Objective:To investigate perioperative management of anesthesia for septic shock.Methods:Anesthesia performed on an elderly patient with septic shock who underwent emergency surgery in Beijing Hospital was analyzed and summarized, with a literature review.Results:Etomidate, Ketamine, cis Atracurium and Remifentanil are preferred for anesthesia induction, and Remifentanil and Sevoflurane are the first choices for anesthesia maintenance.Combined application with Dexmedetomidine may improve patients' prognosis.For septic shock patients with new-onset atrial fibrillation, β-blockers are preferred for perioperative anti-arrhythmia.If necessary, propafenone or amiodarone can be used for cardioversion.Perioperative ultrasound evaluation may be used to guide perioperative fluid therapy and vasoactive drug administration for septic shock in the future.Conclusions:Anesthesiologists should place a high value on and have a good command of the main aspects of perioperative management of anesthesia for septic shock.

Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Objective To evaluate the efficacy of dexmedetomidine combined with remifentanil for drug-induced sleep endoscopy (DISE) in the patients with snoring. Methods Sixty patients of both sexes with snoring, aged 18-61 yr, with body mass index of 21. 0-33. 1 kg∕m2 , of American Society of Anesthe-siologists physical statusⅠ or Ⅱ, scheduled for elective DISE, were randomly divided into either dexme-detomidine combined with propofol group (group P) or dexmedetomidine combined with remifentanil group (group R), with 30 patients in each group. Dexmedetomidine was infused within 10 min in a loading dose of 0. 6 μg∕kg, followed by an infusion of 0. 6 μg·kg-1 ·h-1 for 10 min in both groups. Then propofol was given by target-controlled infusion with the initial target effect-site concentration (Ce) of 1. 0 μg∕ml in group P, and remifentanil was given by target-controlled infusion with the initial target Ce of 1. 5 ng∕ml in group R. At 2 min after the target effect-site and plasma concentrations were balanced, the Ces of propofol and remifentanil were adjusted by increments of 0. 2 μg∕ml and 0. 2 ng∕ml, respectively, until satisfactory snoring occurred and then the Ce was maintained at this level in P and R groups. Bispectral index value was re-corded at 5 min after admission to the operating room (T1 ), at 20 min of dexmedetomidine infusion (T2 ), at 2 min after the target effect-site and plasma concentrations were balanced (T3 ), at the beginning of DISE (T4 ), when the nasopharyngolarygnoscope reached the site of oropharynx (T5 ) and at the end of DISE (T6 ). Observer's Assessment of Alertness∕Sedation scale scores were recorded at T1-4 . The time for prepar-ing sedation, recovery time, the lowest value of SpO2 and development of adverse events were recorded. Re-sults Sixty patients completed DISE successfully. Compared with group P, the bispectral index value at T3-6 was significantly increased, the time for preparing sedation was prolonged, the recovery time was short-ened, the lowest value of SpO2 was increased, and the incidence of respiratory depression was decreased in group R (P< 0. 05). There was no significant difference in Observer's Assessment of Alertness∕Sedation scale scores at T1-4 between two groups ( P> 0. 05). Conclusion Combination of dexmedetomidine and remifentanil produces better efficacy for DISE than combination of dexmedetomidine and propofol in the pa-tients with snoring.

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.

Objective To study the clinical application value of individualization portal for knee arthroscope meniscoplasty. Methods The clinical data of 100 patients who had underwent knee arthroscope meniscoplasty were retrospectively analyzed. In the patients, 50 cases were performed with routine portal (group A), and other 50 cases were performed with individualization portal (group B). The operation time, curative effect and incidence of complications were compared between 2 groups. Results The operation time in group B was significantly lower than that in group A:(28.8 ± 3.1) min vs. (39.5 ± 5.4) min, and there was statistical difference (t = 12.151, P<0.01). There was no statistical difference in excellent and good rate between group A and group B: 94%(47/50) vs. 96%(48/50),χ2=0.522, P>0.05. The incidence of meniscus and cartilage injury in group B was significantly lower than that in group A: 2% (1/50) vs. 14% (7/50), and there was statistical difference (χ2 = 4.891, P<0.05). There was no statistical difference in incidence of hematoma between 2 groups (P>0.05). There was no ligament injury, infection, vascular and nerve injury, deep vein thrombosis, instrumentation damage and synovial fistula. Conclusions The individualization portal for knee arthroscope meniscoplasty is more convenient. It can shorten operation time and decrease meniscus and cartilage injury. But it has no influence on clinical effect and other complications.

5-fluorouracil (5-Fu) is a basic drug in the treatment of advanced gastric cancer. It is widely used in chemotherapy regimens for metastatic gastric cancer. However, the reaction rate was only 10%~30% when used 5-Fu alone. Interindividual variation in the enzyme activity of the 5-Fu metabolic pathway can affect the metabolism extent of 5-Fu and the efficacy of chemotherapy based on 5-Fu. In this review the roles of thymidylate synthase and thymi-dine phosphorylase enzymes factors involved in the 5-Fu metabolic pathway and the efficacy of fluoropyrimidine treat-ment in the metastatic gastric cancer are discussed.

