Twenty-eight children with laryngeal papilloma aged 10 months -3.5 yr weighing 8-15 kg received CO2 laser treatment under serf-retaining laryngoscope from May 2003 to May 2007. There were 17 patients without laryngeal obstruction, 7 patients with 1st degree laryngeal obstruction and 4 patients with 2rid or 3rd degree laryngeal obstruction. Different techniques of anesthesia were used for patients with different degrees of laryngeal obstruction. In patients without laryngeal obstruction anesthesia was induced with intramuscular ketamine 5 mg/kg. After the patients lost consciousness midazolam 0.1 mg/kg, ketamine 1-2 mg/kg or fentanyl 2 μg/kg was given iv. Tracheal intubation was facilitated with succinyl-cboline 1.5 mg/kg. In patients with 1st degree laryngeal obstruction, ketamine 5 mg/kg was given ira. The patients kept spontaneous breathing. Tracheal intubaiion was pedormed under topical anesthesia with 1% tetracaine. In patients with 2nd and 3rd degree laryngeal obstruction tracheal intubation was performed awake without any premedication under topical anesthesia with 1% tetracaine. The trachea was intubated with the tracheal tube 1 size smaller than the regular size. Anesthesia was maintained with propofol 3-5 mg·kg1·h-1 and intermittent iv boluses of ketamine 1-2 mg/kg and vecuronium 0.05-0. 1 mg/ kg. Dexamethasone 0.2-0.3 mg/kg was given iv at the end of operation. The patients were extubated when the patients regained consciousness and SpO2≥ 96% on air. In one patient with Ist degree laryngeal obstruction emergency tracheotomy was performed during induction of anesthesia. Anesthesia was otherwise smooth and recovery was uneventful.

Objective To investigate the effects of different doses of ketamine on spatial cognitive function and the expression of mRNA and protein of N-methyl-D-uspartate (NMDA) receptor subunits NR1 and NR2B in the hippocampus of aged rats.Methods Forty SD rats of both sexes aged 15 months weighing 470-570 g were randomly divided into 4 groups (n=10 each) : one control group (C) and three ketomine groups (K1 ,K2 ,K3).The animals in group K1 ,K2 and K3 received intraperiteneal(IP) ketaminc 10,20 and 100 mg/kg respectively once a day for 3 days,whereas the animals in control group received IP normal saline instead of ketamine.One day after the last drug administration,the animals underwent Morris water maze test 4 times a day for 3 consecutive days.The animals were killed within 1 h after the last test for determination of the expression of NR1 mRNA and NR2B mRNA (using RT-PCR) and protein (using immuno-histochemistry) in the hippocampus.Results The latency period and swimming distance of water maze test were significantly longer on the 2nd and 3rd days in group K3 than in control group.The NR2B mRNA and protein expression was significantly lower in group K3 than in control group.Conclusion Anesthetic dose of ketamine decreases spatial cognitive function and the expression of NR2B mRNA and protein in aged rats whereas subanesthetic doses of ketamine do not.

Seven cases scheduled for cesarean section following combined spinal-epidural anesthesia,complicating the premature detachment of placenta,which occurred in the 2nd Affdiated Hospital of Wenzhou Medical College from January 1997 to December 2006,were analyzed to determine the risk factors.The results showed that the supine hypotensive syndrome after combined spinal-epidural anesthesia and anxiety before cesarean section were closely related to the premature detachment of placenta.The incidence rate of the premature detachment of placenta after combined spinal-epidural anesthesia is low,but the prermature of detachment of placenta is severe if it occurs,and the effectively prophylactic measures should be taken,including premedication with midazolam to eliminate anxiety before cesarean section and prevention of supine hypotensive syndrome after combined spinal-epidural anesthesia.

