Objective To investigate the effect of intraoperative amino acid infusion on perioperative glucose metabolism. Methods Thirty-six adult mongrel dogs of both sexes weighing 12-16 kg undergoing partially small intestine resection under general anesthesia were randomly allocated to one of 4 groups (n=9 each): Ⅰ control group received normal saline (C);Ⅱ,Ⅲ,Ⅳ amino acid group (A1, A2, A3) received iv infusion of 2.85%, 5.70% and 11.4% 18-amino acid respectively at 12 ml·kg-1·h-1 during operation starting from skin incision until the end of operation. The animals were premedicated with ketamine and diazepam. Anesthesia was induced with propofol 5-10 mg/kg, fentanyl 2 μg/kg and vecuronium 0.2 mg/kg and maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and vecuronium. The animals were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. ECG, MAP, HR, PET CO2 and esophageal T0 were continuously monitored. Venous blood samples were collected before anesthesia (T1), 15 min after induction of anesthesia (T2), 15, 30 min and 1 h after skin incision (T3-5), when abdomen was closed (T6) and 1,2,4,8 and 24 h after operation (T7-11) for determination of plasma glucose, lactate, insulin and glucagon. Liver biopsy was performed at T6-11 and muscle biopsy at T2,6,11 for measurement of hepatic and muscle glucagon. Homa index was used to estimate the degree of insulin resistance. Results The plasma glucose and insulin concentrations were significantly increased at T3-11 as compared with the baseline at T1 in all 4 groups (P<0.05). The plasma insulin concentrations were significantly higher in group A1 (at T6), group A2 (at T3,6) and group A3 (at T3-11) than in group C (P<0.05). Homa index was significantly higher in group A3(at T3-8) than in group C. Conclusion Intraoperative amino acid infusion increases plasma insulin concentration but does not prevent glycogenolysis especially high dose amino acid infusion.

Objective To investigate the changes of cognitive function after major non-cardiac surgery and the relationship between the postoperative cognitive dysfunction(POCD)and the intraoperative cerebral oxygen metabolism in the elderly.Methods Sixty-four patients(49 male,12 female)aged 65-85 yr undergoing elective major non-cardiac surgery were enrolled in this study.A battery of four neuropsycbological tests was administered 2-3 days before and 7 days after surgery by an experienced psychometrician.A postoperative deficit in any test was defined as a cognitive decline by more than or equal to the preoperative standard deviation of that test in all patients.As long aft any patient showed cognitive decline in two or more tests.this situation was defined as POCD.Blood samples were taken from radial artery and internal jugIIlar vein simultaneously for blood gas analysis immediately (T1) and 2 h (T2) after induction of anesthesia,and just before leaving postanesthesia care unit (T3).The ratio of cerebral blood flow to cerebral oxygen metabolic rate(CBF.CMR02)was calculated.Results Sixty-one patients completed postoperative neuropsychological tests and 10 cases(16.4%)had POCD.Logistic regression analysis showed that the abnormality of CBF/CMR02 during operation was associated with the occurrence of POCD.Conclusion The occurrence of POCD after major non-cardiac surgery is related to the abnormality of cerebral oxygen metabolism during operation.

Objective To investigate the protective effect of desflurane preconditioning on human umbilical vein endothelial cells against anoxia-reoxygenation(A/R)injury.Methods The human umbilical vein endothelial cell line(ECV304)was provided by the Liver Cancer Institute,Zhongshan Hospital,Fudan University.ECV304 cells were randomly divided into 5 groups:group Ⅰ normal control;group Ⅱ A/R;group Ⅲ A/R+rhTNF-α;group Ⅳ Des + A/R and group Ⅴ Des + A/R + rhTNF-α.In group Ⅱ-Ⅴ the cells were exposed to 95% N2 + 5% CO2 in an incubator for 30 min followed by 60 min reoxygenation.In group Ⅲ and Ⅴ rhTNF-α(10 ng/ml)10 μl was added to the cells as soon as reoxygenation was started,while in group Ⅳ and Ⅴ the cells were pretreated with 7.2% desflurane for 30 min followed by 10 min washout before A/R.Apoptosis in endothelial cells was detected by fluorescence flow cytometry and TUNEL.Endothelial cells were examined with electron microscope for apoptosis and necrosis.Results The rates of apoptosis in the endothelial cells were significantly higher in A/R group and A/R + rhTNF-α group than in control group.Desflurane preconditioning significantly attenuated apoptosis in the endothelial cells induced by A/R and A/R + rhTNF-α respectively.Electron microscopy showed that there were significantly more necrotic cells in A/R group and A/R + rhTNF-α group.However in the two desflurane preconditioning groups(Ⅳ and Ⅴ)the cells were in a state of duplication and self-repairing.Conclusion Preconditioning with 30 min 7.2% desflurane can attenuate the A/R-induced injury to human umbilical vein endothelial cells.

