From May 2012 to May 2013, 60 chronic male smokers received an intravenous infusion of dexmedetomidine 1 μg/kg (Group D, n=30) or an equal volume of normal saline (Group C, n=30) before anesthesia induction.At time of dexmedetomidine or normal saline dosing , after induction of anesthesia, 1 and 3 min after intubation, the heart rates and rate-pressure products were significantly lower in Group D than Group C ( P<0.05 ).Thus the dosing of dexmedetomidine before anesthesia induction could suppress the cardiovascular responses of endotracheal intubation in chronic smokers and avoid increasing myocardial oxygen consumption so as to protect heart functions.

OBJECTIVE: To determine the effect of ulinastatin on plasma thromboxane B(2) and deep vein thrombosis(DVT) in elderly patients after hip joint replacement. METHODS: Eighty ASAI-IIpatients aged 65-81 years undergoing hip joint replacement were randomly divided into 4 groups (n=20): Group U1 (ulinastatin 5 000 U/kg);Group U2 (ulinastatin 10 000 U/kg); Group U3 (ulinastatin 20 000 U/kg); and Group C (the same volume of saline as control).The blood samples were collected at 5 time points: preoperation (T(1)), immediately after the operation (T(2)), 1 d (T(3)), 2 d (T(4)) and 3 d after the operation (T(5)), respectively. Thromboxane B(2) was detected, and DVT was also examined through color Doppler ultrasonography 3 d after the operation. RESULTS: Compared with T(1), the level of thromboxane B(2) significantly increased in Group C at T(2)-5, in Group U1 at T(2-4), in Group U2 and U3 at T(2) (P<0.01). Compared with Group C, the concentration of thromboxane B(2) decreased in Group U1 at T(2-3), in Group U2 and U3 at T(2-4) (P<0.01). Compared with Group U1, thromboxane B(2) significantly decreased in Group U2 and U3 at T(2-4) (P<0.01).The incidence rate of DVT was 40% in Group C, 10% in Group U1. There was no incidence of DVT in the Group U2 and U3 (P>0.05). CONCLUSION Ulinastatin can inhibit blood thromboxane B(2) level in dose dependent manner and prevent DVT in elderly patients after hip joint replacement.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Glycoproteins ; therapeutic use ; Hip Fractures ; surgery ; Humans ; Male ; Thromboxane B2 ; blood ; Trypsin Inhibitors ; therapeutic use ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging ; etiology ; prevention & control

OBJECTIVE: To determine the effect of lung protection mechanical ventilation on respiratory function in the elderly undergoing spinal fusion. METHODS: Sixty 70-85 year old patients, ASA class II or III, undergoing spinal fusion were randomly assigned into 2 groups (30 in each group): a protection mechanical ventilation group (group P) and a conventional mechanical ventilation group (group C). Low VT and low level positive end expiratory pressure (PEEP) mechanical ventilation were applied in group P (VT=6mL/kg, RR=12-18 b/min, I:E=1:2, PEEP=10 cmH2O, alveolar recruitment performed once every 15 min), while traditional ventilation was used in group C ( VT=10-12 mL/kg, RR=12 b/min, I:E=1:2). Arterial blood samples were taken and pH, PaO2, PaCO2, PaO2/FiO2, A-aDO2, HR, SBP, DBP and CVP were recorded before the operation (T0), 1 h after tracheal intubation (T1), tracheal extubation immediately (T2), 1 h after tracheal extubation (T3), 1 d, 2 d, and 3 d after the operation (T4, T5, and T6). The pulmonary complication was also examined 1 d after the operation. RESULTS: At T1, T2, T3, T4 and T5, PaO2 and PaO2/FiO2 in group P were higher than those in group C, but A-aDO2 in group P was lower than that in group C. Five patients had bronchitis, 5 had hyoxemia, and 3 had atelectasis in group C, but 2 bronchitis in group P. The incidence of pulmonary complication was 43.3% in group C and 6.6% in group P. There was no significant difference in HR, SBP, DBP and CVP between the 2 groups. CONCLUSION Lung protection mechanical ventilation improves the arterial oxygenation and accelerates the recovery of respiratory functions in elderly patients after spinal fusion operation, with no influence on hemodynamics.
Aged ; Aged, 80 and over ; Anesthesia, General ; Female ; Humans ; Hypoxia ; prevention & control ; Male ; Positive-Pressure Respiration ; methods ; Postoperative Complications ; prevention & control ; Pulmonary Ventilation ; Respiration, Artificial ; methods ; Respiratory Function Tests ; Spinal Fusion ; methods

