Objective To investigate the changes in BIS values induced by TCI of sufentanil at different target concentrations (Cr) during propofol anesthesia. Methods Fifty ASA Ⅰ or Ⅱ patients aged 18-57 yr undergoing elective surgery under general anesthesia were randomly divided into 5 groups (n = 10 each) based on CTof sufentanil: 0.07, 0.10, 0.14, 0.20 and 0.28 ng/ml. BIS, ECG, HR, MAP, SpO2, PET CO2 were continuously monitored. Anesthesia was induced with propofol TCI. The initial target plasma concentration (Cp) was set at 3.0 μg/ml. If the patient remained conscious 5 rain after the equilibrium between Cp and target effect-site concentration (Ce) was achieved, the Cp of propofol was increasing in increments of 0.3 μg/ml until consciousness was lost (LOC). Propofoi TCI was maintained at this level and Cp and Ce were recorded. TCI of safentanil was then started at the different Cp set in the 5 groups. When the equilibrium between Cp and Ce of safentanil was achieved, tracheal intubation was facilitated with succinyl choline 1.5 mg/kg and the patients were mechanically ventilated (VT= 8-10 mi/kg, RR = 8-12 bpm, PETCO2 = 30-35 mm Hg). BIS value, HR, MAP, SP and DP were recorded before induction of anesthesia at LOC (T0) and 1,2, 3, 4, 5 and 6 min after sufentanil TCI was started. Results There was no significant difference in Cp and Ce of propofol at LOC (T0) among the 5 groups. BIS value was decreasing after the beginning of TCI of sufentanil and was significantly lower than the BIS value at T0. The changes in BIS value was negatively correlated with the Cp and Ce of sufentanil. Conclusion TCI of sufentanil can decrease BIS value further during propofol anesthesia.

Objective To investigate the effects of three different effect-site concentration (Ce) of sufentanil given by TCI on the minimum alveolar concentration of sevoflurane for blunting adrenergic responses to skin incision(MAC_(BAR))in patients undergoing abdominal surgery.Methods Eighty ASAⅠ orⅡ patients,aged 20-60 yr,body mass index<30 kg/m~2,undergoing elective abdominal surgery,were randomly divided into 4 groups(n=20 each):control group(group so)and 3 sufentanil groups(group S_1,S_2,S_3).The patients were unpremedicated.Anesthesia was induced with TCI of propofol(target plasma concentration 3.5 μg/ml)and TCI of remifentanil(Ce 4 ng/ml).nacheal intubation was facilitated with rocuronium 0.6 mg/kg after the patients lost consciousness.The patients were mechanically ventilated.And then propofol and remifentanil were immediately stopped and anesthesia was maintained with inhalation of sevoflurane and a mixture of nitrous oxide and oxygen,fresh gas flow set at 10 L/min maintaining for at least 20 min.In group S_0,sufentanil was not given after intubation.In group S_1,S_2 and S_3,TCI of sufentamil was started after intubation at Ce of 0.12,0.18 and 0.24 ng/ml respectively.In group S_0,S_1,S_2 and S_3,sevoflurane inhalation was started with the initial end-tidal concentration of 3.0%,1.8%,1.3% and 1.1% respectively.The patients'response to skin incision was described as positive if MAP or HR increased by≥25%,or negative(MAP or HR increased by<25%).If the response was positive,the end-tidal concentration of sevoflurane for the next patient was increased by 1.2 times,while if negative,decreased by 1.2 times.The sevoflurane MAC_(BAR) was determined by up-and-down sequential trial.Results Compared with group S_0,the MAC_(BAR) of sevotlurane was significantly decreased in group S_1,S_2 and S_3(P<0.05).Compared with group S_1,the MACB_(BAR) of sevoflurane was significantly decreased in group S_2 and S_3(P<0.05).No significant difference was found in the MACB_(BAR) of sevoflurane between group S_2 and S_3 (P<0.05).Conclusion TCI of sufentanil at Ce of 0.12,0.18 and 0.24 ng/ml can significantly reduce MAC_(BAR) of sevoflurane and enhance the inhibitory effect of sevoflurane on stress response in a concentration-dependent manner.

