Objective To explor the safty and the effect of controlled intravenous analgesia with remifentanil on hyoxemia in obese patients with painless gastroscopy.Methods One hundred patients undergoing painless gastroscopy were randomly and equally allocated into 2 groups(50 each).In group R,anesthesia was induced with TCI(target-controlled infusion) of remifentanil,and the target plasma concentration (Cp) of propofol was set at 2ng/ml.In group N,the same volume of saline was continues infusion.MAP,RR and HR were monitored and recorded before the examination(T0),the time point of examination start(T1),gastroscopy go through glottis(T2),at the end of the operation (T3) and 5 min after examination (T4).The effect of sedation was evaluated by Ramsay.Except that,gastroscopy time,the satisfaction of patient,anesthetist and endoscopist were recored.In addition,apnea,bradycardia,hypoxemia,myoclonus,body movement,hypotension and postoperative complications were also recorded.Results Compared with group N,in group R,HR,MAP and rate of body movement were significantly decreased (P ＜ 0.05).Except that,the satisfaction of patient and endoscopist were increased (P ＜ 0.05).Conclusion TCI of remifentanil can provide satisfaction sedation for obese patients with painless gastroscopy with few adverse effects.

Objective To investigate the effects of limb ischemia-reperfusion injury(I-RI) on blood coagulation.Methods Eighteen patients scheduled for unilateral knee arthroscopy surgery under epidural anesthesia were treated with an inflatable tourniquet to ptoduce ischemia for (42 ± 6) min.Venous blood was taken before tourniquet inflation,at 30 min during ischemia,3 min and 30 min during reperfusion for measuring blood coagulation by thrombelastography(TEG).Results TEG showed the decreases in reaction time(R value) and coagulation time(K value),and the increases in alpha angle(α) and maximal amplitude(MA),which were all within the normal limits and had no significant differences among four time points of testing.Conclusion I-RI of the limbs has no significant effects on blood coagulation.

Objective To observe the effect of preemptive analgesia with lornoxicam on balance of Th1/Th2 during radical gastrectomy. Methods Thirty patients undergoing selective radical gastrectomy were randomly divided into 2 groups with 15 cases each. Lornoxicam 8 mg was used.before surgery,and PCA with lornoxieam and morphine was used for postoperative analgesia in group Ⅰ.PCA with morphine was used for postoperative analgesia in group Ⅱ. Plasma cortisol, interferon-γ(IFN-γ) and interleukin-4 (IL-4) were measured before induction of anesthesia(T_0 ), at the end ofoperation(T_1 ),at 24 h(T_1 ) and 72 h(T_3 ) after operation. Results Compared to that at T_0 ,Cor washigher at T_1 and T_2 in group Ⅱ and at T_2in group I(P<0. 05). (Cor levels at T_1 and T_2were lower ingroup Ⅰ than those in group Ⅱ(P<0. 05). IL-4 of group Ⅰ was lower at T_2 than that at T_0 (P<0.05). IL_4 at T_3 was lower in group Ⅰ than that in group Ⅱ (P < 0.05). IFN-γ of group Ⅰ washigher at T_1 than that at T_0 (P<0. 05), which was higher at T_2 than that of group Ⅱ(P＜0. 05). Theratio of IFN-γ/IL-4 in both groups was significantly higher at T_1-T_3 than those at T_0, which at T_2 washigher in group Ⅰ than that in group Ⅱ (P<0. 05). Conclusion Preemptive analgesia with lornoxicamcan alleviate the excurtion degree of Th1/Th2 and improve inmmnological suppression after radicalgastrectomy.

The effects of morphine, pethidine and fentanyl on adenyl cyclase (AC) and phospho- diesterases (PDE) in rabbit bronchial smooth muscle were examined in vitro. The results were as follows: morphine could inhibit the activity of AC which was decreased from 15. 9911 ? 0. 8597u to 15.0463?0. 7989u, P

Objective To investigate the role of pentose phosphate pathway (PPP) after upper abdominal operationMethods Twenty-six patients undergoing upper abdominal surgery, were divided randomly into three groups: epidural block(EB,n=10), intravenous propofol anesthesia(PRO, n=10) and intravenous procaine balanced anesthesia(IPBA,n=6) The venous blood samples were collected to measure of erythrocytes hexokinase (HK), phosphofructokinase (PFK) and glucose-6-phasphate dehydrogenase (G-6PD), and activities, and plasma glucose before anesthesia induction, 60 min after incision,60 min after surgery, on the 1st and 2nd postoperative daysResults Compared with the values before anesthesia, the activities of erythrocyte HK and PFK decreased significantly on the 1st postoperative day in three groups (P