Objective To investigate the effects of lappaconitine on the perioperative immune function.Methods Twenty-four ASA I or II patients aged 23-64 yr undergoing elective radical mastectomy (8 patients),iaminectomy and vertebral canal decompression (8 patients) or femoral head replacement (8 patients ) were randomly divided into 2 groups (n=12 each): control group (C) and lappaconitine group (L).In group L ondansetron 4 mg was given IV and lappaconitine 8 mg was infused IV over 30 rain before induction of anesthesia.In group C equal volume of normal saline was infused instead of lappaconitine.Anesthesia was induced and maintained with propofol,remifentanil and rocuronium.Lappaconitine 0.28 mg/ml was continuously infused at 2 ml/h after induction of anesthesia in group L.When the patients recovered from anesthesia after operation,PCA with 0.28 mg/ml lappaconitine was started (background infusion 2 ml/h,bolus dose 0.5 ml and lockout interval 15 min).In group C pethidine 50 mg and droperidol 2.5 mg were given IM on demand.Venous blood samples were taken at 30 rain before induction of anesthesia(T1,baseline),immediately (T2) and at 24 h(T3) and 48 h (T4)after operation for determination of TNF-α,IL-2,IFN-γ and sIL-6R concentration by ELISA.CD3,CD4,CD8 and NK cell expression was determined using flow cytometry and the ratio of CD4/CD8 was calculated.The concentrations of IgA,IgM,IgG,CD3 and CD4 were determined by radioimmunoassay.Results Plasma SIL-6R and TNF-α concentrations were significantly lower while IL-2,IgA,IgG,IgM concentrations and CD4/CD8 ratio were significantly higher after operation in group L than in group C.Conclusion Lappaconitine can improve perioperafive humoral immune function thus contributing to its analgesic and anfi-inflammatory effects.

Objective To investignte the effects of ambroxol on lung injury in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Thirty-six ASA Ⅱ or Ⅲ children of both sexes aged≤8 yr,weighing≤25 kg undergoing repair of ventricular septal defect (VSD) under CPB were randomly divided into 3 groups (n=12 each):I control group (C);II low dose ambroxol group (2.25 mg/kg) (A,) and III moderate dose ambroxol group (4.50 mg/kg) (A2).Ambrexol was diluted with normal saline 10 ml and infused slowly after skin incision in group A1 and A2.In group C equal volume of normal saline(10 ml) was infused instead of ambroxol.Blood samples were taken from radial artery before skin incision,at 20 rain of CPB,20 rain after aortic unclamping,2 h and 6 h after temtination of CPB and 12 h after operation for determination of plasma MDA concentration and SOD activity and blood gas analysis.Respiratory index (RI) and pulmonary compliance (CL)were calculated.Results The plasma MDA concentration and RI were significantly lower while plasma SOD activity was significantly higher in group A2 than in group C and A1·CL was significantly higher in group A2 than in group C.Conclusion Ambroxol 4.50 mg/kg can attenuate lung injury in children undergoing cardiac surgery with CPB by decreasing lipid peroxidation.

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rat model of sepsis.Methods Thirty healthy New Zealand rabbits of both sexes weighing 2.0-3.0 kg were randomly divided into 3 groups (n=10 each):group I sham operation; group II sepsis and group III AHH+sepsis.Sepsis was produced by modified colon ascendens stent peritonitis(CASP).At 4 h after CASP group III meceived HES 130/0.4 20 ml/kg iv at a rate of 20 ml/min.The MAP and HR were monitored and recorded at 4 h (before AHH) and 5,6,7,8 h after CASP.Blood samples were taken from carotid artery and superior mesenterie vein (SMV) at 4 h and 8 h after CASP for blood gas analysis and determination of plasma D-lactate concentration and intestinal oxygen extraction ratio.The rabbits were sacrificed at 8 h after CASP and a segment of ileum of 3 cm in length,5 cm from ileocecal valve,was removed for determination of wet/dry ileum weight ratio and microscopic examination.The degree of damage to intestinal mucous membrane was scored according to Chiu score (0=normal,5=severe damage).Results Sepsis-induced hypotension and metabolic acidosis,increased plasma D-lactate concentration,decreased intestinal oxygen extraction ratio,increased wet/dry ileum weight ratio and Chiu score in group II as compared with group I.AHH with HES 130/0.4 20 ml/kg significantly attenuated the scpsis-induced changes in group III.Conclusion AHH with HES 130/0.4 can attenuate damage to intestinal mucosal barrier produced by sepsis.