Objective:To investigate the influence of electroacupuncture on auditory evoked potential index (AAI) during propofol sedation.Methods: According to propofol effect site concentration, 24 patients for operation were randomly allocated to group 1 (1.0 μg/mL), group 2 (1.5 μg/mL) and group 3 (2.0 μg/mL). Propofol was administered intravenously, points Hegu (LI4) and Neiguan (PC6) were electro-acupunctured, and changes in AAI were recorded.Results:AAI significantly rose in all groups during the initial several minutes after electro-acupuncture and significantly fell in group 2 at 20 min after electro-acupuncture(P＜0.05).Conclusion:AAI can sensitively reflect pain response during electro-acupuncture and electro-acupuncture can strengthen propofol sedation at its medium concentration.

Objective To compare the efficacy of postoperative noninvasive positive pressure ventilation ( NPPV ) plus standard medical therapy ( SMT) with SMT alone in patients with moderate to severe chronic obstructive pulmonary disease ( COPD )Methods Twenty-four patients, after upper abdominal or thoracic surgery, who suffered from COPD and moderate to severe respiratory insufficiency, were randomly allocated to receiving SMT alone (oxygen, aminophylline infusion, nebulized beta-2 agonists and anticholinergics, antibiotics administration and chest physiotherapy; control group ,n=12) or NPPV in addition to SMT(NPPV group ,n=12) NPPV was intermittently given with an air-cushioned face mask under the continuous positive airway pressure of 3 cmH 2O and FiO2 of 35%Results There were not significant differences in baselines between both groups 8 patients in control group ( 667%) and all patients in NPPV group recovered with initial therapy with statistically significant difference (P

Objective To research the different protective effects of general anesthesia combined with thoracic epidural anesthesia on experimental myocardial infarctionMethods Rabbits of experimental group were anesthesitized with 1% sodium pentobarbitone (30 mg/kg, iv) Following tracheal intubation, epidural catheter was put into at T_ 6-7 with the anterior end of the catheter reaching at T_ 2-3 After the epidural anesthesia was made sure to be effective, the anterior descending branches of left coronary artery were ligated Blood samples were collected before ligation, 15, 30, 60, 120, 180 and 240 min after ligation All procedures of control group were similar to those of experimental group except for thoracic epidural anesthesia Nitric oxide (NO), creatine kinase(CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), superoxide dismutase (SOD) were detected The changes of the activities of CK and LDH, and NO level during the research course in both groups were analyzed with liner regression Results The regression coefficients of CK, LDH and NO in the experimental group were significantly lower than those in control group In the experimental group the activities of CK and LDH decreased markedly, NO level increased significantly as compared with those in control groupConclusions General anesthesia combined with thoracic epidural anesthesia produces the protective effects on the myocardial infarction and the stress-induced injury

Objective To research the stress to experimental myocardial infarction under general anesthesia combined with thoracic epidural anesthesia(TEA) Methods Nine rabbits in experimental group were anesthetized with 1% sodium pentobarbitone with tracheal intubation after sectioned, and after the epidural catheters was put into to make sure that the epidural anesthesia was effective, the anterior descending branches of their left coronary artery were ligated All procedures in control group were similar to those of experimental group except for thoracic epidural anesthesia The blood samples from left common carotid artery before ligation were taken 15,30,60,120,180 and 240min after ligation, to measure the plasma levels of monoamine neurotransmitters with high performence liquid chromatography, the Ag Ⅱ and cortisol levels with radioimmunoassay TNFa content in non infarction myocardium was assessed with immunohistochemistry Results There were no differences in NE and 5 HT levels between both groups before ligation Thirty min after the ligation, NE level in experimental group remained unchanged, but in control group increased markedly(P

