Objective To determine the ED50 of remifentanil needed for tracheal intubation without neuromuscular relaxant in children when combined with sevoflurane inhalation.Methods Twenty-five ASA Ⅰ or Ⅱ children of both sexes,aged 4-9 yr,scheduled for elective surgery under general anesthesia were enrolled in this study.Anesthesia was induced with inhalation of 5% sevoflurane in 100% oxygen and PETCOM2was maintained at 30-35 mm Hg.Remifentanil was injected intravenously over 30 s after 3 min inhalation of sevoflurane.Tracheal intubation was performed 90 s after the completion of remifentanil injection.The experiment was performed using the modified Dixon's up-and-down method.The initial dose of remifentanil was set at 1.2 μg/kg and the ratio between two successive doses was 1.2.Intubation conditions were assessed by a blinded observer using Viby-Mogensen scale.If the conditions were not good,roenronium 0.3 mg/kg was then injected intravenously to facilitate intubation.The ED50 of remifentanil and 95% confidence interval (95% CI) were calculated.Results The ED50 of remifentanil combined with inhalation of scvoflurane required for successful intubation was 0.68 μg/kg in the absence of neuromuscular relaxant,and 95% CI was 0.65-0.71 μg/kg.Conclusion The ED50 of remifentanil required for tracheal intubatiun without neuromuscular relaxant drug is 0.68 μg/kg (95% CI 0.65-0.71 μg/kg) when combined with 5% sevoflurane inhalation in children.

Objective To study the operative technique and effect of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa and placenta accreta. Methods Retrospective analysis was conducted on the intraoperative situation of forty-one cases and information of follow-up twenty-nine cases, which were pernicious placenta previa and placenta accreta and delivered in the First Affiliated Hospital of Zhengzhou University from May 1, 2013 to June 30, 2014. Diagnosis was confirmed by line of color Doppler ultrasound and MRI for all patients before operations. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the digital subtraction angiography operation room before cesarean. At the same time of fetal delivery, 10 ml normal saline was injected into the balloon immediately, which results in filling of the balloon and blocking of the aorta. According to the area and depth of placenta implantation and implantation or penetration of the posterior bladder wall, placenta separation, partial resection of the uterine wall and partial bladder resection and repair were performed correspondingly. Meanwhile, saline in the balloon was pumped out gradually until empty. Condition of placenta implantation, blood loss and blood transfusion volume during the operation, intraoperative and postoperative complications, the duration and dose of fetal radiation exposure, and Apgar score of neonates were analyzed. Results Among the 41 cases, penetrative placenta and implanted placenta were observed in five cases and 36 cases, respectively. The latter 36 cases including 28 cases of bladder posterior wall accreta and eight cases of bladder posterior wall penetration. For all cases, the average operation time was (68.5±15.3) min, the mean blood loss in the operation was (1 058±960) ml, among which eight received blood transfusion with an average of (600±400) ml, and the mean hospital stay was (8.2±2.3) d. Uteruses were reserved in all cases. The mean duration and dose of fetal radiation exposure was (8.1±3.6) s and (5.2±2.9) mGy, and the Apgar score of neonates was 8.7±0.5 at 1 min and 9.5±0.3 at 5 min, respectively. The patients were followed up until October 31, 2014. Among them, six were lost, six were still in puerperium, 18 were breast-feeding, and the menses of 11 had returned. Conclusion Preset abdominal aortic balloon catheter in pernicious placenta previa and placenta accrete patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.

Objective To compare HC video-laryngoscope with Macintosh laryngoscope for tracheal intubation.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index 19-27 kg/m2,Mallampati grade Ⅰ-Ⅱ,undergoing elective surgery,were randomly divided into 2 groups (n =30 each):HC video-laryngoscope group (group H) and Macintosh laryngoscope (group M).After induction of anesthesia,the patients underwent orotracheal intubation assisted by HC video-laryngoscope in group H,and by Macintosh laryngoscope in group M.The glottic exposure time,intubation time,Cormack-Lehane grade,the number of pressing the cricoid and intubation-related complications were recorded.Results The rate of satisfactory glottic exposure was significantly higher and the number of pressing the cricoid was smaller in group H than in group M (P ＜ 0.05).There was no significant difference in the glottic exposure time,intubation time and incidence of intubation-related complications between the two groups (P ＞ 0.05).Conclusion The efficacy of tracheal intubation guided by HC video-laryngoscope is better than that guided by Macintosh laryngoscope.

Objective To explore the application of temporary balloon occlusion in multidisciplinary management of cesarean sec-tion for patients with pernicious placenta previa/accreta.Methods 42 patients with a diagnosis of placenta previa /accrete accepted the temporary aortic balloon occlusion in cesarean section in DSA hybrid operation room were retrospectively studied.Before cesare-an section,intravascular balloon catheter was placed in abdominal aortic.After delivery,the midpoint of filling state balloon was placed at the midpoint of the two renal arteries openings before placental dissection.The amount of blood loss and blood transfusion, operation time,the infants'radiation doses and postoperative complications were determined.Results All patients were successfully fulfilled cesarean section and conserved uteri.The amount of blood loss,blood transfusion,operation time,occlusion time and the infants’radiation doses were (586±355)mL,(422±283)mL,(75.5±1 1.9)min,(22.4±7.2)min and (4.2±2.9)mGy,respec-tively.During follow-up,complications were not found during operation and after operation.Conclusion In women with pernicious placenta previa/accreta,temporary aortic balloon occlusion can effectively control postpartum hemorrhage and reduce the risk of un-desirable hysterectomy.

