ObjectiveTo investigate the efficacy of intravenous parecoxib combined with femoral nerve block on postoperative analgesia and knee functional rehabilitation in elderly patients following total knee replacement.MethodsForty elderly patients with osteoarthritis schedu[ed for total knee arthroplasty under general anesthesia,aged 65-74 years,weighing 45-90 kg,ASA [Ⅱ,were randomly divided into two groups( n ＝ 20 each).FNB group received femoral nerve blockade for postoperative analgesia ( local injection of 0.25 ％ ropivacaine 25 ml at the end of surgery,repeated every 8 h up to 72 h after surgery).FNB-Pa group received the femoral nerve blockade plus the parecoxib (administered Ⅳ bolus of 40 mg 30 min before the end of surgery,12,24,and 48 h after surgery respectively).Pain was scored at rest or during continuous passive motion using Visual Analog Scale (VAS).The Hospital for Special Surgery (HSS) knee score was determinated before surgery,at 24,48 and 72 h after surgery respectively.Side effects were also recorded in both groups.Results VAS score was significantly lower at rest and during continuous passive motion in FNB-Pa group than in FNB group ( P < 0.05).Compared with baseline value,HSS score increased significantly during postoperative analgesia in both groups( P < 0.05 or 0.01 ).HSS score were significantly higher at 48 h and 72 h after surgery in FNB-Pa group than in FNB group ( P < 0.05).No severe related side effects occured in both groups.ConclusionFemoral nerve block in combination with intravenous parecoxib can safely and effectively relieve the static and dynamic pain after total knee replacement and is helpful for rehabilitation of the prosthesis knee joint function after surgery.

AIM:To investigate the effects of propofol on ammonia-induced neocortical astrocyte aquaporin-4 expression in rats and its mechanism. METHODS:Astrocytes were separated from newborn Sprague Dawley rats. Glial fibrillary acidic protein,the specific protein of astrocyte,was labeled by cell immunofluorescence method. The purity of astrocyte achieved to 95% was considered to be used in the study. Grouping:cultured astrocytes were randomly divided into 5 groups (n=3):normal control group (N); ammonia-incubated for 24 h group (NH_4Cl-24 h); p38 antagonist SB203580 (10 μmol/L) pretreated group (SB); propofol (10 μmol/L) pretreated group (P); solvent (DMSO) control group (C). SB203580,propofol and DMSO were pretreated for 30 min before astrocytes were exposed to NH_4Cl. Cell morphology was assessed by light microscopy. The expression of aquaporin-4; p38 and p-p38 were detected by Western blotting. RESULTS:Astrocytes were found significant swelling when exposed to 5 mmol/L NH_4Cl in NH_4Cl-24 h group compared to control group. Pretreatment with propofol and SB203580 decreased astrocyte swelling. No significant change in total p38 in all groups was observed (P>0.05) by Western blotting analysis,while the levels of p-p38 and AQP4 in group SB and group P were significantly decreased compared to group C and group NH_4Cl-24 h (P<0.05).CONCLUSION:The expression of AQP4 is regulated by p38 pathway. Propofol pretreatment down-regulates aquaporin-4 expression through preventing the ammonia-induced p38 phosphorylation.

Objective To investigate the changes in pulmonary gas exchange and intrapulmonary shunting during orthotopic liver transplantation (OLT) without veno-venous bypass. Methods Sixteen ASA III-IV patients with end-stage liver diseases were studied. Anesthesia was induced with midazolam 0.1 mg ? kg-1 , fentanyl 10 ?g kg -1 , scopolamine 0.6 mg, and vecuronium 0.1 mg ? kg-1 and maintained with isoflurane and propofol infusion (2-3 mg? kg-1h-1 ) supplemented with intermittent iv boluses of midazolam, fentanyl and vecuronium. The patients were intubated and mechanically ventilated with 100% O2 Swan-Ganz catheter was inserted via right internal jugular vein. Radial artery was cannulated. MAP, HR, ECG, CVP, SpO2 and PET CO2 were continuously monitored. Body temperature was maintained at≥35.5℃ during operation. Blood samples were taken from radial and pulmonary artery for blood gas analysis. P(A-a) O2 and Qs/Qt were calculated immediately before operation (T1 ), cross-clamping (T2) and unclamping of inferior vena cava and portal vein (T3 ) , 5 min (T4) and 90 min (T5 ) after graft reperfusion and at the end of operation (T6). Results P(A-a) O2 and Qs/Qt were both higher than normal value at T1 . PaCO2, P(A-a) O2 and Qs/Qt increased significantly at T3 and T4 as compared with those at T2 P(A-a)O2 and Qs/Qt were significantly decreased at T5 and T6 as compared with those at T3 and T4 Qs/Qt was positively correlated with P(a-A) O2 and PAP. Conclusion There is a certain degree of intrapulmonary shunt before and during orthotopic liver transplantation without veno-venous bypass. The amount of fluid infused should be strictly controlled during anhepatic phase.

