Objective:To investigate the effect of ultrasound-guided erector spine plane block(ESPB)on postoperative analgesia in elderly patients undergoing abdominal operation.Methods:This was a prospective study.A total of 50 patients undergoing cholecystectomy and choledochotomy under laparotomy and general anesthesia were divided into two groups(n=25, each)according to the random number table method.The patient-controlled intravenous analgesia was named as the group P, and a single ESPB(the group E)was conducted with 0.33% ropivacaine 30 ml before induction of anesthesia as add-on to the management of group P. The block rang of ESPB, visual analogue scale(VAS)at 4, 12, 24 h postoperatively, number of analgesia pump pressure, number of patients receiving parecoxib sodium medication, complications related to the ESPB including dyspnea and local anesthetic systemic toxicity and anal exhaust time were recorded in the two groups.Results:The range of pain block in group E included the spinal innervation area(T5~T12)(13 cases)and(T6~L1)(12 cases). Compared with the group P, the group E showed that EVAS scores at 4, 12, 24 h postoperatively were decreased(4.2±1.1 vs.1.4±0.6, 4.0±0.8 vs.1.8±1.2, 3.5±0.9 vs.2.0±1.1, P<0.01), the number of analgesia pump pressure and the number of patients receiving supplemental parecoxib sodium were decreased(2.5±0.9 vs.9.9±1.5, 20.0% or 5 cases vs.64.0% or 16 cases, t=10.566, χ2=9.934, P<0.01), and the anal exhaust time was shortened[(20.1±1.9)h vs.(24.5±2.1)h, t=7.388, P<0.01]. No patients had dyspnea or local anesthetic toxicity. Conclusions:Ultrasound-guided ESPB has less complications, lower dose of postoperative opioid analgesics, faster recovery of postoperative intestinal function.

Objective: To evaluate the effects of ketamine anesthesia on proteome in hippocampus in aged rats. Methods: Thirty healthy male Wistar rats, aged 20 months, weighing 560-610 g, were divided into 2 groups (n=15 each) using a random number table method: control group (group C) and ketamine group (group K). In group K, ketamine 80 mg/kg was intraperitoneally injected, additional 1/2 initial dose was given when the righting reflex was recovered, and anesthesia was maintained for 3 h. Morris water maze test was performed starting from 1st day after the end of anesthesia.Five rats were selected at days 1 and 7 after the end of anesthesia and sacrificed, and hippocampal tissues were obtained to extract proteins.Proteins extracted from rat hippocampi were identified by 2-dimensional electrophoresis (2-DE). The differentially expressed proteins were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and biological information system. Results: Compared with group C, the escape latency and total swimming distance to find the submerged platform in Morris water maze at the 1st day after anesthesia were significantly prolonged in group K (P<0.05 or 0.01). The MALDI-TOF-MS analysis showed that there were 21 differentially expressed proteins at 1st day after ketamine anesthesia, of which 6 proteins (involving maintenance of intracellular protein homeostasis, energy metabolism, etc.) presented with up-regulated expression and 15 proteins (involving synaptic vesicle transport efficiency, synaptic structural and functional plasticity, maintenance of intracellular protein homeostasis, NMDA-mediated Ca²⁺ signal transport, energy metabolism, etc.) presented with down-regulated expression.There were 8 differentially expressed proteins at 7th day, including 3 proteins with up-regulated expression and 5 proteins with down-regulated expression (P<0.05). Conclusion Ketamine anesthesia can induce 21 differentially expressed proteins in hippocampi of aged rats, involving synaptic vesicle transport efficiency, synaptic structural and functional plasticity, intracellular protein homeostasis, NMDA-mediated Ca²⁺ signal transport, energy metabolism, and etc.which may be involved in the mechanism of ketamine-induced temporary cognitive dysfunction.

