Objective To compare the outcomes of two temperature maintenance strategies during radical resection for carcinoma of oesophagus and their effects on postoperative shivering. Methods Thirty ASA Ⅰ-Ⅱ patients undergoing radical resection for carcinoma of oesophagus were randomly assigned to hypothermia group (HT group, patients were not wanned perioperatively, n=10), intraoperative normothermia group (INT group, patients were warmed only intraoperatively, n=10) and perioperative normothermia group(PNT group, patients were warmed before induction of anesthesia and during anesthesia, n=10). The tympanic temperature began to be recorded 20 min before induction of anesthesia at intervals of 10 min. Results There was no significant difference in the decrease velocity of tympanic temperature during the first hour after induction of anesthesia between HT group and INT group, while both were significantly higher than that of PNT group (P<0.05). There was no significant difference in the tympanic temperature within 70 min after induction of anesthesia between HT group and INT group, while both were significantly lower than that of PNT group (P<0.05). The tympanic temperature of HT group continued to decrease 70 min after induction of anesthesia, while that of INT group and PNT group began to increase. There were significant differences in the tympanic temperature 80 min to 180 min after induction of anesthesia among these three groups(P<0.05). The incidences of postoperative shivering were 8, 5 and 2 in HT group, INT group and PNT group, respectively. The scores of thermal comfort scale were 19±10, 41±7 and 51±11 in HT group, INT group and PNT group, respectively, and there were significant differences among these three groups(P<0.05). Conclusion Compared with INT, PNT can more effectively maintain perioperative normothermia, reduce the incidence of shivering and relieve the patients' cold thermal discomfort in radical resection for carcinoma of oesophagus.

Objective To investigate the effect of intraoperative hypothermia and warming on hemostasis using thromboelastography(TEG)during radical esophagus cancer operation performed under general anesthesia combined with thoracic epidural block.Methods Sixteen ASA Ⅰ or Ⅱ patients undergoing elective radical esophagus cancer operation were randomly allocated to one of two groups(n=8 each):control group and warming group.The patients were unpremedicated.The operating room temperature was set at 21℃.Epidural catheter was placed at T_(7,8) and advanced 4 cm into epidural space.Correct epidural placement was confirmed by a test dose of 4 ml 1% lidocaine.0.375% bupivacaine was used during operation.General anesthesia was induced with fentanyl,thiopental and succinylcholine and maintained with isoflurane inhalation and intermittent i.v.boluses of vecuronium after endobronchial intubation with double lumen catheter.The patients were mechanically ventilated (V_T=8-10 ml?kg~(-1),RR=10-12 bpm,I:E=1:2,FiO_2=100%).In warming group TC-2000 wanning system (Thermacave,USA)was used.The lower part of the body was warmed for 45 min before induction of anesthesia (temperature was set at 38℃).After induction warming was continued(temperature was set at 43℃).In control group no wanning was provided.The fluid infused during operation was all warmed to 37℃.Tympanic temperature measurement was started from 20 min before induction and recorded every 10 min afterwards.TEG was performed before induction of anesthesia(T_0) and at 150 min after induction(T_1).The blood samples were divided into 2 aliquots of which one was tested at 37℃ and the other at patient's actual core temperature.Results The two groups were comparable with respect to age,sex,body weight duration of operation and the amount of fluid infused during operation.At T_1 the tympanic temperature was 34.7?0.4℃ in control group and 36.5?0.3℃ in warming group.At T_1 in control group the reaction time(R)and clot formation time(K)were significantly prolonged and a angle was significantly reduced when TEG was measured at core temperature compared with those measured at 37℃ (P＜0.05).At T_1 when TEG was measured at core temperature R and K were significantly shorter and a angle was significantly wider in warming group than in control group (P＜0.05).There was no significant difference in MA between the two groups at T_1.Conclusion Mild hypothermia developed during operation can impair bemostasis.Maintenance of normal body temperature(core temperature)during operation is necessary.

Objective To assess the efficacy of recoil of inflating syringe plunger in limiting laryngeal mask airway (LMA) cuff pressure.Methods Sixty ASA Ⅰ or Ⅱ patients aged 22-64 yr with body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were enrolled in this study.LMA Supreme (Laryngeal Mask Co.Singapore) size # 3 (for patients with body weight ≤50 kg) or # 4 (for patients with body weight ＞ 50 kg) was placed after induction of anesthesia.Correct position of LMA was confirmed by fiberoptic bronchoscopy.The LMA cuff was inflated to 60,80,100 and 120 cm H2O step by step using a 20 ml-syringe.The cuff pressure was measured with a monometer through a 3-way stopcock and maintained at each level for 10 seconds.The plunger was then allowed to recoil.The cuff pressure at the end of recoil (residual cuff pressure) was recorded.The patients were mechanically ventilated.The inspiratory pressure was limited to 30 cm H2 O.The airway pressure at which the air started to leak between LMA and larynx (leak pressure-Pleak) was recorded.Results The residual cuff pressure following the 4 inflating pressures was all ＜ 60 cm H2 O.The Pleak was ＞20 cm H2O.There was no significant difference in residual cuff pressure and Pleak between size # 3 and # 4.Conclusion Recoil of inflating syringe plunger can limit LMA pressure to safe level.

