Objective To investigate the relationship of intraoperative cerebral oxygen saturation(rSO_2 )monitored with near-infrared cerebral oximeter (INNOS 5100) and postoperative cognitive dysfunction in patientsoperated upon under isoflurane or sevoflurane anesthesia and to determine the critical rSO_2 value below whichpostoperative cognitive dysfunction may occur.Methods Sixty ASA Ⅰ- Ⅱ patients of both sexes aged 62-80 yr,weighing58-77 kg schedules for elective abdominal surgery or surgery on the low limb were divided into threegroups according to their levels of education: group Ⅰthe illierate and uneducated (n = 20); group Ⅱ primaryschool education (6yr education (n = 20). Each group was furtherdivided into isoflurane and sevoflurane subgroups (n = 10 in each subgroup). The patients were unpremedicated.Anesthesia was induced with intravenous atropine 0. 3mg, propofol 1 .0-1. 5 mg?kg~(-1), fentanyl 2-3?g?kg~(-1) andvecuronium o. 1-0.2 mg?kg~(-1) and maintained with isoflurane or sevoflurane inhalation (0.9-1. 1 MAC )supplemented with intermittent i.v. boluses of fentanyl and recorded before anesthesia (baseline), after O_2inhalation(T_1), after induction of anesthesia(T_2), after skin incision (T_3), during operation (T_4)and at the end ofsurgery (T_5). Mini-Mental State Examination (MMSE) was performed before anesthesia and 1,4, 8, 12 and 24 hafter surgery. BP, HR, ECG, SpO_2, P_(ET) CO_2 and end-tidal concentration of inhalational anesthetics werecontinuously monitored during anesthesia. Results In all three groups rSO_2 was significantly lower during operation(T_4) and at the end of surgery (T_5 ) than baseline (T_0 ) (P

Objective To investigate the relationship between intraoperative cerebral oxygen saturation (rSO2) and postoperative cognitive dysfunction with near-infrared cerebral oximeter (INVOS 5100) in patients operated under inhalational combined intravenous anesthesia, and to determine the critical rSO2 value below which postoperative cognitive dysfunction may occur. Methods Sixty ASAⅠ-Ⅱ patients of both sexes were selected, aged 62-80yr, weighed 58-77kg, scheduled for elective abdominal surgery or surgery on the low limb. All the patients were divided into three groups according to their educational background: in group Ⅰ were the illiterate and uneducated patients (n=20);group Ⅱ the primarily educated patients (<6yr education) (n=20), and group Ⅱ the well educated patients (>6yr education) (n=20). Each group was further divided into isoflurane and sevoflurane subgroups (n=10 in each subgroup). All patients received no pre-medication. Anesthesia was induced with intravenous atropine 0.3mg, propofol 1.0-1.5mg kg-1, fentanyl 2-3μg*kg-1 and vecuronium 0.1-0.2mg*kg-1, and maintained with isoflurane or sevoflurane inhalation(0.9-1.1 MAC) supplemented with intermittent i.v. boluses of fentanyl, and recorded after entering room (baseline) (T0), after O2 inhalation (T1), after induction of anesthesia (T2), after skin incision (T3), during operation (T4), the end of surgery (T5), and awaking (T6). Mini-Mental State Examination (MMSE) was performed before anesthesia and 1, 4, 8, 12 and 24h after surgery. BP, HR, ECG, SpO2, PETCO2 and end-tidal concentration of inhalational anesthetics were continuously monitored during anesthesia. Results In all three groups rSO2 was significantly lower during operation (T4) and at the end of surgery (T5) than baseline (T0) (P<0.05). In all patients the MMSE scores at 1h after operation were significantly lower than the baseline value (P<0.05). The MMES scores in all patients significantly declined within 1-4h after surgery, and the cognitive function recovered at 4h after surgery in 85% patients. The critical values of rSO2 below which postoperative cognition dysfunction may occur were: 45 (group Ⅰ), 47 (group Ⅱ) and 49 (group Ⅲ) for isoflurane anesthesia subgroups;47 (group Ⅰ), 48 (group Ⅱ) and 50 (group Ⅲ) for sevoflurane subgroups. Conclusion The perioperative rSO2 should be maintained up to above 50% to reduce the incidence of postoperative cognitive dysfunction under inhalational combined intravenous anesthesia.

Objective To evaluate the accuracy of spectral entropy including response entropy(RE)and state entropy(SE)as a new electroencephalographic measure of depth of sedation during general anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients aged 20-55 yr undergoing elective abdominal surgery were studied.Anesthesia Was induced with intravenous propofol,fentanyl and vecuronium.After tracheal intubation anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium.BP,HR,SpO2,spectral entropy(Datex-Ohmeda)and BIS(Aspect Medical)were monitored during anesthesia.Loss of eyelash reflex and unresponsiveness to verbal stimulus and mild prodding and shaking were considered to be signs of loss of consciousness(LOC).The time of regaining consciousness Was defined as the time when patients started responding to verbal commands.RE,SE and BIS were recorded before anesthesia(baseline),10 min before LOC,immediately after LOC,immediately after tracbeal intubation,1 h after skin incision,10 min before regaining consciousness immediately after consciousness was regained and 10 min after extubation.Results There were sisnificant changes in RE,SE and BIS during the transition from consciousness to LOC.The RE,SE and BIS values for LOC were 76,73 and 68 with sensitivity of 94%,95%and 92%and specificity of 92%,94%and 91%respectively.The accuracy of RE.SE and BIS in predicting LOC was 93%,95%and 94%respectively.The RE,SE and BIS values for regaining consciousness were 82,75 and 70 with sensitivity of 95%,95%and 91%and specificity of 93%,96%and 93%respectively.The accuracy in predicting regaining of consciousness was 98%,96%and 97%respectively.Conclusion Entropy index Can accurately monitor level of sedation during general anesthesia.

