Objective To observe the therapeutic effects and adverse events of gentamicin and triamcinolone acetonide on primary trigeminal neuralgia. Methods Forty patients with primary trigeminal neuralgia were allocated into two groups to receive a peripheral nerve block with lidocaine combined with gentamicin (gentamicin group) or triamcinolone aeetonide (triamcinolone acetonide group), respectively,once a week for 5 weeks. The pain intensity were assessed using visual analogue scale (VAS) before treatment and once a week just prior to every treatment, continued to make such assessment every month until 3 months after treatment. The pain relief rate and the occurrence of adverse events were also evaluated.Results The VAS of patients in two groups decreased significantly after treatment (P < 0.01). Compared with triamcinolone aeetonide group, the VAS in gentamicin group were higher during the early 3 weeks after treatment (P< 0.05 or < 0.01). At the observing point of 2, 3 months after treatment, the VAS in gentamicin group were lower than that in triamcinolone acetonide group(P< 0.01). The effective rate in gentamicin group was lower than that in triamcinolone acetonide group during the early 2 weeks after treatment, the clinical cure rate in gentamicin group was higher than that in triamcinolone aeetonide group at the observing point of 2, 3 months (70% and 60% vs 15% and 5%). Conclusion Compared with the triamcinolone aeetonide, the therapy of the gentamicin has slower onset time and longer sedative duration, has no corticosteroids-related side effect, and also has the possibility of repeat blocking time after time.

ObjectiveTo investigate the effects of intravenous fentanyl combined with scalp nerve block with ropivacaine on the hemodynamic response to skin incision during craniotomy.Methods43 ASA Ⅰ～Ⅱ patients scheduled for selective frontotemporal craniotomy were randomly assigned into 3 groups: the isoflurane group(group I,n=14), the fentanyl group (group F, n=15) and the fentanyl-ropivacaine group (group B, n=14 ).Anesthetic induction was performed with IV remifentanil 2 μg/kg, propofol 2 mg/kg, and vecuronium 0.1mg/kg. Group F received fentanyl 3 μg/kg 5 min before skin incision .Group B received the same doses of fentanyl prior to skin incision as well as scalp nerve block with 1% ropivacaine before induction. Anesthesia was maintained with isoflurane. The "up and down" method was used to determine MAC-BAR in each group.ResultsThe end-tidal isoflurane concentration blocking sympathetic response to incision in group I, F and B were 2.0%,1.8%,1.0% respectively.The MAC-BAR of group I, F and B were 1.7 MAC,1.55 MAC,0.8 MAC respectively. The end-tidal isoflurane concentration blocking sympathetic response to incision and MAC-BAR of group B decreased obviously compared with that of group I and F(P<0.05).ConclusionIntravenous fentanyl combined with scalp nerve block with ropivacaine can successfully reduce the hemodynamic response to skin incision.

ObjectiveTo determine the effectiveness of scalp nerve block for attenuating intraoperative hemodynamic stress, decreasing anesthetics and postoperative pain in neurosurgical patients.Methods60 adult patients undergoing frontotemporal craniotomies were randomly divided into three groups to receive scalp nerve block with normal saline as control in group A, 0.8% lidocaine combined with 0.13 % menthol in group B, and 1% ropivacaine in group C after intubation. Anesthesia was maintained with isoflurane. Mean arterial pressure (MAP) was controlled within-20%～+10% of the baseline with isoflurane (maximum limitation of isoflurane was 2 times of minimal alveolar air concentration) and intravenous nicardipine (0.5 mg bolus iv). Heart rate was controlled below 100 bpm with esmolol (50 mg bolus iv). Patient controlled analgesia (PCA) with tramadol was used for the postoperative analgesia. MAP, heart rate (HR) and end tidal isoflurane concentration were monitored during craniotomy. Visual analogous score (VAS) was observed after craniotomy.ResultsThe concentrations of end-tidal isoflurane in group A were significantly higher than that in group B and group C. MAP and HR in group A increased significantly than baseline values during operation, especially in skin incision, opening bone,while MAP and HR in group C did not increased significantly than baseline. VAS within 2 h postoperative in group B was significantly lower than that in group A (P<0.05).ConclusionThe scalp nerve block can effectively decrease intraoperative isoflurane concentration, attenuate hemodynamic responses and reduce postoperative pain.

