Objective To investigate the effects of 3 different delivery methods on maternal and fetal complications during labor and determine better mode of delivery. Methods Sixty pregnant women with ASA class Ⅰ or Ⅱ were randomly divided into three groups with 20 cases each: the cesarean section group (group Ⅰ), the pain relief group (group Ⅱ) and normal delivery group (group Ⅲ). In group Ⅰ and Ⅱ, an epidural catheter was placed through L_(2-3) interval. 0.5% ropivacaine was injected via the epidural catheter for continuous epidural anesthesia in group Ⅰ. After a loading dose of 8-10 mL 0.125% ropivacaine+2 μg/mL fentany, the patient-controlled epidural analgesia (PCEA) during labor was started with bolus 5 mL, lockout interval 20 min and back ground infusion rate 6-8 mL/h in group Ⅱ. The level of block was controlled below T_(10). BP, HR and RR were continuously monitored during labor. Blood samples were taken from umbilical vein at delivery for blood gas analysis and determination of lactate concentration. Neonates were assessed by Apgar score and neurological and adaptive capacity score (NACS). Maternal postoperative complications were recorded. Results There was no statistical differences in plasma pH, PCO_2, PO_2, SO_2, Apgar score and NACS among 3 groups. The umbilical vein blood lactate concentration was significantly increased in group Ⅱ and Ⅲ compared to the group Ⅰ, while blood lactate concentration in group Ⅱ was lower than that in the group Ⅲ (P<0.05). Base excess (BE) was significantly higher in group Ⅲ than in group Ⅰ. Compared with group Ⅱ and Ⅲ, maternal postoperative complications such as urinary retention, postpartum hemorrhage and so on were increased significantly in group Ⅰ (P<0.05). PCEA provided satisfactory effect in group Ⅱ. Conclusions Epidural labor analgesia with 0.125% ropivacaine+2 μg/mL fentany can provide comparative and effective analgesia for pain relief during labor without adverse effects on the mothers and fetuses and may reduce the postoperative complications. It is a safer and more effective technique in pain relief during labor.

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rat model of sepsis.Methods Thirty healthy New Zealand rabbits of both sexes weighing 2.0-3.0 kg were randomly divided into 3 groups (n=10 each):group I sham operation; group II sepsis and group III AHH+sepsis.Sepsis was produced by modified colon ascendens stent peritonitis(CASP).At 4 h after CASP group III meceived HES 130/0.4 20 ml/kg iv at a rate of 20 ml/min.The MAP and HR were monitored and recorded at 4 h (before AHH) and 5,6,7,8 h after CASP.Blood samples were taken from carotid artery and superior mesenterie vein (SMV) at 4 h and 8 h after CASP for blood gas analysis and determination of plasma D-lactate concentration and intestinal oxygen extraction ratio.The rabbits were sacrificed at 8 h after CASP and a segment of ileum of 3 cm in length,5 cm from ileocecal valve,was removed for determination of wet/dry ileum weight ratio and microscopic examination.The degree of damage to intestinal mucous membrane was scored according to Chiu score (0=normal,5=severe damage).Results Sepsis-induced hypotension and metabolic acidosis,increased plasma D-lactate concentration,decreased intestinal oxygen extraction ratio,increased wet/dry ileum weight ratio and Chiu score in group II as compared with group I.AHH with HES 130/0.4 20 ml/kg significantly attenuated the scpsis-induced changes in group III.Conclusion AHH with HES 130/0.4 can attenuate damage to intestinal mucosal barrier produced by sepsis.

AIM:To evaluate the prophylactic effect of azasetron in different juncture injection on postoperative nausea and vomiting(PONV)during patients controlled intravenous ananlgesia(PCIA).METHODS:One hundred and twenty patients,scheduled for selective abdominal operations,were randomly divided into four groups:patients received an preoperative intravenous injection of 10 mg azasetron(Group A,n=30),patients received an intravenous injection of 10 mg azasetron during abdominal cavity(Group B,n=30),patients received an intravenous injection of 10 mg azasetron when the operation were finished(Group C,n=30),patients with no azasetron as control(Group D,n=30).The incidence rate and score of PONV,the visual analogue scales(VAS)and Ramsay scores were recorded at 4,8,12,24,48 h postoperatively.RESULTS:There was significant difference between the postoperative VAS during 12 to 48 h and that of 4 h postoperatively(?0.05).CONCLUSION:A preoperative intravenous injection of 10 mg azasetron can be used effectively to prevent PONV during PCIA.

