Objective To evaluate the effects of four different intravenous anesthetic agents on middle cerebral artery blood flow velocity(V MCA) measured with transcranial Doppler sonography (TCD) during induction of general anesthesia Methods Fourty patients were classified randomly into four groups (n=10 each) according to intravenous anesthetic agents used: propofol group (group P, propofol 2 0 mg/kg); etomidate group (group E, etomidate 0 3 mg/kg); midazolam group (group M, midazolam 0 15 mg/kg) and thiopental group (group T, thiopental 5 0 mg/kg) Anesthesia was induced with one of above drugs followed by endotracheal intubation and maintained with sevoflurane and nitrous oxide in oxygen The lungs were ventilated to maintain an end tidal PCO 2 of 35 40 mmHg The V MCA, arterial blood pressure (MAP), heart rate (HR) and end tidal PCO 2 were measured and recorded at following occasions: before induction, 1, 3, 5, 10 and 15min after induction Results There were no significant differences in preinduction data (patient age, body weight, sex, MAP, HR, and V MCA) among four groups Compared with the baselines, V MCA decreased by 34 4% in group P, by 34 2% in group E, and by 31 2% in group T(P0 05)1 min after the administration; immediately after the endotracheal intubation, V MCA increased markedly in group M (P0 05) Conclusions The cerebral artery blood flow velocity can be affected differently by various induction agents

Objective To compare the effects of propofol-alfentanil and sevoflurane-N2O anesthesia on cerebral vascular reactivity to the changes in carbon dioxide (CO2). Methods Forty ASA class I - II patients undergoing abdominal operations, were randomly divided into two groups. In group I (n = 20), anesthesia was maintained with infusion of propofol at 0.1mg.kg-1 .min-1, plus alfentanil at 1ug.kg-1. min-1. In group II (n = 20), anesthesia was maintained with 1 % sevoflurane and N2 O-O2 (N2 O: O2 = 3: 2). Mean arterial blood pressure (MAP), heart rate (HR), body temperature (T), end-tidal CO2 tension (PETCO2 ), sevoflurane concentrations, pulse O2 saturation (SpO2 ) and the parameters of the middle cerebral artery blood flow, including mean blood flow velocity (Vm), diastolic blood flow (Vd), pulse index (PI) and resistance index (RI), were measured at following occasions: after intubation and when PETCO2 reached 40, 45, 50, 45, 40, 35, 30 and 40mmHg, which was achieved through adjusting mechanical ventilation. The CO2 reactivity index (CRI) was calculated as delta Vm/delta PETCO2 ratio. Results CRI and Vm were lower in propofol--alfentanil group than sevoflurane-N2O group (P

0.05] between group L and other two groups.Conclusion PCEA with 0.125% levobupivacaine containing fentanyl 2 ?g?ml-1 provides adequate pain relief after cesarean section with recovery of motor function similar to that with 0.2% ropivacaine and 0.125% racemic bupivacaine.

Objective To explore the near-term therapeutic effect and long-term result of stereotactie surgery in treatment of moderate hypertensive intraeerebral hemorrhage and discuss related problems of the surgery.Methods 60 cases of moderate hypertensive intracerebral hemorrhage were divided into two groups at random.30 cases treated by stereotactie surgery,the others treated by nonsurgical method, the near-term rebleeding rate, mortality rate and longterm living quality of the two groups were analyzed and compared.Results There were no statistical differences in rebleeding rate and mortality rate between the two groups( all P >0.05 ).The long-term result indicated that there was statistical difference in GOS grades between the two groups( P <0.05).The surgical group had better result than nonsurgical group.Conclusion The patients suffered for moderate hypertensive intracerebral hemorrhage treated by stereotsefic surgery had better long-term therapeutic effect than those treated by nonsurgical method.

Objective To screen the ryanodine receptor type 1(RYR1)gene in a Chinese pedigree with malignant hyperthermia(MH).Methods Total genome was extracted conventionally from peripheral leucocytes of the prohand and the other members of the family.In order to detect mutations in the RYR1 gene,part exons were amplified by polymerase chain reaction(PCR)and then subjected tO automatic DNA sequencing.The detected mumfion in the gene was confirmed in the preband and the other members of the family using Fok Ⅰ restriction analysis.Results DNA sequencing of PCR-amplified fragments of the pwband revealed c.6724C＞T (P.T2206M),a recurrent missense mutation which had been detected in Caucasian MH cages.Restriction analysis of all available family members showed that one daughter and one son of the 4 children of the proband were the missense mutation carriers,indicating that they were MH-susceptible individuals.Conclusion The Chinese susceptible to MH carries the simile RYR1 gene mutation to the Caucasians susceptible to MH.

