously in P1 and P2 groups,while the equal volume of normal saline was given in group C.An increment of parecoxib sodium 40 mg was given every 12 h for 6 times after surgery in group P2.General anesthesia combined with epidural anesthesia was used during surgery and patient-controlled epidural analgesia was used for postoperative analgesia in the three groups.Morphine was used as rescue analgesic to maintain VAS score ≤ 3.The consumption of morphine within 72 h after operation,development of adverse effects and development and duration of pain (VAS score ＞ 3) within 6 months after operation were recorded.The blood coagulation was measured at 72 h after operation.Results Morphine was not used within 72 h after operation in P2 group.The abnormality of blood coagulation at 72 h after operation was not observed in the three groups.Compared with group C,no significant changes were found in the incidence and duration of pain within 6 months after operation in P1 group (P ＞ 0.05),the incidence of pain was significantly decreased and duration of pain was shortened within 6 months after operation in P2 group,and the incidence of nausea,vomiting and pruritus was decreased in P1 and P2 groups (P ＜ 0.05 or 0.01).The incidence of nausea,vomiting and pruritus was significantly lower in P2 group than in P1 group (P ＜ 0.01).Conclusion Continuous application of parecoxib sodium for 72 h can decrease the development of post-thoracotomy pain syndrome without increasing the incidence of adverse effects.

Objective To investigate the effects of ABO blood group factors on erythrocyte suspension ( RCS) transfusion reactions in patients. Methods TestⅠA total of 12 600 patients in whom RCS was transfused during operation at the department of anesthesiology of 11 hospitals of Inner Mongolia from January 2006 to January 2014 were selected. The occurrence of transfusion reactions ( fever [ an increase in body temperature>1 ℃ than that before transfusion] , allergy, hemolysis) was recorded in the patients. Test Ⅱ A total of 120 RCS?transfused patients of both sexes, aged 18-55 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, who underwent surgical operation, were divided into 4 groups ( n=30 each) according to the blood group: blood group A group ( group A) , blood group B group ( group B ) , blood group O group ( group O ) and blood group AB group ( group AB) . The standard for RCS transfusion was defined as hemoglobin ( Hb) <7 g∕L, and Hb was maintained>10 g∕L. Before induction of anesthesia ( T1 ) , before blood transfusion ( T2 ) , and at 5 min, and 1, 6 and 24 h after blood transfusion ( T3?6 ) , blood samples were collected from the central vein for determination of the plasma tumor necrosis factor?alpha ( TNF?α) , interleukin?4 ( IL?4 ) and IL?10 concentrations by enzyme?linked immunosorbent assay. Results Among the 12 600 RCS?transfused patients, 216 cases developed transfusion reactions, and the incidence of transfusion reactions was 1.714%. For the patients of different blood groups, the incidence of transfusion reactions from the high to the low was blood group B, blood group AB, blood group A, and blood group O in turn ( P<0. 05 or 0.01) . Compared with group B, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in the other three groups ( P<0.05) . Compared with group AB, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in A and O groups (P<0.05). Compared with group O, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in group A ( P<0. 05 ) . Conclusion ABO blood group factors affect RCS transfusion reactions in the patients, and the incidence of transfusion reactions from the high to the low is blood group B, blood group AB, blood group A, and blood group O in turn.

Objective To explore the feasibility of FloTrac/Vigileo System in hemodynamic monitoring during the surgery of single-lung ventilation patients.Methods Twenty-five patients with thoracoscopic lobectomy under general anesthesia,aged 35-65 years,ASA physical status Ⅰ or Ⅱ, preoperative showed no application taboo of FloTrac/Vigileo system or transesophageal echocardio-graphy (TEE).The radial artery puncture catheter was inserted after getting into the operating room, then connect the FloTrac/Vigileo system,after that the TEE was inserted following the induction of general anesthesia.Using the FloTrac/Vigileo system to record the stroke volume (SVF),cardiac output (COF),stroke volume variation (SVV),at the moment of after turning over (T0),opening chest and single-lung ventilation(T1),single-lung ventilation for 15 minutes (T2),single-lung venti-lation for 30 minutes (T3),single-lung ventilation for 45 minutes (T4)single-lung ventilation for 60 minutes (T5).Using TEE to monitor the index and record the the stroke volume (SVT)cardiac out-put(COT)and inferior vena cava collapse index(cIVC)of the same patient at same time as Group F. Results There was no statistically significant different between SVFand SVTat T0-T5in both groups,Overall correlation analysis,r=0.84,P<0.01.There is no statistically significant different between COFand COTat T0-T5in both groups,Overall correlation analysis,r=0.92,P<0.01. Correlation analysis of SVV of group F and cIVC of group T,the results were positively correlate,r=0.80,P<0.01.Conclusion FloTrac/Vigileo system can be used as a monitoring method for mo-nitoring hemodynamics in thoracic surgery.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.