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) on cerebral O2 supply/consumption and energy metabolism in patients undergoing elective surgery under general anesthesia combined with continuous epidural block. Methods Fourteen ASA Ⅰ or Ⅱ patients of both sexes (9 male, 5 female) aged 44-62 yrs weighing 55-70 kg undergoing elective surgery under general anesthesia combined with epidural block were enrolled in this study. Lactated Ringer's solution 6-8 ml?kg-1 was infused before anesthesia. After correct placement of epidural catheter was confirmed radial artery was cannulated for BP monitoring and blood sampling. BP, EGG, SpO2 and PET CO2 were continuously monitored during anesthesia. General anesthesia was induced with fentanyl, midazolam, propofol and rocuronium and maintained with iaoflurane and intermittent i. v. boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-35 mm Hg. Epidural block was produced by a mixture of 1.33 % lidocaine + 0.167 % dicaine. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 20 ml?kg-1 at 50 ml?min-1 after induction of general anesthesia. Blood samples were taken from artery (a) and jugular venous bulb (jv) simultaneously before AHH (T0) at 15 min (T1) and 120 min (T2) after AHH was accomplished for blood gas analysis and determination of Hb, glucose and lactate concentrations. Cerebral O2 extraction rate (CERO2), glucose extraction rate (CMRglu) , arterial-jugular bulb venous O2 content difference (D a-jvO2) and arterial-jugular bulb venous lactate difference (VADL) were calculated. Results At the end of AHH Hct and Hb decreased by 20% as compared to the baseline values before AHH. S jvO2 was significantly higher, D a-jvO2 smaller and CERO2 lower at T1 than at T0. There were no significant differences in BP, HR, CMRglu and VADL at all time points. Conclusion AHH can increase cerebral O2 supply and has no significant effect on cerebral glucose metabolism during operation performed under general anesthesia combined with epidural block.

Objective To observe the changes of plasma calcitonin gene-related peptide (CGRP) and endothelin (ET) during propofol-induced anesthesia and intubationMethods Thirty-six patients were randomly allocated to receiving intravenous administration with propofol 2mg/kg ( group PP, n=20) or sodium thiopental group (SP, n=16) The venous bloos samples were taken to measure the plasma CGRP and endothelin (ET) concentrations, together with systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), immediately before induction, 2min after P or SP administration, 2min, 7min, 15min after intubationResults SBP decreased immediately after induction in both groups (P005), increased markedly in group SP (P

Objective To compare the effects of different modes of delivery on arterial oxygen saturation in the fetus.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients aged 22-32 yr with a single fetus at full term lying in normal headdown position were divided into 3 groups according to the modes of delivery (n =40 each):group cesarean section (group CS) ; group labor analgesia (group LA) and group spontaneous labor (group SL).In group CS cesarean section was performed under epidural anesthesia with 0.5％ ropivacaine.Epidural catheter was placed at L2,3 interspace in groups CS and LA.In group LA labor analgesia was started from the first stage and maintained until complete cervical dilatation.The patients received epidural PCA (PCEA) with O.125 ％ropivacaine plus fentanyl 2 μg/ml.PCEA setting was as follows:a loading dose of 8-10 ml; demand bolus 5 ml;20 min lockout; background infusion 6-10 ml/h.Blood samples were taken from umbilical artery at delivery for blood gas analysis and determination of serum concentrations of lactate,β-endorphin (β-EP) and neuropeptide Y (NP-Y).Apgar score and neurological and adaptive capacity score (NACS) were recorded.Results There was no significant difference in Apgar score,NACS and NP-Y and β-EP concentrations in umbilical arterial blood among the 3 groups.The lactate concentration and the absolute value of BE were significantly higher while pH was lower in group SL than in groups CS and LA.PO2 was significantly higher while PCO2 was lower in group LA than in groups SL and CS,and the lactate concentration and absolute value of BE were significantly lower while pH was higher in group LA than in group SL.Conclusion The 3 modes of delivery have significant effects on arterial oxygenation in fetus but have no clinical significance.

