Objective To evaluate the perioperative monitoring of adult patients with hepatic encephalopathy under orthotopic liver transplatation (OLT).Methods Combined intravenous and inhalational general anesthesia was used for 18 patients with hepatic encephalopathy from October 2003 to August 2004. Rapid-sequence induction was performed. Propofol, 1 to 1.5 mg/kg, and fentanyl, 4 ?g/kg, were used. Norcuron, 0.1 mg/kg, was added to facilitate tracheal intubation. All patients were subjected to piggyback liver transplantation. Hemodynamics, respiratory, blood gas, blood biochemistry, coagulation function, body temperature, liver and kidney functions, urine output, and bleeding output were monitored during operation. According to the situations of patients, platelet, cryoprecipitate, fibrinogen, coagulation factors and ulinastatin were administrated.Results Eighteen patients tolerated the operation. Only 4 patients died of multiple organ dysfunction syndrome after operation. The survival rate reached was up to 77.8 %. The main blood gas change during perioperative phase was metabolic acidosis and hyposodium, hypokaleamia, hypocalcium. The main hemodynamics change during operation was that HR was increased significantly, and CO was higher than normal value before operation, and CO, CVP, SPAP and DPAP decreased significantly in anhepatic stage. Compared with those before operation, ALT, AST, BUN and Cr were increased significantly in neohepatic stage.Conclusions It is very important to pay more attention to these patients with hepatic encephalopathy during different stages of OLT. Drugs not affecting the function of liver and kidney should be selected. Benzodiazepine should be avoided. Supplementation of coagulation factors, CRBC and electrolyte was necessary. The key point is to protect renal function, maintain enough urine output and treat brain edema.

Objective To investigate the peri operative changes and anesthetic management during orthotopic liver transplantation (OLT) Methods General anesthesia or general anesthesia combined with epidural anesthesia was applied During the anhepatic phase, extracorporeal veno venous bypass (EVVB) was established Hemodynamics, respiratory function, blood gas, biochemistry, blood coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored According to the different characteristics of the pre anheptic phase, anheptic phase and neoheptic phase during OLT, the corresponding anesthetic management was supplied Results Applying EVVB during the anheptic phase could keep hemodynamics stable, but in 15 min of the primary anheptic and neoheptic stages a transient circulatory instablity occurred,and the rapid blood volume expansion was required Through comprehensive management, there was no obvious acid base disturbance during the phases The hypocalcemia, hypokalemia and hyperglycemia occurred and thebody temperature changed greatly,to require timly corrective measures Certain coagulative disturbances occurred, to require the supplement of coagulation factors, proper hemostatic drugs and protamine for neutralizing heparin Intraoperatively, anti rejection drugs were required Peri operatively, the blood glucose levels were higher than normal Conclusions Utilizing EVVB during the anheptic phase can be helpful to maintain hemodynamics stable, prevent obvious acidosis and hyperkalemia The anesthetic management during the neoheptic phase should be required to correcte hypothermia, hypocalcemia, hypokalemia, hyperglycemia and disturbence of coagulation

Objective To observe the changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation Methods During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was utilized in 20 patients undergoing live transplantation Systemic and pulmonary hemodynamics were monitored through Swan-Ganz catheter during whole procedures Results As compared with the preoperative values , MAP remained unchanged in normal range during perioperative period;CO,CI,LVSW and RVSW decreased significantly during anhepatic phase and increased markedly 15 min after hepatic reperfusion (P

