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Effect of nicardipine on perioperative insulin sensitivity in patients with essential hypertension

The Journal of Clinical Anesthesiology.2010;26(2):97-99.

Objective To investigate the effect of nicardipine on perioperative insulin sensitivity in patients with essential hypertension(EH). Methods Thirty-eight patients undergoing lobectomy continuously after induction of anesthesia in group N, while normal saline was infused in group C instead of nicardipine. Blood samples were taken immediately before induction of anesthesia(T_0), 2 h after skin incision(T_1) ,4 h after surgery(T_2) and 24 h after surgery(T_3). Blood glucose(BG) and plasma insulin (Ins) were measured. The Insulin sensitivity index (ISI) was calculated. Results Values of BG at T_2and T_3 in group C were higher than those at T_0 (P<0. 05). Value of Ins at T_2 in group C was higher than that at T_0 (P<0. 05),which at T_3 in group C was significantly higher than that at T_0 (P<0. 01). ISI at T_2 in group C was lower than that at T_0 (P<0. 05) ,which at T_3 in group C was lower significantly than that at T_0 (P<0. 01). Values of BG and Ins at T_3 in group N were higher than those at T_0 (P<0. 05), ISI at T_3 in group N was lower than that at T_0 (P<0. 05). Value of BG at T_2 was significantly lower in group N than that in group C(P<0. 05). Value of Ins at T_3 was significantly lower in group N than that in group C(P<0. 01). ISI at T_2 and T_3 in group N was min~(-1) infused continuously during and after lobectomy can increase significantly insulin sensitivity and improve postopertive insulin resistance state in EH patients.

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Expression of EAAC1 in dorsal root ganglion in rats with inflammatory pain-morphine tolerance

Yi CHEN ; Yonghao YU ; Guolin WANG

The Journal of Clinical Anesthesiology.2010;26(1):54-56.

Objective To explore the role of excitatory amino acid carrier 1 (EAAC1)in dorsal root ganglion (DRG) in the mechanism of developing morphine tolerance. Methods Thirty male SD rats were implanted intrathecal catheters and randomized into 6 groups with 5 rats each. The rats of 4 groups were made into the model of adjuvant-induced arthritis in the left hind limb and were administered intrathecally, morphine 10 μg(group M_(10)), morphine 20μg(group M_(20)), morphine 20 μg plus naloxone 10 μg(group MN) ,or saline(group C) respectively. The other 2 groups without were administered intrathecally saline (group C_0) or morphine 20 μg (group M0). The drugs were administered twice daily for 7 days. Mechanical withdrawl threshold(MWT) of the left hind limb was examined to evaluate the behavior. Immunohistochemistry was used to detect the expression of EAAC1 in the left L_(3-4) and L_(4-5) DRG. Results Morphine tolerance was formmed stably in the arthritis rats of group M_(10) and group M_(20) after administering morphine for 7 days. The expression of EAAC1 in DRG was downregulated. Conclusion DRG EAAC1 may be involved in the mechanism of developing morphine tolerance in rats with inflammatory pain.

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Effect of anesthesia methods on perioperative body temperature in patients undergoing operation for esophagus cancer

Xiaojun HUA ; Faping WU ; Huaying WU

The Journal of Clinical Anesthesiology.2010;26(1):11-13.

Objective To investigate the effect of different anesthesia methods on perioperative body temperature. Methods Eighty patients undergoing esophagus cancer resection were randomized into two groups of combined general and epidural anesthesia(GEA, group A,42 cases) and general anesthesia(GA, group B, 38 cases). Epipharynx and peripheral temperatures were recorded at the same time every 30 minutes for 3 hours after induction. Epipharynx temperature was recorded than after when circulating water mattresses and fluid warming were used to rewarming. The incidence of postoperative shivering was recorded. Results The peripheral temperature was gradually decreased after induction in both groups. The core temperature was decreased quickly within the first 1 hour in both groups, which was reduced slowly within the next two hours with a greater magnitude of temperature reduction in group A than that in group B(P<0.05). The incidence of shivering was higher in group A than that in group B during warming up. Conclusion The patients undergoing long procedures such as esophagus cancer recection under GEA is at more risk for hypothermia than those under GA.

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Clinical analysis on cognitive dysfunction early after non-cardiac surgery in elderly

Lanying LIN ; Caizhu LIN

The Journal of Clinical Anesthesiology.2010;26(1):8-10.

