Journal Detail Information

1

Cite

Share

Validity of stroke volume variation for predicting fluid responsiveness in different grades of intra-abdominal pressure

Hui QI ; Qin GU ; Ning LIU ; Yin XU ; Beiyuan ZHANG ; Yunhong HAN

The Journal of Clinical Anesthesiology.2017;33(8):805-807.

Objective To evaluate the validity of stroke volume variation (SVV) for predicting fluid responsiveness in different grades of intra-abdominal pressure (IAP).Methods Forty pigs were involved in the study.Hypovolemia was made by blood withdraw of 30% of estimated blood volume from each animal via carotid artery.All the pigs were randomized into four groups namly 0 mm Hg (L0), 15 mm Hg (L15), 25 mm Hg (L25) and 35 mm Hg (L35).Nitrogen was inflated slowly till IAP to 0, 15, 25 and 35 mm Hg.Fluid loading was performed with 500 ml hydroxyethyl starch within 30 minutes.Hemodynamic parameters were evaluated by the thermodilution technique of pulse induced continuous cardiac output (PiCCO).SVV and stroke volume (SV) were measured before and after fluid loading.Results In groups L0 and L15, SVV was positive correlated with changes in SV (r=0.888, 0.942, respectively, P<0.05).In groups L25 and L35, there were poor correlations between SVV and changes in SV(r=0.068,-0.114, respectively).Conclusion When IAP was slightly increased up to 15 mm Hg, SVV remains an effectiveness index to predict fluid responsiveness index, however it failed to assess fluid responsiveness effectively when IAP is further raised up to 25 mm Hg or more.

2

Cite

Share

Effects of dexmedetomidine on oxygen-glucose deprivation/reperfusion-induced neuronal apoptosis

Kai KANG ; Fang KANG ; Yujun SHEN ; Yuxian SHEN ; Xiang HUANG ; Juan LI

The Journal of Clinical Anesthesiology.2017;33(8):793-796.

Objective To investigate protective effects of dexmedetomidine on oxygen-glucose deprivation/reperfusion(OGD/R)-induced neuronal apoptosis.Methods SH-SY5Y cells were differentiated to neurons with ATRA and followed by TPA.According to the results of preliminary experiment, OGD/R modle was constructed by oxygen-glucose deprivation(OGD) for 12 h and reperfusion(R) for another 12 h.During the start of the OGD, neurons were immediately divided into six groups: group D0(0 μmol/L dexmedetomidine), group D1(0.1 μmol/L dexmedetomidine), group D2 (1 μmol/L dexmedetomidine), group D3 (10 μmol/L dexmedetomidine), group D4(100 μmol/L dexmedetomidine), group D5 (1 000 μmol/L dexmedetomidine).After reperfusion 12 h, the cell viability was evaluated by the method of MTT.The cellular apoptosis was observed by flow cytometry method.The protective effects of different concentration dexmedetomidine on OGD/R-induced neuronal apoptosis were investigated.Then in chosen the exact group having protective effects, endoplasmic reticulum stress specific protein mesencephalic astrocyte-derived neurotrophic factor (MANF) and pro-apoptotic protein Caspase-3 and CHOP were detected by Westernblot method.Results Compared with group D0, there was no difference on the cell viability and cellular apoptosis induced by OGD/R in groups D1 and D2, but a significant decrease and increase in groups D4 and D5 (P<0.01 or P<0.05).And only group D3 had a neuroprotective effect, significantly increased the cell viability and inhibited the apoptosis (P<0.01).Further studys found that group D3 significantly up-regulated ER stress specific protein MANF (P<0.01) and inhibited up-regulation of Caspase-3 and CHOP (P<0.01).Conclusion These data suggest that 10 μmol/L dexmedetomidine had neuroprotective effect on OGD/R-induced neuronal apoptosis and significantly increased cell viability.Our results also indicate that up-regulation of ER stress specific protein MANF and inhibition of CHOP and Caspase-3 by MANF are involved in the neuroprotective effects of Dexmedetomidine.

3

Cite

Share

Intervention effect of remifentanil regulated human umbilical vein endothelial cell oxidative stress injury induced by hydrogen peroxide

Xia LI ; Jian MENG ; Lirong ZHANG ; Bo YAN

The Journal of Clinical Anesthesiology.2017;33(8):789-792.