Objective: To evaluate the proper sedative/hypnotic depth during total intravenous anesthesia (TIVA) with propofol,fentanyl and muscular relaxant. Method:Thirty ASA grade Ⅰ or Ⅱ patients were induced with propofol. The EEG values were monitored during loss of consciousness and period of no response to a transcutaneous electrical stimulation,and at the total propofol induction dosage of 6 mg?kg~(-1). After intubation,the patients were randomly allocated into two groups. The rate of propofol infusion was regulated to maintain bispectral index(BIS) values between the light sedative/hypnotic point and 5 below (group A),or to the values between the deep sedative/hypnotic point and 5 below (group B). Result: BIS values were 71?8 and 58?8 at the light and deep sedative/hypnotic points, respectively;The propofol infusion rate in group A was significantly lower than that in group B (4.2?0.9 vs 7.4?1.5mg?kg~(-1)?h~(-1)). Fentanyl, nimodipine and pancuronium dosages were not different between group A and B. Conclusion:During general anesthesia,the sedative/hypnotic depth titrated at the loss consciousness level,is proper with maintanence dose at 4.5-5mg?kg~(-1)?h~(-1)of propfol for the safe use even without montoring of EEG-BIS.

Objective To observe the respiratory depression of sufentanil and remifentanil with target-controlled infusion under propofol sedation or not, and compare the effect of respiratory depression of the two drugs. Methods Eighty patients scheduled for elective neurosurgery were allocated into four groups by random digits table: the sufentanil group (group S), the remifentanil group (group R), the combination of sufentanil and propofol group (group SP) and the combination of remifentanil and propofol group (group RP),each group was 20 cases. The respiratory rate (RR), minute ventilation (MV),partial pressure of end-tidal carbondioxide ( PETCO2), pulse oxygen saturation (SpO2), mean arterial pressure ( MAP ), heart rate (HR), observer's assessment of alertness/sedation (OAA/S) were measured and respiratory depression was defined as one of the following end points were achieved: muscle rigidity, RR ＜ 6 beats/min, MV ＜ 3 L/min,PETCO2 ＞ 55 mm Hg ( 1 mm Hg = 0.133 kPa), SpO2 ＜ 0.90 or apnea ＞ 15 s. Results The calculated effect concentration (Ce) of sufentanil for respiratory depression were (0.46 ± 0.14) μ g/L in group S and (0.23 ±0.06) μ g/L in group SP, and Ce of remifentanil for respiratory depression were (5.22 ± 2.11 ) μ g/L in group R and (2.22 ± 1.02) μ g/L in group PP. Some respiratory parameters,such as RR,MV were decreased and PETCO2 was increased significantly as the increase of Ce. Conclusions Target-controlled infusion of equal analgesic plasma concentration of sufentanil and remifentanil can suppress spontaneous respiration significantly with the increase of plasma concentration. There will be a synergetic effect after combining with propofol, and respiratory depression will appear at lower concentration. But equal analgesic plasma concentration of the two drugs have no significant difference in the effect of respiratory depression.

Objective To investigate the effects of different target concentrations of remifentanil when combined with propofol on BIS in patients undergoing neurosurgery. Methods Fifteen ASA Ⅰ or Ⅱ patients, aged 18-64 yr, weighing 50-85 kg, scheduled for intracranial surgery, were involved in this study. The patients received propofol by target controlled infusion (TCI) at a target effect site concentration (Ce) of 3μg/ml. TCI of remifentanil was started after TCI of propofol reached the preset Ce and Ce of remifentanil was increased step by step from 2 ng/ml to 3, 4, 5, 6, 7 and 8 ng/ml. Invasive BP, MAP, HR and BIS were continuously monitored and recorded when remifentanil reached the each preset Ce. Vecuronium 0.1 mg/kg was injected iv when Ce of remifentanil reached 5 ng/ml, and then the patients were intubated and mechanically ventilated 3 min later. The changes in BP, MAP, HR and BIS were recorded. When HR < 50 bpm and/or MAP < 60 mm Hg, TCI of remifentanil was stopped and iv atropine or ephedrine was given. Results BIS was significantly decreased after TCI of remifentanil when propofol reached 3 μg/ ml compared with the baseline value ( P < 0.05 or 0.01). BIS was significantly decreased when Ce of remifentanil ≥6 ng/ml compared with that when propofol reached 3 μg/ml ( P < 0.05 or 0.01) .Conclusion Low-concentration of remifentanil when combined with propofol has no effect on BIS, but when Ce of remifentanil≥ 6 ng/ml, BIS is obviously decreased.

