Objective To investigate the effect of intraoperative amino acid infusion on perioperative glucose metabolism. Methods Thirty-six adult mongrel dogs of both sexes weighing 12-16 kg undergoing partially small intestine resection under general anesthesia were randomly allocated to one of 4 groups (n=9 each): Ⅰ control group received normal saline (C);Ⅱ,Ⅲ,Ⅳ amino acid group (A1, A2, A3) received iv infusion of 2.85%, 5.70% and 11.4% 18-amino acid respectively at 12 ml·kg-1·h-1 during operation starting from skin incision until the end of operation. The animals were premedicated with ketamine and diazepam. Anesthesia was induced with propofol 5-10 mg/kg, fentanyl 2 μg/kg and vecuronium 0.2 mg/kg and maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and vecuronium. The animals were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. ECG, MAP, HR, PET CO2 and esophageal T0 were continuously monitored. Venous blood samples were collected before anesthesia (T1), 15 min after induction of anesthesia (T2), 15, 30 min and 1 h after skin incision (T3-5), when abdomen was closed (T6) and 1,2,4,8 and 24 h after operation (T7-11) for determination of plasma glucose, lactate, insulin and glucagon. Liver biopsy was performed at T6-11 and muscle biopsy at T2,6,11 for measurement of hepatic and muscle glucagon. Homa index was used to estimate the degree of insulin resistance. Results The plasma glucose and insulin concentrations were significantly increased at T3-11 as compared with the baseline at T1 in all 4 groups (P<0.05). The plasma insulin concentrations were significantly higher in group A1 (at T6), group A2 (at T3,6) and group A3 (at T3-11) than in group C (P<0.05). Homa index was significantly higher in group A3(at T3-8) than in group C. Conclusion Intraoperative amino acid infusion increases plasma insulin concentration but does not prevent glycogenolysis especially high dose amino acid infusion.

Objective To investigate the changes of cognitive function after major non-cardiac surgery and the relationship between the postoperative cognitive dysfunction(POCD)and the intraoperative cerebral oxygen metabolism in the elderly.Methods Sixty-four patients(49 male,12 female)aged 65-85 yr undergoing elective major non-cardiac surgery were enrolled in this study.A battery of four neuropsycbological tests was administered 2-3 days before and 7 days after surgery by an experienced psychometrician.A postoperative deficit in any test was defined as a cognitive decline by more than or equal to the preoperative standard deviation of that test in all patients.As long aft any patient showed cognitive decline in two or more tests.this situation was defined as POCD.Blood samples were taken from radial artery and internal jugIIlar vein simultaneously for blood gas analysis immediately (T1) and 2 h (T2) after induction of anesthesia,and just before leaving postanesthesia care unit (T3).The ratio of cerebral blood flow to cerebral oxygen metabolic rate(CBF.CMR02)was calculated.Results Sixty-one patients completed postoperative neuropsychological tests and 10 cases(16.4%)had POCD.Logistic regression analysis showed that the abnormality of CBF/CMR02 during operation was associated with the occurrence of POCD.Conclusion The occurrence of POCD after major non-cardiac surgery is related to the abnormality of cerebral oxygen metabolism during operation.

Objective To investigate the protective effect of desflurane preconditioning on human umbilical vein endothelial cells against anoxia-reoxygenation(A/R)injury.Methods The human umbilical vein endothelial cell line(ECV304)was provided by the Liver Cancer Institute,Zhongshan Hospital,Fudan University.ECV304 cells were randomly divided into 5 groups:group Ⅰ normal control;group Ⅱ A/R;group Ⅲ A/R+rhTNF-α;group Ⅳ Des + A/R and group Ⅴ Des + A/R + rhTNF-α.In group Ⅱ-Ⅴ the cells were exposed to 95% N2 + 5% CO2 in an incubator for 30 min followed by 60 min reoxygenation.In group Ⅲ and Ⅴ rhTNF-α(10 ng/ml)10 μl was added to the cells as soon as reoxygenation was started,while in group Ⅳ and Ⅴ the cells were pretreated with 7.2% desflurane for 30 min followed by 10 min washout before A/R.Apoptosis in endothelial cells was detected by fluorescence flow cytometry and TUNEL.Endothelial cells were examined with electron microscope for apoptosis and necrosis.Results The rates of apoptosis in the endothelial cells were significantly higher in A/R group and A/R + rhTNF-α group than in control group.Desflurane preconditioning significantly attenuated apoptosis in the endothelial cells induced by A/R and A/R + rhTNF-α respectively.Electron microscopy showed that there were significantly more necrotic cells in A/R group and A/R + rhTNF-α group.However in the two desflurane preconditioning groups(Ⅳ and Ⅴ)the cells were in a state of duplication and self-repairing.Conclusion Preconditioning with 30 min 7.2% desflurane can attenuate the A/R-induced injury to human umbilical vein endothelial cells.

