Objective To evaluate the effect of isoflurane post-conditioningon the expression of pro apoptotic proteins in the conical neurons exposed to oxygen-glucose deprivation and restoration (OGD/R) in rats.Methods Primary cortical neurons isolated from male Sprague-Dawley rats (within 24h after birth),were cultured in vitro and inoculated in 6-well culture plate (2 ml/well) at a density of 1 × 106/ml.The cells were divided into 3 groups (n =12 each) using a random number table:control group(group C),OGD/R group,and isoflurane post-conditioning group (Ⅰ group).In OGD/R group,the cells were incubated in glucose-free BBS aerated with 95 ％ N2 for 30 min followed by restoration of 2-glucose supply for 1 h.At 24 h of incubation,the cells were collected for detection of neuronal apoptosis (.using Hoechst/PI staining),caspase-3 expression (by Western blot),expression of Bid,Bim and Puma mRNA (by PCR),and expression of Bid,Bim and Puma (by Western blot).Apoptosis rate was calculated.Results Compared with S group,the apoptosis rate was significantly increased,and the expression of caspase-3 and Bid,Bim and Puma mRNA and protein was upregulated in OGD/R group.The apoptosis rate and expression of caspase-3 and Bid,Bim and Puma mRNA and protein were significantly lower in Ⅰ group than in OGD/R group.Conclusion Isofluranepost-conditioning inhibits apoptosis in the cortical neurons exposed to OGD/R through down-regulating pm-apoptotic proteins in rats.

Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in the elderly patients undergoing minimally invasive direct coronary artery bypass (MIDCAB).Methods Thirty six patients of both sexes,aged 65-78 yr,with the left ventricular ejection fraction ≥ 45％,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅰ-Ⅲ),scheduled for elective MIDCAB in the left thorax,were randomly divided into 2 groups (n =18 each):double-lumen endotracheal tube group (group D) and bronchial blocker group (group B).Anesthesia was induced with midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,fentanyl 10μg/kg and cisatracurium 0.15-0.20 mg/kg.The patients were intubated with a left-sided double-lumen endotracheal tube 5 min later in group D.The patients were intubated with a single-lumen endotracheal tube 5 min later,and then Coopdech bronchial blocker was inserted into the primary bronchus in group B.The patients were mechanically ventilated.Before induction of anesthesia,at 2 min before intubation,immediately before and after intubation,and at 1 and 2 min after intubation,mean arterial pressure (MAP),heart rate (HR),and mean pulmonary arterial pressure (mPAP) were recorded and rate-pressure product (RPP) was calculated.The requirement for vasoactive drugs was recorded during induction of anesthesia.Lung collapse developed after the pleura was opened was also recorded.Surgical exposure was scored at the end of operation.Results Compared with group D,MAP,HR RPP and mPAP were significantly decreased after intubation,the requirement for nicardipine and esmolol was decreased,and no significant change was found in the requirement for atropine and metaraminol,rate of lung collapse and score of surgical exposure in group B.Conclusion Compared with doublelumen tube,bronchial blocker can provide sufficient exposure of the surgical filed,and intubation-induced fluctuation of hemodynamics is small in the elderly patients undergoing MIDCAB.

Objective To determine the optimum dose of dexmedetomidine for lumbar plexus combined with sciatic nerve block when mixed with ropivacaine.Methods Eighty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-63 yr,weighing 47-83 kg,scheduled for elective ankle joint surgery,were randomly divided into 4 groups (n =20 each) using a random number table:ropivacaine group (group R) and different doses of dexmedetomidine mixed with ropivacaine groups (RD1-3 groups).Lumbar plexus block was performed by using psoas-compartment approach guided by a nerve stimulator.0.5％ ropivacaine 20 ml was injected in group R.0.5％ ropivacaine 20 ml containing dexmedetomidine 1.0,1.5 and 2.0 μg/kg was injected in RD1 3 groups,respectively.Labat's sciatic nerve block was performed,and 10 ml of the corresponding drug was injected in each group.The onset time and duration of sensory and motor blockade,and side effects such as cardiovascular events and excessive sedation were recorded.Results There was no significant difference in the onset time and duration of sensory and motor blockade between the four groups.The duration of sensory and motor blockade was significantly longer in RD1-3 groups than in group R,in RD2 and RD3 groups than in group RD1,and in RD3 group than in RD2 group.The incidence of over-sedation and bradycardia was significantly higher in RD3 group than in RD1.2 groups.Conclusion The optimum dose of dexmedetomidine is 1.5 μg/kg for lumbar plexus combined with sciatic nerve block when mixed with ropivacaine.

