Objective To discuss Extracorporeal Membrane Oxygenation(ECMO) management method and effect during inter-hospital transport of potential cardiac death donors after cardiac death (DCD).Methods 8 potential donors after cardiac death with brain injury were supported by ECMO for inter-hospital transport.All donors were inserted Medtronic overall cannula into one side femoral artery and venous.The position of catheters were guided by ultrasound.The front-end of venous catheter located in the junction of atrium and inferior vena cava,meanwhile the front-end of artery catheter was below renal artery.100 IU/kg heparin was injected before inserting cannulas.Flow of ECMO maintained at 2.0～3.0 L/min,and oxygen flow was 2～3 L/min during ECMO supporting.When hemodynamics of potential donors were stable,patients were moved into ambulance with ECMO for inter-hospital transport.Results A total of 8 ECMO transports were performed for central circulatory collapse caused brain injury.Patients were previously cannulated and on ECMO prior to transport and transported a distance of more than 100 kilometer from our institution by ambulance.ECMO running times were 120 min,and operation process circulatory stable.Conclusion ECMO can ensure inter-hospital transport of potential donors after cardiac death safety.

Objective To observe the effects of shenfu injection (SFI) on the awakening quality of the patients with hepatitis B cirrhosis undergoing splenectomy under general anethesia. Methods Forty patients with hepatitis B cirrhosis and hepatic insufficiency (ASA classⅡ~Ⅲ) underwent splenectomy by general anesthesia. Patients were all sent into the post-anesthesia care unit (PACU) shortly after the operation with unconscious and no spontaneously breathing. They were randomly divided into two groups: SFI treatment group (Group SFI, n =20) and normal saline controlled group (Group NSC, n = 20). SFI group were treated with SFI (1 mL/kg, i. v.) in 10 minutes, and NSC group were treated with normal saline (1 mL/kg,i.v.). The time of eyes opening, extubation of tracheal catheter and the detention time of PACU were recorded. The heart rate (HR) and the average artery presses (MAP) were monitored at 4 time points: before SFI and normal saline administration, 5 min, 15 min, and 45 min after administration. The incidence of restlessness during the patients awakening period was also recorded. Results The time of eyes opening, extubation and the detention time of PACU of SFI group show no significant difference compared with the NSC group (P > 0.05). SFI and normal saline intravenous injection did not cause significant changes on HR and MAP at the time of 5 min , 15 min and 45 min compared to the time of before administration (P > 0.05). The incidence of restlessness during the patients resuscitation period in SFI group were lower than in NSC group (P < 0.05). Conclusion Shenfu injection can effectively improve the awakening quality and decrease the incidence of restlessness of the patients with hepatitis B cirrhosis undergoing splenectomy under general anesthesia during the awakening period in PACU.

Objective To determine the incidence of pre- and postoperative myocardial ischemia (MI) in patients undergoing noncardiac surgery and to identify the predictors of perioperative MI. Methods One hundred and fifty patients (99 male, 51 female) aged 42-89 yr, weighing 35-87 kg undergoing elective noncardiac surgery were enrolled in this study. Patients with left or right bundle branch block, left ventricular hypertrophy, low voltage on ECG using limb leads, being treated with digoxin or on artificial pacemaker were excluded from the study. The patients were premedicated with intramuscular atropine 0.5 mg and phenobarbital sodium 0.1 g, and were monitored continuously with dynamic ECG (DMS Holler 5.0 USA) for at least 12 h before surgery and 48 h after surgery. The incidence of MI, the number of ischemic episodes, the duration of MI and the area under the ST curve per hour were computed pre- and postoperatively. Factors that could affect MI including age, sex, weight, ASA class, history of cardiac disease, cardiac risk factors, cardiac medication, anesthesia, surgery, laboratory and other physiological data were also recorded. The potential predictors of perioperative MI were identified by univariate model and were then entered into multivariate logistic models. Results The incidence of preoperative MI was 4.7% and postoperative MI was 22.7 % . The incidence of MI and number of ischemia episodes achieved peak levels at 12-24 h after operation, while the duration of MI and the area under the ST curve peaked at 0-12 h after operation. Predictors of postoperative MI were : preoperative MI identified by ECG, age ≥ 65 yr, ASA class ≥ Ⅲ , history of angina, or hypertension or diabetes and high VAS score. Conclusion Postoperative MI usually develops on the first day after surgery. The patients at high risk for developing postoperative MI can be identified by predictors.