Objective To establish oxidative stress model of hydrogen peroxide treatment by using human umbilical vein endothelial cells (ECS) as cell model to study the protective mechanism of anti oxidative stress and determine the signal transduction pathway of remifentanil.Methods Primary cultured human umbilical vein endothelial cells which were incubated with 0.1 M hydrogen peroxide to establish injury model to study remifentanil protection and related pathways.The experiment was divided into nine groups: control group (group C), Hydrogen peroxide group (group H1), Hydrogen peroxide+SP600125 group (group H2), Hydrogen peroxide+SB203580 group (group H3), Hydrogen peroxide+PD98059 group (group H4), hydrogen peroxide+remifentanil group (group HR1), hydrogen peroxide+remifentanil+SP600125 group (group HR2), hydrogen peroxide+remifentanil+SB203580 group (group HR3), hydrogen peroxide+remifentanil+PD98059 group (group HR4).Groups H1, H2, H3 and H4 only performed MAPK pathway blockade experiments.Groups HR1, HR2, HR3 and HR4 individually added remifentanil 10 ng/ml to protect 1 h.SOD activity, MDA level, Caspase-3 activity were detected and anti oxidative stress of remifentanil observed to confirm preliminary transduction pathway;Using RT-PCR expression levels of c-Jun before was observed before and after treated with remifentail 10 ng/ml.The aim was to determine the transduction pathway of the signaling molecules.Results Compared with group C, SOD activity were decreased significantly, MDA performance level were increased significantly in groups H1, H2, H3 and H4 (P<0.05).Compared with group H1, SOD activity was increased significantly, MDA performance level was decreased significantly in group HR1 (P<0.05).SOD activity difference and MDA performance level of groups HR2 and H2 had no statistical significance.Compared with group H3, SOD activity was increased significantly, MDA performance level was decreased siginificantly in group HR3 (P<0.05).Compared with group H4, SOD activity was increased significantly, MDA performance level was decreased significantly in group HR4 (P<0.05).Caspase-3 activity of groups H1, H2, H3 and H4 were higher significantly than that of group C (P<0.05).The level of C-Jun mRNA in group H1 was significantly higher than that of group C;But it was higher in group HR1 than that of group C, it was significantly lower than that of group H1 (P<0.05).Conclusion By activating the JNK pathway and its downstream signaling molecule c-Jun, remifentanil 10 ng/ml has the effect of increasing SOD activity, reducing the level of MDA expression and playing a role in anti oxidative stress.

4

Cite

Share

Effects of remifentanil postconditioning after myocardial ischemia reperfusion in rats

Hong ZHENG ; Pengtao LIN ; Wenhua CHEN ; Lanlan WANG ; Lizhen LI

The Journal of Clinical Anesthesiology.2017;33(8):785-788.

Objective To explore the effect of remifentanil postconditioning on rats subjected to ischemia reperfusion injury and the relative mechanisms.Methods Seventy-eight Sprague-Dawley rats, weighing 200-250 g, were randomly divided into six groups (n=13): sham group (group S), ischemia/reperfusion group (group IR), naloxone group (group NAL), 5 μg·kg-1·min-1 remifentanil postconditioning group (group R1), 10 μg·kg-1·min-1remifentanil postconditioning group (group R2) and 20 μg·kg-1·min-1remifentanil postconditioning group (group R3).Group IR was given 45 min ischemia in the left descending anterior (LAD), followed by a 24-h period of reperfusion.Groups R1, R2, R3 received 10 min of remifentanil infusion of 5, 10 and 20 μg·kg-1·min-1 after 35 min ischemia followed by a 24 h period of reperfusion.Group NAL was given injection of naloxone 0.1 mg/kg at the point of 25 min myocardial ischemia, after 10 min, then remifentanil 10 μg·kg-1·min-1 for 10 min.The myocardial infarct size and pathological changes of myocardial tissue were observed, serum cTnI, LDH and CK-MB level were measured.Results Compared with group S, serum cTnI, LDH and CK-MB and myocardial infarct size were markedly increased in groups IR, NAL, R1, R2 and R3 (P<0.05), and pathologic injury of myocardial cells were augmented.In comparison with group IR, the indexes were decreased in groups R1, R2 and R3 (P<0.05).Conclusion Remifentanil postconditioning could protect against myocardial ischemia reperfusion injury in rats.The protection may be related to remifentanil activating the opioid receptors.There were ceiling effects of remifentanil postconditioning induced myocardial protection.

5

Cite

Share

Efficacy of preemptive analgesia with ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine for circumcision in pediatric patients

Qi YIN ; Jingyun ZHANG ; Dingrong TANG ; Guangming ZHU ; Yunxia FAN

The Journal of Clinical Anesthesiology.2017;33(8):776-779.