Objective To evaluate the effects of ketamine anesthesia on proteome in hippocampus in aged rats.Methods Thirty healthy male Wistar rats,aged 20 months,weighing 560-610 g,were di-vided into 2 groups(n＝15 each)using a random number table method: control group(group C)and ket-amine group(group K).In group K,ketamine 80 mg/kg was intraperitoneally injected,additional 1/2 ini-tial dose was given when the righting reflex was recovered,and anesthesia was maintained for 3 h.Morris water maze test was performed starting from 1st day after the end of anesthesia.Five rats were selected at days 1 and 7 after the end of anesthesia and sacrificed,and hippocampal tissues were obtained to extract proteins.Proteins extracted from rat hippocampi were identified by 2-dimensional electrophoresis(2-DE).The differentially expressed proteins were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS)and biological information system.Results Compared with group C,the escape latency and total swimming distance to find the submerged platform in Morris water maze at the 1st day after anesthesia were significantly prolonged in group K(P＜0.05 or 0.01).The MAL-DI-TOF-MS analysis showed that there were 21 differentially expressed proteins at 1st day after ketamine an-esthesia,of which 6 proteins(involving maintenance of intracellular protein homeostasis,energy metabo-lism,etc.)presented with up-regulated expression and 15 proteins(involving synaptic vesicle transport ef-ficiency,synaptic structural and functional plasticity,maintenance of intracellular protein homeostasis,NMDA-mediated Ca2+signal transport,energy metabolism,etc.)presented with down-regulated expres-sion.There were 8 differentially expressed proteins at 7th day,including 3 proteins with up-regulated ex-pression and 5 proteins with down-regulated expression(P＜0.05).Conclusion Ketamine anesthesia can induce 21 differentially expressed proteins in hippocampi of aged rats,involving synaptic vesicle transport efficiency,synaptic structural and functional plasticity,intracellular protein homeostasis,NMDA-mediated Ca2+signal transport,energy metabolism,and etc.which may be involved in the mechanism of ketamine-induced temporary cognitive dysfunction.

Objective:To investigate the effects of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)on intraoperative pulmonary function in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods:This was a retrospective case-control study.A total of 40 elderly patients undergone robot-assisted radical resection of prostate cancer were enrolled and divided into the control group and the DP-guided group(n=20, each group)based on the random number table method.Data on the peak inspiratory pressure(PIP)at time points including 4 min after the first PEEP set(T1), 4 min, 1 hour, 2 hours(T2-4)after the second PEEP set, and 1 min after closing abdomen(T5), lung compliance(Crs), PEEP and the partial pressure of carbon dioxide in end expiratory gas(PetCO 2)were recorded and compared between the two groups.Blood gas analysis was conducted, and the oxygenation index(OI), alveolar-arterial oxygen tension difference(A-aDO 2)and the dead space volume/tidal volume(Vd/Vt)were calculated. Results:Compared with the control group, Crs, OI and PaO 2 were increased and DP, Vd/Vt, A-aDO 2 and PaCO 2 were decreased in the DP-guided group at each time point( P<0.05). PIP showed no significant difference between the two groups at each time point( P>0.05). Compared with T1, PIP and DP were increased and Crs was decreased( P<0.05)in both groups at T2-T4( P<0.05). At T5, PIP was increased in both groups( P<0.05), Crs was decreased and DP was increased in the control group( P<0.05), while Crs and DP had no significant difference in the DP group at T1( P>0.05). OI and PaO 2 showed no significant difference between the two groups at T2-T5( P>0.05). Vd/Vt and PaCO 2 were increased in both groups at T3-T5( P<0.05). Compared with T1 levels, A-aDO 2 was increased in the control group at T3-T5( P<0.05)and in the DP group at T4( P<0.05). Conclusions:DP-guided individualized PEEP can reduce the occurrence of intraoperative atelectasis, improve intraoperative respiratory mechanical state and gas exchange, reduce the risk of potential ventilator-related lung injury and has good lung-protective effects of PEEP in elderly patients undergoing robot-assisted laparoscopic prostatectomy.