Objective To evaluate the reliability of Amsterdam Preoperative Anxiety and Information Scale (APAIS) score in evaluating the preoperative anxiety of Chinese people.Methods One hundred sixty Chinese patients of both sexes, aged 18-60 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective surgery, were enrolled.Preoperative anxiety of the patients was assessed with APAIS score and Spielberger's State-Anxiety Inventory (S-AI) questionnaire during the preoperative interview.Cronbach's alpha of total anxiety and need for information scores was calculated.Four thresholds of total anxiety score in identifying preoperative severe anxiety was set as 10, 11, 12 and 13.S-AI questionnaire was considered as the standard, and the correlation between total anxiety score and S-AI questionaire was tested.Results The Cronbach's alpha of total anxiety and need for information scores was 0.84 and 0.71, respectively.When the threshold of total anxiety score in identifying preoperative severe anxiety was 12, the total anxiety score was highly correlated with S-AI questionnaire, the Kappa value was 0.62, 95％ confidence interval was 0.46-0.78, the sensitivity was 0.71, the specificity was 0.90, and the positive predictive value was 0.78.Conclusion APAIS score can be used to assess the preoperative anxiety of Chinese people.

Objective To investigate the effects of CYP3A4* 1G genetic polymorphism on fentanyl pharmadynamics after intravenous injection in healthy female velunteers,Methods Twenty-eight healthy female volunteers aged 18-25 yr weighing 45-70 kg were enrolled in this study.The CYP3A4 * 1G genetic polymorphic sites were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).The volunteers were assigned into 3 groups according to their genotypes:group Ⅰ wild homozygote ; group Ⅱ mutation heterozygote and group Ⅲ mutation homozygote.Fentanyl 5 μg/kg was injected iv over 1 min.Pain threshold was measured using electrical stimulation before and at 45,150 and 240 min after fentanyl injection.Results Pain threshold was significantly higher at 45 and 150 min after iv fentanyl injection in mutation homozygote group than in mutation heterozygote group and wild homozygote group.There was no significant difference in pain threshold between mutation heterozygote group and wild homozygote group.Conclusion CYP3A4* 1G genetic mutation can enhance the analgesic efficacy of fentanyl after intravenous injection in healthy female volunteers.

Aortic stenosis is a valvular heart disease(VHD)mainly caused by rheumatic fever se-quelae,congenital aortic valve structural abnormalities,senile aortic valve calcification,and so on,among which calcific aortic stenosis is the chief form of aortic stenosis.Echocardiography is often used technique to evaluate and diagnose aortic stenosis in the world,the normal adults aortic valve area(AVA)≥3.0 cm2,when AVA decreases to 1/3 or more of the normal,the aortic valve forward flow will be blocked,most mild to moderate and some severe aortic stenosis patients have no clinical symptoms during daily activities.The epidemiology of aortic stenosis varies greatly in different regions,ages,genders,and races.Aortic stenosis increases the risk of perioperative cardiovascular complications in non cardiac surgery,the risk depends on VHD severity and non cardiac surgery type,the perioperative mortality of untreated severe aortic stenosis pa-tients undergoing non cardiac surgery is high.This review describes the recent progress in the diagnosis,classification,pathological mechanism,treatment and perioperative anesthesia management of aortic stenosis undergoing non-cardiac surgery.

Objective To evaluate the effects of hearing disorder factors on analgesic efficacy of propofol. Methods Ninety?five patients with hearing disorders, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-60 yr, with body mass index of 20-30 kg∕m2, scheduled for elective ear surgery, served as test group(group T). Ninety?five patients with normal hearing function, of Ameri?can Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-60 yr, with body mass index of 20-30 kg∕m2, scheduled for elective non?ear surgery, served as control group(group C). Propofol was given at the initial target plasma concentration of 1.2 μg∕ml. When the target plasma concentration was achieved, 1 min later the concentration was increased in increments of 0.3 μg∕ml. When the patients lost eyelash reflex and had no responses to clapping on the shoulder, bispectral index value and target plasma and effect?site concentrations of propofol, consumption of propofol and time for loss of consciousness were recorded. Re?sults Compared with group C, no significant change was found in bispectral index value at baseline or at loss of consciousness(P>0.05), the target plasma and effect?site concentrations and consumption of propofol were significantly decreased, and the time for loss of consciousness was shortened in group T(P<0.05). The consumption of propofol required at loss of consciousness was gradually reduced with the aggra?vated severity of hearing disorders in group T(P<0.05). Conclusion The analgesic efficacy of propofol is enhanced in the patients with hearing disorders.

