1) in group R was shortest among the four groups Conclusions Combination of clonidine with local anesthetics in subarachnoid block is effetive and safe, 50?g clonidine can improve the effects of ropivacaine without significant change in hemodynamics

Objective To compare clinical effects of continuous spinal, epidural and combined spinal-epidural anesthesia for arthroplasty in the elderly over 70 years. Methods Sixty geriatric patients, ASA status Ⅱ~Ⅲ degree, aged 71~98 yr, undergoing arthroplasty operation on hip or knee joint, were randomly assigned to group of continuous spinal anesthesia, group of combined spinal-epidural anesthesia, or group of continuous epidural anesthesia, with twenty patients of per group. T_ 10 anesthesia level was aimed by 0.5% bupivacaine titrated carefully. Results All anesthesia were clinically satisfied with average anesthesia level T_ 10(T_ 7~11). Bromage's motor blockade scale in group of continuous spinal anesthesia was higher than that in group of continuous epidural anesthesia. Amount of bupivacaine consumptions were (8.0?1.8)mg, (13.7?9.7)mg, (39.4?16.6)mg in groups of continuous spinal anesthesia, combined spinal-epidural anesthesia, and continuous epidural anesthesia respectively (P0.05). Conclusions With 0.5% bupivacaine titrated carefully, all kinds of continuous spinal, epidural and combined spinal-epidural anesthesia are clinical efficient in the elderly over 70 years for arthroplasty, of which continuous spinal anesthesia is recommended due to the most stable hemodynamics.

Objective To investigate the effect of morphine on P-glycoprotein (P-gp) expression in mouse brain microvascular endothelial cells. Methods The mouse brain microvascular endothelial cell line b. End3 was purchased from ATCC company (USA) and cultured at 37 ℃ in high glucose serum-free medium RPMI 1640 in 10 cm petri dishes and assigned to one of 3 groups(n = 9 each): Ⅰ control group (group C); Ⅱ morphine group (group M) and Ⅲ PDTC + morphine group (group P + M). In group M the cells were exposed to morphine 1 μg/ml while in group P + M the cells were pre-incubated with PDTC (NF-κB inhibitor) 5 μmol/L for 1 h before treatment with morphine. In group M and P+ M after being treated with morphine 1 μg/ml for 24 h, the cells were collected for determination of P-gp expression and NF-κB p65-abcb1b protein-DNA binding analysis. Results P-gP expression and NF-κB p65-abcb1b protein-DNA binding were up-regulated in group M as compared with group C. The up-regulation was negated by pre-incubation with PDTC in group P + M. Conclusion Morphine can induce up-regulation of the expression of endogenous P-gp in mouse brain microvascular endothelial cells by NF-κB mediated-abcb1 b gene activation.

Objective To evaluate the role of microglial activation in dorsal root ganglia in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR).Methods Seventy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 2 groups (n =35 each):group sham operation (group S) and group SMIR.The rat model of persistent postoperative pain evoked by SMIR was established according to the method described by Flatters.Pain behavior was assessed by mechanical paw withdrawal threshold to yon Frey filament stimulation at 1 day before and 1,3,7,12,22 and 32 days after operation.Five animals were sacrificed at each time point in each group for microglia count in dorsal root ganglia.Results Compared with group S,mechanical paw withdrawal threshold was significantly decreased at 3-22 days after operation,and microglia count was significantly increased at 3-12 days after operation in group SMIR (P ＜ 0.05).Conclusion Microglial activation in dorsal root ganglia may be involved in the development of SMIR-evoked persistent postoperative pain in rats.

Objective To evaluate the different effects of laryngeal mask and mask ventilation during bronchoscopy in elder patients. Methods 120 old patients (ASA I-III) were divided into three group according to the table of random number as following:surface anesthesia with autonomous respiration (group I);endoscope mask ventilation (group II);laryngeal mask airway ventilation (group III). Oxygen inhalation through nasal tube in groupⅠ,group II and group III was ventilated with endoscope mask and LMA respectively ,thenwe observed whether there were adverse effects or not during the procedure. Results The adverse reactions of group I were more than other groups. Compared with the group I, variance of MAP,HR, RR, SpO2 in the groupⅡand groupⅢ had less changes, the cases with severe bucking decreased significantly, and satisfaction degree increased markedly, (P <0.01or P<0.05 ) . The incidence rate of resp iratory depression and airway obstruction in groupⅡwas higher than that in groupⅢ (P<0.05). Conclusion Endoscope mask ventilation and LMA can both be adopted in analgesia bronchoscopy for old patient. LMA under general anesthesia to transbronchial lung biopsy would control respiration according to the demand at any time.LMA has more advantage in the operation for the stable respiration and hemodynamics and less complications.

