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.

ObjectiveThe purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on blocking the development of acute respiratory distress syndrome (ARDS) induced by acid aspiration. MethodsTwenty new Zealand rabbits were used. Dilute HCl was instilled into right bronchus of the rabbits. The rabbits were then divided randomly into two groups: injury group and treatment group. In injury group ( n = 10) rabbits received no treatment except mechanical ventilation. In treatment group ( n = 10) immediately after acid instillation the rabbits received an intravenous bolus of PGE1 followed by a continuous infusion. Blood gas, airway pressure and dynamic and static compliance were measured before and after acid instillation. Blood samples were taken from artery for determination of 6-k-PGF1α, TXB2, NO2-/NO3- and ET-1. The animals were killed and the wet/dry lung weight (W/D) ratio and total protein of bronchoalveolar lavage fluid(BALF) of right lung were measured. Microscopic examination of the lung was done. ResultsIn treatment group PaO2 was significantly higher than that in injury group after acid instillation. Plasma 6-k-PGF1α and NO2-/NO3- levels were significantly higher in treatment group while plasma TXB2 and ET-1 levels were significantly lower. W/D ratio and TP of BALF of right lung were significantly lower in treatment group. The inflammatory changes were diffuse in injury group while in treatment group they were localized and less severe. Conclusions PGE1 can lessen severity of ARDS induced by acid aspiration. It may protect pulmonary vascular endothelial cells through maintaining the balance between PGI2 and TXA2 and that between NO and ET-1 .

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 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 determine the changes in interleukin-8 (IL-8) and interleukin-1?(IL-1?) mRNA expressions in alveolar macrophages during isoflurane anesthesia. Methods Twenty-four ASA Ⅰ-Ⅱ male patients undergoing partial hepatectomy were randomly divided into two groups: group Ⅰ isoflurane; group Ⅱ general combined with epidural anesthesia. The age ranged from 43 to 67 years and body weight from 50 to 74kg. The patients were unpremedicated. Anesthesia was maintained with propofol infusion (4-6mg? kg-1?h-1 ) fentanyl and vecuronium in both groups. In addition 1% isoflurane was inhaled in group I and continuous epidural anesthesia with a mixture of 1 % lidocaine + 0.2% poutocaine (5ml/h) was performed in groupⅡ . ECG, SpO2, BP and HR were continuously monitored during anesthesia. Alveolar macrophages were harvested by bronchoalveolar lavage immediately and 4h after induction of anesthesia. RNA was extracted from harvested cells and cDNA was synthesized by reverse transcription. Expressions of IL-8 and IL-1? were measured by semiquantitative polymerase chain reaction using ?-actin as an internal standard. Results Gene expression of IL-8 and IL-1? in alveolar macrophages increased significantly at 4h after induction of anesthesia. The increase was greater in group Ⅰ than in group Ⅱ( P

Objective To compare the effectiveness of patient-controlled propofol sedation (PCS) against propofol sedation with TCI during epidural anesthesia. Methods Thirty-two ASA Ⅰ -Ⅱ patients (18 male , 14 female) aged between 23-71 years, undergoing lower abdominal surgery or surgery on lower limb were randomly divided into two groups: PCS group ( n =16) and TCI group ( n = 16). Propofol sedation was started when epidural anesthesia was shown to be satisfactory. In PCS group a loading dose of propofol 0.5?g?kg-1 was given. The bolus dose was 0.3mg?kg-1 and the lock-out interval 2 min. There was no background infusion of propofol. In TCI group the initial target concentration of propofol was set at 1. 5?g?kg-1 target concentration was adjusted according to OAA/S score which was maintained at 3 during operation. Radial artery was cannulated and arterial blood samples were taken for determination of blood propofol concentration before and 5, 15, 30, 45 min after incision. OAA/S score was evaluated every 5 min and at the same time BIS and 95% SEF were recorded. The total amount of propofol infused during operation was recorded and whether the patient was satisfied with sedation was inquired. Results All patients expressed great satisfaction with the sedation in both groups. In PCS group the level of sedation was lighter and less propofol was consumed than in the TCI group. (2.5mg?kg-1 ?h-1 vs 3.8mg?kg?h-1, P

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.