In the recent years,the earthquake occured frequently in the whole world which caused the increased incidence of crush syndrome (CS). The four limbs and torso will be bleeding and swelling when they are prounded and crushed from the heavy objects. The necrosis of muscular tissue causes massive production of toxin which leads to a series of symptoms including hypotension ,kidney dysfunction and so on. The serious acute kidney injury (AKI) will be vital. When CS-AKI ,the ascending velocity of urea nitrogen and K+ levels in the blood is quicker than those of general AKI;many kinds of immune cells are activated to engender a great deal of inflammatory mediators;the blood dynamics is often unstable. Therefore, it is advocated that the blood purification treatment should be carried early to eliminate excessive metabolic produces in vivo,to reduce the cardiovascular complication occurrence, and to avoid the irreversible change of the kidney function.

ve To compare the effects of coronary-artery-bypass (CAB) surgery with and without cardiopulmonary bypass(CPB) on hemodynamics and the function of the grafts. Methods Thirty-five patients undergoing elective CAB surgery were studied. CAB was performed either with hypothermic CPB (n = 15) or without CPB(off-pump, n = 20) . The patients were premedicated with intramuscular pethidine 50 mg and scopolamine O.3mg. Anesthesia was induced with intravenous midazolam 5-15mg, fentanyl 5-20?g?kg and pancuronium 0.1 mg?kg-1 or pipecuronium 0.1 mg?kg-1 and maintained with iv infusion of fentanyl 6-10?g?kg-1, propofol 2-4mg?kg-1?h-1 and intermittent boluses of pancuronium, midazolam supplemented with 1%-1.5% isoflurane inhalation. In off-pump group naso-pharyngeal T?was maintained at 37.2℃ during operation. The amount of heparin used was equal to about one-third of amount used during CPB and ACT was maintained above 250 seconds. MAP was maintained at 70-90 mm Hg. While blood vessel was being grafted onto the coronary arteries heart rate was maintained at 60-80 bpm, otherwise esmolol 10-20mg was given iv every 5 min until it was satisfactorily controlled. In CPB group, during CPB naso-pharyngeal T?was maintained at 32℃-34℃, MAP at 50-70 mm Hg and blood gases and electrolytes within normal range. Right radial artery was cannulated and 7.5F Swan-Ganz catheter was inserted via internal jugular vein into pulmonary artery for hemodynamic monitoring and blood gas analysis. ECG, SpO2 were continuously monitored during operation. At the end of operation in patients with internal mammary artery used as graft, the flow rate of grafts was measured with 3mm Doppler probe.Results (1) After CAB cardiac index (CT) increased significantly in off-pump group(P0.05) . (3) There was no significant difference in the blood flow of artery graft and myocardial oxygen delivery (MDO2), and consumption ( MVO2) as well as MDO2/MVO2 between the two groups. Conclusions Off-pump CAB surgery has less effects on hemodynamics but systemic and myocardial oxygen delivery and consumption are similar between the two groups.

Subacute thyroiditis is a common type of thyroid pain disease. Severe symptoms include fever and severe pains in the thyroid gland. Throughout many years of clinical experience, the author found that TCM treatment for subacute thyroiditis is effective, with less adverse reactions. This article reported two cases of subacute thyroiditis treated recently.

Objective The study was designed to compare the effects of desflurane and isoflurane on the vecuronium-induced neuromuscular block in the elderly patients. Methods Thirty ASA class I - II elderly patients aged over 70 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups: desflurane group ( I , n = 10) ; isoflurane group ( II , n = 10) and 3 control group ( III , n = 10). Anesthesia was induced with midazolam 0.02-0.05 mg? kg-1 , propofol 0.5-2.0 mg ? kg-1 and fentanyl 2-5?g? kg-1 maintained with inhalation of 6% desflurane(1 MAC) +50% N2O in oxygen (group I ) or 1.15% isoflurane + 50% N2O in oxygen(group II ) or 50% N2O in oxygen (group III ) supplemented with intermittent iv boluses of propofol and fentanyl when necessary. Neuromuscular block was monitored using accelograph (TOF GUARD , Denmark) .A total dose of vecuronium 40 mg ?kg-1 was divided with 4 equal doses of 10?g ? kg-1 , which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak (T1 was no longer depressed in the height of 3 successive stimuli) .The cumulative dose-response curves of the 3 groups were established. The onset time and maximum depression of T1 of the initial dose and 3 incremental doses were recorded. After the last increment of 10 ?g?kg-1, the time for T1 to returned to 25% ,75% ,90% and TOF ratio(T4/T1) to 70% were recorded. The recovery index was also calculated.Results The demographic data were comparable between the 3 groups. The ED50 and ED95 were significantly lower in desflurane and isoflurane groups than those in control group(P 0.05 ) . The time for T1 to return to 25 % , 75 % and 90 % was significantly longer in desflurane and isoflurane group than that in the control group. The recovery from vecuronium-induced neuromuscular block was slower in desflurane group than that in isoflurane group( P

The pharmacodynamics and its circulatory effects of alcuronium and atracurium were investigated in cardiac and noncardiac surgical patients.The results demonstrated that:l Compared with atracurium group,the duration of action of alcuronium is longer in cardiac patients than that of non-cardiac patients, but there is no difference in the onset of action between these two groups; 2. Half of the patients which received alcuronium need reversal with neostigminel 3. The effects on the circulation of these two drugs were nor remarkable;Therefore,alcuronium is also suitable for cardiac and non-cardiac surgical patients