Objective To analyse the cognitive dysfunction early after non-cardiac surgery in elderly. MethodsEighteen elderly patients undergoing selective non-cardiac surgery were investigated. General anesthesia was used in 11 patients and combined epidural-spinal anesthesia in 7 cases. The operations involved orthopedic, thoracic, abdominal and urologic surgeries. The patients were premedicated with phynoharbital 0. 1g and scopolamine 0. 3mg. Results All patients suffered from typical POCD that occurred during 1 to 3 days after operation. The symptoms were more severe at night. The patients with POCD were treated effectively with intravenous injection of midozolam and muscle injection of haloperidol in 15 cases. The symptoms of POCD were attenuated by injection of pethidine in 2 cases. One case had to be given intravenous infusion of propofol continually for 16 hours. All patients were cured without psychological complications before discharge Conclusion POCD is a common complication in the elderly and should be treated actively.

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Effects of children's mentality on mental symptoms during recovery period of ketamine anesthesia

Xiao CHEN ; Xian DING ; Jun ZOU

The Journal of Clinical Anesthesiology.2010;26(2):132-134.

Objective To investigate the effects of children's mentality on mental symptoms during recovery period of ketamine anesthesia. Methods According to the mentality, forty-five children undergoing smalminor surgery were assigned into active group, stable group and fretful group with 15 cases each. Child was anaesthetized by ketamine alone. RP, BP, HR and SpO_2 were recorded at the end of operation, 5,10 and 30 min after operation. Meanwhile the expression, feeling, behavior, talking and activity were observed. Results RR, BP, HR in active group and fretful group were significantly higher than those in stable group. There was a significant difference in the expression, feeling, behavior, talking and activity among three groups. Conclusion Children's mentality has a significant effect on mental symptoms and hemodynamics during recovery period of ketamine anesthesia.

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Age difference of remifentanil in pharmacokinetics

Manhe ZHANG ; Jingui GAO ; Xiumin ZIIOU

The Journal of Clinical Anesthesiology.2010;26(2):127-128.

Objective To study the age difference of remifentanil in pharmacokinetics. Methods ASA class Ⅰ or Ⅱ patient,s undergoing selective operation under general anestesia were assigned into group A (65 to 82 years old) and group B(18 to 64 years old) with 60 cases each. Remifentanil 4 μg/kg was infused during induction. Arterial blood samples 1 ml were taken at 1,2,3,5,7,10,15,20,25,30,45,60 min after injection and the concentrations of remifentanil were detected using liquid-liquid extraction and capillary GC-MS-SIM. Results The values of elimination half-tirne(t_(1/2β)), volume distribution(Vd) and clearance(CL) were significantly higher in group A than those in group B[t_(1/2β), (18. 1±9. 2) min vs. (9. 4±4. 6) min, Vd, (60.7±18.2) L vs. (45.3±10.6)L, CL, (2.1±0.3) L/min vs. (3.8±0.4) L/min](P<0.05). Conclusion The t_(1/2β),Vd and CL are significantly higher in the elderly than those in the younger.

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Effects of penehyclidine on respiratory mechanics in patients with chronic obstructive pulmonary disease

Huaguang LIU ; Hongpu YU ; Shuping PANG

The Journal of Clinical Anesthesiology.2010;26(2):160-161.

Objective To investigate the effects of penehyclidine on respiratory mechanics after tracheal intubation in patients with chronic obstructive pulmonary disease. Methods Sixty-six patients with chronic obstructive pulmonary disease were divided randomely into two groups. Group Ⅰ (penehyclidine group, 33 cases) was intravenously injected 1 mg of penehyclidine before intubation, group Ⅱ (control group, 33 cases)was not given bronchodilator. Lung-chest walt compliance, airway pressure, and resistance were measured at 1 h,4 h,and 6 h after tracheal intubation. Results Patients in group Ⅰ had significantly both lower airway pressure and resistance and higher lung-chest wall compliance than group Ⅱ (P < 0. 05). Conclusion Penehyclidine produces higher lung-chest wall compliance and lower airway pressure and resistance in patients with chronic obstructive pulmonary disease.

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Alteration of MEK-ERK and NF-κB signal transduction pathway in spinal cord of rats with neuropathic pain

Xiaogao JIN ; Qingyu SHI ; Ailin LUO

The Journal of Clinical Anesthesiology.2010;26(2):151-153.