Objective To investigate the activity of autonomic nervous system (ANS) in elderly patients with diabetes mellitus ( DM) after non-cardiac surgery. Mehtods Thirty ASA Ⅰ-Ⅲ patients aged ≥ 60 yrs undergoing elective abdominal surgery or operation on the lower limbs were assigned to one of 2 groups ( n =15 each) : DM group and non-DM group. The patients were monitored with Holter (DMS Co, U.S. A) the day before and on the 1st and 2nd day after operation. Heart-rate variability (HRV) including total power (TP), high frequency (HF), low frequency (LF), very low frequency (VLF) and LF/HF ratio were recorded. Results TP and HF were significantly lower in DM group than in non-DM group before operation ( P

To explore the relationship between the perioperative change in erythrocytic pyruvate kinase (PK) activity and surgical hyperglycemia in the patients undergoing upper abdominal surgery under intravenous procaine balanced anesthesia. Seventeen patients with ASA grade Ⅰ～Ⅱ, being scheduled for selective cholecystectomy or subtotal gastrectomy, were randomly enrolled in our study. PK activity of erythrocytes and its pertinent modulators, such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), inorganic phosphate (Pi), magnesium, plasma glucose and serum insulin were dynamically assayed in the surgical patients receiving intravenous procaine balanced anesthesia. The results showed that PK activity was decreased significantly at 10 min and 24 hours after operation as compared with that of preoperative period. Changes in PK activity were positively correlated with ATP/ADP ratio( r =0 680, P 0 05). It is our supposition that the decreased PK activity and the disturbance of glycolytic pathway might be directly or indirectly induced by anesthesia and surgical trauma, leading to hindrance of utilization of glucose and Pi, as well as synthesis of ATP. Therefore, an inhibition of glycolytic reaction is one of the important mechanisms of "surgical hyperglycemia".

ObjectiveTo investigate the effects of combination of dexmedetomidine and sufentanil preconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts.MethodsForty male SD rats weighing 180-220 g, aged 8-10 weeks, were anesthetized with intraperitoneal 3％pentobarbital 60 mg/kg and heparin 3000 U/kg.The hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95％O2-5％CO2 at 36.5-37.5 ℃.Forty isolated rat hearts were randomly divided into 5 groups ( n =8 each):control group (group C),I/R group,dexmedetomidine preconditioning group (group DP),sufentanil preconditioning group (group SP),and dexmedetomidine + sufentanil preconditioning group (group DS).I/R injury was induced by 30 min of ischemia followed by 120 min of reperfusion.Groups DP,SP and DS received 30 min of perfusion with K-H solution containing dexmedetomidine 2.3 ng/ml,sufentanil 3.77 ng/ml and dexmedetomidine 2.3ng/ml + sufentanil 3.77 ng/ml respectively at 30 min before ischemia.Coronary flow (CF),left ventricular developed pressure (LVDP),± dp/dtmax and HR were measured at 15 min of equilibration,immediately before ischemia,at 30 min of ischemia and at 120 min of reperfusion.The superoxide didmutase (SOD) and myeloperoxidase (MPO) activities and the malondialdehyde (MDA) content in myocardial tissues and infarct size were determined at 120 min of reperfusion.Results Compared with group C,CF,LVDP, ± dp/dtmax,HR and SOD activity were significantly decreased,and MPO activity,MDA concent and infarct size were significantly increased in the other 4 groups ( P ＜ 0.05).Compared with group I/R,CF was significantly decreased in groups DP and DS,HR was significantly decreased in groups SP and DS,and LVDP, ± dp/dtmax and SOD activity were significantly increased,and MPO activity,MDA content and infarct size were significantly decreased in groups DP,SP and DS ( P ＜0.05).Compared with group DS,CF was significantly decreased and HR increased in group DP,and SOD activity was significantly decreased,CF,MPO activity,MDA content and infarct size were significantly increased in group SP (P ＜ 0.05 ),and no significant change was found in SOD and MPO activities,MDA content and infarct size in group DP ( P ＞ 0.05).Conclusion Dexmedetomidine combined with sufentanil preconditioning can reduce I/R injury in isolated rat hearts,but the myocardial protection is not further enhanced.