Objective To compare the cardiomyocyte apoptosis and early postoperative recovery in patients undergoing cardiac valve replacement under propofol-or midazolam-combined anesthesia.Methods Forty NYHA class Ⅱ or Ⅲ patients (aged 48-64 yr and weighing 45-78 kg) undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) were randomly divided into midazolam group (Group M) and propofol group (Group P) (n=20each). The patients were premedicated with morphine 0.1 mg/kg i.v. and scopolamine 0.3 mg i.v. Anesthesia was induced with midazolam 0.2 mg/kg (in Group M) or propofol 2 mg/kg (in Group P) combined with fentanyl 10 μg/kg and vecuronium 0.1 mg/kg, and maintained with propofol 5 mg. kg-1·h-1 (in Group P) or midazolam 0.1 mg·kg-1·h-1(in Group M) and intermittent i.v. boluses of fentanyl and vecuronium after tracheal intubation. The patients were mechanically ventilated with PETCO2 maintained at 35-45 mm Hg. Myocardial tissues were obtained from the right atrium before and after CPB for determination of apoptosis in cardiomyocytes (by TUNEL). The apoptotic index was calculated. The expression of caspase-3 and caspase-9 was determined by immunohistochemical avidin-biotin-peroxidase complex (ABC) technique staining. The mean airway pressure (MAP) and heart rate (HR) were monitored. Aortic cross-clamping time, surgical and CPB times, spontaneous recovery of normal heart beat, emergence from anesthesia, extubation time and duration of ICU stay were recorded and compared between the two groups.Results The percentage of spontaneous recovery of normal heart beat after release of aortic cross clamp was significantly higher and the need for dobutamine support was significantly less in Group P than in Group M ( P ＜ 0.05). The emergence from anesthesia was significantly more rapid, the extubation time and the ICU stay were significantly shorter in Group P than in Group M (P＜0.05). There were no significant differences in apoptosis index and expression of caspase-3 and caspase-9 before CPB between the two groups. The apoptosis index and expression of caspase-3 and caspase-9 were significantly increased after CPB in Group M and significantly higher than those after CPB in Group P (P＜0.05).Conclusion Cardiomyocyte apoptosis in patients undergoing CPB can be inhibited and the postoperative recovery is more rapid under propofol-combined anesthesia.

ObjectiveTo evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation.MethodsForty-five ASA Ⅰ or Ⅱ patients with stomach cancer ( n =15) or colorectal cancer ( n =30) aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study.The 30 patients with colorectal cancer were randomly divided into 2 groups ( n =15 each):group control (group Ⅰ ) and group lumbar epidural group(group Ⅱ ).The 15 patients with stomach cancer received thoracic epidural block (group Ⅲ ).Epidural block was performed at L2.3 interspace in groups Ⅰ and Ⅱ and at T9.10 interspace in group Ⅲ.After a test dose of 3 ml 1.5％ lidocaine,a bolus of 1.5％ lidocaine 12 ml (in groupsⅡ and Ⅲ ) or 12 ml of normal saline (in group Ⅰ ) was injected into epidural space.Target-controlled infusion(TCI) of propofol was started at 12 min after epidural lidocaine.Target plasma concentration of propofol was set at 4 μg/ml.Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness.Tracheal intubation was facilitated with vecuronium 0.1 ng/kg.The patients were mechanically ventilated.Radial artery was cannulated for direct BP monitoring and blood sampling.BIS value was monitored (Aspect Medical System).The number of spinal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI.Arterial blood sampies were collected at 2,3,4 and 5 min of propofol TCI for determination of plasma concentration of propofol ( by HPLC).BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI.ResultsThe BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ and in group Ⅲ than in group Ⅱ.There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump.ConclusionThe efficacy of thoracic epidural block enhancing propofol sedation is higher than that of lumbar epidural block.

