OBJECTIVETo observe the myocardial protective effect of electroacupuncture (EA) at Neiguan (PC 6) in the patients with valve replacement via extracorporeal circulation.

METHODSFifty patients of rheumatic cardiac disease planned for valve replacement were graded as II or III level according to America Society of Anesthesiologists (ASA) and were randomized into an observation group and a control group, 25 cases in each one. The same anesthesia and valve replacement via extracorporeal circulation were adopted in the patients of the two groups. In the observation group, 30 min before operation, EA was used to stimulate bilateral Neiguan (PC 6) till the end of operation. The venous blood was collected at 5 time points separately, named before aorta blockage (T1), 15 min after aorta open (T2), 30 min after aorta open (T3), 6 h after opening (T4) and 24 h after opening (T5). The concentrations of malondial dehyde (MDA), superoxide dismutase (SOD) and cardiac troponin 1 (cTnI) were determined in serum. The heart re-beating and the total dosage of vasoactive drugs after operation were recorded.

RESULTSCompared with those before aorta blockage, MDA and cTnI at each time point of aorta open were all apparently increased in the patients of the two groups (all P<0. 05), and SOD was reduced apparently (P<0. 05). Compared with the control group, at the time points from T3 to T5 , MDA and cTnL were lower apparently in the observation group as compared with those in the control group (all P<0. 05) and SOD was higher than that in the control group (P<0. 05). The dosage of vasoactive drugs was reduced apparently (P<. 05).

CONCLUSIONEA at Neiguan (PC 6) alleviates oxidative stress injury and has the protective effect on ischemic reperfusion myocardium.

Acupuncture Points ; Adult ; Cardiac Surgical Procedures ; Electroacupuncture ; Female ; Heart Valves ; surgery ; Humans ; Male ; Malondialdehyde ; blood ; Middle Aged ; Oxidative Stress ; Rheumatic Heart Disease ; blood ; metabolism ; surgery ; therapy ; Superoxide Dismutase ; Troponin I ; blood

Objective To study the effect of transcutaneous electrical acupoint stimulation(TEAS) on endtidal concentration of sevoflurane in upper abdominal operation.Methods The use of prospective,randomized,blinded principles.A total of 50 patients underwent selective epigastric operations with ASA Ⅰ - Ⅱ were randomly divided into group A(25 cases) and B(25 cases).In group A,TEAS was performed and sevoflurane was inhaled during operation.In group B,only sevoflurane was inhaled and TEAS was not performed during operation.Electrical stimulation on Nei-guan,He-gu and Zu-sanli was performed for 30min before induction of anesthesia in group A and meanwhile patients in group B were waiting for 30min in operating room.After intubation,in group A,TEAS was performed persistently and sevoflurane was inhaled,meanwhile remifentanil was infused persistently during operation.In group B,only sevoflurane was inhaled and remifentanil was infused persistently during operation.At time points:before TEAS( T0 ),skin incision( T1 ),exploratory laparotomy( T2 ),30min after exploratory laparotomy ( T3 ),60min after exploratory laparotomy( T4 ),blood glucose and angiotensin Ⅱ were measured,recorded 10min after the start of surgery,once for each end-tidal sevoflurane concentration.Results End-tidal concentration of sevoflurane of group A ( 1.4 ± 0.2 ) ％,was significantly lower than group B( 1.9 ± 0.4 ) ％ ( t =3.147,P ＜ 0.01 ).Cortisol and angiotensin Ⅱ were increased at T1 and T2 compared with T0 in both groups(F =2.256,2.432,2.132,2.334,all P＜0.05).Cortisol and angiotensin Ⅱwere decreased in group A compared with in group B at T1 ～T4(t =2.159,2.232,2.453,2.602,al1 P ＜0.05).Conclusion TEAS can decrease end-tidal concentration of sevoflurane and stress response.TEAS combined with sevoflurane has synergistic effect on general anesthesia.