Objective To evaluate the effects of different doses of dexmedetomidine administered intranasally on the median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion in the pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged 1-3 yr,with body mass index of 20-26 kg/m2,scheduled for elective surgery under general anesthesia,were divided into 3 groups using a random number table:control group (group C),dexmedetomidine 1 μg/kg group (group D1) and dexmnedetomidine 2 μg/kg group (group D2).At 20 min before induction of anesthesia,dexmedetomidine 1 and 2 μg/kg (diluted to 1 ml in normal saline) were intranasally administered in D1 and D2 groups,respectively,and the equal volume of normal saline was intranasally administered in group C.Children were separated from their parents at 20 min after intranasal administration and admitted to the operating room.The target plasma concentration of propofol was determined by modified Dixon's up-and-down method.The initial target plasma concentration of propofol was set at 5.4 μg/ml.The target plasma concentration of propofol was increased/decreased by 10％ in the next patient according to the response to LMA insertion,and the ratio between the two successive concentrations was 1.1.Patients' sedation status and LMA acceptance were evaluated when patients were separated from their parents.Patient's satisfaction with sedation and with LMA acceptance was recorded.Probit analysis was used to calculate the EC50 of propofol inhibiting responses to LMA insertion.Results Compared with group C,the satisfactory rates of sedation and LMA acceptance were significantly increased,and EC50 of propofol inhibiting responses to LMA insertion was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the satisfactory rates of sedation and LMA acceptance were significantly increased,and the EC50 of propofol inhibiting responses to LMA insertion was decreased in group D2 (P＜0.05).Conclusion Dexmedetomidine 1 and 2 μg/kg administered intranasally both can decrease the EC50 of propofol inhibiting responses to LMA insertion in the pediatric patients,and 2 μg/kg produces better efficacy.

Objective To evaluate the efficacy of phloroglucinol combined with dyclonine hydrochloride mucilage in preventing catheter-related bladder discomfort (CRBD)during recovery from anesthesia in patients under general anesthesia.Methods A total of 120 male patients scheduled for laparoscopic cholecystectomy under general anesthesia,aged 18-60 years,weighing 46-80 kg, ASA physical status I or II,were randomly divided into 3 groups (n=40 in each group):group of combination of phloroglucinol and dyclonine hydrochloride mucilage (group P),sufentanil group (group S)and control group (group C).After induction of general anesthesia,the patients in group P were tracheally incubated and then inj ected with 5 ml dyclonine hydrochloride mucilage per urethra.In the meantime,for patients of groups S and C,equal volume of normal saline was inj ected and paraffin oil was used to lubricate for urethral catheterization.The catheter was clamped and then reopened 30 min later.At 15 min before the end of surgery,80 mg Phloroglucinol,0.10 μg/kg sufentanil and an equal volume of normal saline were injected intravenously in group P,group S and group C,respec-tively.The catheter was removed when the patients were fully awake.The awakening time and extu-bation time were recorded.In addition,Riker sedation-agiation scale (SAS)score was documented at 5 min (T1),15 min (T2),30 min (T3),1 h (T4)and 2 h (T5)after extubation.The occurrence and severity of CRBD within 2 h after surgery,as well as occurrence of nausea and vomiting and respira- tory depression were recorded.Results Compared with group C,the SAS score at T1-T4and inci-dence and severity CRBD were decreased,whereas the emergence time and extubation time were pro-longed in group S.The SAS score at T1-T5,incidence and severity of CRBD were decreased (P<0.05),and no significant change was found in emergence time and extubation time in group P.Com-pared with group S,the SAS score at T1-T4was increased,whereas the SAS score at T5,incidence and severity of CRBD were decreased,and the emergence time and extubation time were shortened in group P (P<0.05).There was no significant difference in the incidence of nausea and vomiting,re-spiratory depression and extubation time among the three groups. Conclusion Dyclonine hydrochloride mucilage injected per urethra combined with phloroglucinolol injected intravenously at 1 5 min before the end of surgery can reduce the incidence and severity of CRBD during the recovery from anesthesia in the patients under general anesthesia.

Objective:To study on the association between vasoactive-inotropic score(VIS) and mortality of total arch replacement in Stanford type A aortic dissection(TAAD) patients.Methods:Data of TAAD patients admitted from January 2018 to November 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 187 patients were finally included in the analysis. 30-day mortality was calculated and the patients were divided into death group(18 cases) and non-death group(169 cases). The VIS at each time point and perioperative indexes of the two groups were compared. The value of VIS in predicting mortality was analyzed.Results:The 30-day mortality was 9.63%(18/187). The operation time, cardiopulmonary bypass time, ventilator assistance time, the incidence of tracheotomy and major postoperative complications in the death group were significantly higher than those in the non-death group( P<0.05). VIS of death group was significantly higher than that of non-death group( P<0.05). At each time point, the area under ROC curve(AUC) of VIS was greater than 0.500( P<0.05), among which AUC of ICU 48 h VIS was the largest(0.817), and the best cut-off point of ICU 48 h VIS was determined to be 9, sensitivity 61.1%, specificity 92.3%. Logistic regression analysis showed that ICU 48 h VIS was an independent risk factor for predicting the death of total arch replacement in TAAD patients( OR=1.465, 95% CI: 1.194-1.796, P<0.001). Conclusion:When ICU 48 h VIS≥9, the risk of death was increased in patients with total arch replacement of TAAD. VIS may be a useful reference index for predicting the mortality of total arch replacement in TAAD patients in the early postoperative period.