Objective:To investigate the influence of electroacupuncture on auditory evoked potential index (AAI) during propofol sedation.Methods: According to propofol effect site concentration, 24 patients for operation were randomly allocated to group 1 (1.0 μg/mL), group 2 (1.5 μg/mL) and group 3 (2.0 μg/mL). Propofol was administered intravenously, points Hegu (LI4) and Neiguan (PC6) were electro-acupunctured, and changes in AAI were recorded.Results:AAI significantly rose in all groups during the initial several minutes after electro-acupuncture and significantly fell in group 2 at 20 min after electro-acupuncture(P＜0.05).Conclusion:AAI can sensitively reflect pain response during electro-acupuncture and electro-acupuncture can strengthen propofol sedation at its medium concentration.

Objective To investigate the effect of isoflurane administered before ischemia on polymorphonuclear neutrophil (PMN) infiltration and expression of adhesion molecules in the lung injured by ischemia-reperfusion.Methods One-hundred and twenty male SD rats weighing 250-350 g were randomly divided into 4 groups ( n = 30 each) :Ⅰ sham operation group (S) ;Ⅱ I/R group in which hilum of left lung was clamped for 45 min and then undamped for reperfusion; Ⅲ Iso + I/R in which 1 MAC isoflurane was inhaled for 30 min before ischemia and Ⅳ Iso + S in which 1 MAC isoflurane was inhaled for 30 min without I/R. The animals were anesthetized with intraperitoneal pentobarbital 50 mg?kg-1 then tracheostomized and mechanically ventilated with 100% O2(VT= 10-15 ml?kg-1) . PaCO2 was maintained at 35-45 mm Hg. Right jugular vein and left carotid artery were cannulated for BP monitoring, blood sampling and fluid and drug administration. Anesthesia was maintained with ketamine 10 mg?kg-1?h-1 and vecuronium 0.1 mg?kg-1?h-1. 1 MAC isoflurane (1.38% in rats) was inhaled for 30 min before hilum of left lung was clamped with an atraumatic clamp. Left lung ischemia was maintained for 45 min then the left lung was released for reperfusion. MAP was monitored and blood gases were analyzed during experiment. The animals were killed at the end of 45 minute ischemia and at 30, 60 and 120 min reperfusion and left lung was removed for: (1) determination of W/D lung weight ratio, myeloperoxidase (MPO) activity and expression of ICAM-1 mRNA; (2) light and electron microscopic examination; (3) broncho-alveolar lavage (BAL). BAL fluid (BALF) was collected and the number of cells, percentage of PMN and total protein concentration in BALF and the expression of CD18 on PMN surface were determined. Results The W/D lung weight ratio, MPO activity and expression of ICAM-1 mRNA in the lung tissue, the percentage of PMN and TP concentration in BALF and the expression of CD18 on PMN surface were all significantly increased during reperfusion in I/R group but isoflurane pretreatment significantly attenuated the I/R induced increases. Histological examination showed that the I/R induced lung injury was also ameliorated by isoflurane pretreatment. Conclusion Inhalation of isoflurane before ischemia could protect the lungs against I/R injury by inhibiting the PMN infiltration and expression of ICAM-1 mRNA and CD-18.

120 g?L-1. The estimated intraoperative blood loss was 1 000-1 500 ml. The patients were randomly divided into 3 groups ( n = 16 each): group Ⅰ lactated Ringer's solution (LR); group Ⅱ LR-6% HES and group Ⅲ colloid (6% HES). Blood was removed from radial artery after induction of anesthesia. The target Hct was 28% . The volume of blood removed = body weight (kg)?7.5 ? (preop Hct -target Hct) / 0.5?(preop Hct + target Hct). The removed whole blood was replaced with lactated Ringer's solution in a three to one ratio in group Ⅰ or with 6% HES in a one to one ratio in group Ⅲ. In group Ⅱ half of the removed whole blood was replaced with LR and the other half with 6% HES. The EVLW, HR, BP, Cardiac index (CI) and dp/dtmax were monitored by PiCCO and recorded before induction of anesthesia (T0), immediately after induction of anesthesia (T1), immediately after and 15 min after ANH (T2,3), immediately before and after reinfusion (T4,5) . Hct, colloid osmotic pressure and blood gases were also measured and recorded. Results The 3 groups were comparable with respect to M/F ratio, age, body weight and the volume of whole blood removed. MAP, HR, SpO2 and CVP were stable during operation in all 3 groups. Hct was significantly decreased after ANH as compared with the baseline at T0 in all 3 groups. The osmotic pressure was significantly decreased after ANH in group Ⅰ and Ⅱ and was significantly higher in group Ⅱ and Ⅲ than in group Ⅰ after ANH. CI and dp/dtmax were significantly decreased after ANH as compared to the baseline at T0 in all 3 groups. There was no significant difference in EVLW, PaO2 and [ HCO3- ] among the 3 groups. Conclusion Moderate ANH with crystalloid or colloid has little effect on EVLW and oxygenation in patients with normal cardio-pulmonary function.

