Objective To evaluate the clinical intubation of Bonfils intubation fiberscope in difficult airway of acromegaly patients.Methods Fifteen acromegaly patients who have one of the following criteria of preoperative airway assessment,Mallampati score ≥3,thyromental distance (≤6 cm),mouth opening(≤3.5 cm).After routine anesthetic induction the patients were intubated with Bonfils intubation fiberscope.Haemodynamic changes were observed and handling of the Bonfils intubation fiberscope was evaluated in terms of the ease of insertion into oropharynx,visualization of epiglottis,advancement into glottis aperture and slide down the tracheal tube.Intubating time and success rate were also recorded.Postoperatively,sore throat or hoarseness were followed up for all patients.Results After intubation systolic pressure and heart rate increased as compared with pre-intubation((P

Objective To compare the GlideScope video-laryngoscope and Macintosh laryngoscope for double-lumen tube (DLT) intubation.Methods Seventy ASA Ⅰ-Ⅲ patients,aged 18-75 yr,scheduled for thoracic surgery and requiring one-lung ventilation,were randomly divided into 2 groups (n =35 each):Macintosh laryngoscope group (group M) and GlideScope video-laryngoscope group (group G).Anesthesia was induced with propofol,fentanyl and rocuronium.The exposure of glottis obtained with Macintosh laryngoscope and GlideScope video-laryngoscope was assessed using Cormack-Lehane grade.DLT intubation was assisted with Macintosh laryngoscope or GlideScope video-laryngoscope.The Cormack-Lehane grade,difficulty of DLT placement,and reverse DLT placement were recorded.The success rate of DLT placement at first attempt and intubation time were also recorded.Blood pressure and heart rate were recorded before intubation and at 0 and 3 min after intubation.The postoperative side effects were recorded.Results Compared with M group,the intubation time was significantly prolonged,the difficulty of DLT placement and blood pressure at 0 and 3 min after intubation were increased in G group (P ＜ 0.05).There was no significant difference in the success rate of DLT placement at first attempt,rate of reverse DLT placement,Comark-Lehene grade and heart rate at each time point between the two groups (P ＞0.05).The Comark-Lehene grade obtained with GlideScope video-laryngoscope was superior to that obtained with Macintosh laryngoscope in G group (P ＜ 0.05).Conclusion GlideScope video-laryngoscope can provide a better exposure of glottis and improvement in the intubating conditions,but the method is more complex and the response to intubation is stronger than Macintosh laryngoscope for DLT intubation.

Objective To investigate the effect of ketamine pretreatment on acute tolerance to morphine in rats with chronic inflammatory pain.Methods Twenty-four adult male SD rats weighing 180-200 g were randomly divided into 3 groups (n=8 each): group Ⅰ morphine (M) ,group Ⅱ ketamine (K) and group Ⅲ ketamine + morphine (KM). Chronic inflammatory pain was induced by subcutaneous injection of Freund's adjuvant 0.125 ml into the plantar surface of left hindpaw. Three days after Freund's adjuvant injection, the animals received intraperitoneal (IP) morphine 5 mg/kg in group M, IP ketamine 10 mg/kg in group K or IP ketamine 10 mg/kg 10 min before IP morphine 5 mg/kg in group KM once a day for 3 consecutive days respectively. The paw withdrawal threshold to yon Frey hair stimulation (PWT) and paw withdrawal latency to noxious thermal stimulation(PWLT) using the hot plate test were measured before Freund's adjuvant injection (T0, baseline), and every day before (T1) and at 15 (T2), 30 (T3), 60 (T4) and 120 min (T5) after medication for 3 days (D1,2,3).Results PWT was significantly increased after medication on D1,2,3 in group KM but only on D1,2 in group M. PWLT was significantly prolonged after medication on D1,2,3 in group KM but only on D1 in group M. Conclusion Ketamine 10 mg/kg pretreatment can decrease the acute tolerance to morphine in rats with chronic inflammatory pain.

Objective To evaluate the feasibility of tracheal intubation without muscle relaxant after induction of anesthesia with propofol-remifentanil given by target controlled infusion (TCI) .Methods Twenty-eight ASA Ⅰ or Ⅱ patients of both sexes (15 males, 13 females) aged 18-67 yrs weighing 43-89 kg scheduled for elective operation under general anesthesia were studied. Midazolam 0.03 mg?kg-1 was given i. v. as premedication. Anesthesia was induced with propofol and remifentanil and both of them were given by TCI. The target effect site concentration of propofol was set at 3 ?g?ml-1 and that of remifentanil at 4 ng?ml-1. BP, HR and bispectral index (BIS) were monitored during induction and intubation. The results of tracheal intubation were graded as satisfactory, average and poor baaed on intubation conditions and intubation response including easiness of ventilating the patients via face mask, jaw relaxation, easiness of inserting laryngoscope and visualization of larynx, the vocal cord position and patients response to intubation such as cough, limb movement and response to cuff inflation.Results HR and BP were significantly increased within 1 min after intubation as compared to the baseline values before intubation ( P