Objective To investigate the effect of sufentanil on anoxia/rexogenation (A/R)-induced injury to H9c2 cells incubated in high-glucose culture medium. Methods The H9c2 cells were cultured in low-glucose DMEM/F12 culture medium supplemented with 10% fetal bovine serum. The cells were seeded in 96-well or 6-well plates and randomly divided into 5 groups ( n = 12 wells each): normal glucose control group (group NC),high-glucose control group (group HC), high-glucose + A/R group (group HA/R), high-glucose + sufentanil +A/R group (group HSA/R), high glucose + naloxone + A/R group (group HNA/R). The cells were exposed to 95 % N2-5 % CO2 in an incubator at 37 ℃ for 3 h followed by 3 h reoxygenation. In group NC, the cells were incubated in low-glucose culture medium for 48 h. In group HC, the cells were incubated in high-glucose culture medium for 48 h. In group HA/R, the cells were incubated in high-glucose culture medium for 48 h before anoxia.In group HSA/R, after the cells were incubated in high-glucose culture medium for48 h, sufentanil was added to the culture medium with the final concentration of 10-9 mol/L at 15 min before anoxia. In group HNA/R, after the cells were incubated inhigh-glucose culture medium for 48 h, naloxone was added to the culture medium with the final concentration of 10-6 mol/L, 10 min later sufentanil was added with the final concentration of 10-9 mol/L at 15 min before anoxia. The cell viability was measured by MTT assay. The amount of lactic dehydrogenase (LDH) released in the supernatant and superoxide dismutase (SOD) activity were measured. Results The cell viability and SOD activity were significantly lower, while the amount of LDH released was significantly higher in the other groups than in group NC, in groups HA/R and HNA/R than in group HC, and in group HNA/R than in group HSA/R (P ＜ 0.01 ). The cell viability and SOD activity were significantly higher, while the amount of LDH released was significantly lower in group HSA/R than in group HA/R ( P ＜ 0.01 ). There was no significant difference in the parameters mentioned above between group HNA/R and group HA/R ( P ＞ 0.05). Conclusion Sufentanil can attenuate A/R-induced injury to H9c2 cells with high-glucose incubation, and the mechanism may be related to the activation of opioid receptors.

Objective To investigate the effect of pretreatment with dexmedetomidine alone or in combination with sufentanil on myocardial ischemia-reperfusion (I/R) injury in rats.Methods Fifty healthy male Sprague-Dawley rats,weighing 250-300 g,were anesthetized with intraperitoneal pentobarbital sodium 60 mg/kg.Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min of reperfusion.The rats were then randomly divided into 5 groups (n =10 each):sham operation group (group S),group I/R,dexmedetomidine pretreatment group (group DP),sufentanil pretreatment group (group SP),and dexmedetomidine + sufentanil pretreatment group (group DS).In group S the anterior descending branch was only exposed but not ligated.Dexmedetomidine 0.5μg/kg and sufentanil 0.1μg/kg were injected intraperitoneally 30 min before ischemia in groups DP and SP,respectively.Dexmedetomidine 0.5 μg/kg and sufentanil 0.1 μg/kg were injected intraperitoneally 30 min bbefore ischemia in group DS.Arterial blood samples were collected at 120 min of reperfusion for determination of serum creatine kinase (CK) and lactic dehydrogenase (LDH)concentrations.The rats were sacrificed at 120 min of reperfusion and hearts were removed for microscopic examination.Myocardial infarct size was calculated.The malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in myocardial tissues were measured.Results Compared with group S,the serum CK and LDH concentrations were significantly increased,the myocardial infarct size was enlarged,and SOD activity was decreased in the other groups,MDA content was significantly increased in groups I/R,DP and SP (P ＜ 0.05 or 0.01).Compared with group I/R,the serum CK and LDH concentrations,MDA content and myocardial infarct size were significantly decreased,and SOD activity was increased in groups DP,SP and DS (P ＜ 0.05).Compared with group DS,the serum CK concentration was significantly increased,the myocardial infarct size was enlarged,and MDA content was increased in groups DP and SP,and LDH concentration was significantly increased and SOD activity was decreased in group DP (P ＜ 0.05).The pathological changes were significantly attenuated in groups DP and SP compared with group DS.Conclusion Dexmedetomidine pretreatment can reduce myocardial I/ R injury in rats,dexmedetomidine combined with sufentanil pretreatment provides better efficacy than either alone,and inhibition of lipid peroxidation is involved in the mechanism.