0.05) but CO, SV and CVP increased and SVR decreased significantly after AHH in both groups as compared with those before AHH. pH, Lac and COP did not change significantly after AHH. There was no significant difference in the volume of solution infused, blood loss, CO, SV, CVP and SVR between the two groups. Conclusion Age is not a primary factor negating the use of AHH. Under combined general-epidural anesthesia AHH with 6% hydroxyethyl starch (15 ml?kg-1 ) can be well tolerated by the elderly patients without cardiac and pulmonary disease.

Objective To analyze the risk factors associated with postoperative respiratory failure (PRF) in elderly patients undergoing noncardiac surgery. Methods In a prospective randomized joint study, 582 patients conforming to the criteria established by the four medical centers were enrolled for analysis. Univariate analysis and multivariate logistic regression analysis were used to examine the relations between perioperative risk factors and PRF. PRF was defined as mechanical ventilation after operation lasting for more than 48h or reintubation and mechanical ventilation within 6h after extubation.Results Fifty-one patients developed PRF (8.8%) . Multivariate logistic regression analysis identified that the type of surgery, ASA physical status classification, history of COPD and plasma albumin upper abdominal surgery and peripheral vascular surgery. The reason that neurosurgery topped the list was that most neurosurgical patients suffered from severe head injury and postoperative mechanical ventilation was prolonged because of coma. Our study showed that physical status was also a significant predictor of PRF. According to ASA classification, one class higher increased the risk by 6.325 time s. Conclusion Based on these predictors of PRF, in high risk elderly patients necessary measures can be taken to decrease the development of PRF.

Objective Neutrophils (PMNs) play an important role in the myocardial injury-induced by ischemia/reperfusion. The purpose of the study was to assess the role of PMN in anoxia/reoxygenation (A/R) injury to primary cultured myocytes and the protective effects of desflurane preconditioning (DPC) .Methods Myocytes obtained from ventricle were cultured in MEM medium for 3 days. The cultured myocytes were then randomly divided into 4 groups : group Ⅰ A/R; group Ⅱ PMNs + A/R; group Ⅲ DPC + A/R and group Ⅳ DPC + PMNs + A/ R. In all four groups the cultured myocytes were subjected to anoxia by being incubated in a tightly closed incubator filled with 95 % N2 + 5 % CO, for 2 h, followed by one hour reoxygenation (95 % O2 + 5 % CO2). In group Ⅱ and Ⅳ 5.0 ? 106 ml -1 PMNs isolated from peripheral blood or bone marrow were added to the medium during the one hour reoxygenation. In group Ⅲ and Ⅳ the myocytes were exposed to 9 % desflurane for 1 h before A/R. The activities of lactic dehydrogenase (LDH) and creatine kinase (CK) and the concentration of cardiac troponin (cTnT) in the supernatant were measured before and at the end of the experiment. Cell survival rate, beating rate and arrhythmia rate of the cultured myocytes were also calculated under phase-contrast microscope before and at the end of the experiment.Results A/R caused significant increase in LDH and CK-MB activities, cTnT concentration and arrhythmia rates and decrease in beating rates except in group Ⅲ . The differences in LDH, CK-MB activities and arrhythmia rates between the baseline value and the value obtained at the end of the experiment were significantly lower in group Ⅳ than those in group D but still higher than those in group Ⅰ . The cell survival rate was significantly higher in group Ⅳ than that in grorp Ⅱ . Conclusion Neutrophil accentuates A/R injury while desflurane preconditioning attenuates neutrophil-mediated A/R injury to primary cultured myocytes.

Objective To investigate the effects of nitric oxide (NO) inhalation on the expression of TNF-?,IL-8 and CD11b mRNA in lung tissue during acute respiratory distress syndrome (ARDS) induced by intravenous injection of endotoxin in dogs.Methods Twelve pure bred beagle dogs of both sexs weighing 8-12.5 kg were randomly divided into 2 groups: NO group received mechanical ventilation with NO inhalation (n = 6) and control group received only mechanical ventilation ( n = 6) . Sepsis and ARDS were induced by intravenous injection of endotoxin as described in detail in our previous paper. Hemodynamics and pulmonary oxygenation were monitored and shunt fraction was calculated. At the end of experiment the animals were sacrificed and lung tissue was obtained aseptically and stored in the liquid nitrogen at - 180℃ . The total RNA was extracted. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of TNF-?,IL-8 and CD11b mRNA. The total RNA was reversely transcripted to cDNA. Then the cDNA was amplified by PCR. The product of PCR was scanned by gel-image analysis system.?-action was used as internal control. Semi-quantitative method was adopted for measurement of TNF-? ,IL-8 and CD11b mRNA expression. Results The expression of TNF-?, IL-8 and CD11b mRNA in lung tissue was significantly decreased in NO group compared with those in control group.Conclusion NO inhalation reduces expression of TNF-?, IL-8 and CDllb mRNA in lung tissue during ARDS induced by intravenous endotoxin.