Objective To examine the relationship between the perioperative changes in cytokines and the postoperative complications after esophagecotomy. Methods Twenty-five ASA Ⅱ-Ⅲ patients undergoing esophagectomy were divided into two groups: group A without postoperative complication (n = 17), group B with postoperative complications including pulmonary infection (in 2 patients), pleural effusion (in 3 patients), cardiac arrhythmia(in 2 patients) and anastomosis hemorrage(in 1 patient) (n = 8). Blood samples were taken before anesthesia(T0 ), at skin incision(T1), 2h after chest was opened(T2 ), 60 min after lungs were inflated (T3) and 1,4, 24h after surgery (T4, T5, T6 ) for determination of serum IL-6, IL-8 and IL-10 concentrations. The durations of SIRS, the definition of which was set by American College of Chest Physicians /Society of Critical Care Medicine (ACCP/SCCM), was also recorded. Results The demographic data including age, sex and body weight were comparable between the two groups. There was also no significant difference in preoperative lung function, duration of surgery, blood loss during surgery and duration of unilateral lung ventilation between the two groups. The duration of SIRS was shorter in group A than that in group B. In both groups serum IL-6 and IL-8 levels increased significantly at T2 (after thoracotomy) reached their peak values at T4, and then gradually declined but were still significantly higher than the baseline values(T0). The serum IL-6 level was significantly higher at T6 (24h after surgery) in group B than that in group A. The serum IL-8 level was significantly higher at T3-6 in group B than that in group A. The IL-6/IL-10 and IL-8/IL-10 ratio were significantly lower at T5-6 in group A than those in group B. Conclusions The postoperative complications may occur due to the inflammatory response, and/or anti-inflammatory mediators insufficiency. The IL-6/IL-10 and IL-8/IL-10ratio may be of value in predicting the prognosis.

Objective To investigate the kinetics processes of TLR2 and TLR4 in CD14~+ monocyte of patients during and after cardiac surgery with cardiopulmonary bypass(CPB) and the effects of dexamethasone(DXM) on the regulation of TLR2 and 4 in CD14~+ monocyte. Methods Twenty patients undergoing elective atrial/ventricular septal defect correction were randomized to received 1 mg/kg dexamethasone or placebo before induction of anesthesia. The CD14~+ monocyte surface TLR2 and TLR4 and the intracellular HSP70 were stained and analyzed by flow cytometry, and plasma level of TNF-?, IL-6, IL-10, NO and MDA were measured at following times: before the dexamethasone or placebo were administer(T1), before starting CPB(T2), immediately after aortic declamping(T3), 30min after aortic declamping(T4), 5h after skin closure(T5) and 24h after skin closure(T6). Results Both the HSP70~+ TLR2~+ monocytes and HSP70~+-TLR4~+ monocytes,the plasma concentration of TNF-?, IL-6, NO and IL-10 were upregulated after introduction (P

Objective To examine the changes in the difference between the target and actually measured plasma concentrations of propofol administered by target-controlled infusion (TCI) during the three phases (preanhepatic, anhepatic, neohepatic) of orthotopic liver transplantation. Methods Ten ASA Ⅲ-Ⅳ patients aged 30-54 yr, weighing 56-79 kg undergoing orthotopic liver transplantation were enrolled in the study. The patients were unpremedicated. Radial artery was cannulatecl and Swan-Ganz catheter was placed via right internal jugular vein. BP, ECG, SpO2 , PCT CO2, PAP, PCWP, body temperature and blood gases, electrolytes and glucose were monitored during operation. Anesthesia was induced with scopolamine 0.6 mg, midazolam 0.05 mg ? kg , etomidate 0.2 mg ? kg-1 , fentanyl 5 ?g ? kg-1 and rocuronium 0.6 mg ? kg -1 . Propofol was given with the TCI system after induction. Target plasma propofol concentration was set at 0.5 ?g ? ml -1 which was maintained during operation. Arterial blood samples were taken after equilibrium between plasma and effect site concentrations had been reached and during the three phases of orthotopic liver transplantation. Plasma propofol concentration was measured by high-performance liquid chromatography with fluorescence detection. Results One patient was excluded from data analysis because TCI propofol was stopped during operation. The average measured plasma propofol concentration in the nine patients were significantly higher during anhepatic phase than those during preanhepatic and neohepatic phases ( P

