OBJECTIVETo compare the efficacy and safety of remifentanil with fentanyl used for intraoperative anesthesia.

METHODSFifty-four patients undergoing modified radical mastectomy or total hysterectomy were randomly assigned to remifentanil group or fentanyl group with 27 cases in each group. Anesthesia was induced with propofol (2 mg/kg) and either remifentanil (2 micrograms/kg) or fentanyl (2.5 micrograms/kg), and was maintained with inhalation of nitrous oxide in oxygen (2:1) and a continuous infusion of either remifentanil (0.2 microgram.kg-1.min-1) or fentanyl (0.03 microgram.kg-1.min-1). Depth of anesthesia, hemodynamic changes, recovery profile of anesthesia, postoperative analgesia and adverse reactions were observed.

RESULTSThe number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly fewer than that in the fentanyl group (P < 0.05). Hemodynamic changes during intubation, skin incision, maintenance of anesthesia and extubation in the remifentanil group were significantly smaller than those in the fentanyl group (P < 0.05, P < 0.01). The time to opening eyes on command and the time for extubation after surgery were comparable between the two groups. More patients in the remifentanil group required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (P < 0.05). There was no significant difference between the two groups in the aspect of adverse reactions.

CONCLUSIONThe anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability compared with fentanyl without compromising recovery from anesthesia.

Adolescent ; Adult ; Anesthetics, Intravenous ; therapeutic use ; Breast Neoplasms ; physiopathology ; surgery ; Female ; Fentanyl ; therapeutic use ; Hemodynamics ; drug effects ; Humans ; Hysterectomy ; Mastectomy, Modified Radical ; Middle Aged ; Pain, Postoperative ; prevention & control ; Piperidines ; therapeutic use

OBJECTIVESTo construct small interfering (siRNA) Sox9 expression plasmid and transfer it into human chondrosarcoma cells HTB-94, and to check the mRNA and protein expression of Sox9 and cell growth and apoptosis of HTB-94 human chondrosarcoma cells.

METHODSsiRNA(Sox9) expression plasmid was designed and synthesized. And it was transferred into HTB-94 human chondrosarcoma cells. Then the expression of the mRNA and protein of Sox9, cell growth and apoptosis in transferred HTB-94 human chondrosarcoma cells were checked.

RESULTSThe recombinant plasmid was confirmed by enzyme digestion analysis and DNA sequencing. The expression of the mRNA and protein expression of Sox9 in transferred HTB-94 were significantly reduced. The cell growth of HTB-94 was inhibited, and the apoptosis of HTB-94 was remarkably increased.

CONCLUSIONsiRNA (Sox9) expression plasmid could be transferred into HTB-94 human chondrosarcoma cells. And it can reduce the mRNA and protein expression of the HTB-94, inhibit the cell growth and cause the apoptosis of the tumor cells.

Apoptosis ; Cell Proliferation ; Chondrosarcoma ; metabolism ; pathology ; Genetic Vectors ; Humans ; Plasmids ; genetics ; RNA, Messenger ; genetics ; RNA, Small Interfering ; genetics ; SOX9 Transcription Factor ; genetics ; metabolism ; Transfection ; Tumor Cells, Cultured

OBJECTIVETo evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries.

METHODSSixty American Society of Anesthesiologists (ASA) I - II patients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group (n = 30) and rocuronium + neostigmine (R + N) group (n = 30).All patients received midazolam (0.02 mg/kg), fentanyl (1 microg/kg), propofol(1.5-2 mg/kg), and rocuronium (0.6 mg/kg) to facilitate tracheal intubation and no more relaxant thereafter. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen (N(2)O:O(2) = 1:1). At the end of the procedure, neuromuscular blockade was not reversed in R group, while antagonism was accomplished with neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) in R + N group. Immediately after tracheal extubation and on arrival in the PACU, the train-of-four (TOF) ratio at the adductor pollicis of all patients were measured using acceleromyography. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and peak expiratory flow rate (PEFR) of all patients were measured using spirometry before surgery, after administration of midazolam and fentanyl, immediately after tracheal extubation, on arrival in the PACU, and after the TOF ratio recovered to 1.0. The TOF ratio and pulmonary function between two groups were compared.

RESULTSImmediately after tracheal extubation and on arrival in the PACU, the mean TOF ratio in R group was significantly lower than that in R + N group (P < 0.05). The mean time to achieve TOF ratio of 0.9 and 1.0 in R group was significantly longer than in R + N group (P < 0.05). Immediately after tracheal extubation and on arrival in the PACU, FVC, FEV(1), and PEFR were significantly lower in R group than in R + N group (P < 0.05). FVC, FEV(1), and PEFR after administration of midazolam and fentanyl and after TOF ratio recovered to 1.0 were significantly lower than the baseline values in all patients (P < 0.01).

CONCLUSIONSAfter a single intubating dose of rocuronium, residual paralysis exists in the majority of patients undergoing laparoscopic gynecological surgeries. The pulmonary function is impaired after the surgery, even after recovery of TOF ratio to 1.0.