Objective To investigate the efficacy of preemptive analgesiawith ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine for circumcision in pediatric patients.Methods Forty-five pediatric patients with ASA grade Ⅰ undergoing elective circumcision were randomly divided into 3 groups (n=15 each).The same intravenous compound anesthesia was used in the three groups.The pediatric patients underwent ultrasound-guided modified dorsal penile nerve block with a mixture of 0.1 ml/kg of 0.2% ropivacaine and 0.8% lidocaine before operation in group A and group B.The pediatric patients were given ketorolac tromethamine 1 mg/kg intramuscular injection before operation in group A and group C.The total consumption of propfol and sufentanil, occurrence of intraoperative body movement and respiratory depression, emergence time, time from waking up to going out of PACU and adverse reactions such as postoperative agitation, nausea, vomiting and pruritus were aslo recorded.The requirement for postoperative paracetamol suppositories was recorded.Results Compared with group C, the total consumption of propfol and sufentanil were significantly decreased, incidence of body movement andrespiratory depression were significantly decreased, the emergence time and time from waking up to going out of PACU was significantly shortened, requirement for paracetamol suppositories were significantly decreased in group A and group B(P<0.05).Compared with group B, incidence of requirement for paracetamol suppositories was significantly decreased in group A (P<0.05).No pediatric patients developed postoperative nausea, vomiting, pruritus and incidence of emergence agitation had no statistical difference in the three groups.Conclusion Preemptive analgesia with ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine is safe and effective when used for circumcision in pediatric patients, and it has good efficacy of postoperative analgesia.

6

Cite

Share

Application of transesophageal doppler mornitoring in early diagnosis and treatment of transurethral resection syndrome in patients undergoing transurethral resection prostate

Wei ZHANG ; Jiawu WANG ; Xiaoqing CHAI ; Xin WEI ; Yunxiang WU ; Jun MA ; Yuanhang LUAN

The Journal of Clinical Anesthesiology.2017;33(8):772-775.

Objective To explore the value of transesophageal doppler in transurethral resection prostate.Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled.Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5).By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.Results CVP at T1-T5 were not significantly changed compared with that at T0.Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5were significantly decreased (P<0.05).CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01).CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05).Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01).No patient had serum sodium ion concentration less than 125 mmol/L.Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP.It is useful in early diagnosis and treatment of TURS.

7

Cite

Share

Influence of different volumes of ropivacaine with the same solubility on diaphragmaticparalysis following ultrasound-guided supraclavicular brachial plexus block

Xiuxia BAO ; Juanjuan HUANG ; Haorong FENG ; Xianghe WANG

The Journal of Clinical Anesthesiology.2017;33(8):768-771.

Objective To investigate the effects of different volumes of ropivacaine with the same solubility in supraclavicular brachial plexus block(SCBPB) under ultrasound guidance on ipsilateral diaphragmaticparalysis.Methods Seventy two patients (32 males,40 females, aged 18-65 years, of ASA Ⅰ or Ⅱ, scheduled for the right upper limb fracture internal fixation removal were randomized into group A (0.375% ropivacaine 20 ml) and group B (0.375% ropivacaine 30 ml), 36 cases in each group.The onset and duration of sensory and motor block were observed as well as complication.Diaphragmatic excursion were evaluated by M type ultrasound before and 30 min after drug injection under eupnea and forced respiration through observing diaphragmatic excursion to study diaphragmatic paralysis.Results The onset time of sensory block and maintaining time of sensory block or motor block had no significant difference between the two groups.Compared with group A,the onset time of motor block in group B was significantly shorter (P<0.05).Twelve cases (33.3%) in group A and 22 cases (61.1%) in group B respectively showed complete or partial hemidiaphragmatic paralysis 30 min after drug injection.Compared with group A, the rate of diaphragmatic paralysis in group B was significantly higher (P<0.05).Conclusion Supraclavicular brachial plexus block under ultrasound guidance with 0.375% ropivacaine 20 ml or 30 ml both can provide excellent anesthetic effect.0.375% ropivacaine 20 ml is less likely to lead to diaphragmatic paralysis.

8

Cite

Share

Observational study about dezocine combined with dexmedetomidine for sedation and analgesia in ICU patients with mechanical centilation

Jingyi DUAN ; Zhenyu ZHANG ; Yuan XU

The Journal of Clinical Anesthesiology.2017;33(8):765-767.

