ObjectiveTo determine the median effective dose (ED50) of intrathecal (IT) hyperbaric and hypobaric ropivacaine for elective cesarean section.MethodsForty parturients aged 20-40 yr at full term undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized to receive IT 0.5 ％ hyperbaric (group HR) and hypobaric ropivacaine (group LR) ( n =20 each).The initial dose was 9 mg and the dose was increased/decreased by 1 mg in the next parturient using an up-and-down sequential allocation technique.Analgesia was considered acceptable if adequate analgesia reached T7 or higher in response to pin prick until 20 min after IT ropivacaine and no supplemental epidural analgesic was required during the operation.ED50 and 95％confidence interval (CI) were calculated.ResultsThe ED50 and 95 ％ CI were 9.34 mg (95 ％ CI 8.34-10.46mg) for 0.5％ hyperbaric ropivacaine and 9.64 mg (95％ CI 8.90-10.44 mg) for 0.5％ hypobaric ropivacaine.ConclusionBaricity has no effect on the efficacy of IT ropivacaine for cesarean section.

Objective To assess the incidence rate of postoperative nausea and vomiting (PONV) after total intravenous anesthesia (TIVA) with propofol versus sevoflurane-based anesthesia with or without ondansetron in patients undergone gynecological laparoscopy. Methods Totally 138 patients were randomly divided into three groups: sevoflurane group (Sev group) sevoflurane-ondansetron group (Sev-O group),and propofol TIVA group (TIVA group),with 46 cases in each. In the Sev and Sev-O groups,anesthesia was maintained by inhalation of 50% N2O and sevoflurane;in the Sev-O group,8 mg of prophylactic ondansetron was given intravenously 30 minutes prior to the end of the operation. In the TIVA group,target-controlled infusion of propofol and remifentanil were used. In each group,the incidence of nausea and vomiting and use of antiemetic drugs in 24 hours after the surgery were recorded. Results In 0 to 2 hours after the operation,the incidence rate of nausea and vomiting in the TIVA group was significantly lower than that in the Sev group [22% (10/46) vs 54% (25/46),?2=10.376,P=0.001] and Sev-O group [50% (23/46),?2=7.986,P=0.005]. In 2-6 hours,the rate in the Sev-O group was lower than that in the Sev group [22% (10/46) vs 46% (21/46),?2=5.887,P=0.015]. The total incidence rate of nausea and vomiting in 24 hours after the operation was 57% (26/46) in the TIVA group,which was significantly lower than that in the Sev group [80% (37/46),?2=6.093,P=0.014]. In the Sev,Sev-O,and TIVA groups,there were 13 (28%),6 (13%),and 6 (13%) cases respectively received antiemetic drugs after the surgery. Conclusions Compared with sevoflurane-based anesthesia,propofol TIVA results in a lower rate of PONV after gynecological laparoscopy.