To investigate epidural morphine(M) combined with triamcinolone A(TA) for advanced cancer pain and to study pharmacokineties of TA. Method.. TA 40mg/w was epidually combined with M3.84?3.94mg/d in 104 advanced cancer patients and TA blood concentration was measured with high performance liquid chromatography. Result: The rate of adverse reaction was 7.69% and visual analog scale was 3.16?2.83. The plasma elimination half life (t_(1/2)) was 1.63?0.36d; plasma accumulation coefficient (R) was 1.06-1-0.04?g/ml. Conclusion: The analgesic effect of M is potentiated by TA and there is no TA accumulation in plasma following long-term epidural administration.

0.05). Conclusion: With slow absorption rate and long half life of elimination, the epidural administration at one week interval can avoid the accumulation of triamcinolone A.

Objective To investigate the effects of propofol sedation on different areas of cerebral cortex and memory during operation performed under epidural anesthesia using EEG non-linear monitor and determine the critical value of approximate entropy, the EEG non-linear parameter, without implicit memory.Methods Ten ASA I or II patients of both sexes aged 42-56 yr weighing 59-73 kg undergoing elective abdominal or lower limb operation under epidural anesthesia were enrolled in the study. The patients were unpremedicated. After correct placement of epidural catheter was confirmed, a mixture of 2% lidocaine and 0.3% tetracaine 13-15 ml was injected via the catheter. Propofol was then infused i.v. at 6 mg?kg-1?h-1 for sedation. BP, HR and SpO2 were continuously monitored. The EEG non-linear monitor (ZN16E) was used. The sensors were placed on frontal (FP1 , FP2 ) , temporal (T3 , T4 ), parietal (C3 , C4 ) and occipital ( O1 , O2 ) regions. Approximate entropy and topographic map of approximate entropy were recorded before and during propofol infusion. Sedation scores (OAA/S, 1 = deep sleep, 5 = alert) were assessed during operation The patients' explicit and implicit memory scores were estimated by Process Dissociation Procedure during anesthesia sedateon Results The approximate entropy was significantly decreased during propofol sedation compared to the baseline value before sedation. OAA/S score were maintained at 1 during operation. The explicit and implicit memory scores were significantly decreased during propofol sedation compared to the baseline scores before anesthesia sedation( P

0.05).Furthermore,logistic regressive equations of prediction probability and RE,SE,BIS were calculated as ln [Pk/(1-Pk)]=-19.825+0.243x,ln [Pk/(1-Pk)]=-18.012+0.236x and ln [Pk/(1-Pk)]=-21.780+0.316x,respectively.From the perspective of sensitivity/specificity,RE,SE and BIS had threshold values for regaining consciousness of 83,76 and 71 with sensitivity/specificity of 0.90/0.85,0.89/0.80 and 0.88/0.78,respectively.RE was 30s earlier than BIS in predicting regaining consciousness.Conclusion Compared with BIS,entropy index seems to be a more accurate and sensitive electroencephalographic measure,and is promising in clinical application.

0.05),while the entropy index showed significant differences between the two groups(P

Objective To study the brain distribution of propofol and its effect on memory under intravenous combined anesthesia. Methods 20 patients undergoing elective abdominal abdomen and limb operations were randomly divided into propofol 8mg?kg -1 ?h -1 group (n=10) and 10mg?kg -1 ?h -1 group (n=10). The perioperative EEG non-linear topographic map of approximate entropy was recorded. The perioperative patients' memory was estimated by process dissociation procedure (PDP) after operation. Results Comparing with pre-operative examination results, the intra-operation explicit and implicit memory markedly declined in both propofol 8mg?kg -1 ?h -1 group and 10mg?kg -1 ?h -1 group. There was statistically significant difference between the pre-operative and intra-operative explicit and implicit memory (P

Objective To study the cerebral distribution of inhalational anesthetics and their effect on memory under inhalational combined with intravenous anesthesia. Methods 45 patients, undergoing elective abdominal and limb operations, were randomly divided into: isoflurane group (n=15), sevoflurane group (n=15), and desoflurane group (n=15). The narcosis was maintained by inhalational anesthetics combined with intravenous anesthetics. EEG non-linear topographic map of approximate entropy was recorded. The perioperative memory of the patients was estimated by process dissociation procedure (PDP) after patients awoke. Results Comparing with pre-operative examination results, there was distinct declination of intra-operation explicit and implicit memory in all three groups, and the difference was statistically siqnificant (P