Objective To compare the efficacy of sevoflurane combined anesthesia and propofol combined anesthesia in elderly patients undergoing abdominal surgery.Methods Sixty patients aged 65-80 yr scheduled for elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n = 30 each): sevoflurane group (group S) and propofol group (group P).Anesthesia was induced with TCI of sufentanil and propofol.The initial target effect-site concentration (Ce) of sufentanil was set at 0.25 ng/ml and initial target plasma concentration (Cp) of propofol set at 2.0 μg/ml,and then both concentrations were increased in 0.5 μg/ml increment when they reached the balance until loss of consciousness.Tracheal intubation was facilitated with rocuromitm 0.6 mg/kg and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration set at 1.0%-2.0%) in group S,TCI of prepofol (Cp set at 2-4 μg/ml) in groups P, and sufentanil by TCI ( Ce set at 0.15 ng/ml) and iv infusion of vecurenium 0.15 mg·g-1·h-1 in both groups. .BIS value was maintained at 40-60,and changes of MAP and HR were less than 30% of the baseline value in both groups.The use of vasoactive drugs during perioperative peried,time of awakening,extubation and consciousness were recorded and compared between the 2 groups.Results The usage rate of urapidil was significantly decreased,and the awakening time,extubation time and consciousness time shortened in group S compared with group P.Conclusion Sevoflurane-sufentanil combined anesthesia provides better hemodynamic stability and faster recovery than propofol-sufentanil combined anesthesia in elderly patients.

Objective To observe the postoperative analgesic effects of perioperative intravenous parecoxib in gerontal patients undergoing laparoscopic cholecystectomy. Methods A prospective,randomized, double-blind, placebo-controlled, parallel group study was performed. The 40 American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ patients (aged 60-80 years) undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly allocated to 2 groups (n = 20,each): the parecoxib group received intravenous parecoxib 40 mg at 10 minutes before incision and 12 hours and 24 hours after incision; however, the placebo group received 5 ml normal saline instead of parecoxib at the same time. The intensity of algesia was measured using visual analogue scale (VAS)scores (1-10, 0 = no pain, 10 = worst pain), and was recorded at 2, 4, 6, 12, 24 hours after operation. The patients' global evaluation of postoperative analgesia was recorded and compared between the two groups. Results The VAS scores at the different time points were significantly less in parecoxib group than in placebo group (all P＜ 0.05). The patients' global evaluation of postoperative analgesia was higher in parecoxib group than in placebo group [(8. 1 ± 1.2) scores vs.(5.2± 0. 9 ) scores, t = 7. 402, P ＜ 0. 05]. Conclusions Intravenous parecoxib can effectively relieve postoperative algesia and improve postoperative analgesia after laparoscopic cholecystectomy.

Objective To investigate the efficacy of anesthesia with propofol-remifentanil given by targetcontrolled infusion (TCI) for thymectomy in patients with myasthenia gravis ( MG). Methods Forty-five ASA Ⅰ or Ⅱ MG patients aged 16-64 yr weighing 45-95 kg undergoing thymectomy were studied. Anesthesia was induced with TCI of propofol (target plasma concentration 4 μg/ml) and remifentanil (target effect-site concentration 4 ng/ml). Thracheal intubation was performed after topical anesthesia with 2% lidocaine 2-3 ml and then the patients were mechanically ventilated. Anesthesia was maintained with TCI of propofol ( target plasma concentration 3-5 μg/ml) and remifentail (target effect-site concentration 3-6 ng/ml). Sufentanil 0.15 μg/kg was injected intravenously for analgesia 30 min before operation. The success rate of intubationat at first attempt, body movement in response to skin incision, recovery time, extubation time, extubation condition at the end of operation and cardiovascular events were recorded. Results Thracheal intubation was performed successfully in all patients. The success rate of intubation at first attempt was 100%. No body movement occurred during skin incision in the patients.Recovery time was 1.0-3.2 min and extubation time 2.6-7.0 min. All patients were successfully extubated at the end of operation. Bradycardia developed in 3 patients and hypotension in 4 patients during induction, but they all returned to normal after symptomatic treatment. Bradycardia developed in 3 patients during operation, but returned to normal after symptomatic treatment. Conclusion Anesthesia with TCI of propofol and remifentanil can be used safely and effectively in MG patients undergoing thymectomy.

