A 66-year-old male patient with anxiety and depression received lorazepam 1 mg twice daily and buspirone 10 mg twice daily. Two months later, the patient developed chills, fever, drowsiness, and stiffness of limbs, etc. Laboratory tests showed white blood cell count 13.5×10 9/L, neutrophils 0.89, C-reactive protein 68.7 mg/L, serum creatinine 211 mmol/L, direct bilirubin 10.3 mmol/L, alanine aminotransferase 96 U/L, aspartate aminotransferase 121 U/L, creatine kinase (CK) 4 557 U/L, CK-MB 83 U/L, lactate dehydrogenase 462 U/L, α-hydroxybutyrate dehydrogenase 339 U/L, and troponin 116 ng/L. Malignant syndrome caused by buspirone was considered. The drug was stopped, lorazepam was continued, and oxygen inhalation, ECG monitoring, physical cooling, anti-infection, and other treatments were given. The patient still had fever and developed deep coma, with brown urine and myoglobin >3 000 mg/L. Secondary rhabdomyolysis was considered. Anti-infection treatment was continued and treatments such as correcting electrolyte balance, alkalizing urine, and diuresis were given. On the 10th day of drug withdrawal, the patient had normal limb activity and urine color, his creatine kinase was 246 U/L, and myoglobin was 856 mg/L. One month later, the laboratory tests showed no obvious abnormalities and no malignant syndrome releted symptoms recurred. The rhabdomyolysis secondary to malignant syndrome in the patient was considered to be possibly related to buspiron and the combination with lorazepam might promote its occurrence.

A 66-year-old male patient with anxiety and depression received lorazepam 1 mg twice daily and buspirone 10 mg twice daily. Two months later, the patient developed chills, fever, drowsiness, and stiffness of limbs, etc. Laboratory tests showed white blood cell count 13.5×10 9/L, neutrophils 0.89, C-reactive protein 68.7 mg/L, serum creatinine 211 mmol/L, direct bilirubin 10.3 mmol/L, alanine aminotransferase 96 U/L, aspartate aminotransferase 121 U/L, creatine kinase (CK) 4 557 U/L, CK-MB 83 U/L, lactate dehydrogenase 462 U/L, α-hydroxybutyrate dehydrogenase 339 U/L, and troponin 116 ng/L. Malignant syndrome caused by buspirone was considered. The drug was stopped, lorazepam was continued, and oxygen inhalation, ECG monitoring, physical cooling, anti-infection, and other treatments were given. The patient still had fever and developed deep coma, with brown urine and myoglobin >3 000 mg/L. Secondary rhabdomyolysis was considered. Anti-infection treatment was continued and treatments such as correcting electrolyte balance, alkalizing urine, and diuresis were given. On the 10th day of drug withdrawal, the patient had normal limb activity and urine color, his creatine kinase was 246 U/L, and myoglobin was 856 mg/L. One month later, the laboratory tests showed no obvious abnormalities and no malignant syndrome releted symptoms recurred. The rhabdomyolysis secondary to malignant syndrome in the patient was considered to be possibly related to buspiron and the combination with lorazepam might promote its occurrence.

Objective To evaluate the topical anesthetic effects of compound lidocaine cream ( CLC) coated endo-tracheal tube on the prevention of cough/agitation during extubation in thyroidectomy under general anesthesia . Methods 42 patients scheduled for thyroidectomy in Peking Union Medical College Hospital were continuously en -rolled in this prospective double-blinded randomized controlled trial .Patients were randomized into two groups . Group L were intubated with endotracheal tube coated with CLC , while the control group , group C with liquid par-affin .The end point of study was spontaneous or induced cough /agitation during extubation .Hemodynamic parame-ters and the consumption of opioids were recorded .Patients were followed for major complications during their stay in hospital .Results Spontaneous cough/agitation rate was lower in group L than group C ( 15% vs 65%, P<0.01 );so was induced cough/agitation (35%vs 90%, P<0.001 );the value of SBP ×HR was lower in group L at 1 min after extubation ( P<0.05 ) .Conclusions The topical anesthetic effects of CLC coated endotracheal tube could prevent cough and agitation during extubation in thyroidectomy under general anesthesia .