Adolescent ; Adult ; Airway Extubation ; Androstanols ; administration & dosage ; adverse effects ; Female ; Gynecologic Surgical Procedures ; Humans ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; adverse effects ; Paralysis ; chemically induced ; Postoperative Period ; Respiratory Function Tests ; Young Adult

OBJECTIVETo investigate perioperative patterns of melatonin and cortisol secretion rhyme in patients undergoing coronary artery bypass grafting surgery.

METHODSEleven male patients scheduled for elective coronary artery bypass grafting surgery (CABG) under hypothermic cardiopulmonary bypass (CPB) were enrolled in the study. Anesthesia was induced and maintained with propofol (3 mg.kg-1.h-1) and supplemented with fentanyl (15 micrograms/kg). Blood samples were taken during surgery at specific time-points and every 3 h in the immediate postoperative period and postoperative day 2 and day 3. Plasma melatonin and cortisol levels were measured by radioimmunoassay and enzyme-linked immunosorbent assay respectively.

RESULTSDuring surgery, plasma melatonin levels were below the minimum sensitivity level but low levels, without circadian variation, were measured during the immediate postoperative period. During postoperative day 2 and day 3, circadian secretion patterns of melatonin were present in 10 patients and showed an inverse correlation with light intensity exposed (r = -0.480, P = 0.01). Plasma cortisol levels in the immediate postoperative period were significantly higher than those before induction of anesthesia (P < 0.01). During postoperative day 2 and day 3, only 3 patients regained circadian secretion of cortisol.

CONCLUSIONSIt is concluded that melatonin and cortisol secretion are disrupted during cardiac surgery and in the immediate postoperative period.

Cardiopulmonary Bypass ; Circadian Rhythm ; Coronary Artery Bypass ; Coronary Disease ; physiopathology ; surgery ; Humans ; Hydrocortisone ; secretion ; Intraoperative Period ; Male ; Melatonin ; secretion ; Middle Aged ; Monitoring, Intraoperative ; Postoperative Period

Adult ; Aged ; Female ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Shoulder Dislocation ; therapy

OBJECTIVETo explore the acting mechanism of electrical field in electrical injury.

METHODSThirty-six New Zealand white rabbits were employed in the study and were randomly divided into 7 groups. There were 12 rabbits in group 1 and 4 in each group of other 6 groups. The animal model of nonthermal electrical injury previously replicated was employed in the study. Experiment with paralleled muscular fibers in electrical field was carried out in groups 2 approximately 4, while that of vertical muscular fibers in electrical field in groups 5-7. Anatomical examination was done to determine the index of deep burn injury (IDBI) in all groups of rabbits at 0, 2 and 24 postburn hour (PBH). Histological and ultrastructural examination, gamma picturing and isotope scanning with 99mTc were done in group 1 at 2 PBH.

RESULTSThere was no obvious skin injury in the white rabbits in group 1. Deep tissue necrosis was identified under the small electrode. Constant muscular spasm was observed in the inner side of the thigh. The muscles in paralleled electrical field suffered more severe injury than those in vertical one. Tissue injury was more severe in those areas with higher current density, less soft tissue, and also in the central area of the axis of the electric field. There were obvious changes in the perfusion and blood pool phases in these areas as observed with the aid of 99mTc. Light microscopic examination revealed swelling and necrosis of muscular fibers. Under electron microscopy, it was found that there were edema and dissolution with separation of lipid molecular layers of cell membrane, Shortened nucleus with partial dissolution of nuclear membrane, increased heparin granules within nucleus, swelling of mitochondria and endoplasmic reticulum, myofilament dissolution, expanded gap between myofilament and decreased number of heparin granules.

CONCLUSIONNon-thermal tissue injury in the electrical field, in terms of cell, ultrastructural and molecular levels, was induced and aggravated by all the factors constituting high voltage electrical field.

Animals ; Electric Injuries ; pathology ; Lower Extremity ; injuries ; Necrosis ; Rabbits ; Soft Tissue Injuries ; pathology

OBJECTIVETo observe the effectiveness of using cell saver (CS) during surgery on blood sparing and its impact on patient's hematology and coagulation function.

METHODSOne-hundred and thirty-eight patients undergoing elective surgery were recruited for intraoperative blood salvage using CS. Blood routine, blood chemistry and coagulation function were measured before surgery, after infusion of salvaged blood and postoperative day 1, respectively.

RESULTSIn total, 112,056 ml of packed red blood cells were collected, with a mean value of 812 ml per patient. The percentage of autologous blood transfusion volume to the total blood transfusion volume was from 48% to 89%. Allogenic blood transfusion rate was from 5% to 100%. Compared with the values before surgery, the hemoglobin concentration, platelet count, plasma total protein and fibrinogen concentration decreased significantly after the transfusion of salvaged blood and the first postoperative day (P < 0.05 or P < 0.01), while the prothrombin time was significantly prolonged (P < 0.05).