Objective:To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury.Methods:The clinical data of 103 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled. According to the cardiac troponin I (cTnI) at admission of ICU, they were divided into septic myocardial injury group (cTnI ≥ 0.15 μg/L) and non-septic myocardial injury group (cTnI < 0.15 μg/L). The serum levels of heart-type fatty acid-binding protein (H-FABP), procalcitonin (PCT), C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB), cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury. Spearman correlation analysis was used to analyze the correlation of each index; receiver operating characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to analyze the early diagnosis and prognostic value of each index and APACHEⅡ score alone or combined detection in patients with septic myocardial injury.Results:① Among 103 patients with sepsis, 58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury. The serum levels of PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury [PCT (μg/L): 3.46±1.35 vs. 1.89±0.43, CRP (mg/L): 81.1±26.8 vs. 65.3±19.1, NT-proBNP (U/L): 8 261.4±2 346.9 vs. 6 120.2±1 809.6, CK-MB (U/L): 15.89±6.25 vs. 12.14±4.24, cTnI (μg/L): 1.50 (0.91, 2.21) vs. 0.18 (0.16, 0.19), H-FABP (μg/L): 26.45±8.24 vs. 12.82±5.73, APACHEⅡ score: 24.0 (18.0, 29.0) vs. 16.0 (14.0, 18.0), all P < 0.01]. Spearman correlation analysis showed that PCT, CRP and APACHEⅡ scores were positively correlated with NT-proBNP, CK-MB, cTnI and H-FABP. ROC curve analysis showed that H-FABP in the diagnosis of septic myocardial injury (AUC = 0.916) was superior to NT-proBNP (AUC = 0.756) and CK-MB (AUC = 0.675); the AUC of NT-proBNP and CK-MB combined with H-FABP was 0.921, the sensitivity was 82.1%, and the specificity was 88.2%.② Twenty-three patients survived in 28 days, and 35 died. The levels of serum PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in death group were significantly higher than those in survival group [PCT (μg/L): 3.86±1.27 vs. 2.84±1.24, CRP (mg/L): 92.3 (65.0, 101.7) vs. 74.3 (65.7, 79.8), NT-proBNP (ng/L): 9 106.4±2 013.9 vs. 6 975.5±2 266.7, CK-MB (U/L): 17.90±6.49 vs. 12.82±4.46, cTnI (μg/L): 2.11±0.86 vs. 1.12±0.44, H-FABP (μg/L): 30.08±7.90 vs. 20.93±5.14, APACHEⅡ score: 25.0 (20.0, 30.0) vs. 19.0 (17.0, 24.0), all P < 0.01]. ROC curve analysis showed that H-FABP in evaluating 28-day death of patients with septic myocardial injury (AUC = 0.839) was superior to PCT (AUC = 0.707), CRP (AUC = 0.716), NT-proBNP (AUC = 0.761), CK-MB (AUC = 0.733), cTnI (AUC = 0.824) and APACHEⅡ score (AUC = 0.724); the AUC of NT-proBNP and cTnI combined with H-FABP was 0.888, the sensitivity was 91.4%, and the specificity was 82.6%. Conclusions:H-FABP plays an important role in the early diagnosis and prognosis of septic myocardial injury. Early combined detection of NT-proBNP, CK-MB and H-FABP can significantly improve the diagnostic ability of septic myocardial injury, and NT-proBNP and cTnI combined with H-FABP can significantly improve the ability to predict the adverse prognosis of sepsis myocardial injury.

Objective:To evaluate the effect of intraoperative dexmedetomidine (DEX)infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery.Methods:Sixty pa-tients aged 1 8 to 65 (American Society of Anesthesiologists,ASA Ⅰ -Ⅱ),scheduled for spinal surgery from January 201 4 to May 201 4 were randomized into two groups.The DEX group (n =30)received 0.5 μg/kg of DEX ten minutes before anesthesic induction,followed by an infusion of DEX at 0.2 μg/(kg·h)intraoperatively and the control group (n =30)was given identical amounts of normal saline. At the end of surgery,the patients of both groups received patient-controlled intravenous analgesia (PCIA)with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout).Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU).The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded.The time for recovery and extubation were recorded.The followed-up evalua-tions were performed to assess Ramsay scores,visual analogue scale (VAS)pain scores as well as side effects in PACU and 48 h after surgery.Results:Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 1 0 min (P <0.05).MAP was lower in DEX group than that in control group after extubation and in PACU (P <0.05).Compared with control group,the propofol consumption during anesthesic induction,the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P <0.05).There were no differences between the two groups as to the time for recovery or extubation.Compared with control group,the VAS pain scores were significantly decreased (P <0.01 ),the incidence of postoperative nau-sea and vomiting in DEX group were significantly decreased (P <0.05)48 h after surgery.Conclusion:Intraoperative infusion of DEX improved quality of recovery,provided good analgesia,and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223％.The constituent ratio of cesarean section under general anesthesia was 1.75％, the constituent ratio of emergency cesarean section under general anesthesia was 60.2％, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7％.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway (LMA) group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score (P＞0.05).There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.