Objective To investigate the effects of target-controlled infusion (TCI)of dexme-detomidine on the median effective concentration of effect-site (Ce50 )of propofol at loss of conscious-ness (LOC)in patients.Methods Sixty-four patients,28 males and 36 females,aged 20-60 years, ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery,were randomly allocated to receive dexmedetomidine of 0 ng/ml (group P),dexmedetomidine of 0.4 ng/ml (group D1),dexmedetomi-dine of 0.6 ng/ml (group D2)and dexmedetomidine of 0.8 ng/ml (group D3)for 1 5 min before TCI of propofol,n =1 6 in each group.The propofol infusion was started to provide an effect-site concen-tration of 1.0 μg/ml,and increased by 0.2 μg/ml when propofol effect-site concentration and target concentration were equilibrium until LOC.Results The Ce50 (95%CI )at loss of consciousness in groups P,D1,D2 and D3 were 2.30 (2.24-2.36)μg/ml,1.92 (1.87-1.96 )μg/ml,1.60 (1.55-1.65)μg/ml and 1.41 (1.35-1.45 )μg/ml,respectively.There was a negative correlation between the effect-site concentration of propofol-induced LOC and target concentration of dexmedetomidine (r=-0.84,P <0.01).Compared with groups P,D1 and D2,the incidence of bradycardia was higher in group D3 (P <0.05).Conclusion The Ce50 of propofol-induced LOC gradually decreases with in-creasing target concentration of dexmedetomidine.Combining propofol with dexmedetomidine of 0.4 or 0.6 ng/ml that can reduce the Ce50 of propofol-induced LOC,which is suitable for induction of an-esthesia with a lower incidence of bradycardia.

Objective To evaluate the sedative interaction between dexmedetomidine and propofol.Methods Sixty-four American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index of 19.0-25.0 kg/m2,scheduled for elective surgery under general anesthesia,were allocated into 4 groups (n =16 each) using a random number table:different target concentrations of dexmedetomidine groups (D1-4 groups).Dexmedetomidine was administered by target-controlled infusion (TCI) with the Markku model.The target plasma concentrations of dexmedetomidine were 0,0.4,0.6 and 0.8 ng/ml in D1-4 groups,respectively.At 15 min of dexmedetomidine TCI,propofol was given by TCI with Schnider model,and the initial target effect-site concentration was set at 1.0 μg/ml.After the target effect-site and plasma concentrations were balanced,the target effect-site concentration of propofol was gradually increased in increments of 0.2 μg/ml until loss of consciousness (Observer's Assessment of Alertness/Sedation Scale score was 1).The model of pharmacodynamic interaction was used to analyze the sedative interaction between the two drugs.Results There was no statistically significant difference in residual sums of squares fitted by using the model of pharmacodynamic interaction between the target effect-site concentration of propofol and target plasma concentration of dexmedetomidine at loss of consciousness (P＞0.05).The linear dimensionless parameter of pharmacodynamic interaction was 0.The median effective effect-site concentration of propofol was 2.38 μg/ml at loss of consciousness,and the median effective plasma concentration of dexmedetomidine was 2.03 ng/ml at loss of consciousness.Conclusion Dexmedetomidine and propofol interact additively in terms of sedation.