Objective To investigate the changes in the expression of keratin genes in renal tissues during renal ischemia-reperfusion (I/R) injury in mice.Methods Six wild type male C57/B6 mice,aged 50 days,weighing 20-30 g,were divided into 2 groups (n=3 each) using a random number table:sham operation group (Sham group) and I/R group.Right renal arteries and veins were clamped for 1 h followed by reperfusion,and the left kidneys were removed to establish the model of renal I/R injury.At 24 h of reperfusion,blood samples were collected from the left ventricle for determination of serum creatinine and urea nitrogen concentrations by colorimetric method.The right kidney specimens were obtained for pathologic examination and for determination of the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA (by quantitative real-time polymerase chain reaction [qRT-PCR]) and keratin genes (by Affemetrixc DNA microarray).The differentially expressed genes identified were further confirmed by qRT-PCR.Results Compared with Sham group,the serum creatinine and urea nitrogen concentrations were significantly increased,the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA was up-regulated (P＜0.05),and the damage to the renal tubules was aggravated in I/R group.The results of microarray analysis showed that only keratin 20 gene (the expresion was up-regulated) was the differentially expressed gene (P＜0.05),and the results measured by qRT-PCR were consistent with those measured by Affemetrixc DNA microarray.Conclusion Keratin 20 gene expression in renal tissues is up-regulated during renal I/R injury in mice,and the change may be involved in the endogenous protective mechanism during renal I/R injury.

Objective To investigate the effects of β_2 agonist salbutamol aerosol on the uptake of sevoflurane in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A randomized, placebo-controlled and double-blinded trial was designed. Twenty-six patients were recruited and randomly allocated to salbutamol group (group E, n=13) and placebo group (group C, n=13). Eligible patients were elderly patients with ASA physical status Ⅱ-Ⅲ, a body mass index (BMI) between 18 and 30 kg/m~2, well-defined clinical diagnosis of COPD. Routine monitoring (consists of a three-lead ECG, pulse oximetry, noninvasive blood pressure and expired gas analysis) was instituted and 500 mL Ringer's lactate solution was administered. Bispectral index (BIS) monitoring was initiated prior to induction. All subjects were received inhaled aerosol 200 μg according to manufacturers' recommendations 30 minutes before induction of anesthesia. Controlled ventilation was applied after the trachea was intubated. When stable hemodynamics was maintained for 5 minutes, fresh gas flow was set to 2 L/min with 2% sevoflurane in admixture, then HR, invasive arterial blood pressure (IABP), SpO_2, P_(ET)CO_2, bispectral index (BIS), minimum alveolar concentration (MAC), concentrations of inhaled sevoflurane (F_I) and end-tidal (F_E) were recorded at 1, 2, 3, 4, 5, 7,10, and 15 minutes after inhalation of sevoflurne. The P_(peak) and P_(plat) were also measured in 1, 5, and 10 minutes after the successful endotracheal intubation. Results Compared to the placebo group, the F_E was significantly higher at 2, 3, 4, and 5 minutes in experiment group. Peak airway pressure and plateau pressure in experiment group were strikingly lower than control group (P<0.05). There was no statistical significance about BIS variations between these groups in respective time in spite of increased MAC (P>0.05). Conclusions The increasing rate of alveolar concentration of sevoflurane was accelerated after the administration of inhaled salbutamol aerosol (200 μg) 30 minutes before induction of anesthesia, it might increase the uptake of sevoflurane.

Objective Ventriculoperitoneal shunt (VPS)is preferable in treatment for normal pressure hydrocephalus (NPH). In this study, the factors related to the motor recovery after VPS were analysed.Method Twenty-six patients were treated with VPS, and four factors, that are duration of symptoms, open lumbar puncture(LP) pressure, improvement after LP ,and motor recovery of twelve months after operation,were assessed. Results Twelve months after VPS, the better motor recovery after VPS was related to shorter duration of symptoms, higher open LP pressure, and symptom improvement after LP. Conclusion The patients with shorter duration of symptoms, higher open LP pressure, and symptom improvement after LP are often responsive to VPS.