Objective To investigated the effects of patient controlled intravenous analgesia and ultrasound guided patient?controlled paravertebral block on pulmonary function in patients with multiple fractured ribs? Methods From May 2015 to March 2016,60 patients with multiple rib fractures in Ningbo NO?6 Hospital with American Society of Anesthesiologists Ⅱ-Ⅲ underwent internal fixation, including 30 males and 30 females aged from 16 to 70 years ( mean age ( 54?6 ± 15?2 ) years ) . All patients were randomly divided into 2 groups (n=30 each):patient controlled intravenous analgesia(PCIA) group and patient controlled thoracic paravertebral block(PCPB) group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline. The PCIA pump was set up to deliver a 2 ml bolus dose with 15 minutes lockout interval and background infusion at 2 ml/hour.In PCPB group,the patients received paravertebral injection of 0?2% ropivocaine 15 ml on the corresponding area of fractured side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0?75% ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose, with 15 minutes lock out interval and background infusion at 5 ml/hour? Both analgesia lasted to 72 hours after operation.Before the operation,at 30 minutes,60 minutes,1 day,2 days,3 days after analgesia,arterial blood samples were collected to test the levels of pH,PaO2 ,PaCO2 ,PaO2/FiO2 and PA?aDO2 . The pulmonary function was also examined before and 3 days after the operation through FEV1 and FEV1%? Results Compared with PCIA group at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, the level of PaO2 ( ( 85?1 ± 9?7 ) mmHg vs? ( 72?4 ± 12?3)mmHg,(90?3±12?4)mmHg vs? (73?5±7?8)mmHg,(94?2±8?2)mmHg vs? (86?1±5?6)mmHg, (98?5±7?0)mmHg vs? (88?8±7?5)mmHg,(99?6±9?8)mmHg vs? (91?3±8?6)mmHg,P<0?05)) and PaO2/FiO2 were significantly increased ( ( 405?1 ± 46?0 ) mmHg vs? ( 340?1 ± 58?9 ) mmHg, ( 430?5 ± 59?1) mmHg vs? ( 344?0 ± 65?4 ) mmHg, ( 448?3 ± 39?1 ) mmHg vs? ( 410?1 ± 26?7 ) mmHg, ( 460?1 ± 33?5)mmHg vs? (423?2±36?5)mmHg,(465?1±28?2)mmHg vs? (435?1±40?8)mmHg,P<0?05)), the level of PA?aDO2 was decreased ((22?9±4?6)mmHg vs? (36?6±5?1)mmHg,(17?7±4?7)mmHg vs?(34?5±2?9)mmHg,(13?8±4?1)mmHg vs? (21?9±3?2)mmHg,(13?5±4?6)mmHg vs? (19?2± 3?8)mmHg,(12?4±2?0)mmHg vs? (17?7±2?4)mmHg,P<0?05)), and FEV1,FEV1% were significantly increased at 3 days after operation in PCPB group ((2?9±0?4)mmHg vs? (2?2±0?5)mmHg, (78?1± 4?7) mmHg vs? ( 64?8 ± 4?3 ) mmHg; P<0?01 ) ) . Conclusion Ultrasound guided patient?controlled paravertebral block improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple?fractured ribs after internal fixation operation.

Objective To investigated the effects of patient controlled intravenous analgesia and ultrasound guided patient?controlled paravertebral block on pulmonary function in patients with multiple fractured ribs? Methods From May 2015 to March 2016,60 patients with multiple rib fractures in Ningbo NO?6 Hospital with American Society of Anesthesiologists Ⅱ-Ⅲ underwent internal fixation, including 30 males and 30 females aged from 16 to 70 years ( mean age ( 54?6 ± 15?2 ) years ) . All patients were randomly divided into 2 groups (n=30 each):patient controlled intravenous analgesia(PCIA) group and patient controlled thoracic paravertebral block(PCPB) group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline. The PCIA pump was set up to deliver a 2 ml bolus dose with 15 minutes lockout interval and background infusion at 2 ml/hour.In PCPB group,the patients received paravertebral injection of 0?2% ropivocaine 15 ml on the corresponding area of fractured side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0?75% ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose, with 15 minutes lock out interval and background infusion at 5 ml/hour? Both analgesia lasted to 72 hours after operation.Before the operation,at 30 minutes,60 minutes,1 day,2 days,3 days after analgesia,arterial blood samples were collected to test the levels of pH,PaO2 ,PaCO2 ,PaO2/FiO2 and PA?aDO2 . The pulmonary function was also examined before and 3 days after the operation through FEV1 and FEV1%? Results Compared with PCIA group at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, the level of PaO2 ( ( 85?1 ± 9?7 ) mmHg vs? ( 72?4 ± 12?3)mmHg,(90?3±12?4)mmHg vs? (73?5±7?8)mmHg,(94?2±8?2)mmHg vs? (86?1±5?6)mmHg, (98?5±7?0)mmHg vs? (88?8±7?5)mmHg,(99?6±9?8)mmHg vs? (91?3±8?6)mmHg,P<0?05)) and PaO2/FiO2 were significantly increased ( ( 405?1 ± 46?0 ) mmHg vs? ( 340?1 ± 58?9 ) mmHg, ( 430?5 ± 59?1) mmHg vs? ( 344?0 ± 65?4 ) mmHg, ( 448?3 ± 39?1 ) mmHg vs? ( 410?1 ± 26?7 ) mmHg, ( 460?1 ± 33?5)mmHg vs? (423?2±36?5)mmHg,(465?1±28?2)mmHg vs? (435?1±40?8)mmHg,P<0?05)), the level of PA?aDO2 was decreased ((22?9±4?6)mmHg vs? (36?6±5?1)mmHg,(17?7±4?7)mmHg vs?(34?5±2?9)mmHg,(13?8±4?1)mmHg vs? (21?9±3?2)mmHg,(13?5±4?6)mmHg vs? (19?2± 3?8)mmHg,(12?4±2?0)mmHg vs? (17?7±2?4)mmHg,P<0?05)), and FEV1,FEV1% were significantly increased at 3 days after operation in PCPB group ((2?9±0?4)mmHg vs? (2?2±0?5)mmHg, (78?1± 4?7) mmHg vs? ( 64?8 ± 4?3 ) mmHg; P<0?01 ) ) . Conclusion Ultrasound guided patient?controlled paravertebral block improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple?fractured ribs after internal fixation operation.