Objective To evaluate the efficacy of thoracic paravertebral block for preemptive analgesia in the patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB).Methods Sixty patients of both sexes,aged 54-75 yr,weighing 55-82 kg,of American Society of Anesthesiologists physical Ⅱ or Ⅲ,with New York Heart Association Ⅰ-Ⅲ,scheduled for elective MIDCAB,were randomly divided into 2 groups (n =30 each) by using a random number table:control group (group C) and thoracic paravertebral block group (group P).Thoracic paravertebral block was performed under the guidance of a nerve stimulator in group P.A paravertebral catheter was placed at T4,5 interspace,a test dose of 0.5％ ropivacacine 5 ml was injected through the catheter,and 5 min later a bolus dose of 0.5％ ropivacacine 15 ml was injected.Anesthesia was induced with intravenous etomidate,midazolam,fentanyl and vecuronium.All the patients were intubated with a double-lumen endobronchial tube and mechanically ventilated,and end-tidal pressure of carbon dioxide was maintained at 30-40 mmHg.Anesthesia was maintained with intravenous injection of fentanyl and vecuronium,intravenous infusion of propofol,and inhalation of sevoflurane.Bispectral index value was maintained at 40-60.When systolic blood pressure ＞ 160 mmHg,fentanyl 0.1 mg was injected intravenously.Both groups started to receive patient-controlled intravenous analgesia (PCIA) after extubation until 48 h after operation.PCIA solution contained morphine in 100 ml of normal saline.The PCIA pump was set up with a 2 mg bolus dose,a 10 min lockout interval and background infusion at a rate of 0.5 mg/h.Visual analogue scale was maintained ≤ 4.When visual analogue scale＞4,morphine 4 mg was injected intravenously as rescue analgesic.The consumption of intraoperative fentanyl was recorded.The consumption of morphine and requirement for rescue analgesics were recorded within 24 and 48 h after operation.The adverse reactions such as somnolence,nausea and vomiting,respiratory depression,pruritus,and atelectasis were recorded within 48 h after operation.The extubation time after operation,length of time in intensive care unit,and recovery time after operation were recorded.At 24 and 48 h after operation,pulmonary function was detected,the forced vital capacity (FVC) expressed as a percentage of the predicted value (FVC％),and forced expiratory volume in 1 second (FEV1)expressed as a percentage of the predicted value (FEV1 ％) were recorded,and the ratio of FEV1/FVC was calculated.Blood gas analysis was performed,and arterial oxygen partial pressure and partial pressure of arterial carbon dioxide were recorded at 24 and 48 h after operation.Results Compared with group C,the intraoperative consumption of fentanyl and consumption of morphine within 24 and 48 h after operation were significantly reduced,the extubation time and length of time in intensive care unit were shortened,FVC％ and FEV1％ were increased at 24 and 48 h after operation,the partial pressure of arterial carbon dioxide and incidence of somnolence were decreased (P＜0.05),and no significant change was found in the FEV1 / FVC,arterial oxygen partial pressure,requirement for rescue analgesics and recovery time after operation in group P (P＞0.05).Conclusion Thoracic paravertebral block analgesia can provide good preempive analgesia in the patients undergoing MIDCAB.

Objective To evaluate the effect of mild hypothermia on the activity of hippocampal pro tein kinase R-like endoplasmic reticulum kinase (PERK) in a mouse model of cerebral ischemia-reperfusion (I/R).Methods One hundred and twenty male C56BL6 mice,weighing 20-30 g,aged 7 weeks,were randomly divided into 3 groups (n=40 each) using a random number table:sham operation group (group S),I/R group,and mild hypothermia group (group H).Cerebral I/R was induced by occlusion of bilateral common carotid arteries for 15 min followed by reperfusion in anesthetized mice.In group H,surface cooling was performed immediately after reperfusion,and the rectal temperature was maintained at 32-34 ℃ for 3 h.In I/R and S groups,the rectal temperature was maintained at 36.8-37.2 ℃.At 6,12,24 and 72 h of reperfusion,10 mice were sacrificed in each group,and the hippocampi were removed for determination of the number of apoptotic neurons in hippocampal CA1 region (by TUNEL),and phosphorylated PERK (p-PERK) expression (by Western blot).Results Compared with group S,the number of apoptotic neurons was significantly increased,and the expression of p-PERK was up-regulated at each time point in I/R and H groups (P＜0.05).Compared with group I/R,the number of apoptotic neurons was significantly decreased,and the expression of p-PERK was downregulated at each time point in group H (P＜0.05).Conclusion Mild hypothermia can reduce endoplasmic reticulum stress through inhibiting hippocampal PERK activity,thus attenuating cerebral injury in a mouse model of cerebral I/R.