ObjectiveTo assess negative risk factors associate with short-term and long-term poor outcome of acute heart failure syndromes(AHFS) and provide evidence to emergently proceed to AHFS low risk stratification.Methods A retrospective cohort study was conducted. 125 AHFS patients who met research criterion were enrolled from Guangxi Baise People's Hospital and Youjiang District People's Hospital of Baise City. The patients were divided into poor outcome and relatively low-risk groups by the results of short- and long-term follow-up of their outcomes. The patient's vital signs and disease history were collected at the first time after admission, and auxillary examination parameters were recorded. The poor outcomes occurring in the follow-up periods from the admission to after discharge for 30 days(short-term) and 1 year(long-term)were recorded, and Cox hazard regression was used to analyze the negative risk factor in the short- and long-term.Results There were 58 cases(46.4%)with poor outcome and 30 cases(24.0%)dead in short-term, and there were 111 cases(88.8%) with poor outcome and 39 cases(31.2%) dead in the long-term follow up. Seven negative risk factors were identified by Cox regression. They were no previous or de novo myocardial infarction〔short-term: hazard ratio(HR)=0.36, 95% confidence interval (95%CI)=0.20-0.65,P=0.001〕, lymphocyte ratio 0.20-0.40(short-term:HR=0.13, 95%CI=0.04-0.47, P=0.002; long-term:HR=0.42, 95%CI=0.26-0.68,P=0.001),oxygenation index(PaO2/FiO2)>300 mmHg (1 mmHg=0.133 kPa,short-term:HR=0.23, 95%CI=0.09-0.54,P=0.001),estimated glomerular filtration rate (eGFR)>60 mL·min-1·1.73 m-2(short-term:HR=0.31, 95%CI=0.16-0.64,P=0.002;long-term:HR=0.54, 95%CI=0.36-0.83,P=0.004),left ventricular ejection fraction(LVEF)>0.50(short-term:HR=0.29, 95%CI= 0.10-0.85,P=0.024), P wave terminal force in lead V1(PtfV1)>-0.04 mm·s(short-term:HR=0.29, 95%CI= 0.14-0.60,P=0.001), planar QRS-T angle<90°(long-term:HR=0.46, 95%CI=0.27-0.77,P=0.003). ConclusionsOur patients with AHFS cohort have very poor outcomes both in short-term and long-term follow up. Those with the following characteristics: no previous or de novo myocardial fraction, lymphocyte ratio 0.20-0.40, PaO2/FiO2>300 mmHg, eGFR>60 mL·min-1·1.73 m-2, PtfV1>-0.04 mm·s, LVEF>0.50 and planar QRS-T angle<90°are more likely to have optimal short-term and long-term outcome.

Objective To identify the risk factors for perioperative major adverse cardiac events (MACEs)in elderly patients with coronary heart disease (CHD) undergoing orthopedic surgery.Methods One hundred and twenty-nine patients with CHD,aged ≥65 yr,undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009,were selected.The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery.Age,sex,history of coronary reconstruction,myocardial infarction,heart failure,angina,systemic angionosis,cerebrovascular disease and diabetes,basic and preoperative blood pressure,routine blood test,serum creatinine,blood glucose,preoperative electrocardiography (ECG) and ultrasonic cardiography,ASA,intraoperative blood transfusion,operation and anesthesia time,entering ICU after surgery and postoperative volume of drainage were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs.Results Twenty-one patients developed perioperative MACEs (16.3 %).Logistic regression analysis showed that unstable angina within 6 months,preoperative haematocrit ≤ 35%,preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this population (P ＜ 0.05),and the risk indexes of the factors were 5,3,3 and 4,respectively.Conclusion Unstable angina within 6 months,preoperative haematocrit ≤ 35 %,preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.