Objective To compare the therapeutic effect of inhaled aerosolized and intravenous milrinone,a phosphodiesterase-3 inhibitor in rats with oleic acid-induced acute lung injury (ALI) .Methods Forty male SD rats weighing 300-350 g were randomly divided into 4 groups (n=10 each) : group Ⅰ normal control: group Ⅱ ALI; group Ⅲ milfinone inhalation and group Ⅳ intravenous milrinone.The animals were anesthetized with intraperitoneal 2% pentobarbital 40 mg/kg,tracheostomized and mechanically ventilated (FiO2 30%,VT 10 ml/kg,RR 80 bpm,I:E=1:2).The chest was opened and the heart was exposed.Pulmonary artery was catheterized via fight ventricle.MAP,CVP,airway pressure and pulmonary artery pressure (PAP) were monitored.ALI was induced with 10% oleic acid 2 ml/kg administered through fight external jugular vein in group Ⅱ,Ⅲ and Ⅳ.In control group 0.1% BSA solution 2 ml/kg was administered iv instead of oleic acid.In group Ⅲ at 30 min after oleic acid administration aerosolized milrinone 1 mg/ml was inhaled 4 times at 60 min interval.Each time milrinone was inhaled for 10 min.In group Ⅳ at 30 min after oleic acid administration a bolus of 10 μg/kg milrinone was given iv followed by 10 min milrinone infusion at 1 μ·kg-1·min-1.The same procedure was repeated 4 times at 60 min interval.MAP and PAP were recorded and blood samples were taken from carotid artery and pulmonary artery for blood gas analysis at the 1st,2nd,3rd and 4th treatment.PaO2/FiO2 and Qs/Qt were calculated.The animals were sacrificed by exsanguination after the 4th treatment.The lungs were removed.The left lung was lavaged.Neutrophil count and protein content in broncho-alveolar lavage fluid (BALF) were determined.W/D lung weight ratio and lung myeloperoxidase (MPO) activity were measured.The uhrastructure of the lung was examined with electron microscope.Results The MAP was significantly lower after oleic acid adminstration in group Ⅳ than in other 3 groups.PaO2/FiO2 was significantly decreased and Qs/Qt increased by iv oleic acid in group Ⅱ ,Ⅲ and Ⅳ.PAP was significantly increased after iv oleic acid in group Ⅱ ,Ⅲ and Ⅳ but was significantly lower in group Ⅲ and Ⅳ than in group Ⅱ .The neutrophil count and total protein content in BALF,W/D ratio and lung MPO activity were significantly increased in group Ⅱ ,Ⅲ and Ⅳ as compared with control group(Ⅰ) and were significantly higher in group Ⅳ than in group Ⅲ.The lung damage induced by oleic acid was less serious in group Ⅲ and Ⅳ than in group Ⅱ .Conclusion Inhaled aerosoLized milrinone has better therapeutic effect than intravenous milrinone in rats with oleic acid-induced ALI and is safer.

Objective To determine the median effective concentration (EC50) of amitriptyline for intravenous regional anesthesia (IVRA) in rats.Methods Ninety healthy male SD rata weighing 190-240 g were randomly divided into 3 groups (n=30 each) : amitripryline group,bupivncaine group and lidocaine group.The rat's tail was divided into 3 epual parts: the proximal,middle and distal part.A 24 gauge needle was inserted into vena caudalis in the distal part.Esmarch bandage was applied around the tail from distal to proximal to expel blood from the taft and was removed after a tourniquet was applied between the proximal and middle part of the tail to occlude artery.0.5 ml of amitriptyline,bupivncaine or lidocaine was injected into the taft vein immediately after the application of the tourniquet.Ten minutes after drug administration the tourniquet was released.The ECho was determined by the up-and-down sequence method.The initial concentration of amitriptyline was 0.05%,the consecutive concentration-ratio was 1.4i4; the initial concentration of bupivacaine was 0.03%,the consecutive concoatration-ratio was 1.667 and the initial concentration of lidncaine was 0.08%,the consecutive concentrationratio was 1.250.EC50 and 95% confidence interval were calculated.Tail-flick latency (TFL) was assessed at 1 h before (baseline) and at 3 min and 2 d after drug administration.Central nervous system toxicity (seizure,convulsion,death) and local tissue damage to the tail were also recorded.Results The EC50 for IVRA was 0.111% (95% CI,0.092%-0.133%) in amitripthline group; 0.058% (95% CI,0.048%-0.078%) in bupivacaine group and 0.129% (95% CI,0.103%-0.160%) in lidocaine group respectively.The EC50 was significantly lower in bupivacaine group than in amitriptyline and lidocaine group.There was no significant difference in EC50 between amitriptyline and lidocaine group.The TFL measured at the proximal part of the tail was not significantly different between different time points in each group.The TFL measured at the middle part at 3 rain after drug adminisuation was significantly increased as compared with the baseline in all 3 groups but was not significantly different between the baseline and that measured at 2 d after drug administration.No CNS toxicity and local tissue damage were found during the experiment in all 3 groups.Conclusion Amitriptyline can produce intravenous regional anesthesia.The potency of amitriptyline is significantly lower than that of bupivncaine but is not significantly different from that of lidocaine.