Objective A 23-year-old female patient who had a past history of sexual - precocity and fracture developed hyperhyroidism 8 months ago. Radiological examination revealed enlargement of sella turcica and a adrenal gland nodule. The patient was diagnosed to have McCune -Albright syndrome and scheduled for resection of left subtotal adrenalectomy under general anesthesia. The patient was taking (1) thiamazole 5 mg t. i. d. and propranolol 10 mg q. d. for hyperthyroidism; (2) adalat 10 mg t. i. d. and potassium citrate 20 ml t. i. d. for Cushing syndrome and (3) calcium tablets for osteoporosis. Anesthesia was induced with intravenous midazolam 1 mg, fentanyl 50 ?g and vecuronium 1 mg followed by propofol 150 mg and succinyl choline 100 mg. The patient was intubated and mechanically ventilated (VT = 500 ml, RR =10 bpm, I: E = 1 :2) . PET CO2 was maintained between 35 - 45 mm Hg. Anesthesia was maintained with inhalation of isoflurane and N2O - O2 (1:2) and intermittent i.v. boluses of fentanyl and vecuronium. The BP was increased to 180/110 mm Hg after induction of anesthesia. Urapidil 10 mg was given intermittently i.v. During the exploration of adrenal gland BP was again increased to 200/140 mm Hg. Nitroglycerin was infused i.v. and BP was decreased to 120-130/80-90 mm Hg and was kept at this level till the end of operation. Hydrocortisone succinate 100 mg was infused i.v. slowly after operation. The operation went smoothly. The patient was extubated and the postoperative course was uneventful.

Objective To compare the efficacy and safety of anesthetizing patients with propofol-remifentanil given by TCI targeting effect-site vs plasma. Methods Forty-four ASA Ⅰ - Ⅱ patients aged 20 -65 yr undergoing laparascopic cholecystectomy were randomly divided into two groups : group P targeting plasma concentration (n = 22) and group E targeting effect-site concentration ( n - 22) . The patients were given midazolam 1 mg and scopolamine 0.3 nig i. v. in the operating room before anesthesia. Auditory evoked potential, BP, HR and SpO2 monitoring were started before induction of anesthesia. Anesthesia was induced with propofol and remifentanil given by TCL using two Graseby 3500 infusion pumps. The target concentration of propofol was set at 4 ?g ? ml-1 and remifentanii at 2 ng ? ml -1 . Remifentanil infusion was started 2 min before propofol infusion. When the patients lost consciousness (no response to patting and request for eye-opening), succinylcholine 2 mg?kg-1 was given i. v. to facilitate intubation. Intubation score was assessed. The time required for loss of consciousness after TCI of propofol was started (TLOC), the amount of propofol and remifentanil infused and auditory evoked potential index (AAIs) when the patients lost consciousness were recorded. The patients were mechanically ventilated (VT 8-10 ml, RR 10 bpm) and PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with N2O inhalation, TCI of propofol - remifentanil and intermittent i.v. boluses of vecuronium. Propofol -remifentanil target concentrations were titrated against AAIs value below 20 during maintenance of anesthesia. At the end of operation quality of anesthesia was evaluated. The total amount of propofol and remifentanil consumed were recorded. Aldrate post anesthetic recovery score and postoperative pain score were also assessed. Results TLOC was significantly shorter in group E [(0.45 ?0.1) min] than that in group P (0.86 ? 0.3 min) ( P

Objective To compare the effects of desflurane, enflurane and isoflurane on onset time,duration of action and recovery time of pipecuronium. Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-60yr weighing40-80 kg were randomly divided into 3 groups: (1) desflurane group (n = 10); (2) enflurane group(n = 10) and(3) isoflurane group (n = 10). The patients were premedicated with intramuscular pethidine 1 mg?kg~(-1) andatropine 0 .01 mg?kg. Anesthesia was induced with midazolam 0. 03 mg?kg~(-1), propofol 0.5-1 .0 mg?kg~(-1)andfentanyl 2?g?kg~(-1) .When the patients fell asleep neuromuscular function was monitored by accelerography usingTOF stimulation. Pipecuronium 0.045 mg?kg~(-1) was given i. v. as soon as T_1 was 100 % blocked (T_1= 0), anotherdose of propofol was given, making the total dose of propofol amount to 2.5 mg' kg?kg~(-1).Tracheal intubation wasperformed. The patients were mechanically ventilated and P_(ET) CO_2 was maintained at 35-45 mm Hg. Desflurane oreaflurane or isoflurane was inhaled with N_2O-O_2(2: 1) .The end-tidal desflurane, enflurane or isofluraneconcentration was maintained at 0. 65 MAC(desflurane= 3. 9 %, enflurane = 1. 1 %, isoflurane = 0. 75 % ). Duringoperation when deeper anesthesia was needed intermittent i. v. blouses of fentanyl were given. The onset time, thetime needed for T_1 to return to 5 %, 10 %,25 %, 50 %,75 % of control and recovery index were recouled andcompared among the three groups.Results The demographic data including age, weight, sex and types ofoperation were not significantly different among the 3 groups. Three were no significant differences in onset time,recovery time (time for T_1 to return to 5 %, 10 %,25 %,50 % and 75 % of control) and recovery index amongthe 3 groups. Conclusion Desflurane can prolong the duration of action and recovery time of pipecuronium justlike enflurane and isoflurane but there were no significant differences among the 3 groups.