Objective To investigate the effect of astragalus membranaceus on the ultrastructure of small intestinal epithelial cells in rabbits with hemorrhagic shock. Methods Twenty-four New Zealand white rabbits of both sexes weighing 2-3 kg were randomly divided into 3 equal groups : (A) control group received normal saline iv ( n = 8); (B) group HI received astragalus membranaceus 20 mg? kg-1 iv ( n = 8); ( C) group H2 received astragalus membranaceus 10 mg?kg-1 iv ( n = 8 ). Animal model of hemorrhagic shock-resuscitation was established according to Wigger's. A strip of small intestine, 10 cm in length was taken from distal end of ileum for electron microscopic examination. The two-dimensional structural parameters and three-dimensional structural parameters of mitochondria were calculated. Results (1) Morphological changes of small intestine : in group H1 epithelial cells were orderly arranged, with relatively normal mitochondria and intestinal villi were slender and orderly; in group H2 the nuclei in epithelial cells were dwindled, the intestinal villi were thin and short and unorderly arranged with slightly swelled mitochondria and blurring ridges. Endoplasmatic reticulum was dilated; in group C the gaps between epithelial cells widened. There were a lot of apoptotic cells. Microvilli were thin and short and swelled. Mitochondria were swelled with broken ridges. Endoplasmatic reticulum was severely dilated. (2) Structural parameters of mitochondria : in group C there were least mitochondria and the swelling of mitochondria was severe; in group H1 there were plenty of mitochondria and the swelling was slightest; in group H2 the changes in mitochondria were between group C and H1. Conclusion Astragalus membranaceus can protect small intestine from ischemia/reperfusion injury in a dose-dependent manner.

0.05), but pretreatment with yohimbine 10 ug significantly reduced the antinociceptive effect of tramadol ( 10ug) at 35 min and 40 min and the nociception score increased by 56% and 41 % respectively ( P 0.05). Scatchard analysis of the saturation isotherms showed that H-yohimbine was bound to a single binding site with a Kd value of 1.79 nM. The competition curve of tramadol was sigmoidal with a Ki value of 34.14 uM and an IC50 value of 68.25 uM. Tramadol was 19 000-fold less potent for binding to a2-adrenoceptor of the spinal cord as compared to H-yahimbine. Conclusion Intrathecal tramadol produces time-dependent antinociception. Tramadol has very low affinity with a2-adrenoceptor of the spinal cord. A part of its intrathecal antinociceptive effect was related to indirect a2-adrenoceptor effect of the spinal cord.

Objective To evaluate the effect of lipo-alprostadil on lung injury in patients undergoing orthotopic liver transplantation.Methods Forty-eight ASA Ⅱ-Ⅳ patients of both sexes,aged 45-64 yr,weighing 45-70 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =24 each):control group (group C) and lipo-alprostadil group (group A).Anesthesia was induced with midazolam,propofol,fentanyl and vecuronium and maintained with sevoflurane,sufentanil and vecuronium.The patients were tracheal intubated and mechanically ventilated.Lipo-alprostadil 5 μg in 10 ml of normal saline was infused intravenously and slowly over 30 min before induction of anesthesia and at 1 h of neohepatic phase in group A.Lipoalprostadil was not administrated in group C.Peak inspiratory pressure (PIP),mean inspiratory pressure (Pmean),dynamic lung compliance (Cd),oxygenation index (OI),respiratory index (RI) and the concentrations of inflammatory cytokines in exhaled breath condensate (EBC) were recorded immediately before operation,at the end of operation,and at 24 h after operation.The occurrence of pulmonary complications was recorded within 7days after operation.Results Compared with group C,PIP,Pmean,RI,and TNF-α and IL-8 concentrations in EBC were significantly decreased,while Cd and OI were increased at the end of operation and 24 h after operation,and the incidence of acute lung injury and pulmonary infection were decreased within 7 days after operation (P ＜0.05),and no significant change in the other indexes was found in group A (P ＞ 0.05).Conclusion Lipo-alprostadil has protective effect on lung in patients undergoing orthotopic liver transplantation.

