Excitatory Amino Acids ; secretion ; Humans ; Neurotransmitter Agents ; secretion ; Pain, Postoperative ; etiology ; metabolism ; prevention & control

Objective To evaluate the analgesic efficacy and safety of patient controlled intravenous analgesia (PCIA) with tramadol for labor analgesia as compared with combined spinal-epidural analgesia (CSEA) + patient controlled analgesia (PCEA) with ropivacaine and fentanyl. Methods Eighty ASA Ⅰ - Ⅱ full term primigravidae in active labor (at 2 ～ cm cervical dilation) who had a single fetus with vertex presentation and were expected to have a vaginal delivery were randomly divided into 3 groups: 1 control group received no analgesia ( n = 30), Ⅱ group A received CSEA + PCEA with ropivacaine and fentanyl ( n = 30) and Ⅲ group B received PCIA with tramadol (n = 20) . In group A CSEA was performed at L2-3. Ropivacaine 2.5 mg and fentanyl 5 mg were injected intrathecally. A catheter was then advanced 4 cm into epidural space cephalad for PCEA with a mixture of 0.1% ropivacaine with fentanyl 5?g?ml-1 (background infusion 4 ml?h-1 , demand bolus 4 ml with a 15 min lockout interval). In group B the loading dose of tramadol was 1 mg?kg-1 followed by background infusion of 0.75% tramadol at a rate of 2 ml?h-1 (demand bolus 2 ml with a 10 min lockout interval and a total dose limit of 500 mg) . The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified Bromage score. The vital signs (BP, HR, SpO2), fetal heart rate, labor process, mode of delivery, Apgar score of neonates and side effects of analgesia were recorded. Results Good analgesia was achieved with high patient satisfaction in group A (96.7%) and B (95%) as compared with control group, but there was no significant difference in VAS score between group A and B. The onset time of analgesia was significantly shorter in group A (2.4 ? 1.2) min than that in group B (5.3 ? 2.7) min ( P

Objective To assess the efficacy and safety of smoking intervention by anesthesiol-ogists in surgical patients.Methods A total of 182 male patients,aged 18-79 years,ASA grade Ⅰ-Ⅲ,scheduled for elective noncardiovascular and nonthoracic surgery,were assessed preoperatively. Patients were randomized to either the control group or the intervention group,n =91 each.The con-trol group did not receive specific smoking cessation intervention.The intervention group received brief counseling by the anesthesiologist,leaflets on smoking cessation,including pictorial health warning labels,smoking cessation clinic’s smokers’hot line and WeChat public number.Anesthesia methods,operation time,treatment time in PACU,the rate of smoking cessation at 30 days postop-eratively,perioperative complications and smoking status at 30 days postoperatively were recorded. Results One hundred and sixty-six patients were included in the analysis finally.There was no signif-icant difference between two groups in 30 days of follow-up postoperatively.Self-reported smoking re-duction in the postoperative 30 days the intervention group was significantly lower than that in the control group (36.9% vs.22.0%,P <0.05).For smokers,there was a relationship between the lev-el of eCO and the smoking cessation rate,it was 83.3% in the intervention group and 40.0% in the control group (P <0.05).There was no significant difference of overall rate of combined intraopera-tive and immediate postoperative complications between two groups.Conclusion Smoking cessation intervention launched by anesthesiologists promotes 30 days of abstinence postoperatively.

Objective To compare the efficacy of nitroglycerine administered by local application and intravenous injection for uterine relaxation in patients undergoing caesarean section. Methods Sixty ASA Ⅰ patients, aged 25-35 yr, weighing 60-90 kg, undergoing caesarean section, were randomly allocated into 3 groups ( n = 20 each): control group (group C), intravenous injection group (group I) and local application group (group L). Combined spinal-epidural block was used in the patients. After isolation of uterus, nitroglycerine 0.2 mg was injected intravenously in group Ⅰ and was injected into uterine muscle in group L. The delivery time, blood loss during operation and MAP at the time of uterus incision and 3, 5, 10, 15 and 20 min after uterus incision were recorded. Results Compared with group C, MAP at the time of uterus incision was significantly decreased and the delivery time was significantly shortened in group Ⅰ and L, and the blood loss during operation was significantly increased in group Ⅰ while decreased in group L ( P ＜ 0.05). MAP at the time of uterus incision and 3, 5, and 10 min after uterus incision was significantly increased, the delivery time was significantly shortened, and the blood loss during operation was significantly decreased in group L compared with group Ⅰ ( P ＜ 0.05). Conclusion Local application of nitroglycerine exerts better efficacy than intravenous injection for uterine relaxation in patients undergoing caesarean section.