Objective To investigate the relationship between circadian rhythm of perioperative melatonin secretion and neuropsychological status in patients undergoing coronary artery bypass grafting (CABG) .Methods Forty male ASA Ⅱ-Ⅲ patients aged 45-60yr scheduled for elective CABG under hypothermic cardiopulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated to CPB group ( n = 20) or off-pump group (n - 20). Blood samples were taken before induction of anesthesia (T1 ), 10 min after tracheal intubation (T2), 10 min after heparinization (T3) , 2h after skin incision (T4), immediately before neutralization of heparin with protamine (T5 ), at the end of surgery after skin suture (T6 ) and every 3h after operation for 24h for determination of plasma melatonin concentration using enzyme-linked immunosorbent. Degree of depression was assessed by Self-Rating Depression Scale; anxiety by the State-Trait Anxiety Inventory and cognitive function by neuropsychological tests respectively, the day before operation, 7-10 days after surgery and 3 months postoperatively. Results In the 24 hours after operation the circadian secretion pattern of melatonin was kept in 2 patients in CPB group and 6 patients in off-pump group, but disturbed in the remaining patients in both groups. Postoperative depression scores were significantly higher than the preoperative baseline values in both groups. Anxiety scores at 7-10 days after operation were significantly higher in CPB group than those in off-pump group (P

5) who were conscious and had no obvious cardio-respiratory and hepato-renal dysfunction were enrolled in this study. The patients received intravenous PCA with morphine for the first 48 hours. The PCIA morphine solution contained morphine 2-6mg?ml-1 and droperidol 1-2 mg?30 ml-1 . PCIA included a bolus dose of morphine 1-3 mg with a 5 min lockout. No background infusion was given. Morphine PCIA was then combined with transdermal fentanyl. The initial dose of transdermal fentanyl was 25?g ? h-1 in the first two to three days. The dose was then gradually increased in 25 ?g?h-1 increments according to VAS scores and the amount of Ⅳ morphine needed to reduce the persistent pain until transdermal fentanyl alone could provide sufficient relief of persistent pain and Ⅳ morphine was given only for breakthrough pain. Pain intensity (VAS scores) before and after treatment, daily consumption of morphine (mg?d-1) and transdermal fentanyl (?g?h-1), vital signs and side effects were recorded.Results The 13 patients included 6 males and 7 females. Their mean (?SD) age was 54?15 yrs and body weight 53? 8 kg. There was positive correlation between the titrated dose of transdermal fentanyl (??k-1) and the initial need of Ⅳ morphine (mg?day-1). Y= 1.3606 X + 6.5088. Persistent pain intensity and breakthrough pain intensity evaluated by VAS scores were significantly reduced during the treatment ( P

Objective To determine the changes in perioperative plasma melatonin, cortisol and neuron-specific enolase (NSE) and neuropsychological function in patients who developed CNS complications after coronary artery bypass grafting (CABG) .Methods Three patients developed CNS complications (cerebral infarction, motor aphasia, motor and sensory aphasia) after CABG performed under hypothermic cardiopulmonary bypass (CPB) were studied. Blood samples were taken before induction of anesthesia (T1) , 10 min after tracheal intubation (T2), 10 min after heparinization (T3), at 30 min of CPB (T4) , immediately after discontinuation of CPB (T5), at closure of chest (T6), immediately after returning to ICU (T7) and every 3 h in ICU for 24 h (T8-15) for determination of plasma concentrations of NSE, cortisol and melatonin using enzyme-linked immunosorbent assay and radioimmunoassay. Cognitive function was measured before and 10 to 20 days after operation using a battery of tests, while depression and anxiety were assessed by self-rating depression scale and state-trait anxiety inventory respectively. Results The plasma NSE concentration was increased after operation in all 3 patients. The circadian rhythms of melatonin and cortisol were disturbed in patient 1 and 2 during the 24h after operation but were retained in patient 3. In patient 1 and 3 the performance of the trailing making test, the digit symbol subtest of WAIS-R and the stroop color word interference test were poor, meanwhile they became more depressed and less anxious. Conclusion In patients who develop CNS complication after CABG, there are cognitive decline, sentimental disorders and disrupted circadian rhythm of melatonin and cortisol secretion.