We introduced Case based learning into traditional bilingual teaching, dividing the hepatobiliary surgery teaching into four phases: preview, introduction, group discussion and estimation after class . Through the classroom organization analysis of common cases of liver and gallbladder surgery, we took students as the main body, teacher as the guide, to complete the bilingual teaching. Auxiliary case based learning used in bilingual teaching of liver and gallbladder surgery practice is beneficial to improving the quality of bilingual teaching, and helps to cultivate the students' clinical thinking. However, there are still some deficiencies of the case aided bilingual teaching, which needs continuous improvement.

36 week of gestation who requested labor analgesia were assigned to one of two groups according to cervical dilation (n = 60 each): latent group (cervical dilation

Objective To compare the induction of and emergence from anesthesia with target-controlled infusion (TCI) of propofol-remifentanil/fentanyl and isoflurane inhalation. Methods Sixty ASA Ⅰ -Ⅱ patients (26 male, 34 female) aged

Objective To evaluate the effects of different storage periods at room temperature on domestic cisatracurium-induced neuromuscular (N-M) block.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,scheduled for elective operations under general anesthesia,were randomly divided into 3 groups (n =40 each):cisatracurium stored for 60 days at 4-8 ℃ group (group LT),cisatracurium stored for 30 days at room temperature group (group RT30) and cisatracurium stored for 60 days at room temperature group (group RT60).Anesthesia was induced with iv injection of midazolam and target-controlled infusion of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3-5 ng/ml).A bolus of cisatracurium 0.2 mg/kg was given intravenously over 5-10 s as soon as the patients lost consciousness.N-M block was monitored with TOF-Watch SX (Organon,Netherlands).Single stimulation was applied to the ulnar nerve at wrist.The maximal degree of N-M block,onset time,clinical duration,recovery index and 75 ％ recovery time were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition was evaluated.Hypotension,bradycardia and skin allergy were recoded.Results Compared with group LT,no significant change was found in the onset time,clinical duration,recovery index and 75％ recovery time in group RT30 (P ＞ 0.05),and the onset time was significantly prolonged,clinical duration and 75％ recovery time were shortened in group RT60 (P ＜ 0.05).The onset time was significantly longer and clinical duration was shorter in group RT60 than in group RT30 (P ＜ 0.05).The intubation condition was excellent or good in the three groups and there was no significant difference among the three groups.There was no significant difference in the incidence of hypotension and bradycardia among the three groups (P ＞ 0.05).No patients developed skin allergy.The maximal degree of N-M block was 100％ in groups LT,RT30 and RT60 except one case with 95％ in group RT60.Conclusion No significant change is found in the N-M block induced by domestic cistracurium when stored for 30 days at room temperature,however,the N-M block is significantly attenuated when stored for 60 days at room temperature.

Objective: To evaluate the clinical profile of target controlled infusion based anesthesia using remifentanil and propofol. Methods: 16 ASA I II patients undergoing elective laparoscopic cholecystectomy were enrolled. Remifentanil was set at 7?g?L -1 as target and propofol at 3 mg?L -1 throughout the whole procedure. The hemodynamics during induction of anesthesia and recovery profiles were recorded. Arterial blood samples for analysis of remifentanil were taken 15min after infusion, 20 min after infusion and at time of emergence. Results: After induction of anesthesia, systolic blood pressure (SBP) decreased from (144?27) mm Hg to (101?18) mm Hg ( P 0.05). SBP, MBP and HR remained stable after intubation for 3min. No patient showed haemodynamic stress to tracheal intubation. Times from stopping administration of anesthetics until full spontaneous respiration, eye opening, tracheal extubation, orientation and discharging from the postanesthetic care unit (PACU) were (12?6), (9?4), (13?6), (15?5) and (19?7) min respectively. Measured drug values of remifentanil were (4.6?9.5) ?g?L -1 , (6.6?11.5) ?g?L -1 , (1.2?8.7) ?g?L -1 respectively. Conclusion: Remifentanil/propofol TCI based anesthesia achieved the optimal hemodynamic stability during anesthesia induction and maintenance, and better recovery profile from anesthesia. Measured drug values of remifentanil showed a considerable interindividual variation and more lower than the set target.