Objective:To evaluate the effects of sugammadex on the quality of recovery after laparoscopic bariatric surgery in severely obese patients.Methods:One hundred and eighty patients, aged 18-65 yr, with body mass index ≥ 40 kg/m 2, undergoing elective laparoscopic bariatric surgery, of American Society of Anesthesiologists physical status Ⅲ, were enrolled and divided into 2 groups ( n=90 each) by the random number table method: sugammadex group (S group) and neostigmine group (N group). Before anesthesia, bilateral T 6 and T 9 paravertebral nerve blocks were performed, and 0.33% ropivacaine 15 ml was injected on each side.When the reappearance of T 2 was monitored under train-of-four (TOF) stimulation after the end of surgery, and sugammadex 2 mg/kg was intravenously injected in S group, and neostigmine 0.04 mg/kg and atropine 0.02 mg/kg were intravenously injected in N group.After the patient was transferred to the general ward, flurbiprofen axetil 50 mg was injected intravenously every 12 h, and oxycodone and flurbiprofen axetil were used for patient-controlled intravenous analgesia at the same time.When the numerical rating scale (NRS) score ≥4 and the analgesic pump was ineffective, bilateral T 7 paravertebral nerve block was performed for rescue analgesia, and 0.33% ropivacaine 15 ml was injected on each side.The postoperative quality of recovery was assessed by the 15-item Quality-of-Recovery scale before operation and at 24 h after operation.The TOF ratio ≥ 0.9 and extubation time were recorded.The SpO 2 at the time of transfer to post-anesthesia care unit (PACU), the lowest SpO 2 and occurrence of SpO 2 < 92% during PACU were recorded.The occurrence of residual muscle relaxation and Ramsay sedation score were recorded at 30 min after entering PACU.The time of PACU stay, time to the first off-bed activity and length of hospital stay were recorded.The cumulative consumption of oxycodone, requirement for rescue analgesia, dizziness, nausea and vomiting, hypoxemia, and pulmonary complications were recorded within 48 h after operation. Results:There were no significant differences in the total score of 15-item Quality-of-Recovery scale before surgery and at 24 h after surgery, cumulative consumption of oxycodone within 48 h after surgery, rate of rescue analgesia, and incidence of dizziness, nausea and vomiting, hypoxemia and pulmonary complications between the two groups ( P>0.05). Compared with N group, the scores of the three recovery indicators (feel energized with enough rest, engagement in work or family activities, and tension and anxiety) were significanatly increased, time to TOF ratio ≥ 0.9, extubation time, time of PACU stay, time to the first off-bed activity and length of hospital stay were shortened, and the incidence of residual muscle relaxation was decreased in S group ( P<0.05). Conclusions:Antagonizing residual muscle relaxation with sugammadex is helpful for the recovery of severely obese patients after laparoscopic bariatric surgery.

Objective:To evaluate the hemostatic effects of our self-designed pelvic band with inflatable balloon in a swine model of hemodynamically unstable pelvic fracture.Methods:"Open-book like" fractures were created with the external iliac blood vessels exposed in 24 12-month-old female Bama miniature pigs which were randomly divided into 4 groups ( n=6). Group C (the control group) was subjected to no treatment other than exposure of the external iliac blood vessels, group D to no treatment following destruction of the external iliac blood vessels, group T1 to fixation with simple pelvic band after destruction of the external iliac blood vessels, and group T2 to fixation with our self-designed pelvic band with inflatable balloon after destruction of the external iliac blood vessels. The 4 groups were compared in terms of 40-min survival rate, bladder pressure, peak lactate value, total blood loss, bleeding rate, infusion rate, and angiographic images. Results:There was no significant difference in the baseline indexes among the 4 groups before experiment, showing comparability ( P>0.05). The 40-min survival rate in group T2 was 83.3% (5/6), significantly higher than that in groups D and T1 [0% (0/6) and 0% (0/6)] ( P<0.05). There were no significant differences among groups C, D, T1 and T2 in bladder pressure [(6.67±1.03) mmHg, (5.83±1.94) mmHg, (6.00±1.55) mmHg, and (6.00±1.10) mmHg] or in total blood loss among groups D, T1 and T2[(1,198.0±182.9) mL, (1,252.0±148.4) mL, and (1,150.0±125.7) mL] (all P>0.05). The peak lactate value in group T2 [(2.26±0.24) mmol/L] was significantly lower than that in group D [(5.00±0.60) mmol/L] and group T1 [(3.86±0.57) mmol/L], and the bleeding rate and infusion rate in group T2 [(25.83±5.49) mL/min and (26.00±4.69) mL/min] were also significantly lower than those in group D [(83.50±19.85) mL/min and (71.50±29.11) mL/min] and group T1 [(54.17±15.59) mL/min and (54.17±8.98) mL/min] (all P<0.05). Angiography showed contrast agent extravasation in group T2, especially from the artery, but the extravasation speed in group T2 was significantly slower than that in group D. Conclusion:In a swine model of hemodynamically unstable pelvic fracture, our self-designed pelvic band with inflatable balloon has a definite hemostatic effect on vascular injury which is better than that of a simple pelvic band.