Objective Anti-N-methyl-D-Aspartate (NMDA) receptor encephalitis is a rare disease,recently described as autoimmune disorder of paraneoplastic limbic encephalitis,which is related to the NMDA receptor antibodies and frequently develops in young women with ovarian teratoma.The disease is usually accompanied by symptoms of psychosis and abnormal behaviors,autonomic nervous system dysfunction,central hypoventilation,and hyperthermia.During induction and maintenance of general anesthesia,we should be aware of adverse reactions such as cardiovascular events,hyperthermia and respiratory insufficiency.In order to maintain vital signs stable,pharmacological agents including vasopressors,β-blockers,antihypertensives,and anticholinergics should be prepared before the surgery.Invasive monitoring for blood pressure can be set if necessary.This study described the method for anesthetic management of 3 patients with anti-NMDA receptor encephalitis undergoing resection of ovarian teratoma under general anesthesia.Preoperative treatment included antipsychotic,anti-infective and immune therapy.General anesthesia was induced with propofol,rocuronium,fentanyl and midazolam to facilitate tracheal intubation and was maintained with inhalation of sevoflurane (mixed with oxygen and air) and intermittent iv boluses of fentanyl and rocuronium during the surgery.All the drugs mentioned above had no interaction or had slight indirect action on anti-NMDA receptors to avoid NMDA-related adverse reactions.In conclusion,the adequate preparation for the surgery should be done in this kind of patients,we should avoid using anesthetics having NMDA receptor antagonism (such as ketamine,N2O,methadone,dextromethorphan,phencyclidine) or other anesthetics acting indirectly (such as pentobarbital) on the NMDA receptors during anesthetic management in the patients with anti-NMDA receptor encephalitis.

Objective To evaluate the effect of gabapentin for treatment of neuropathic pain induced by bilateral sciatic nerve chronic constriction injury (bCCI) of rats.Methods Forty-eight female SPF Sprague-Dawley rats,weighing 180-200 g,aged 7-9 weeks,were randomly divided into 4 groups (n =12 each) using a random number table:control group (C group),sham operation group (S group),bCCI group,and bCCI + gabapentin group (G group).Gabapentin 100 mg/kg was intraperitoneally injected once at 15 min before operation and twice a day during 7-13 days after operation for 7 consecutive days.The bilateral mechanical paw withdrawal threshold (MWT),thermal paw withdrawal latency (TWL) and number of cold-stimulated paw withdrawal were measured before operation (baseline) and at 1,3,6,8,10,14 days after operation.Results Compared with C group,the bilateral MWT was significantly decreased,and the bilateral TWL was shortened in bCCI and G groups,and no significant change was found in MWT and TWL in S group.Compared with bCCI group,the bilateral MWT was significantly increased,the bilateral TWL was prolonged,and no significant change was found in the number of cold-stimulated paw withdrawal in G group.Conclusion Gabapentin can relieve thermal and mechanical hyperalgesia induced by bCCI,however,it exerts no effect on cold allodynia in rats.

Objective To evaluate the effects of different sequences of intravenous administration on fentanyl-induced cough during induction of general anesthesia.Methods One hundred patients of both sexes,aged 18-70 yr,weighing 42-88 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were equally randomized to 2 groups using a random number table:fentanyl-propofol group (group FP) and propofol-fentanyl group (group PF).In FP group,fentanyl 3 μg/kg was injected intravenously over 3 s,and then propofol 1.5 mg/kg was injected intravenously.In PF group,propofol 1.5 mg/kg was injected intravenously,and then fentanyl 3μg/kg was injected intravenously over 3 s.The development,intensity and onset time of cough were recorded within 1 min after fentanyl injection.Results Compared with FP group,the incidence of cough was significantly decreased,and no significant change was found in the intensity and onset time of cough in PF group.Conclusion Administration in the propofol-fentanyl sequence can reduce the development of fentanyl-induced cough as compared with that in the fentanyl-propofol sequence during induction of general anesthesia.

Objective To compare the GlideScope video-laryngoscope and Macintosh laryngoscope for double-lumen tube (DLT) intubation.Methods Seventy ASA Ⅰ-Ⅲ patients,aged 18-75 yr,scheduled for thoracic surgery and requiring one-lung ventilation,were randomly divided into 2 groups (n =35 each):Macintosh laryngoscope group (group M) and GlideScope video-laryngoscope group (group G).Anesthesia was induced with propofol,fentanyl and rocuronium.The exposure of glottis obtained with Macintosh laryngoscope and GlideScope video-laryngoscope was assessed using Cormack-Lehane grade.DLT intubation was assisted with Macintosh laryngoscope or GlideScope video-laryngoscope.The Cormack-Lehane grade,difficulty of DLT placement,and reverse DLT placement were recorded.The success rate of DLT placement at first attempt and intubation time were also recorded.Blood pressure and heart rate were recorded before intubation and at 0 and 3 min after intubation.The postoperative side effects were recorded.Results Compared with M group,the intubation time was significantly prolonged,the difficulty of DLT placement and blood pressure at 0 and 3 min after intubation were increased in G group (P ＜ 0.05).There was no significant difference in the success rate of DLT placement at first attempt,rate of reverse DLT placement,Comark-Lehene grade and heart rate at each time point between the two groups (P ＞0.05).The Comark-Lehene grade obtained with GlideScope video-laryngoscope was superior to that obtained with Macintosh laryngoscope in G group (P ＜ 0.05).Conclusion GlideScope video-laryngoscope can provide a better exposure of glottis and improvement in the intubating conditions,but the method is more complex and the response to intubation is stronger than Macintosh laryngoscope for DLT intubation.