Objective To investigate the pharmacodynamics of sufentanil required to inhibit the body movement induced by tetanic stimulation and skin incision when combined with propofol in patients undergoing thoracic or abdominal surgery. Methods Fifty ASA Ⅰ or Ⅱ patients aged 18-57 yr undergoing elective thoracic or abdominal surgery were randomized into 5 groups sufentanil target effect-site concentration (Ce) (n = 10 each):0.07, 0.10, 0.14, 0.20 and 0.28 ng/ml groups. Anesthesia was induced with TCI of propofol at the target plasma concentration of 3.0-3.2 μg/ml. As soon as the patients lost consciousness, infusion of sufentanil with the corresponding Ce was started in the each group. One tetanic stimulus (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) was given after the target effect-site and plasma concentrations were balanced. Tracheal intubation was facilitated with succinylcholine 1.5 mg/kg. The concentrations of propofol and sufentanil were maintained until 4 min after skin incision. The body movement was observed during tetanic stimulation and skin incision. The effective effect-site concentration (EC50, EC94) of sufentanil and 95% confidence interval (CI) were calculated using probit regression analysis. Results The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation when combined with propofol were 0.12 (95% CI 0.09-0.14) ng/ml and 0.20 (95% CI 0.17-0.31) ng/ml respectively. The EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 (95% CI 0.11-0.16) ng/ml and 0.21 (95% CI 0.17-0.29) ng/ml respectively. There was no significant difference in the EC50 and EC95 of sufentanil between the two different stimuli (P ＞ 0.05). Conclusion The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) when combined with propofol were 0.12 and 0.20 ng/ml respectively, the EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 and 0.21 ng/ml respectively and there was no significant difference in the pharmacodynamics between the two different stimuli, indicating that tetanic stimulation as an alternative to skin incision can be used to evaluate the pharmacodynamics of anesthetics.

Objective To evaluate the influencing factors for postoperative odynophagia in elderly patients undergoing intraoperative transesophageal echocardiography (TEE) examination for cardiac surgery.Methods A total of 96 patients with intraoperative TEE examination for cardiac surgery was divided into two groups:the elderly group (patients aged ≥65 years,n=60) and the young group (patients aged ＜ 65 years,n =36).Clinical data were retrospectively analyzed.Postoperative odynophagia was assessed by number rating scale (NRS) scores.Characteristics of postoperative odynophagia were compared between the two groups.Influencing factors for postoperative odynophagia were analyzed by multivariable logistic regression analysis.Results The incidence of postoperative odynophagia and the average NRS score were higher in the elderly group thanin the young group [88.3％ vs.66.7％,(2.6±1.7) vs.(1.4±0.9),P＜0.05 or 0.01].Multivariate logistic regression analysis showed that preoperative oral lidocaine plasmagel,oropharyngeal mucosal injury and duration of TEE insertion were independent influencing factors for postoperative odynophagia (all P＜0.01).Conclusions The incidence of postoperative odynophagia is higher and the degree of odynophagia is more serious in elderly patients undergoing intraoperative TEE examination for cardiac surgery.Postoperative odynophagia can be relieved by applying the preoperative oral lidocaine plasmagel,reducing oropharyngeal mucosal injury and shortening the duration of TEE insertion.