CONCLUSIONSThe use of CS during surgery can, to a certain extent, reduce the requirement of allogenic blood. However, reinfusion of large amount of salvaged blood may affect coagulation function.

Adult ; Aged ; Blood Coagulation Tests ; Blood Loss, Surgical ; Blood Transfusion, Autologous ; methods ; Blood Volume ; Coronary Artery Bypass ; Elective Surgical Procedures ; Female ; Heart Valve Prosthesis ; Humans ; Intraoperative Care ; Male ; Middle Aged ; Prothrombin Time

OBJECTIVETo investigate the relationship between the circadian rhythm of perioperative cortisol secretion and neuropsychological states in patients undergoing coronary artery bypass grafting surgery.

METHODSForty male patients scheduled for elective coronary artery bypass grafting (CABG) under hypothermic cardio-pulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated into CPB group or off-pump group with 20 patients in each group. Blood samples were withdrawn during surgery at specific time-points and every 3 h for 24 h in the immediate postoperative period. Plasma cortisol was measured by radioimmunoassay. All subjects were investigated preoperatively as well as 7 to 10 d and 3 months postoperatively with a comprehensive neuropsychologic assessment, while depression and anxiety were assessed by Self-Rating Depression Scale and the State-Trait Anxiety Inventory respectively.

RESULTSDuring postoperative 24 h, three patients in the CPB group and 7 patients in the off-pump group were demonstrating a circadian secretion pattern, while they were disturbed in the remaining patients in both groups. Postoperative depression scores of patients in both groups were significantly higher than preoperative values. Postoperative anxiety scores of patients in the CPB group were significantly higher than those in the off-pump group. The CABG with CPB patients showed a significant deficit in the Digit Span subtest of the WAIS-R and the Stroop colour word interference test. The disturbed cortisol circadian secretion in the CPB group correlated with depression and the Stroop colour word interference test, whereas in the off-pump group it correlated with depression, Digit Span subtest (forward), symbol digit modalities test and the Stroop colour word interference test. Degree of depression correlated with some items of cognitive dysfunctions.

CONCLUSIONPerioperative secretion rhythm of cortisol in patients undergoing CABG surgery with CPB or off-pump was disturbed. The disordered cortisol may correlate directly or indirectly through mood with neuropsychological deficits.

Cardiopulmonary Bypass ; Circadian Rhythm ; Coronary Artery Bypass ; adverse effects ; psychology ; Coronary Artery Bypass, Off-Pump ; psychology ; Extracorporeal Circulation ; Humans ; Hydrocortisone ; secretion ; Hypothermia, Induced ; Intraoperative Period ; Male ; Middle Aged ; Postoperative Period

OBJECTIVETo investigate the changes of perioperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures.

METHODSTwenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation. Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol. pHi and plasma lactate were also measured at the same time points.

RESULTSSerum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation. CRP was not detectable until the first day after operation. Peak concentration of IL-6 had positive relationship with CRP. These variables changed more significantly in colorectal group than that in orthopaedic group (P < 0.05). pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P < 0.05).

CONCLUSIONIL-6 may reflect tissue damage more sensitively than CRP. Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Adult ; Aged ; C-Reactive Protein ; metabolism ; Colorectal Neoplasms ; blood ; physiopathology ; surgery ; Female ; Gastric Acidity Determination ; Gastric Mucosa ; metabolism ; Humans ; Hydrocortisone ; blood ; Hydrogen-Ion Concentration ; Interleukin-6 ; blood ; Intervertebral Disc Displacement ; blood ; physiopathology ; surgery ; Lactic Acid ; blood ; Male ; Middle Aged ; Perioperative Care ; methods ; Spinal Stenosis ; blood ; physiopathology ; surgery

OBJECTIVETo summarize experience of perioperative anesthetic management for patients undergone excision of pheochromocytoma and complicated with catecholamine cardiomyopathy.

METHODSPerioperative anesthetic management for surgical treatment of three cases of pheochromocytoma complicated with catecholamine cardiomyopathy was described and discussed according to literature reports.

RESULTSThe catecholamine cardiomyopathy of the three cases presented with left ventricular hypertrophy, congestive cardiac failure and acute myocardial infarction. After removal of the pheochromocytoma under general anesthesia, a prolonged hypotension occurred in all of the three cases. In order to maintain stable hemodynamics, large dose of catecholamine was required after surgery. All of the three patients were survived and discharged.

CONCLUSIONSIt is suggested that myocardial dysfunction may be another important factor for the prolonged hypotension after removal of the tumor. Meticulous preoperative assessment of heart function is of primary importance for the management of anaesthesia during surgical procedures.

Adrenal Gland Neoplasms ; blood ; surgery ; Adult ; Anesthesia, General ; Cardiomyopathies ; blood ; etiology ; Catecholamines ; blood ; Female ; Heart Failure ; blood ; etiology ; Humans ; Male ; Pheochromocytoma ; blood ; surgery