Objective To investigate the effect of midazolam on ventilatory response to carbon dioxide (CO 2) when it is used as sedative supplement to epidural blockade(EB) Methods Fifteen ASA Ⅰ Ⅱ patients [age (49?7) years , weight (56?13)kg] undergoing upper abdominal surgery were studied Patients with respiratory disease were excluded No patient was addicted to smoking,alcohol,received any sedatives or hypotics within one month before surgery The patients were premedicated with intramuscular phenobarbital 0 1g and atropine 0 5mg Epidural catheter was inserted in a cephala direction for 4 cm into epidural space via the tuohy needle at T 9 10 1% lidocaine and 0 2% pontocaine solution was used for epidural block The level of block was T 3 5 When the level of block was fixed, midazolam 0 1 mg/kg was given intravenously Respiratory rate(RR), tidal volume (V T), end tidal concentration of CO 2 (P ET CO 2) and pulse oxygen saturation (SpO 2) were measured before anesthesia (baseline values), before midazolam when the level of block was fixed and 5 min after midazolam Measurement of ventilatory response to CO 2: the patient was asked to breathe with a closed system without a CO 2 absorber P ET CO 2 increased to 55 mm Hg in 6 10 min RR,V T and minute ventilation (MV) were measured at P ET CO 2 40, 45, 50, and 55 mm Hg The patient then breathed fresh air and P ET CO 2 returned to normal 5 min after midazolam the measurment was repeated The CO 2 ventilatory response curve was obtained by plotting MV against the corresponding P ET CO 2 Results P ET CO 2, RR and SpO 2 did not change significantly after epidural block and midazolam There was no significant change in V T after epidural block as compared with the baseline value but V T decreased significantly after midazolam(P

Objective To investigate the effects of anesthesia on plasma level of endothelin(ET) and atrial natriuretic polypeptide (ANP) in patients undergoing upper abdominal surgery. Methods Thirty ASA Ⅰ -Ⅱ patients(14 male, 16 female), aged 31-68 years and weighing 41-82kg, undergoing elective upper abdominal surgery were divided into three groups with ten patients in each group: Ⅰ desflurane group,Ⅱ isoflurane group and Ⅲ propofol group. The patients were premedicated with intramuscular phenobarbital sodium O.1g and atropine 0.5mg. Anesthesia was induced with midazolam 0.lmg?kg-1, propofol 1 mg?kg-1, vecuronium .015mg?kg-1 and fentanyl 4?g?kg-1 . After intubation the patients were mechanically ventilated and PET CO2 was maintained with 1.0 MAC desflurane in group I or 1.0 MAC isoflurane in groupⅡ or propofol infusion at 60-70 ?g ?kg-1?min-1 in groupⅢ and vecuronium infusion at l-2?g?kg-1?min-1 . ECG, HR, BP, SpO2, PETCO2, end-tidal concentration of desflurane or isoflurane, tidal volume (VT), total compliance ( C?), Pplat, Ppeak were monitored during anesthesia. Blood samples were taken from peripheral vein before anesthesia(T1 ), after induction(T2), 10 min(T3), 50 min(T4) after skin incision and at the end of surgery(T5 ) for determination of plasma levels of ET and ANP by radioimmunoassay. Results (1) There was no significant difference in plasma levels of ET between group Ⅰ and Ⅱ , but ET level decreased significantly during isoflurane inhalation. (2) There was no significant change in plasma ANP level during anesthesia in group I but plasma ANP level decreased significantly at 50 min after skin incision in group Ⅱ and increased significantly at the end of operation in group Ⅲ . (3) MAP decreased significantly after induction in the three groups.Conclusions Anesthesia induced with propofol and maintained with isoflurane could be anesthesia of choice patients with airwayhyperreactivity in terms of plasma ET level which is a strong bronchial constrictor.

Objective Surgical stress induces a series of endocrine and metabolic changes including glucose metabolism and insulin-resistance. The purpose of the present study was to investigate the changes in glucose transporter-4 (Glut-4) mRNA expression in skeletal muscle after cholecystectomy under epidural block. Methods One gram of the rectus abdominis muscle was taken while abdomen was being opened and closed in patients undergoing cholecystectomy under epidural block. Total RNA of the muscle cells was extracted by trizol one-step template. RT-PCR was used to determine the Glut-4 mRNA amplification products with ?-actin mRNA as an internal control. The Glut-4 mRNA expression was expressed by (desired gene/ ?-actin?100% . The plasma glucose and insulin levels were determined at the same time. Results Glut-4 mRNA expression was significantly reduced (P 0.05 ) . Conclusions The results indicated that the synthesis of Glut-4 is suppressed by surgical stress of cholecystectomy under epidural block leading to insulin resistance.

