To observe the effects pf propofol combined with fentanyl on metabolic rate of energy cxpen diture in anesthesia. Method: Thirty-one elective neurosurgical adult patients, ASA class Ⅰ-Ⅱ, received tolal intravenous anesthesia with propofol combined with fentanyh Oxygen consumption (VO_2), carbon dioxide production (VCO_2), respiratory quotient(RQ), metabolic rate(MR)were measured. Resuh: VO_2 and MR increased when patients' posture changed or there existed strong operative stimulation. VO_2 and MR during post induction were 91.09% and 91.29% of the level before anesthesia respectively(P

Objective To compare the myocardial protection effects of cold blood cardioplegia and cold crystalloid cardioplegia in patients undergoing valve replacement surgery.Methods One hundred adult patients with cardiac function Ⅱ～Ⅲ class undergoing primary elective valve replacement surgery due to rheumatic heart disease were retrospectively analyzed.For patients with cardiac arrest,cold blood cardioplegia was applied to 50 cases(Group B),and cold crystalloid cardioplegia to the others(group C).The process of heart resuscitation,the postoperative need of dopamine,the blood pressure and heart rate,the postoperative level of serum myocardial enzyme,the intensive care unit(ICU) stay after operation were collected and statistically analyzed.All the cardioplegic solution was perfused in a similar manner and topical cooling was employed simultaneously.Results There were less cases in group B than in group C who needed isoprenaline for cardiac resuscitation after clamp removal(P0.05).Conclusion The cold blood cardioplegia and cold crystalloid cardioplegia have similar myocardial protection effects on rheumatic heart disease patients with cardiac function Ⅱ～Ⅲ class undergoing valve replacement surgery.

AIM:To compare the reliability and plaque area between using high-cholesterol diet and high-cho-lesterol diet with corn oil to establish a rabbit atherosclerotic model .METHODS:Eighteen New Zealand rabbits were ran-domly divided into 3 groups (6 rabbits each):normal diet group (group C), high-cholesterol diet group (group H1) and high-cholesterol diet containing 6%corn oil group (group H2).All rabbits were fed for 12 weeks, and their body mea-sured was weighed at the end of every weeks .The serum levels of high-density lipoprotein cholesterol ( HDL-C) , low-den-sity lipoprotein cholesterol ( LDL-C) , total cholesterol ( TC) and triglyceride ( TG) were measured by automatic chemistry analyzer at 0 week and 12 weeks.At the end of 12 weeks, the thoracic aorta of 8-cm length since aortic root was isolated from the rabbit after anesthesia , and stained with Sudan IV or oil red O to verify the existence of plaque .The percentage of plaque area (PA/IA) in the intima area was further calculated by ImageJ 2x software.RESULTS:At the end of 12-week feeding, the serum levels of HDL-C, LDL-C and TC in both group H1 and group H2 were significantly higher than those in group C, and serum TG in group H2 was significantly higher than that in group C .Serum HDL-C in group H2 was signifi-cantly higher than that in group H1, but no significant difference of serum LDL-C, TC and TG between group H1 and group H2 was found .There was no plaque in the intima in group C , and plaques were observed in the intima of all rabbits in group H1 and group H2.Rabbit atherosclerotic models in both group H 1 and group H2 were established with a success rate of 100%.The values of PA/IA in group H1 [(49.74 ±18.78)%] and group H2 [(56.95 ±26.74)%] were both sig-nificantly higher than that in group C (0%), and no significant difference of PA/IA between group H1 and group H2 was observed.CONCLUSION:High-cholesterol diet with or without corn oil can establish a rabbit atherosclerotic model with a success rate of 100%after 12-week feeding , and the percentage of plaque area in the total aortic intimal area is not differ-ent in the 2 feeding methods .

Perioperative fluid management in gastrointestinal surgery is one of the key points to maintain sufficient blood perfusion and oxygen delivery for the organs, tissues and cells. Different strategies of fluid management have different influences on postoperative complications and mortality. After systematic review of related literature, we found that compared with the conventional liberal liquid administration, restricted liquid management and goal directed liquid management would benefit patients in general. With the guidance of cardiac output (CO), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV) and pulse perfusion variation index (PVI), which can dynamically monitor the reactivity to volume, individualized goal-directed liquid management was more likely to maintain the perioperative hemodynamic stability, guarantee adequate tissue and organ blood perfusion and oxygen delivery, reduce perioperative complications, and shorten the postoperative hospital stay. In addition, the potential risk of tissue hypoperfusion caused by restricted liquid management should draw the clinicians' attention. More researches are needed to explore the right timing, the appropriate type of liquid and the reasonable amount of liquid to maintain the best functional state of tissues and organs perioperatively.
Blood Pressure ; Digestive System Surgical Procedures ; Fluid Therapy ; Humans ; Perioperative Care ; Postoperative Complications ; Postoperative Period ; Stroke Volume