Objective To evaluate the effect of neuromuscular block on the airway sealing pressure of laryngeal mask airway (LMA) i-gel in patients undergoing general anesthesia.Methods Sixty patients scheduled for elective surgery under general anesthesia with LMA i-gel were randomly allocated to one of three groups (n =20 each):control group (group C),rocuronium 0.3 mg/kg group (group R1) and rocuronium 0.6 mg/kg group (group R2).Anesthesia was induced with target-controlled infusion of propofol and remifentanil.The target plasma concentration of propofol was 3.5 μg/ml,and the target effect-site concentration of remifentanil was 3.0 ng/ml.When the patients lost consciousness and after the target plasma and effect-site concentrations were balanced,LMA i-gel was inserted to perform mechanical ventilation.After insertion of LMA i-gel,rocuronium 0.3 and 0.6 mg/kg were injected in R1 and R2 groups,respectively.The airway sealing pressure of LMA i-gel was detected immediately after insertion of LMA i-gel and at 1 min after administration of rocuronium.Results There was no significant difference in the airway sealing pressure of LMA i-gel between groups and within groups(P ＞ 0.05).Conclusion Neuromuscular block has no significant effect on the airway sealing pressure of LMA i-gel in patients undergoing general anesthesia.

Objective To compare the EC50 ～ EC95 for propofol and remifentanil targetcontrolled infusion(TCI)at loss of consciousness (LOC) and without response to a standard Hoxious painful stimulus in elderly and young adult patients.Methods A total of 102 (American society of anesthesiologists) ASA Ⅰ-Ⅱ patients undergoing elective surgery under general anesthesia were enrolled in this study and divided into control group (aged 18-64 years,n=52) and elderly group (aged≥65 yrs,n=52).Propofol TCI was started at target plasma concentration (Cp) of 1.2 mg/L and the Cp increased by 0.3 mg/L every 30s until loss of consciousness (LOC),kept the target effectsite concentration (Ce) of propofol at LOC.Remifentani TCI was started at Cp of 2.0 μg/L,increased by 0.3 μg/Levery 30s until loss of somatic response to a tetanic stimulus (50Hz,80mA,0.25ms,4s) Cp,Ce,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean artery pressure (MAP) and heart rate(HR) were recorded.The Ce of propofol at LOC,the Ce of remifentanil at loss of somatic response to noxious stimulus in 50％-95％ of the patients (EC50-EC95),and 95％ confidence interval were determined by probit method.The adjustment required for TCI propofol with remifentanil in elderly patients was explored.Results In elderly group,the propofol Ce at LOC was (2.0±0.3) mg/L,significantly lower than that in control group (2.9±0.2) mg/L (t=6.168,P＜0.01) and EC50-EC95 of remifentanil at loss of somatic response to noxious stimulus in elderly group (3.5-5.4) μg/L was similar to that in control group (3.7-5.9) μg/L.Conclusions For TCI propofol and remifentanil in elderly patients,the requirement of Ce of propofol is significantly decreased and Ce of remifentanil required in elderly patients is similar to adult patients.

Objective To explore the feasibility and safety of fentanyl, sufentanil or remifentanil combined with target-controlled infusion (TCI) of propofol for sedation in the elderly undergoing colonoscopy. Methods In this prospective randomized study, 60 patients undergoing colonoscopy and propofol TCI were randomly assigned to group F (fentanyl), group S (sufentanil) and group R (remifentanil)(each n=20). Patients in group F received a single bolus of fentanyl, while those in group S and group R received TCI sufentanil and remifentanil separately. The blood pressure, heart rate, blood oxygen content and Bispectral index (BIS) were monitored, and all the complications were recorded. Results All patients were adequately sedated. There were no significant differences in general conditions, hemodynamics changes, sedation depth and adverse event among the three groups (all P＞0.05). Time for recovery was longer in group F [(21.3±4.6) min] than in group S [(19.9±3.3) min] and group R [(15.9±1.8) min, P＜0.05]. Conclusions For the elderly undergoing colonoscopy, sedation with fentanyl, sufentanil or remifentanil combined with propofol TCI is feasible and safe. It is more excellent for the remifentanil group at shorter discharge time.