Objective To investigate the effect of epidural morphine for analgesia on the number of interstitial cells of Cajal (ICC) in the rabbit colon.Methods Thirty healthy rabbits of either sex,weighing 2.0-2.5 kg,were randomly divided into 2 groups (n =15 each):control group (group C) and morphine group (group M).The animals were anesthetized with iv 20% urethane 4 ml/kg.The epidural analgesia was performed at L3,4 interspace.In group M morphine 9.2 ug· kg-1 · h-1 was infused into the epidural space for 7 consecutive days,while the equal volume of normal saline was infused instead in group C.The characteristics of excrement and constipation were recorded during morphine infusion.Normal saline or Chinese ink mixture 5 ml was administered via a gastric tube inserted through the mouth 1 day after the end of administration.The rabbits were sacrificed 30 min later and laparotomy was performed.The intestinal segment numbered from the pylorus to the ileocecal region of the bowel was removed and the length of the intestinal segment and propelled distance of the ink within the intestinal tract were measured in the tension-free state.The rate of propelled distance was calculated.The proximal and distal colon tissues were taken for measurement of the expression of c-kit (by immunohistochemisty) and ICC count,and stained with haematoxylin and eosin for examination of pathological changes.Results Compared with group C,the incidence of constipation was significantly increased,and the rate of propelled distance,and expression of c-kit and ICC count in proximal colon tissues were decreased at 3-7 days of morphine infusion (P ＜ 0.05),and no significant change was found in the expression of c-kit and ICC count in distal colon tissues in group M (P ＞ 0.05).Conclusion Epidural morphine for analgesia can inhibit the motor function of the intestinal tract in rabbits,and reduction in the number of ICC count in proximal colon is involved in the mechanism.

Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.

Objective To investigate the effect of stellate ganglion block(SGB)on heart mte variability (HRV)during thyroidectomy performed under cervical plexus block.Methods Forty-five ASA Ⅰ or Ⅱ pafients of both sexy8(8 males,37 females) aged 20-60 yr,weighing 40-70 kg undergoing elective thyroidectomy under cervical plexus block were randomly divided into 3 groups(n=15 each):group Ⅰ control,group Ⅱ left SGB and group Ⅲ right SGB.The parameters of HRV included low frequency(LF),high frequency(HF),LFnu,HFnu and LF/HF ratio.SBP,DBP,HB and HRV parameters were recorded before anesthesia(To,baseline),immediately(T1) and at 5 and 10 rain after cervical plexus block(T2,T3),at the beginning and end of operation (T4,T5).Results SBP and DBP were significantly increased at different time points after cervical plexus block in all 3 groups.Compared with the baseline at T0,LFnu and LF/HF ratio were significantly increased while HR,HF and HFnu decreased during operation in group Ⅰ,LF,HF and HFnu were significantly decreased while HR increased during operation in group Ⅲ(P<0.05),but no significant change in HRV parameters was found during operation in group Ⅱ(P>0.05).Compared with group Ⅰ,HR and LFnu were significantly decreased while HF and HFnu increased in group Ⅱ(P<0.05),but no significant change was found in the indexes mentioned abovein group Ⅲ (P>0.05).Conclusion SGB can adjust cervical plexus block-induced sympathetic excitability and maintain the balance between sympathetic and parasympathetic tension.Left SGB outweighs right SGB.

Objective To design and formulate a electronic preoperative preparation checklist for applying in the preoperative preparation,to reduce missing rate in preoperative preparation and transfer,to improve patient satisfaction,to avoid operation delay and medical accident caused by inappropriate preparation.Methods A total of 145 patients with surgery from March 2013 to February 2013 were as experimental group,and 158 patients with surgery from March 2012 to February 2012 were as control group.The experimental group was used electronic preoperative preparation checklist for preoperative preparation and transition,and the control group was used conventional methods.The incidence of mistake for preoperative preparation and transfer and both surgeon's and patient's satisfactory were compared between two groups.Results After applying the electronic preoperative preparation checklist,the incidence of mistake for preoperative preparation and transfer in experimental group reduced significandy to 1.37％(2/145) and 4.83％ (7/145),compared with the incidence of control group 6.33％(10/158),11.39％(18/158),and the differences between two groups were statistically different (x2=4.870,4.305,P ＜ 0.05).Both surgeon's and patient's satisfactory were improved dramatically,the satisfactory in experimental group improved to 100.00％(50/50)and 97.93％(142/145),compared with the satisfactory of control group 90.00％(45/50) and 90.51％(143/158),and the differences between two groups were statistically different(x2=5.263,7.459,P ＜ 0.05).Conclusions Implementing the electronic preoperative preparation checklist can reduce the incidence of mistake before operation and ensure patient operation schedule.Therefore,it could improve nursing care quality and efficiency.