Objective To investigate the signaling pathways involved in the activation of neuron and glia in spinal cord in rats with neuropathic pain. Methods Twelve female SD rats (weighted 150 to 200 g) were randomized into two groups of spared nerve injury(group SNI) and control(group C). Surgery was performed to build model of SNI neuropathic pain in group SNI. Foot-lift response frequency to mechanical stimulation for ipsilateral hindpaw was assessed by 12 g and 2 g touch stimulator at different times. On the 11~(th) day after operation, 3 rats from each group were fixed by perfusion and the expressions of mitogen-activated/extracellular signal-regulated kinase (MEK), p-mitogen-activated/extracellular signal-regulated kinase (p-MEK), p-extracellular regulated protein kinase(p-ERK) and nuclear factor kappa B (NF-κB) were detected by immunohistochemistry method. And proteins from ipsilateral LA-6 spinal cord in other 3 rats from each group were extracted for Western Blot analysis. Western Blot and immunohistochemistry were performed with antibodies specific for MEK, p-MEK, pERK and NF-κB. Results All rats in group SNI developed a relative unchangeable mechanical allodynia since the 5~(th) day after operation. The results of immunohistochemistry method showed that the expression of MEK was mainly in cytoplasm, p-MEK in cell nuclear, p-ERK in astrocyte and NF-κB in neuron according to morphologic observation. Western Blot analysis indicated that the expressions of p-MEK, p-ERK and NF-κB in group SNI were increased significantly compared with those in group C(P<0. 05). Conclusion In the spinal cord of rats with neuropathic pain, MEK-ERK signaling pathway is activated in astrocytes and NF-κB in neurons, which may contribute to the development of neuropathic pain.

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Effects of lidocaine on inflammatory mediators and myocardial enzymes in patients undergoing off-pump coronary artery bypass grafting

Wenjin CHEN ; Zhongkai LIU ; Jihui YIN

The Journal of Clinical Anesthesiology.2010;26(2):121-124.

Objective To study the effects of lidocaine on inflammatory mediators and myocardial enzymes in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Methods Twenty patients underging OPCAB were randomly divided into 2 groups of L and C with 10 cases each. After anesthesia induction, group L was given a bolus of lidocaine 2 mg/kg, which was followed by an infusion of lidocaine 2 mg·kg~(-1)·h~(-1) till the end of operation. Group C was given normal saline instead of lidocaine as the control. Blood samples were taken for the measurements of TNF-a, IL-8, SOD, MDA, cTnⅠ, CK-MB and MYO. The hemodynamics, early postoperative clinical informations and ICU and hospital stay were recorded. Results The increases of TNF-α and IL-8 were significiently less in group L than those in group C(P<0.01 or P<0.05). MDA at 24 h after operation was higher in group C than that in group L(P<0.05). The increases of CK-MB and cTnⅠ at 24 h and 48 h after operation were significiently less in group L than those in group C(P<0. 01 or P <0. 05). The ICU and hospital stays were shorter in group L than those in group C(P<0. 05). Conclusion Continuous infusion of lidocaine during OPCAB can decrease the inflammatory mediators and myocardial enzymes and protect the myocardium.

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Effect of age on pharmacodynamics of cisatracurium target-controlled infusion

Qun YAO ; Jing WANG

The Journal of Clinical Anesthesiology.2010;26(2):115-117.

Objective To evaluate the effect of age on pharmacodynamics of eisatracurium target-controlled infusion(TCI). Methods Forty patients under N_2O-O_2-propofol-fentanyl anesthesia were divided into groups of Ⅰ and Ⅱ with 20 cases each. Under TOF stimulation monitoring, eisatracurium 0. 15 mg/kg was injected and tracheal intubation was performed when TOFr being zero. and the intubation conditions were evaluated. When T1 restored to 50% cisatracurium TCI started to keep TOFr less than 10%. The recovery times of neuromuscular blockade were recorded after stopping infusion. The amount of cisatracurium consumption was calculated. Results Intubation conditions the onset time and recovery index were not significantly different between two groups. The nonresponse period, duration of action, and recovery time were longer in group Ⅰ than those in group B. Cisatracurium consumption was more in group Ⅰ than that in group Ⅱ (P<0.05). Conclusion By TCI,cisatracurium dosage needed for keeping TOFr less than 10% is less,but the recovery process is still longer in the elderly than those in the younger.

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