Objective To evaluate the effects of propofol,etomidate and midazolam on gap junction function in rats in vitro and in vivo.Methods Experiment Ⅰ NRK52E cells were seeded in 6-well plates with the density of 1.0 × 105/ml and randomly divided into 4 groups (n =6 wells each):control group (group C),propofol group (group P),etomidate group (group E) and midazolam group (group M).In group C,NRK52E cells were cultured in DMEM-F12 culture medium containing 10％ fetal bovine serum.In P,E and M groups,propofol,etomidate and midazolam (with the final concentrations of 15,8 and 4μmol/L,respectively) were added to the culture medium,respectively,and the cells were then incubated for 1 h.Parachute dye-coupling assay was used to measure the gap junction function in NRK52E cells.Experiment Ⅱ Twenty-four male Sprague-Dawley rats,aged 2 months,weighing 220-280 g,were randomly divided into 4 groups (n =6 each):propofol group (group P),etomidate group (group E),midazolam group (group M),and control group (group C).In P,E and M groups,propofol 100 mg/kg,etomidate 6 mg/kg and midazolam 5 mg/kg were injected intraperitoneally once a day for 3 consecutive days,respectively.The equal volume of normal saline was given instead in group C.The animals were sacrificed at 30 min after the last administration and the renal cortex was harvested to measure the gap junction function using tissue scrape and load assay.Results Compared with group C,the gap junction function was significantly decreased in P and E groups (P ＜ 0.05),and no significant change was found in the gap junction function in group M (P ＞ 0.05).Conclusion Propofol and etomidate significantly inhibit the gap junction function in NRK52E cells and renal tissues in rats,but midazolam produces no effect.

Objective To evaluate the effects of therapy with small volume of different fluids on renal blood flow in endotoxemia rats.Methods Thirty parthogen-free SD rats weighing 180-250 g were randomly divided into 5 groups (n = 6 each):group Ⅰ control; group Ⅱ LPS; group Ⅲ LPS + 7.5 % hypertonic saline (HS);group Ⅳ LPS + hydrozyethly starch (HES) 130/0.4 and groupⅤ LPS + hypertonic saline plus hydroxyethly starch (HS-HES) 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 40 mg/kg. Left carotid artery was cannulated for BP and HR monitoring and fluid administration. In groupⅡ-Ⅴ LPS 1 mg/kg was administered via arterial cannula. In group Ⅲ, Ⅳ and V 4 ml/kg of 7.5% HS, HES 130/0.4 AND HS-HES 40 were administered via arterial cannula respectively at 30 min after LPS administration.In groupⅠ and Ⅱ normal saline 4 ml/kg was given insteadt. Renal blood flow was measured with Doppler ultrasound before LPS (T1 ,baseline), at 30 min after LPS (T2), 10, 30 and 60 min after fluid therapy (T3, T4, T5). The animals were then sacrificed and both kidneys were removed for microscopic examination with light microscope. Results Renal blood flow was significantly decreased and was significantly recovered to some extent by therapy with different fluids especially with HS-HES 40 in group Ⅴ. Conclusion Therapy with small volume of HS,HES or HS-HES could increase renal blood flow and inprove renal microcirculation especially HS-HES.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from anesthesia in the patients undergoing modified electroconvulsive therapy (MECT) with propofol anesthesia.Methods One hundred and ten patients of both sexes,aged 18-50 yr,weighing 45-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective MECT with general anesthesia,were randomly assigned into 2 groups (n =55 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was infused intravenously in a dose of 0.5 μg/kg (in normal saline 10 ml) over 10 min in group D,while normal saline 10 ml was infused intravenously over 10 min in group C.Propofol 1.5 mg/kg and succinylcholine 0.5 mg/kg were injected intravenously,and MECT was performed in the two groups.The emergence time was recorded.The development of cardiovascular events,nausea and vomiting,respiratory depression,headache,somnolence and agitation during recovery from anesthesia was recorded.Results Compared with group C,the incidence of nausea and vomiting,headache and agitation during recovery from anesthesia was significantly decreased (P＜0.05),and no significant changes were found in the emergence time,and incidence of hypertension,tachycardia,respiratory depression and somnolence during recovery from anesthesia in group D (P＞ 0.05).Conclusion Dexmedetomidine (intravenously infused in a dose of 0.5 μg/kg over 10 min before anesthesia) can raise the quality of recovery from anesthesia in the patients undergoing MECT with propofol anesthesia.