Objective The purpose of this study was to evaluate the effect of prostaglandin E 1 (PGE 1) on blocking the development of acute respiratory distress syndrome (ARDS) induced by acid aspiration. Methods Twenty new Zealand rabbits were used. Dilute HCl was instilled into right bronchus of the rabbits. The rabbits were then divided randomly into two groups: injury group and treatment group. In injury group (n=10) rabbits received no treatment except mechanical ventilation. In treatment group (n=10) immediately after acid instillation the rabbits received an intravenous bolus of PGE 1 followed by a continuous infusion. Blood gas, airway pressure and dynamic and static compliance were measured before and after acid instillation. Blood samples were taken from artery for determination of 6-k-PGF 1?, TXB 2,NO 2 -/NO 3 - and ET-1. The animals were killed and the wet/dry lung weight (W/D) ratio and total protein of bronchoalveolar lavage fluid(BALF) of right lung were measured. Microscopic examination of the lung was done. Results In treatment group PaO 2 was significantly higher than that in injury group after acid instillation. Plasma 6-k-PGF 1? and NO - 2/NO - 3 levels were significantly higher in treatment group while plasma TXB 2 and ET-1 levels were significantly lower. W/D ratio and TP of BALF of right lung were significantly lower in treatment group. The inflammatory changes were diffuse in injury group while in treatment group they were localized and less severe. Conclusions PGE1 can lessen severity of ARDS induced by acid aspiration. It may protect pulmonary vascular endothelial cells through maintaining the balance between PGI 2 and TXA 2 and that between NO and ET-1 .

Objective The purpose of this study was to evaluate the perioperative management of patients with recent myocardial infarction (MI) undergoing non-cardiac surgery.Methods Twelve patients underwent general or thoracic surgery on the 72th to 175th day after acute MI. Their mean age was (67?4 ) years old. All patients received epidural block or epidural block combined with general anesthesia. Epidural catheter was left in place for postoperative analgesia.Results All patients underwent operation smoothly. During operation ECG monitoring showed no ischemic ST-T changes. Postoperative pain relif was satisfactory. No acute heart failure or myocardial reinfarction occurred during their stay in hospital.Conclusions In patients who had recent MI the time interval between the first MI and surgery should not be the only factor in the risk assessment. Other factors such as urgency of surgery, the severity of coronary artery disease, exercise tolerance and complexity of surgery should also be considered. Adequate preoperative evaluation and preparation and maintenance of cardiac function during perioperative period are crucial to the safety of surgery. Epidural block combined with general anesthesia is the anesthesia of choice for patient with recent MI undergoing non-cardiac surgery.

Objective To determine the changes in interleukin-8 (IL-8) and interleukin-1?(IL-1?) mRNA expressions in alveolar macrophages during isoflurane anesthesia. Methods Twenty-four ASA Ⅰ-Ⅱ male patients undergoing partial hepatectomy were randomly divided into two groups: group Ⅰ isoflurane; group Ⅱ general combined with epidural anesthesia. The age ranged from 43 to 67 years and body weight from 50 to 74kg. The patients were unpremedicated. Anesthesia was maintained with propofol infusion (4-6mg? kg-1?h-1 ) fentanyl and vecuronium in both groups. In addition 1% isoflurane was inhaled in group I and continuous epidural anesthesia with a mixture of 1 % lidocaine + 0.2% poutocaine (5ml/h) was performed in groupⅡ . ECG, SpO2, BP and HR were continuously monitored during anesthesia. Alveolar macrophages were harvested by bronchoalveolar lavage immediately and 4h after induction of anesthesia. RNA was extracted from harvested cells and cDNA was synthesized by reverse transcription. Expressions of IL-8 and IL-1? were measured by semiquantitative polymerase chain reaction using ?-actin as an internal standard. Results Gene expression of IL-8 and IL-1? in alveolar macrophages increased significantly at 4h after induction of anesthesia. The increase was greater in group Ⅰ than in group Ⅱ( P