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 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 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 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 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 determine the median effective dose ( ED50 ) of sufentanil blunting re?sponses to double?lumen endotracheal intubation when combined with propofol. Methods American Socie?ty of Anesthesiologists physical statusⅠorⅡpatients, aged 45-64 yr, with body mass index<30 kg∕m2 , of Mallampati classⅠor Ⅱ, undergoing elective thoracic surgery under general anesthesia, were enrolled. Sufentanil was injected intravenously with the initial dose of 0?6μg∕kg, and then propofol 1 mg∕kg was in?jected slowly until the patients lost consciousness. After loss of consciousness, cisatracurium 0?3 mg∕kg was injected intravenously, and propofol 0-1?5 mg∕kg was injected intermittently to maintain bispectral index value ranging from 45 to 55. A double?lumen endotracheal tube was placed at 3 min after administrattion of muscle relaxants. The dose of sufentanil was determined by modified Dixon′s up?and?down method. The dose of sufentanil was increased∕decreased by 0?1 μg∕kg in the next patient. At least 6 independent cross?over pairs were observed, and the test was completed. The response to double?lumen endotracheal intuba?tion was defined as an increase in mean arterial pressure ≥ 20% of the baseline value and∕or heart rate >90 bpm within 5 min after intubation. The ED50 and 95% confidence interval of sufentanil blunting the re?sponses to double?lumen endotracheal intubation were calculated using probit method. Results The ED50 ( 95% confidence interval) of sufentanil blunting the responses to double?lumen endotracheal intubation was 0?464 (0?309-0?580) μg∕kg. Conclusion When combined with propofol, the ED50 of sufentanil blun?ting the responses to double?lumen endotracheal intubation is 0?464 μg∕kg.

The purpose of this clinical study was to evaluate the protective effect of continuous potassic warm blood perfusion on myocardium during warm blood extraeorporeal circalation. Warm blood cardiopulmonary bypass and continuous potassic warm blood perfusion for myocardial protection were used in 39 cases undergoing coronary bypass. 15% potassium chloride was mixed with oxygenated warm blood for continuous myocardial perfusion to induce cardiac arrest. The average nasopharyngeal temperature was maintained at 33.5℃. The warm blood was delivered at a rate of 150 to 200 ml/min; 15% potassium chloride was pumped at a high flow rate of 120 to 160 ml/h and then at a low flow rate of 15 to 20ml/h when electrocardiogram showed straight line. The results showed that 38 cases (97.4%) had spontaneous return of normal sinus rhythm shortly after removal of the aortic crossclamp. Myocardial positive inotropic agents were seldom used and hemodynamics kept stable. Cardiac functions showed fast recovery and there were not serious complications such as perioperative myocardial infarction, low output syndrome and arrhythmia. It is indicated that continuous potassic warm blood perfusion for myocardial protection may have a remarkable results to prevent myocardial anoxemia and reperfusion injury during CPB.

Objective To determine the effective dose 50 (ED50) of sufentanil blunting the responses to double-lumen endotracheal intubation under propofol in elderly patients.Methods A retrospective analysis was conducted on patients aged 65-78 years with body mass index＜30 kg/m2 , American Society of Anesthesiologists (ASA) I or Ⅱ and Mallampati grade Ⅰ or Ⅱ who underwent onelung ventilation under general anesthesia.Induction of anesthesia was initiated with sufentanil.Then propofol was administered to maintain a bispectral index (BIS) value ranging between 45 and 55.When the patients lost consciousness, cisatracurium 0.30 mg/kg was administrated, followed by double lumen endotracheal intubation.The dose of sufentanil was determined by the up and down sequential test.The initial dose was 0.50 μg/kg and the difference between two successive doses was 0.10 μg/kg.Responses to double-lumen endotracheal intubation were defined as the increase in invasive systolic blood pressure≥20％ of the baseline values and/or heart rate ＞90 bpm within 3 min after tracheal intubation.The ED50 (95％ confidence interval) of sufentanil blunting the responses to double-lumen endotracheal intubation was calculated.Results The ED50 (95％confidence interval) of sufentanil blunting the responses to double-lumen endotracheal intubation in elderly patients was 0.331 μg/kg, and the 95％ confidence interval was 0.246-0.409 μg/kg.Conclusions Under propofol to maintain BIS 45 55, the ED50 of sufentanil blunting the responses to double-lumen endotracheal intubation in elderly patients was 0.331 μg/kg.

Objective To investigate the safety and efficiency of a reinforced laryngeal mask airway(LMA) with drain tube in elderly patient undergoing endoscopic sinus surgery.Methods Sixty elderly patients were selected and randomly divided into two groups:a reinforced LMA group (group R,n=30)and a reinforced endotracheal tube group(group T,n=30).Observation items include the difficulty degree of device insertion,the time for successful insertion,the number of attempts required for successful insertion,fiberoptic view of glottis,the difficulty degree of gastric tube insertion,oropharyngeal leak pressure(OLP),ventilatory indicators at a certain time,haemodynamics during insertion,the blood stain on the mask were compared between the two group.The postoperative complications 1,6,24 hours after operation were recorded.Results There were no significant differences in general conditions,the successful insertion rate at first attempt,the total success insertion rate,airway quality and the anesthetic drug dosage between the two groups.The insertion time was shorter in group R than in group T [(34.1± 13.0 s)vs (45.4± 15.6 s),t =5.274,P=0.001].The incidence of cough during extubation was less in group R than in group T [0％ (0/30) vs.53.3％(16/30),x2 =21.222,P=0.000].Conclusions The reinforced LMA with drain tube is safe and effective for elderly patients during endoscopic sinus surgery.

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.