Objective To evaluate ketamine-induced cerebral protection in mice with traumatic brain injury (TBI) by magnetic resonance imaging (MRI).Methods Thirty-two pathogen-free healthy male C57BL/6 mice,aged 8 weeks,weighing 26-30 g,were divided into 4 groups using a random number table:control group (group C,n=7),ketanine group (group K,n=7),TBI group (n=9) and TBI plus ketamine group (group TBI+K,n =9).TBI was produced with a pneumatically driven controlled cortical impact device.Ketamine 150 mg/kg was intraperitoneally injected at l h after operation in TBI+K and K groups,while the equal volume of normal saline was given instead in TBI and C groups.Open field test was conducted at 24 h,72 h and 7 days after operation.The animals in TBI and TBI+K groups were scanned by T1-weighted MRI at 6,24 and 72 h after operation,the animals in C and K groups were scanned by MRI at 24 h after operation,and the development of cerebral edema was observed.Results MRI scan showed no cerebral edema in C and K groups,and different degrees of cerebral edema were found in TBI and TBI+K groups.Compared with group C,the locomotor distance was significantly shortened at 24 and 72 h after operation in group TBI (P＜0.05).Compared with group TBI,the size of cerebral edema was significantly decreased,and the locomotor distance was prolonged at 24 and 72 h after operation in group TBI+K (P＜0.05 or 0.01).Conclusion MRI method further clarifies that ketamine can produce cerebral protection to some extent in mice with TBI.

Objective To investigate the influence of acute hypervolemic hemodilution(HHD)on pharmacokinetics of propofol.Methods Sixteen ASA Ⅰ or Ⅱ patients aged 20-55 yrs undergoing elective surgery under general anesthesia combined with epidural analgesia were randomly allocated into 2 groups(n=8 each);Ⅰ control group and Ⅱ HHD group.The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg.Right internal jugular vein was cannulated for CVP monitoring and blood sampling.Radial artery was cannulated for BP monitoring.All patients in both groups received lactated Ringer's solution(0.7 ml?kg~(-1)? number of hours of fasting before operation)before induction of general anesthesia.In HHD group 4% gelofusine 20 ml?kg~(-1) was infused at the rate of 20 ml?kg~(-1)?h~(-1).Anesthesia was induced with midazolam 0.04 mg?kg~(-1),fentanyl 4 ?g?kg~(-1) and propofol 1.5 mg?kg~(-1).Tracheal intubation was facilitated by succinylcholine 2 mg?kg~(-1).Anesthesia was maintained with isoflurane,fentanyl,vecuronium and epidural analgesia.ECG,BP, SpO_2,P_(ET)CO_2 and CVP were continuously monitored.Blood samples were taken at 1,2,4,6,10,15,30,45, 60,75,90,120,150,180,240,300 and 360 min after propofol was given Ⅳ for determination of plasma concentration of propofol(HPLC).Pharmacokinetic data were analyzed by 3P97 pharmacokinetic software.Results The two groups were comparable with respect to demographic data.Blood propofol concentrations were significantly lower in HHD group than in control group at 1,2,4,6,10 min after propofol injection(P＜0.01), thereafter there was no significant difference in plasma propofol concentration between the two groups(P＞0.05). The pharmacokinetic profile of propofol was well described by a standard three-compartment model.In HHD group V_C was significantly increased,K_(10) and Cl were significantly decreased and T_(1/2?) was significantly prolonged as compared with control group.Conclusion Acute HHD increases V_C,prolongs the T_(1/2?) and decreases K_(10) and Cl, suggesting that the effect of propofol may be potentiated by acute HHD.

Objective:To explore the effect of propofol on the tPA release of hippocampal neurons in developing mice ,so as to investigate whether exogenous tPA could reverse the propofol‐induced neurotoxicity on developing neurons .Methods : The hippocampal neurons of developing mice cultured in vitro were divided into 4 groups(n= 20 each):control group(group C) , propofol group(group Pro) ,group tPA and propofol plus tPA group(group Pro+ tPA) .There was no specific treatment in group C .In group Pro ,propofol was added to the culture media with the final concentration of 5 ,10 ,30 μmol/L ,respectively , and the cells were then incubated for 1 h ,2 h ,3 h ,6 h ,respectively .In group tPA ,tPA was added to the culture media with the final concentration of 1 μmol/L ,and the cells were then incubated for 6 h .In group Pro+ tPA ,both propofol and tPA were added to the culture with the final concentration of 10μmol/L and 1μmol/L ,respectively ,and the cells were then incubated for 6 h .The neuron apoptosis rate and the expression level of actived‐caspase‐3 protein were detected in each group .Results:Compared with that in group C ,the apoptosis rate and the expression level of actived‐caspase‐3 protein in group Pro significantly increased (P< 0 .05) .The tPA level in group Pro was significantly higher than that in group C (P< 0 .05) . Compared with that in group Pro ,the apoptosis rate and the expression level of actived‐caspase‐3 protein in group Pro+ tPA significantly decreased (P< 0 .05) .Conclusions :Propofol induces neurotoxicity on hippocampal neurons of developing mice cultured in vitro by inhibiting neuronal tPA release .And exogenous tPA could partially reverse propofol‐induced neurotoxicity .