Objective To evaluate the efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectomy.Methods Twenty ASA I or II patients of both sexes aged 17-40 yr weighing 52-75 kg undergoing video-assisted endoscopic transthoracic sympathectomy were enrolled in this study.Anesthesia was induced with propofol 2.0-2.5 mg/kg and sufentanil 0.5 μg/kg.Tracheal intubation was facilitated with atracurium 0.6 mg/kg.The patients were mechanically ventilated (VT=8-10 ml/kg,RR=10-12 bpm,I:E =1:2,FiO2=80%).Anesthesia was maintained with infusion of propofol 2-4 mg·kg-1·h-1 and sufentsnil 0.2-0.3/.μg·kg-1 h-1 and intermittent iv boluses of atracurium.At the 30 rain before the end of operation propofol infusion was reduced to 1-2 mg.kg-1·h-1 and sufentanil infusion to 0.1 μg·kg-1 h-1 .BP (SP,DP) and HR were recorded and venous blood samples were taken before induction of anesthesia (baseline),at tracheal intubation at the moment of CO2 insnfflation 10 min and 30 min after CO2 insufflation,5 min after deflation and at extubation for determination of plasma corticesteroid,aldosterone and glucose levels.The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing,eye opening at command and tracheal extubation were recorded.Results SP,DP and HR were within the normal range.Plasma levels of comcesteroid,aldosterone and blood glucose were significantly increased during operation as compared with the baseline values.The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing,eye opening at command and tracheal extubation were4.5±1.9,6.4±2.7 and (12.6±1.5)min respectively.Conclusion Sufentanil 0.1-0.3 μ·kg-1·h-1 combined with propofol 1-4 mg·kg-1.h-1 can inhibit stress response during video-assisted endoscopic transthoracic sympathectomy with stable hemodynamics.

Objective To determine the risk factors for development of early acute renal failure (ARF) after orthotopic liver transplantation (OLT) in patients with normal renal function.Methods Sixty ASA Ⅱ or Ⅲ patients aged 28-64 yr weighing 35-88 kg undergoing OLT were studied.Their preoperative serum Cr and BUN were within normal range.Early ARF was defined as serum Cr≥132 μmol/L and/or BUN≥18 mmol/L within 24 h after operation.The patients were divided into 2 groups: ARF group and non-ARF group.Arterial blood samples and urine specimens were collected before induction of anesthesia for determination of blood β2-micreglobulin(β2-MG) and urinary β2-MG and N-acetyl-β-D-glucurenidnse (NAG). Factors including preoperative liver function,preoperative blood and urinary β2-MG,the amount of urine output and bank blood infused during operation,MAP during anhepatic and neohepatic phase,the amount of vnsoactive drugs and diuretics used during operation,hypotension and arrbythmia during operation were recorded.The risk factors were identified by logistic regression analysis.Results Logistic analysis indicated that serum β2-MG higher than normal value before operation and persistent hypotensien during operation were closely correlated with development of early ARF after OLT.Conclusion Serum β2-MG higher than the normal value before operation.and persistent hypotension during operation are the risk factors for early ARF after OLT.