BACKGROUND: Epidural block(EB) is one of the effective and widely used remedies for lumbar disc herniation(LDH) . Animal experiments have been conducted to study the changes in the local tissue structure in the spinal canel after several treatments with EB.OBJECTIVE: To study the effect of EB for LDH on the local tissue structures in the spinal canel.DESIGN: A non-randomized and controlled clinical observation.PARTICIPANTS: Department of Pathology and Laboratory of Electron Microscope of an Affiliated Hospital of a University.SUBJECTS: Forty patients with LDP, who failed to respond to EB treatment and subsequently received discectomy in the Department of Orthopaedics,First Affiliated Hospital of Sun Yat-sen University from May 1992 to December 1997, were enrolled in this study, with 20 patients receiving discectomy but not EB treatment serving as the control group.METHODS: From the 60 cases, totally 120 specimens of yellow ligament and the disc tissues were obtained during discectomy for optical microscopical examination. A portion of the yellow ligament and the lumbar disc tissues were chosen from EB group(12 cases) and non-EB group(10 cases), respectively, for electron microscope examination(involving altogether 44specimens) . The changes in histology and ultrastructnres in the specimens were compared between the two groups.MAIN OUTCOME MEASURES: ① Main results: the reactive proliferation of the tunica adventitia and inflammatory reaction of the intervertebral disc and yellow ligament; ② Secondary results: changes in the ultrastructure of the anulus fibrosus, nucleus pulposus and yellow ligament.RESULTS: No significant difference was found between the two groups either in light microscopy or electron microscopy in the degree of smoothness and the inflammatory reaction of the cavosurface of the yellow ligament and the disc tissues, nor in the cellular ultrastructures and fibrous arrangement.CONCLUSION: There is no direct relationship between lumbar EB and epidural scar adhesion formation. EB does not affect the ultrastructures of the local tissues in the spinal canal, but care must be taken of the sterilization in the surgical procedure, as chronic inflammatory reaction in the yellow ligament and disc tissues can be present in some patients.

Objective To investigate the effects of different doses of gabapentin on streptozotocin (STZ)-induced diabetic neuropathic pain in rats.Methods Male SD rats aged 6 weeks weighing 180-200 g were used in this study. Diabetes ntellitus ( DM) was induced by intraperitoneal STZ 60 mg/kg and confirmed one week later by blood glucose =16.7 mmol/L before breakfast. The DM rats were randomly divided into 4 groups ( n = 6 each) : gabapentin groups received intraperitoneal gabapentin 30, 60 and 120 mg/kg twice a day (at 9:00 am and 3:00 pm) for 3 weeks respectively and control group received intraperitoneal normal saline 0.6 ml instead of gabapentin. The paw withdrawal threshold to von Frey filament stimulation was measured before and at 30, 60, 120, 180, 240 min after first gabapentin injection and once a week for 3 weeks. Results After gabapentin 60 and 120 mg/kg, the paw withdrawal threshold to mechanical stimuli was significantly increased and lasted for about 4 h. The analgesic effect peaked at 60 min after IP gabapentin injection. Normal saline and gabapentin 30 mg/kg had no significant analgesic effect. The degree of analgesia was significantly decreased at day 14 and 21 of treatment with gabapentin 60 and 120 mg/kg as compared with that at 60 min after gabapentin injection. Conclusion The hyperalgesia and allodynia in rats with diabetes mellitus can be effectively reversed by gabapentin 60 and 120 mg/kg,while long-term use of gabapentin can induce drug tolerance.

Objective To compare the effectiveness of training with a digital video disc ( DVD)-based instruction ver-sus intubation model simulator in placement of endotracheal tube by video -laryngoscope .Methods Sixty patients un-dergoing elective gynecology surgeries and twenty residents of Dept .of anesthesiology were randomized to place a en-dotracheal tube by video-laryngoscope .Results Compared with intubation model simulator , intubation time [ (68 ± 14)s vs (69 ±7)s], score of performance (8.24 ±0.64 vs 8.31 ±0.58), failure rate (3 times/11 vs 1time/9 resi-dents), and instruction rate (5times/11 vs 4times/9 residents) were no statistic difference .Conclusions Digital video disc ( DVD)-based instruction is an alternative way to intubation model simulator in training .