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Objective:To compare the efficacy of different concentrations of ropivacaine for interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery under general anesthesia.Methods:Ninety American Society of Anesthesiologists physical statusⅠor Ⅱ patients (NYHA classⅠorⅡ) of both sexes, aged 18-64 yr, with body mass index of 18.0-26.9 kg/m 2, undergoing elective arthroscopic shoulder surgery were selected, and were divided into 3 groups ( n=30 each) using a random number table method: 0.25% ropivacaine group (group A), 0.375% ropivacaine group (group B) and 0.5% ropivacaine group (group C). Interscalene brachial plexus block was performed with 0.25%, 0.375% and 0.5% ropivacaine 20 ml in A, B and C groups, respectively.Before operation (T 0) and at 30 min (T 1), 4 h (T 2), 6 h (T 3), 8 h (T 4), 10 h (T 5) and 12 h (T 6) after administration, the diaphragmatic mobility was measured and recorded using M-mode ultrasound and forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured using portable spirometer.The occurrence of phrenic paralysis was recorded at T 1-6.The duration of sensory and motor block was recorded.When visual analogue scale score>3 within 24 h after operation, flurbiprofen axetil 50 mg was injected intravenously for analgesia and the consumption was recorded.The adverse reactions such as cardiovascular events, local anesthetic intoxication, Horner syndrome, pneumothorax, and nausea and vomiting within 24 h after administration were recorded. Results:Compared with group A, the diaphragmatic mobility was significantly decreased during quiet breathing at T 1-3 and was decreased during deep breathing at T 2-5, and the diaphragmatic paralysis rate was increased during quiet and deep breathing at T 2-3 in group B, diaphragmatic mobility was decreased during quiet and deep breathing at T 1-6, diaphragmatic paralysis rate was increased during quiet and deep breathing at T 1-4, FEV 1% and FVC% were decreased at T 1 and FVC% was decreased at T 2 in group C, and the duration of sensory and motor block was prolonged in B and C groups ( P<0.05 or 0.01). Compared with group B, the diaphragmatic mobility was significantly decreased during quiet breathing at T 4-6 and was decreased during deep breathing at T 1-6, the diaphragmatic paralysis rate during quiet breathing was increased at T 2-4 ( P<0.05) was increased during deep breathing at T 3-4, and FEV 1 % and FVC % at T 1 were decreased in group C ( P<0.05). There was no significant difference in the postoperative requirement for flurbiprofen axetil and the incidence of adverse reactions within 24 h after administration among the 3 groups ( P>0.05). Conclusion:0.25% ropivacaine 20ml provides better efficacy when used for interscalene brachial plexus block in the patients undergoing arthroscopic shoulder surgery.

Objective To evaluate the effects of sevoflurane postconditioning on myocardial oxidative stress in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ) of both sexes,aged 36-59 yr,weighing 42-71 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were randomly divided into control group (group C,n =25) and sevoflurane postconditioning group (group S,n =25).In group S,4 ％ sevoflurane was infused for 10 min via the extracorporeal circulation machines starting from the time point immediately after aortic unclamping.Before aortic clamping and at 15 min,30 min,6 h,and 24 h after aortic unclamping (T1-5),blood samples were collected from the central vein for determination of the levels of cardiac troponin I (cTnI) in plasma.Myocardial specimens were taken from the left auricle before CPB and after termination of CPB for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity.The restoration of spontaneous heart beat,reperfusion arrhythmia scores,and requirement for vasoactive drugs were recorded.Results Compared with group C,MDA content was significantly decreased,and SOD activity was increased after termination of CPB,the plasma cTnI concentration was decreased at T2-5,the rate of restoration of spontaneous heart beat was increased,reperfusion arrhythmia scores were decreased,and the requirement for dopamine and nitroglycerin was reduced in group S.Conclusion Sevoflurane postconditioning provides myocardial protection by reducing myocardial oxidative stress injury in the patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the changes in cholinergic anti-inflammatory pathway in hippocampi global in aged rats with cerebral ischemia/reperfusion (I/R ) injury .Methods One hundred and twenty male Sprague-Dawley rats , aged 18-22 months ,weighing 450-600 g ,were randomly divided into 2 groups ( n= 60 each):sham operation group (group S) and global cerebral I/R group (group I/R) .The animals were anesthetized with intraperitoneal 10% chloral hydrate 0.4 ml/100 g .Global cerebral I/R was induced by 4-vessel occlusion method described by Pulsinelli .Fifteen rats were sacrificed at 1 ,3 ,5 and 7 days of reperfusion ,and brains were removed for determination of neuronal apoptosis and expression of α7 nicotinic acetylcholine receptor (α7nAChR ) , choline acetyltransferase (ChAT ) ,tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in the hippocampal CA1 region .The apoptosis rate was calculated .Results Compared with group S ,the apoptosis rate was increased and the expression of α7nAChR ,ChAT ,TNF-αand IL-1βwas up-regulated in group I/R ( P<0.05 or 0.01 ) . The expression of α7nAChR and ChAT was up-regulated gradually during reperfusion and peaked at 5 day of reperfusion ( P< 0.05 ) .Conclusion Global cerebral I/R injury can activate cholinergic anti-inflammatory pathway in aged rat hippocampi ,and the activation of this pathway is the endogenous mechanism of inhibition of excessive inflammatory responses in brain tissues .