Objective To identify the risk factors for perioperative major adverse cardiac events (MACEs)in elderly patients with coronary heart disease (CHD) undergoing orthopedic surgery.Methods One hundred and twenty-nine patients with CHD,aged ≥65 yr,undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009,were selected.The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery.Age,sex,history of coronary reconstruction,myocardial infarction,heart failure,angina,systemic angionosis,cerebrovascular disease and diabetes,basic and preoperative blood pressure,routine blood test,serum creatinine,blood glucose,preoperative electrocardiography (ECG) and ultrasonic cardiography,ASA,intraoperative blood transfusion,operation and anesthesia time,entering ICU after surgery and postoperative volume of drainage were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs.Results Twenty-one patients developed perioperative MACEs (16.3 %).Logistic regression analysis showed that unstable angina within 6 months,preoperative haematocrit ≤ 35%,preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this population (P ＜ 0.05),and the risk indexes of the factors were 5,3,3 and 4,respectively.Conclusion Unstable angina within 6 months,preoperative haematocrit ≤ 35 %,preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.

Objective To investigate the role of calpain in the spinal dorsal horn in development of paw inflammatory pain in rats.Methods Forty-eight male SD rats,aged 6 weeks,weighing 160-200 g,were randomly divided into three groups:normal control group(group C,n =8),PBS group( n =16),zymosan-induced paw inflammatory pain group (group Z,n =24).Inflammatory pain was induced by injection of zymosan 1.25 mg into the plantar surface of left hindpaw.Group PBS received the equal volume of PBS 100 μl.The mechanical paw withdrawal threshold (MWT),paw withdrawal thermal latency (PWTL) and maximum thickness of the plantar surface of left hindpaw were measured before (T0 ) and at 30 min,1,2,4,8,24 and 48 h(T1-7 ) after zymosan or PBS injection.Eight rats were sacrificed at T4 in group PBS and at T4.6,7 in group Z respectively.The left lumbar segment (L4-6) was removed to determination of spectrin α Ⅱ breakdown products,IκBα,cyclooxygenase-2 (COX-2)expression and NF-κB activity in the spinal dorsal horn by Western blot.Results Compared with group C,MWT and PWTL were significantly decreased,maximum thickness of paw and NF-κB activity in the spinal dorsal horn were significantly increased,spectrin α Ⅱ breakdown products and COX-2 expression in the spinal dorsal horn were upregulated,while IκBα expression was down-regulated in group Z( P ＜ 0.05 or 0.01 ),but no significant change was found in group PBS( P ＞ 0.05).Conclusion The activation of calpain in the spinal dorsal horn is involved in the development of paw inflammatory pain in rats through activating NF-κB and up-regulating the expression of COX-2.

Objective To investigate the safety and feasibility of anesthesia for patients with myasthenia gravis using target controlled infusion without muscle relaxant.Methods Thirty-one patients with myasthenia gravis were recruited into study.A target controlled infusion was started with targeting effect-site concentration of propofol 3 μg/mL and remifentanil 4 ng/mL.Intubation was performed when patients were unconsciousness and target concentrations of both drugs were reached.No muscle relaxant was used during anesthesia.Blood pressure,heart rate,performance of intubation and respiratory recovery including extubation and wake time were observed.Results All patients were intubated successfully in one attempt.38.7% patients had mild cough when the endotracheal tube past through the vocal cord during intubation.Blood pressure and heart rate at post-intubation increased significantly as compared with pre-intubation (P＜0.01).After cease of drugs,time of spontaneous breathing recovery was (6.5±2.9) min.Extubation and wakeup time were (9.8±3.6) and (7.4±3.1) min respectively.No adverse event was noted.Conclusion Target controlled infusion without muscle relaxant was safe and effective anesthesia for myasthenia gravis patients undergoing thymectomy.