Objective To evaluate the effects of different depths of sedation on serum adiponectin (ADP) concentrations in elderly patients undergoing general anesthesia.Methods A total of 120 elderly patients of both sexes,aged 65-83 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective noncardiac surgery under general anesthesia,were divided into Ⅰ and Ⅱ groups (n =60 each) using a random number table.Propofol was given by closed-loop target-controlled infusion,and bispectral index value was maintained at 40-50 in group Ⅰ and at 50-60 in group Ⅱ.The cognitive function was assessed by the Montreal Cognitive Assessment at 1 day before operation ant 1 and 7 days after operation.Blood samples were collected from the internal jugular vein immediately before surgery,at 2 h after the beginning of surgery and at 1 and 7 days after surgery for determination of serum ADP and S-100β protein concentrations.Results Compared with group Ⅰ,Montreal Cognitive Assessment scores were significantly increased at 1 and 7 days after surgery,the serum concentrations of ADP were increased and S-100β protein concentrations in serum were decreased at 1 and 7 days after surgery,and the intraoperative requirement for ephedrine and atropine and incidence of postoperative cognitive dysfunction were decreased during surgery in group Ⅱ (P＜0.05).Conclusion Maintaining BIS value at 50-60 can reduce the development of postoperative cognitive dysfunction,which is related to the increased concentration of serum ADP in elderly patients undergoing general anesthesia.

Objective To evaluate the effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction (POCD) in elderly patients undergoing pulmonary lobecto-my. Methods A total of 120 elderly patients of both sexes, aged 65-81 yr, of American Society of Anes-thesiologists physical status Ⅱ or Ⅲ, with New York Heart Association Ⅰor Ⅱ, were divided into 3 groups (n＝40 each) using a random number table method: anesthesia group (group GA), epidural block combined with general anesthesia group (group EG), and paravertebral block combined with general anes-thesia group (group PG). In group PG, paravertebral block was performed under ultrasound guidance, 0. 25% ropivacaine 20 ml was injected after the paravertebral catheter was placed, and anesthesia was in-duced after confirming the plane of block. In group EG, epidural block was performed with 2% lidocaine 3 ml after epidural puncture was successfully performed at L6,7interspace, epidural 0. 375% ropivacaine 8-15 ml was intermittently injected, and anesthesia was induced after confirming the height of block. Anes- thesia was induced with IV midazolam 0. 05-0. 10 mg∕kg, etomidate 0. 3 mg∕kg, sufentanil 0. 4 μg∕kg and rocuronium 0. 6 mg∕kg. The patients were tracheally intubated and mechanically ventilated. The develop-ment of POCD was recorded at 1 day before operation and 7 days after operation. Blood samples were col-lected from the internal jugular vein before anesthesia, at 15 min after skin incision and at 7 days after oper-ation for determination of serum adiponectin ( ADP) and S-100β protein concentrations. Results Com-pared with group GA, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were decreased and serum ADP concentrations were increased at 15 min after skin incision and 7 days after operation in PG and EG groups ( P＜0. 05). Compared with group EG, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were increased and serum ADP concentrations were decreased at 15 min after skin incision and 7 days after operation in group PG (P＜0. 05). Conclusion Thoracic paravertebral block combined with general anesthesia induces better efficacy in decreasing the occurrence of POCD than general anesthesia alone or combination of epidural block and general anesthesia in elderly patients undergoing pulmonary lobectomy, which is related to the decreased concentrations of blood ADP in elderly patients undergoing pulmonary lobectomy.