Objective To evaluate the effects on mechanical ventilation in ICU patients with dexmedetomidine merely and combined with dezocine, fentanyl, respectively.Methods Fifty-seven patients with mechanical ventilation in ICU were collected during Jun till Dec in 2016, 35 males and 22 females, aged 18-75 years, and classified into three groups with random number table method, among whom there were 17 patients treated with dexmedetomidine, 20 patients treated with dexmedetomidine combined with dezocine and 20 with dexmedetomidine plus fentanyl, the general condition, pain score, MAP and HR were compared before and after the treatment, ideal treatment time and mechanical ventilation time were also compared among the different groups.Results There were no statistical differences in the general condition, CPOT score, MAP and HR at different points and mechanical ventilation time.Whereas, the time of ideal sedation and analgesia was significantly faster in group C than that of groups A and B (P<0.05).Conclusion Dexmedetomidine combined with dezocine can reach the ideal analgesic effect more rapidly than dexmedetomidine solely or combined with fentanyl.

9

Cite

Share

Analysis of influencing factors of perioperative coagulation dysfunction in neonates with gastrointestinal surgery

Tingting ZOU ; Min DU ; Ying XU

The Journal of Clinical Anesthesiology.2017;33(8):760-764.

Objective To analyze the influencing factors of perioperative coagulation dysfunction in neonates with gastrointestinal surgery.Methods Coagulation indexs, including plasma prothrombin time (PT), partial activated thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen (Fib), were collected retrospectively from June 2002 to April 2016 in gastrointestinal neonatal surgery, as well as perioperative clinical data and the perioperative coagulation dysfunction associated risk factors were analyzed.Results There were 158 cases with abnormal coagulation indexs within 4 hours after operation, including 61 cases of mild abnormalities and 97 cases of obvious abnormalities.Multivariate logistic regression analysis showed that preoperative pneumonia (OR=2.880, 95%CI 1.417-5.852), perioperative low calcium (OR=2.381, 95%CI 1.167-4.857) and invasive puncture catheter (OR=2.490, 95%CI 1.299-4.773) were independent risk factors for neonatal coagulation index abnormality within 4 hours after surgery (P<0.05).Conclusion In the perioperative management, pneumonia should be actively treated, correcting hypocalcemia and choosing concentrations of less than 6.25 U/ml of heparin solution or normal saline careing arteriovenous catheter reduces the occurrence of neonatal postoperative coagulation dysfunction.

10

Cite

Share

Effect of dexmedetomidine on renal functions during renal transplantation patients

Yao LIU ; Bing LI ; Yahui WU ; Hongjun LI

The Journal of Clinical Anesthesiology.2017;33(8):751-754.

Objective To evaluate the effect of dexmedetomidine on renal functions during the anesthesia of renal transplantation.Methods Sixty patients (36 males, 24 females, aged 25-45 years, ASA physical status Ⅱ or Ⅲ), were randomly divided into two groups (n=30 each).Patients in dexmedetomidine group received a loading dose of dexmedetomidine 1 μg/kg within 10 min)and a continuous infusion of dexmedetomidine 0.6 μg·kg-1·h-1 until 30 min toward the end of surgery, while patients in control group received 0.9% sodium chloride injection to maintain equal capacity until 30 min before the end of surgery.Artery systolic blood pressure and heart rate were recorded before anesthesia induction (T1), before vascular anastomosis opening (T2), immediately after vascular anastomosis opening (T3), 30 min after vascular anastomosis opening (T4), after the surgery (T5), venous blood was collected in T2, T4, 24 h after surgery (T6) and 48 h after surgery (T7) to detect the blood urea nitrogen (BUN), serum creatinine (Cr), IL-18 and Cystatin C (Cys C);fluid infusion and urine were recorded.Results Compared with control group, HR of dexmedetomidine group was reduced at T3, SBP of dexmedetomidine group was elevated at T2, T3(P<0.05).Compared with T2, Cys C, BUN, Cr of two groups decreased significantly at T6, T7, and Cys C of dexmedetomidine group was lower than that of control group (P<0.05).Compared with T2, IL-18 of the two groups reduced significantly at T6 and T7, and lowered amplitude in the dexmedetomidine group was greater than that in the control group (P<0.05).Perioperative urine volume in the dexmedetomidine group was more than that in the control group (P<0.05).There was no difference in perioperative fluid infusion between the two groups.Conclusion Perioperative continuous infusion of dexmedetomidine might effectively improve the renal function of renal transplantation patients.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share