Gelofusine is a plasma substitute made from modified fluid gelatin,it's hemodynamic and biochemical effects on organism were studied in 6 anesthetized dogs and 20 patients scheduled for undergoing open heart surgery(OHS). Different degree of isovolemic acute hemodilution was achieved by supplying the gelofusion at the same amount of blood withdrawn. The results showed,in patients group, after hemodilution, no significant changs were observed in HR, MAP, DO_2 and CaO_2, wherease, CO, CI, and VO_2 increased. In dog group, HR and MAP remained, CaO_2 and SVRI decreased, CO, CI, DO_2 and VO_2 increased at the degree of isovolemic hemodilution less than 20 ml/kg, DO_2 began to decrease at the degree of hemodilution greater than 20ml/kg. In both groups, there's no significant changes in the concentration of K~+, Na~+ ,CI~- and pH value after hemodilution. Our findings supports previous observation about gelofusion's effect to maintain the blood volume and reserve the hemostasis,in addition,it has no deterious effect on coagulation

Objective To observe the effects of desflurane, sevoflurane and isoflurane on hepatic oxygen balance and hepatic blood flow Methods Fifteen pigs were randomly divided into three groups: A desflurane group(n=5), B sevoflurane group(n=5), C isoflurane group(n=5) This study observed the effects of desflurane, sevoflurane and isoflurane on systemic and hepatic blood flow and oxygen balance with different concentrations using continuous thermodilution cardiac output monitor and ultrasonic Doppler blood flow monitorResults ①Hepatic blood flow: total hepatic blood flow(THBF) decreased dose-dependently in three groups without significant differences between groups The effects of desflurnae and sevoflurane on THBF were same as those on cardiac output(CO), while the effect of sevoflurane on THBF was larger than that on CO ②Oxygen balance: both systemic oxygen delivery(DO_2) and hepatic oxygen delivery(HDO_2) decreased significantly with the increasing of inhalation concentrations, systemic oxygen delivery(VO_2) and hepatic oxygen consumption(HVO_2) decreased significantly only at high concentration The effects of desflurnae and sevoflurane on HVO_2 and HDO_2 were same as those on VO_2 and DO_2, while the effect of sevoflurane on HDO_2 was larger than that on DO_2, but the effect of sevoflurane on HVO_2 was still same as that on VO_2Conclusions Because of the dose-dependently decreased hepatic blood flow, hepatic oxygen delivery decreases significantly, but hepatic oxygen consumption can be maintained well by self-regulation of hepatic oxygen extraction ratio,indicating that there is almost no influence on hepatic intracellular respiration and metabolism

Objective To investigate the relationship among the depth of midazolam induced sedation, the plasma midazolam concentration and quantified electroencephalogram(EEG) and determine the appropriate depth of sedation during regional anesthesia Methods Twenty adult ASA I II patients(male 7,female 13)scheduled for thyroid adenoma or cyst operation under cervical plexus blockade were studied The age ranged from 19 57 years [mean (46 4?9 5)yr] and weight from 40 83kg[mean (63 1?10 3)kg] Patients with liver or kidney disorders or habitually taking benzodiazepine were excluded The patients were premedicated with phenobarbital sodium 0 1g Dorsalis pedis artery was cannulated for blood sampling Besides blood pressure, heart rate and SpO 2, quantified EEG (BIS and 95%SEF) were continuously monitored and recorded Level of sedation was assessed using the modified observer's assessment of alertness/sedation (OAA/S) scale The BIS, 95%SEF and plasma midazolam concentration (Cm)were correlated with the OAA/S scores using nonparametric Spearman's rank correlation analysis Results As depth of sedation deepened from an OAA/S score of 4 to 1, BIS value decreased from 91 5?2 6 to 63 1?5 7, 95%SEF from 21 4?2 0 to 15 2?2 9 and plasma midazolam concentration increased from (120 8?55 2)ng/ml to (533 0?139 4)ng/ml BIS, 95%SEF and Cm were all well correlated with the OAA/S score The coefficients of correlation between BIS, 95%SEF, Cm and OAA/S score were 0 952,0 674 and -0 856 respectively Conclusions Cm, BIS and 95% SEF are all well correlated with the depth of midazolam induced sedation and can all be used to monitor the depth of midazolam induced sedation, but BIS is the best among them BIS value 75 82 and OAA/S score 2 3 are the most appropriate level of sedation during regional anesthesia

0 05), while the difference between RBco and TDco was significant before CPB was started and 60min after termination of CPB (P

Objective To evaluate the accuracy of a new generation bioimpedance cardiac output monitor as compared with thermodilution and end expiratory CO 2 techniques Methods Sixteen patients (14 males, 2 females) aged (58?12) years undergoing elective coronary artery bypass (CAB) surgery were studied Cardiac output was measured after CAB surgery in ICU using a new generation bioimpedance cardiac output monitor(Rheo Bioimpedance Hemodynamic monitor) and conventional thermodilution technique in 16 patients and end expiratory CO 2 technique in 10 patients Cardiac output was also measured with Rheo Bioimpedance Hemodynamic monitor in 200 healthy volunteers consisting of equal numbers of male and female The volunteers of each sex were further divided into 5 equal groups of 20 each: (1)20 29 years, (2)30 39 years, (3)40 49 years, (4)50 59 years and (5)60 70 years Results Cardiac outputs measured by bioimpedance and thermodilution techniques were well correlated (r=0 83) and there was also a good correlation between cardiac outputs measured by bioimpedance and end expiratory CO 2 techniques(r=0 88) Cardiac out measured with Rheo Bioimpedance Hemodynamic monitor in 200 healthy volunteers showed that there was a significant difference in cardiac output between 60 70 years age group and the other age groups in both male and female Conclusions Cardiac output and other hemodynamic parameters measured with the new generation bioimpedance hemodynamic monitor are accurate and can be used for preoperative cardiovascular function evaluation and postoperative monitoring of dynamic changes in circulatory function