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

AIM: To investigate if pregabalin could depress the acute tolerance induced by morphine when curing the chronic inflammatory pain of rats.METHODS: 24 adult male Sprague-Dawley rats weighing 180-200 g were randomly divided into three groups(8 in each group).Freund's adjuvant was injected subcutaneously in left hind-paw of the rat to establish the chronic inflammatory pain model.3 days later,rats received 3 daily intragastrical(p.o.) morphine 8 mg/kg(M group),pregabalin 3 mg/kg(P group) or morphine 8 mg/kg+pregabalin 3 mg/kg(MP group) administrations respectively.The rats' pressure-withdrawal threshold(PWT) and paw withdrawal thermal latency(PWTL) were determined with Von-Frey hair test and rat hot-plate test respectively.The results of PWT and PWTL before and 15,30,60,120 min after medication were recorded.RESULTS: PWT and PWTL of the rats in M group increased after medication on all the time points of the first day and 15 min of the second day(P

Gabapentin may bind the ? 2? subunit of the voltage -dependent calcium ion channels at the postsynaptic dorsal horn and interrupt t he series of events possibly leading to the experience of a neuropathic pain sen sation. Many clinical studies have clearly demonstrated the efficacy of gabapent in in the treatment of diabetic neuropathy and postherpetic neuralgia. Gabapenti n is considered an effective drug with its minimal side effects and drug interac tions in the management of neuropathic pain syndromes.

Although there are a number of shortcomings with these animal models, they provide important clues in understanding the underlying pathophysiology of neuropathic pain in humans. In these models, cutaneous sensory threshold of the hindlimb ipsilateral to nerve injury is measured. The presence of neuropathic pain in experimental animal models is mainly measured as allodynia or hyperalgesia, in which the normally nonnoxious or mildly noxious stimuli induce a nociceptive behavioral response. This paper mainly discusses the recent findings from the peripheral nerve injury model of neuropathic pain, as well as the different characteristics of these animal models of neuropathic pain.

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.

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 investigate perioperative changes of gastrointramucosal pH (pHi) in major operative patients. Method: Six patients underwent major abdominopelvie operation with radial artery and internal jugular vein catheters, and nasogastric tonometries in place. The phi and hemodynamic, oxygen, and metabolic variables were measured simutaneously before anesthesia, 30 minutes after anesthetic induction, during intraoperation, at the end of operation, and the first 24 hours postoperatively. Result: There was significant decrease in mean pHi(P