Objective To evaluate the effect of parecoxib on the inflammatory response after radical lung cancer surgery in elderly patients.Methods Forty-one ASA Ⅱ or Ⅲ elderly patients of both sexes,aged 65-78yr,weighing 52-81 kg,undergoing elective radical lung cancer surgery performed via a thoracoscope,were randomly divided into control group (group C,n =20) and parecoxib group (group P,n =21).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with intravenous infusion of remifentanil and propofol,inhalation of sevoflurane and intermittent intravenous boluses of vecuronium.Bispectral index value was maintained at 40-50.Group P received intramuscular parecoxib sodium 40 mg at 30 min before anesthesia and at 12,24 and 36 h after surgery.The equal volume of normal saline was given in group C.Both groups received patient-controlled intravenous analgesia with morphine after operation.VAS scores at rest were maintained ≤ 3.The consumption of morphine and Ramsay sedation score at 12,24 and 48 h after operation were recorded.Blood samples were taken from the central vein before surgery (T0),at the end of surgery (T1) and at 12,24 and 48 h after surgery (T2-4) for determination of plasma TNF-α and IL-8 concentrations.Blood samples were collected from the radial artery at T0-4 for determination of PaO2.Alveolar-arterial oxygen tension difference and oxygenation index were calculated.Pulmonary complications were recorded within 2 days after surgery.Results The consumption of morphine,Ramsay sedation score,plasma TNF-α and IL-8 concentrations,alveolar-arterial oxygen tension difference and incidence of pulmonary complications were significantly lower,and oxygenation index was significantly higher in group P than in group C (P ＜ 0.05).Conclusion Parecoxib can reduce the inflammatory response after radical lung cancer surgery in elderly patients,thus improving respiratory function and reducing pulmonary complications after surgery.

Objective To evaluate the effect of PUN282987 on global cerebral ischemia-reperfusion (I/R) injury in aged rats.Methods One hundred and twenty pathogen-free healthy male SpragueDawley rats,aged 18-22 months,weighing 450-600 g,were divided into 3 groups (n=40 each) using a random number table:sham operation group (group S),global cerebral I/R group (group I/R) and α7 nicotinic acetylcholine receptor (α7nAChR) agonist PNU282987 group (group PUN).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 0.4 ml/100g,and global cerebral I/R was produced by 4-vessel occlusion technique in I/R and PUN groups.PUN282987 2.4 mg/kg was injected intraperitoneally before ischemia in group PUN.At 1,5,12 and 24 h of reperfusion,10 rats were randomly selected in each group and then sacrificed,and the brains were removed for detection of the neuronal apoptosis and for determination of the expression of α7nAChR,choline acetyltransferase (ChAT),tumor necrosis factor-α (TNF-α) and intedeukin-1β (IL-1β) in the hippocampal CA1 region.Apoptosis rate was calculated.Results Compared with group S,the apoptosis rate was significantly increased,and the expression of α7nAChR,ChAT,TNF-α and IL-1β was up-regulated at each time point in I/R and PUN groups (P＜0.05).Compared with group I/R,the apoptosis rate was significantly decreased,the expression of α7nAChR and ChAT was up-regulated,and the expression of TNF-α and IL-1β was down-regulated at each time point in group PUN (P＜0.05).Conclusion PUN282987 can reduce global cerebral I/R injury in aged rats.