BACKGROUND: It is reported that ceramide signal pathway may play an important role in the apoptosis of vascular endothelial cell and then lead to the progress of atherosclerosis, such as the formation of foam cells and the proliferation of smooth muscular cells.OBJECTIVE: To study the changes of the sphingomylinase activity and ceramide content in aorta of rabbits with experimental atherosclerosis and investigate the regulative effects and mechanism of emodin on them as compared with positive fenofibrate.DESIGN: Completely randomized controlled design.SETTING: Laboratory of Pharmacology & Toxicology, School of Pharmaceutical Science of Sun Yat-sen University.MATERIALS: The experiment was completed at the Laboratory of Pharmacology & Toxicology, School of Pharmaceutical Science of Sun Yat-sen University from July to December 2003. Totally 48 New Zealand male rabbits were selected. Forty animal models of atherosclerosis were made with high cholesterol feed, and the other 8 rabbits were selected as the normal controls. Model animals were divided randomly into model group, 5 mg/kg emodin group, 10 mg/kg emodin group, 20 mg/kg emodin group and 25mg/kg fenofibrate group with 8 in each group.METHODS: At the seventh weeks of model duplication, 5 mg/kg, 10 mg/kg and 20 mg/kg emodin were perfused in rabbits of emodin groups respectively, and 25 mg/kg fenofibrate was perfused in rabbits of fenofibrate group. Emodin and fenofibrate were diluted or suspensed with 2 mL saline once per day respectively. Rabbits in normal control group and model group were administrated with the same volume of saline for 4 weeks. The rabbits were raised separately and were fed with 135-150 g food per day.MAIN OUTCOME MEASURES: [1] The area of the lipid plaque in aortal intima; [2] the content of serum TC and TG; [3] SOD activity and MDA content; [4] SMase activity and CER content in aorta.RESULTS: Totally 48 rabbits entered the final analysis. [1] Area of the lipid plaque: Area of the lipid plaque was (48.87±15.5) % in the model group, which was larger than that in each emodin group (P ＜ 0.05 or 0.01),especially larger than that in the 10 mg/kg emodin group (22.19±12.9)%while that in the fenofibrate group was similar to that in the model group (P ＞ 0.05). [2] Content of serum TC and TG: The anrtal intima of control was smooth. Content of serum TC and TG in each emodin group were similar to those in the model group (P ＞ 0.05), but those in the 25 mg/kg fenofibrate group were lower than those in the model group (P ＜ 0.05). [3]Content of SOD and MDA in plasma: SOD activity of rabbits in each emodin group was higher than that in the model group (P ＜ 0.05, P ＜ 0.01),but the MDA activity in the 10 mg/kg and 20 mg/kg emodin group was lower than that in the model group (P ＜ 0.05). The MDA activity in the25 mg/kg fenofibrate group was similar to that in the model group (P ＞ 0.05).[4] Content of SMase and CER: Those in the model group were higher than those in the normal control group, but those in the 5, 10 and 20 mg/kg emodin groups were lower than those in the model group; those in the 25 mg/kgfenofibrate group were similar to those in the model group (P ＞ 0.05). [5]Analysis of correlation: Content of SMase was in positive relation with blood cholesterol (r=0.542, P ＜ 0.01), in positive relation with blood MDA (r=0.789, P ＞ 0.01), and in negative relation with blood SOD(r=-0.936, P ＞ 0.01); content of CER was in positive relation with blood cholesterol (r=0.433, P ＞ 0.05), in positive relation with blood MDA (r=0.673, P ＞ 0.01), and in negative relation with blood SOD (r=-0.876, P ＞ 0.01).CONCLUSION: The study finds that emodin, despite its insignificant effects on decreasing TG or TC, can protect vascular endothelial cells and reduce the area of lipid-laden plague of aortal intima by antioxidation, inhibition of the sphingomyelinase activity and reduction of the content of ceramide. It is suggested that moderate dosage of emodin employed in the study may be most appropriate to atherosclerosis treatment.