Objective To observe the effects of dexmedetomidine on the perioperative stress response and immunologic function in hepatectomy patients with hepatitis cirrhosis.Methods Forty patients(Child-Pugh A or B),ASA Ⅱ or Ⅲ with hepatitis cirrhosis undergoing hepatectomy were randomly divided into dexmedetomidine group(group D)and control group(group C)with 20 cases in each.Patients in group D were administered 0.5 μg/kg bolus dose of dexmedetomidine over 10 min, followed by 0.4 μg·kg-1 ·h-1 infusion until closing abdomen.And patients in group C were given normal saline by the same way as in group D.Flow cytometry was used to detect peripheral blood T lymphocytes (CD3 + ,CD4 + ,CD8 + ,CD4 +/CD8 + ),NK cells at 30 min before anesthesia(T0 ),imme-diately(T1 ),24 h(T2 )and 48 h(T3 )after surgery.Enzyme-linked immunosorbent assay was used to detect the levels of inflammatory cytokines concentration(IL-2,IL-10)at T0-T3 and stress hormones (Cor,ACTH,ALD)at T0 ,T2 and T3 .The levels of SBP,DBP and CVP at T0 ,immediately with intu-bation(Ta ),T1 and extubation(Tb ).Results Compared to those at T0 ,the levels of CD3 + ,CD4 + , CD8 + ,CD4 +/CD8 + at T1 and T2 were significantly lower in both groups(P <0.05),and the levels in group D were obviously higher than those in group C(P <0.05).The levels in group D were back to preoperative levels at T3 ,but the levels in group C were still lower than those at T0 (P <0.05).The levels of NK cells were higher at T1 in both groups,and the levels in group D was significantly higher than those in group C(P <0.05).Compared to those at group D,the concentration of IL-2 was lower at T1 and T2 ,the concentration of IL-10 was higher at T2 and T3 in group C (P <0.05).The levels of Cor,ALD,ACTH at T2 and T3 were significantly higher than those at T0 in both groups,but those in group D were markedly lower than those in group C (P < 0.05 ).The SBP,DBP and CVP of two groups was no statistically significant difference at T0 ,and SBP,DBP and CVP of the group D at Ta , T1 ,Tb was lower than that of T0 and group C (P <0.05).Conclusion Patients with hepatitis cirrho-sis underwent general anesthesia has certain immune suppression after liver cancer surgery,and con-tinuous intravenous infusion of dexmedetomidine during anesthesia may suppress the perioperative stress reaction effectively and alleviate the inhibition of immunologic function.

Objective To investigate the effect of midazolam on ventilatory response to carbondioxide (CO2) when it is used as sedative supplement to epidural blockade(EB). Methods Fifteen ASAⅠ -Ⅱ patients [age (49±7) years , weight (56±13)kg] undergoing upper abdominal surgery were studied. Patients with respiratory disease were excluded. No patient was addicted to smoking, alcohol,received any sedatives or hypotics within one month before surgery. The patients were premedicated with intramuscular phenobarbital 0. 1g and atropine 0.5mg. Epidural catheter was inserted in a cephala direction for 4 cm into epidural space via the tuohy needle at T9.10. 1% lidocaine and 0.2% pontocaine solution was used for epidural block. The level of block was T3.5. When the level of block was fixed, midazolam 0.1mg/kg was given intravenously. Respiratory rate(RR), tidal volume (VT), end-tidal concentration of CO2 (PETCO2) and pulse oxygen saturation (SpO2) were measured before anesthesia (baseline values), before midazolam when the level of block was fixed and 5 min after midazolam. Measurement of ventilatory response to CO2: the patient was asked to breathe with a closed system without a CO2 absorber. PET CO2 increased to 55 mm Hg in 6-10 min. RR, VT and minute ventilation (MV) were measured at PETCO2 40, 45, 50, and 55 mm Hg. The patient then breathed fresh air and PETCO2 returned to normal. 5 min after midazolam the measurment was repeated. The CO2 ventilatory response curve was obtained by plotting MV against the corresponding PET CO2. Results PET CO2, RR and SpO2 did not change significantly after epidural block and midazolam. There was no significant change in VT after epidural block as compared with the baseline value but VT decreased significantly after midazolam (P<0.01).There was no significant change in the slope of CO2 ventilatory response curve before and after midazolam but MV at different PET CO2 decreased significantly 5 min after midazolam. Conclusions Midazolam 0. 1mg/kg given after epidural block decreases VT but depression of respiratory center is slight and lasts for only a short period of time.[Key Words] Midazolam; Anesthesia, epidural; Carbon dioxide