AIM: To investigate the effects of granulocyte colony-stimulating factor (G-CSF)-mobilized bone marrow stem cells on treatment of the myocardial infarction in experimental rats. METHODS: Three hours after injected with isoprenaline(ISO) interaperitoneally to develop acute ischemic model, rats' bone marrow stem cells were mobilized by G-CSF and migrated to the site of myocardial infarction. The hearts were harvested from 24 hours to 2 weeks after administration of ISO for histopathological examination. RESULTS: 24 hours after administration of ISO , myocardial infarct zones scattered in the pallium of the control group ,there were a large amoumt of inflammatory cells infiltration around the infarct zones and majority of them were neutrophils. The infarction in the G-CSF treatment group was milder, majority of the infiltrative cells were monocytoid; 48 hours after administration of ISO, infarct zones expanded greatly in control group, while that of the G-CSF treatment group increased just mildly; 2 weeks after administration of ISO, there was no significant scar in the G-CSF treatment group. We also found the regeneration of myocytes in the pallium. CONCLUSION: G-CSF treatment protected the ischemic myocardium and it may be used to treat the acute myocardial infarction.

Perioperative fluid management in gastrointestinal surgery is one of the key points to maintain sufficient blood perfusion and oxygen delivery for the organs, tissues and cells. Different strategies of fluid management have different influences on postoperative complications and mortality. After systematic review of related literature, we found that compared with the conventional liberal liquid administration, restricted liquid management and goal directed liquid management would benefit patients in general. With the guidance of cardiac output (CO), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV) and pulse perfusion variation index (PVI), which can dynamically monitor the reactivity to volume, individualized goal-directed liquid management was more likely to maintain the perioperative hemodynamic stability, guarantee adequate tissue and organ blood perfusion and oxygen delivery, reduce perioperative complications, and shorten the postoperative hospital stay. In addition, the potential risk of tissue hypoperfusion caused by restricted liquid management should draw the clinicians'attention. More researches are needed to explore the right timing, the appropriate type of liquid and the reasonable amount of liquid to maintain the best functional state of tissues and organs perioperatively.

Perioperative fluid management in gastrointestinal surgery is one of the key points to maintain sufficient blood perfusion and oxygen delivery for the organs, tissues and cells. Different strategies of fluid management have different influences on postoperative complications and mortality. After systematic review of related literature, we found that compared with the conventional liberal liquid administration, restricted liquid management and goal directed liquid management would benefit patients in general. With the guidance of cardiac output (CO), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV) and pulse perfusion variation index (PVI), which can dynamically monitor the reactivity to volume, individualized goal-directed liquid management was more likely to maintain the perioperative hemodynamic stability, guarantee adequate tissue and organ blood perfusion and oxygen delivery, reduce perioperative complications, and shorten the postoperative hospital stay. In addition, the potential risk of tissue hypoperfusion caused by restricted liquid management should draw the clinicians'attention. More researches are needed to explore the right timing, the appropriate type of liquid and the reasonable amount of liquid to maintain the best functional state of tissues and organs perioperatively.

Objective To explore the characteristics of respiratory parameters in patients with different body mass index during general anesthesia with tracheal intubation. Methods 102 patients scheduled for otitis me-dia surgery were divided into low weight group(B1,n=32),normal weight group(B2,n=36)and overweight or obese group(B3,n = 34 ). After general anesthesia with tracheal intubation,the tidal volume of anesthetic ma-chine wasadjusted to maintain the end tidal carbon dioxide partial pressure between 35 - 45 mmHg. At 10 min (T1),30min(T2)and 60 min(T3)after adjustment,arterial PH,arterial partial pressure of oxygen(PaO2),arte-rial carbon dioxide pressure(PaCO2),inspiratory tidal volume(VTi),expiratory tidal volume(VTe),end tidal carbon dioxide partial pressure(PETCO2),peak airway pressure(Ppeak),plateau airway pressure(Pplat)and dy-namic lung compliance(Cdyn)were recorded. Results PH and PaO2 were not significantly different at T1-3 among the three groups(P>0.05). As compared with group B1 and B2,PaCO2 was lower in group B3. In comparison with group B2,VTi,VTe and Cdyn were higher in group B1 and lower in group B3(P < 0.05). Ppeak and Pplat were lower in group B1 but higher in group B3(P<0.05). PETCO2 was higher in group B1(P>0.05)while lower in group B3 (P < 0.05). Conclusions With the increase in BMI during general anesthesia with tracheal intubation ,the VTi,VTe,Cdyn,PETCO2 and PaCO2 decrease significantly,but Ppeak and Pplat elevate markedly. BMI is a refer-ence index for setting respiratory parameters.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.