Objective To investigate the effects of inverse ratio ventilation with positive end expiratory pressure (PEEP) on pulmonary function and inflammatory cytokine in patients undergoing pulmonary lobectomy during one-lung ventilation.Methods Eighty patients with one-lung ventilation,52 males,28 females,aged 37-65 years,BMI 21-29 kg/m2,ASA grade Ⅱ,were randomly divided into inverse ratio ventilation (IRV) group and conventional ventilation (CV) group (n=40 each).Patients were all implemented into the program of general anesthesia,and ventilated with different modes.The IRV group were ventilated with a actual tidal volume (VT) of 7 ml/kg,respiratory rate of 12 breaths/min,I:E of 2:1,PEEP 5 cm H2O;in CV group with I:E of 1:2.Respiratory parameters were recorded at baseline (T0),5 min after anesthesia (T1),initiate of one-lung ventilation (T2),45 min of one-lung ventilation (T3) and the end of surgery (T4).Arterial blood was collected to analyze blood gas at T0 and T3 respectively.Meanwhile,oxygenation index was calculated.The concentrations of IL-6,IL-8 and IL-10 in bronchoalveolar lavage fluid (BALF) were measured with fiberoptic bronchoscope by enzyme-linked immunosorbent assay (ELISA).Results Compared with CV group,PaO2was significantly increased and levels of IL-6,IL-8 and IL-10 in BALF were significantly decreased at T3 in IRV group (P<0.05);Ppeak and Pplat were significantly decreased at T1-T4 in IRV group (P<0.05);PEEP,Pmean and CL at T1-T4 were significantly increased at T1-T4 in IRV group (P<0.05).Two cases (5.0%) of hypoxemia were found in CV group,one case (2.5%) of hypoxemia was found in IRV group,but there were no statistically significant differences in both groups.Two groups were not seen to complications such as delay,atelectasis and pneumothorax.Conclusion The oxygenation and hypoxemia were improved and inflammatory cytokine was released in patients with one-lung ventilation.

Objective To evaluate the accuracy of an expiratory resistance device assisting pulse pressure variation (PPV) in predicting volume responsiveness in the spontaneously breathing patients.Methods Forty spontaneously breathing patients of both sexes,aged 22-61 yr,weighing 51-73 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective operation,were enrolled.Before induction of anesthesia,mean arterial pressure (MAP),heart rate (HR),central venous pressure (CVP),cardiac index (CI) and pulse pressure variation (PPVB) were recorded after haemodynamics were stable.Then the expiratory resistance device was used,and MAP,HR,CVP,CI,and PPVA were recorded.The device was then removed.Volume expansion was carried out.6％ hydroxyethyl starch 130/0.4 6 ml/kg was infused over 10 min.MAP,HR,CVP,CI and PPVB were recorded within 3 min after volume expansion.The device was used again,and 1 min later MAP,HR,CVP,CI and PPVA were recorded.The device was then removed.The patients were divided into 2 groups according the percentage of increase in CI after volume expansion (△ CI):△ CI≥ 15％ considered to be a positive response group (group P),and ACI＜15％ considered to be a negative response group (group N).A receiver-operating characteristic (ROC) curve for PPV was plotted.According to the ROC curve,the diagnostic threshold,sensitivity,specificity,area under the curve,and 95％ confidence interval of the expiratory resistance device assisting PPV in predicting volume responsiveness were determined.Results The area under the curve (95％ confidence interval) of PPVA was 0.880 (0.70-0.98),the diagnostic threshold was 13.5％,and the sensitivity and specificity in determining volume responsiveness were 87％ and 88％,respectively.Compared with the value before administration of the loading dose,the CVP and CI were significantly increased,and PPVB and PPVA were decreased after volume expansion in group P,and the CVP and CI were significantly increased after volume expansion in group N (P＜0.05).Compared with group P,the PPVA was significantly decreased before volume expansion,and the CI was increased after volume expansion in group N (P＜0.05).Conclusion The expiratory resistance device can assist PPV in predicting volume responsiveness in the spontaneously breathing patients.