Objective To determine the respiratory depression effect-site concentration (Ce) of remifentanil when used in combination with different target concentrations of propofol in patients undergoing neurosurgical surgery. Method Eighty patients aged 18-64 yr weighing 45-90 kg scheduled for elective neurosurgical surgery were randomly divided into 4 groups (n = 20 each): remifentanil group (group R), remifentanil combined with propefol 1, 1.5, 2 μg/ml group (group RP1, RP1.5, RP2). In group R, RP1, RP1.5 or RP2, the patients received propofol by TCI at target plasma concentration (Cp) of 0, 1, 1.5 or 2 μg/ml respectively, when the preset concentration was reached, received remifentanil via TCI at the initial target Cp of 2 ng/ml, and the concentration was then increased in the increment of 2 ng/ml at 3 min intervals until respiratory depression was achieved. Respiratory depression was defined as one of the following end points: muscle rigidity, RR<6 bpm, MV < 3 L/min, PETCO_2> 55 mm Hg, SpO_2 < 90% or apnea > 15 s. The Ce of remifentanil, amount of remifentanil used and side effects were recorded during respiratory depression. Result The respiratory depression Ce of remifentanil were (5.2±2.1), (3.2±1.0), (2.9 ±1.3) and (2.2±1.0) ng/ml in group R, RP1, RP1,5 and RP2 respectively. Compared with group R, the respiratory depression Ce of remifentanil were significantly decreased in group RP1, RP1.5 and RP2 (P<0.01). Compared with group RP1 and RP1.5, the respiratory depression Ce of remifentanil was significantly decreased in group RP2(P<0.01). There was no significant difference in respiratory depression Ce of remifentanil between group RP1 and RP1.5 (P > 0.05). Conclusion The respiratory depression Ce of remifentanil is (5.2±2.1) μg/ml in patients without sedation. The respiratory depression Ces of remifentanil are (3.2 ±1.0), (2.9 ± 1.3) and (2.2 ±1.0) ng/ml in patients under sedation with propofoi at target Cps of 1, 1.5, 2 μg/ml during neurosurgical surgery.

90%, respectively. Although some shape changed red blood cells were observed in the washed blood, discocytes were the dominant form, with the percentage of discocytes being (58.0 ? 8.0)%. A greater number of shape-changed red blood cells were found in 2-week-old banked RBCs (P

Aim Cerebral ischemic tolerance can be induced by a variety of preconditioning stimuli,such as transient global and focal ischemia,hypoxia,and administration of lipopolysaccharide(LPS),proinflammatory cytokines,anesthetics.Tolerance can be established with two forms: a rapid form in which the trigger induces tolerance to ischemia within minutes and a delayed form in which development of protection takes several hours or days.During ischemia,inflammatory reaction was initiated by toll-like receptors(TLRs) that recognize host-derived molecules released from injured tissues and cells,which exacerbates ischemic injury.In the delayed form of tolerance,the preconditioning stimuli first triggers the TLRs inflammatory pathway,leading not only to inflammation but also to simultaneous upregulation of feedback inhibitors(such as anti-inflammatory cytokines,decoy receptors,and signaling inhibitors),which reduced the inflammatory response to subsequent severe ischemia.The rapid tolerance is achieved by direct interference with membrane fluidity,causing change of lipid rafts leading to inhibition of TLRs signaling pathways.The comprehension of mechanism of cerebral ischemic tolerance highlights new avenues for future prevention and treatment of ischemic brain injury

Objective To evaluate the efficacy and safety of sufentanil used for patient-controlled subcutaneous analgesia (PCSA) with different models after craniotomy.Methods Sixty ASA Ⅰ～Ⅱ patients undergoing craniotomy were randomly divided into two groups with or without background infusion. Sufentanil 0.12 mg was used via patient-controlled analgesia (PCA) and no loading dose was administered. The PCA device was programmed background infusion of 1 ml/h, bolus dose of 0.5 ml in group of using continuance plus PCA model (group CP) and bolus dose of 0.75 ml without background infusion in group P. Hour limit of 3 ml/h, lockout time of 15 minutes were set in two groups. Postoperative pain was assessed at rest and when moving, using Visual Analogue Scale (VAS) at 2 h, 20 h, 24 h, 44 h and 48 h after operation. Side-effects were also recorded systematically during the first 48 h after surgery.Results No significant differences were observed in patients' physical status, fentanyl consumption during operation and anaesthetic time. There were no significant differences in VAS scores between the two groups within 48 h after operation, but the incidence of complaining postoperative pain was significantly more in group P than that in group CP at 20 h and 24 h after surgery (P<0.05). The cumulative analgesic consumption of sufentanil in group CP and group P were 98.73±5.96 μg and 57.25±9.73 μg, respectively (P<0.05). Compared with group P, the mean arterial pressure in 20 h and 24 h were significantly lower in group CP (P<0.05). The sedation degree and the incidence of nausea, vomiting in two groups had no significant differences. No restrain of respiration occurred in two groups. The patients' satisfactory rate with PCA in group CP and group P were 90% and 80%, respectively.Conclusion PCSA with sufentanil and continuance plus PCA model is an effective and safe analgesic method after craniotomy.