Objective To investigate the effects of skin/muscle incision and retraction(SMIR)on mechanical paw withdrawal threshold and the ability of spatial learning and memory in immature rats after adulthood. Methods 27 male SD rats aged 3 weeks and weighing 60 ~ 80 g were randomly divided into 3 groups(n = 9):control group(group C),sham operation group(group Sham)and skin/muscle incision and retraction group (group SMIR). Group SMIR received operation for skin/muscle incision and retraction. Sham group received skin/muscle incision but no retraction.No surgery was operated on C group. Pain behavior was assessed by mechanical paw withdrawal threshold(MWT)to von Frey filament stimulation before and 1,3,7,12,22 and 32 days after operation.The effects of spatial learning and memory function were assessed by Morris water-maze test at 33 days after operation. Results Mechanical paw withdrawal threshold of group SMIR decreased 1 day after operation (P<0.05)and showed no significant difference before and 3,7,12,22,32 days after operation in 3 groups(P >0.05). In Morris water-maze test,compared with Sham and C group,the average escape latency in SMIR was sig-nificantly longer in the water maze navigation experiment(P < 0.01);the ratios of time and path in the quadrant of the platform were obviously lower in SMIR(P < 0.01). There was no statistical difference between sham and C group(P>0.05).Conclusion SMIR did not cause chronic pain but may cause a decrease in the ability of spatial learning and memory in immature rats.

Objective To explore the diagnoses of spontaneous intracranial hypotension,and discuss the therapeutic efficacy of epidural blood patch therapy in spontaneous intracranial hypotension patients.Methods The clinical data of 12 patients with spontaneous intracranial hypotension,admitted to our hospital from January 2013 to December 2018,were retrospectively analyzed.The lumbar puncture results,MR imaging features of the skull and spine,and CT myelography (CTM) features of these patients were analyzed.The treatment efficacies of epidural blood patch,which included blind epidural blood patch and targeted epidural blood patch,were compared.Results The cerebrospinal fluid pressure of 12 patients was ≤ 60 mmH2O.Ten patients (83.3％) showed subdural fluid collections,enhancement of the pachymeninges,engorgement of venous structures,pituitary hyperemia,and sagging of the brain on brain MR imaging,and one of the patient showed pituitary hemorrhage.Seven patients (63.3％) showed spinal dural epithelial fluid accumulation and venous plexus expansion on spine MR imaging,and one of the patient showed dorsolateral dural discontinuous thickening of T6 and forward movement of the spinal cord caused by massive dorsal epidural effusion.Twelve patients in this group underwent CTM,and were found cerebrospinal fluid leakage.Twelve patients applied 14-times epidural blood tests;4 responded well to one-time targeted epidural blood patch therapy,with success rate of 100％;8 patients used blind epidural blood patch therapy,and 6 patients responded well to one-time therapy,with success rate of 75％,one patient improved with blind epidural blood stick twice,and one patient was ineffective twice.Conclusions Head MR imaging combined with spinal MR imaging is a non-invasive method to diagnose spontaneous intracranial hypotension.Myelogram can determine whether there is a leakage of spinal cerebrospinal fluid and accurately locate the leakage site.Epidural blood patch therapy is an effective method for treatment of patients with spontaneous intracranial hypotension.With the precise location of leak points by myelography,targeted epidural blood patch is more effective.

Objective To investigate the application of myelography including digital subtraction angiography myelogram (DSM) and computed tomography myelogram (CTM) in patients with spontaneous intracranial hypotension.Methods The myelography results including DSM and CTM of 10 patients with spontaneous intracranial hypotension form Guangzhou First People's Hospital between January 2013 and June 2018 were retrospectively analyzed.Some patients were treated with targeted epidural blood patch on the basis of myelography.Results Myelography (including DSM and CTM) showed cerebrospinal fluid leakages in all the 10 patients.There were one to 16 leak sites with an average of nine sites (totally 90 leak sites).Forty-two sites (47％) were located in cervical vertebra,19 sites (21％) in thoracic vertebra,22 sites (24％) in lumbar vertebra,and seven sites (8％) in sacral vertebra.On DSM and CTM,cerebrospinal fluid leakage was characterized by the diffusion of contrast agent along one side or the bilateral sides of nerve root,enlargement of the nerve sleeves and paraspinal collections of hyper-demity contrast medium.Two patients whose cerebrospinal fluid leakage occurred in long sections showed more cerebrospinal fluid leakage on CTM than on DSM.Two patients responded well to targeted epidural blood patch on the basis of myelography.The cerebrospinal fluid leakage was completely settled on myelography after the treatment of epidural blood patches.Conclusions Myelography has been shown to assist the diagnosis of spontaneous intracranial hypotension and accurately define the location and extent of cerebrospinal fluid leakages.Myelography can be used to guide targeted epidural blood patch and applied in the reexamination of cerebrospinal fluid leakages after treatment.More cerebrospinal fluid leakages are detected by CTM than by DSM.