Objective To investigate the predictive value of spontaneous cough in extubation patients with craniocerebral in‐jury in ICU .Methods Totally 78 cases of patients with severe craniocerebral injury in ICU was divided into successful exbuation group (53 cases) and failing exbuation group (25 cases) according to the exbuation outcome .With the permission of patients ,the general clinical data ,glasgow coma scale (GCS) scores and spontaneous cough of patients were recorded .Results There were 53 cases suceed ;25 cases of patients failing in exbuation ,accounting for 32 .05% .There were no significant difference between ages , gender ,medical history ,hospital acquired pneumonia (HAP) ,disease kind between two groups (P> 0 .05) ,while had significant difference between smoking ,body mass index (BMI)、GCS scores and spontaneous cough of two groups (P<0 .05) .No significant difference was found between the conventional exbuation parameter of two groups (P> 0 .05) .Receiver operating characteristic curve (ROC) analysis showed that ,GCS scoresarea under the curve (AUC) was 0 .822 ,BMI AUC was 0 .674 ,spontaneous cough AUC was 0 .914 ,and smoking AUC was 0 .856 .Conclusion Smoking ,BMI and GCS scores and spontaneous cough times were all meaningful indices for evaluating exbuation of patients with craniocerebral injury in ICU ,in which spontaneous cough times was an important predictive factor and the most accurate one .

Objective To investigate the effects of different carrier gases on the performance of Ohmeda Tec6 desflurane vaporizer. Methods Forty ASA Ⅰ-Ⅱpatients undergoing surgery under general anesthesia with desflurane were enrolled in this study. The age ranged from 37-67 years(mean age 60 years) and body weight from 46-75kg(mean body weight 59.6kg). After induction of anesthesia and tracheal intubation anesthesia was maintained with desflurane. The fresh gas flow(FGF) rate of Ohmeda 210 anesthesia machine was maintained at 5.0L/min and vaporizer dial was set at 6% or 3% . The inspired Concentration of desflurane(FIdes) was analyzed by a Datex ULT-V Capnomac. Five different carrier gases were used:(1) 100%O2;(2) 70% O2 + 30%N2O;(3) 30% O2 + 70%N2O;(4) 70% O2 + 30% N2;(5)30% O2 + 70% N2. There was an interval of 10 mm between two different carrier gases and 40 samples were analyzed for each carrier gas. Results Different carrier gases markedly affected the outflow of Tec6 desflurane vaporizer. The inspired concentration of desflurane decreased significantly with the decrease in oxygen concentration of FGF. Nitrous oxide affected FIdes more significantly than nitrogen at the same concentration of oxygen. Conclusions The oxygen and nitrous oxide concentration of carrier gas affects the inspired concentration of desflurane when Ohmeda Tec6 desflurane vaporized is used.

Objective: The relationship between intracranial pressure (ICP) and visual evoked potential (VEP) or brainstem auditory evoked potential(BAEP)was investigated. Method:An acute intracranial hypertension animal model was established in ten anesthetized rabbits. The changes of VEP and BAEP were observed by an AXON Systems Sentinel-4 Neurologid monitor at different levels of ICP,which were monitored with a fiberoptic transducer being inserted into the epidural space through a burrhole. Result:Both latencies of waves P_1 and N_2 of VEP was positively correlated with the ICP(r=0.62,r=0.60,P

0 05) 97% Spectral edge frequency (SEF) and median power frequency(MPF) decreased after intravenous clonidine(P0 05) Conclusions The contents of NE and E in cortex can indicate the inhabitive degree of isoflurane on consciousness, and the change of MAC of isoflurane is independent of the changes of NE and E contents in cortex,suggesting that the region where to determine the MAC of isoflurane is not at cortex

0.05) ,but the BIS and SEF95% were significantly different between the isoflurane group and the desoflurane group (P

Objective To investigate the effect of being waked up on bispectral index (BIS) and auditory evoked potential index (AEPI) during emergence from propofol administered by TCI.Methods Twenty ASAⅠorⅡpatients aged 31-63 yrs weighing 52-70 kg undergoing elective cholecystectomy using fiberoptic laparoscope under propofol anesthesia administered by TCI were enrolled in the study. During induction of anesthesia the initial target effect-site concentration of propofol was set at 1.0?g?ml-1 and was increased by 1.0?g?ml-1 until 6.0?g?ml-1 step by step. The BIS and AEPI values and hemodynamic variables were recorded at each target effect-site concentration during induction of anesthesia. At the end of operation the infusion of propofol was stopped and the name of the patient was called loudly every minute asking the patient to open his/her eyes. The BIS and AEPI values were recorded 1 minute before and after the eyes opened on command. Results Both BIS and AEPI correlated closely with target effect-site concentration of propofol during induction of anesthesia. During emergence from propofol at the end of operation the BIS value was 69?7 and 72?10 at 1 min before and after the patients opened eyes on command; while the mean AEPI value was 29.8?6.0 and 73.9?5.9 respectively. The increase in AEPI value was significantly larger than the increase in BIS value. Conclusion Both BIS and AEPI correlate closely with target effect-site concentration of propofol during induction of anesthesia. During emergence from propofol the AEPI is more sensitive to being waked up on command.