Objective To evaluate the efficacy of anesthesia with etomidate administered by TCI in combination with continuous iv remifentanil infusion titrated to maintain BIS values at 40-60 for non-cardiac surgery in a prospective randomized single-blinded multicenter controlled clinical study.Methods Two hundred and forty-four ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr undergoing non-cardiac surgery lasting less than 3 h were randomly allocated into 2 groups:etomidate group (group E,n =123) and propofol group (group P,n =121 ).The patients were unpremedicated.A bolus of midazolam 0.03 mg/kg was injected iv immediately before induction of anesthesia.Anesthesia was induced with sufentanil 0.3-0.4 μg/kg and TCI of etomidate (effect-site concentration (Ce) =0.5-1.0 μg/ml) or propofol (Ce =3-4 μg/ml).Tracheal intubation was facilitated with rocuronium 0.9 mg/kg.The patients were mechanically ventilated (VT 8-10 ml/kg,RR 10-12 bpm,FiO2 =1 ).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of etomidate ( Ce =0.3-0.8 μg/ml ) or propofol ( Ce =3-4 μg/ml) in combination with continuous iv infusion of remifentanil at 0.1-1.0 μg· kg-1 ·min-1 and intermittent iv boluses of rocuronium.BIS values were maintained at 40-60 during operation.Sufentanil 0.1 μg/kg was administered iv before skin closure.Ce at loss of consciousness,during maintenance of anesthesia and at emergence,the consumption of remifentanil and vasoactive agents,the emergence time and extubation time were recorded.The incidences of injecton pain,post-operative nausea and vomiting (PONV) and emergence agitation were measured.Results Ce of etomidate at loss of consciousness,at emergence and during maintenance of anesthesia was (0.50 ± 0.22),(0.16 ± 0.09) and 0.22-0.39 μg/ml respectively.The incidence of injection pain and the consumption of vasoactive agents were significantly lower but more remifentanil was needed in group E than in group P (P ＜0.05 or 0.01).There was no significant difference in emergence time and extubation time between the 2 groups (P ＞ 0.05).The incidence of PONV and emergence agitation were significantly higher during recovery in group E than in group P ( P ＜ 0.05 ).Conclusion The hemodynamics is stabler during operation,but the incidence of PONV and emergence agitation are significantly higher during recovery in group E than in group P.Etomidate induces little injection pain.

ObjectiveTo detect the expressions of orotate phosphoribosyl transferase (OPRT) and dihydropyrimidine dchydrogenase (DPD) mRNA in gastric cancer tissues,and investigate their relationship with the clinicopathological factors.MethodsThe gastric cancer tissues and adjacent normal tissues were collected from 53 patients with gastric cancer at the Affiliated Hospital of Inner Mongolia Medical College from June 2007 to November 2008.The mRNA expressions of OPRT and DPD were detected by reverse transcriptional-polymerase chain reaction,and the correlation between the mRNA expressions of OPRT and DPD and the clinicopathological factors was analyzed.All data were analyzed by using the t test and the one-way analysis of variance.Results The mRNA expression of OPRT in the gastric cancer tissue was 1.15 ± 0.56,which was significantly higher than 0.88 ± 0.31 in the adjacent normal tissues ( t =3.66,P ＜ 0.05 ).The mRNA expressions of DPD in gastric cancer tissues and the adjacent normal tissues were 0.95 ± 0.50 and 0.90 ± 0.41,respectively,with no significant difference between the 2 groups (t =0.68,P ＞ 0.05 ).The mRNA cxprcssions of OPRT in the gastric cancer tissues with no lymph node metastasis was 1.42 ± 0.54,which was significantly higher than 1.00 ± 0.52 in the gastric cancer tissues with lymph node metastasis (t =7.94,P ＜ 0.05 ).Poorly differentiated adenocarcinoma (0.93 ± 0.24) and mucinous adenocarcinoma (1.58 ± 0.38) showed a significantly higher DPD mRNA expression than moderately differentiated or well differentiated adenocarcinoma ( 0.67 ± 0.36 ) ( F =27.71,P ＜ 0.05 ).Conclusions The mRNA expre ssion of OPRT in gastric cancer tissue is higher than that in the adjacent normal tissues,and its expression in patients with lvmph node metastasis is lower than that in patients without lymph node metastasis.Poorly differentiated adenocarcinoma showed higher DPD mRNA expression than moderately or well differentiated adenocarcinoma,and its expression is highest in mucinous adenocarcinoma.

Objective To evaluate the efficacy of streamline liner of pharyngeal airway ( SLIPA) in airway management of general anesthesia. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective breast surgery were randomized into 2 groups (30 cases each): SLIPA group (group S) and laryngeal mask airway (LMA) classic group (group L). Anesthesia was induced with propofol 2 mg/kg, sufentanil 0.15 μ g/kg and vecurium 0.08 mg/kg. SLIPA or LMA was inserted with digital manipulation. Anesthesia was maintained with 1% - 2% sevofluran and 50% N2O in 50% oxygen. The parameters of controlled ventilation were same in both groups. The attempt times, seal pressure and grade of fiberoptic (FOB ) laryngoscopy were measured. SpO2, PErCO2 and peak airway pressure were monitored every 15 minutes after successful laryngeal mask insertion. The complications such as regurgitation of gastric contents and sore throat were assessed by anesthesiologist after surgery. Surgery time, anesthesia time, extubation time and emergence time were recorded. Results Success rate of LMA insertion in both groups were 100%. The first attempt success rates were 90%( 27/30) in group S and 60%( 18/30) in group L (P< 0.05), the FOB grade 4 were 67%(20/30) in group S and 37% (ll/30)in group L(P< 0.05), the maximum seal pressures were (23.6 ± 4.7)cmH2O (1 cm H2O = 0.098 kPa) in group S and (18.8 ± 4.5) cm H2O in group L (P<0.05). SpO2, PErCO2 and peak airway pressure were within normal ranges. The occurrence of sore throat was similar in group S and group L (7 cases vs 6 cases). No signs of regurgitation were detected. Conclusion The SLIPA proved to be a simple, safe and effective airway instrument with little complications during the course of general anesthesia.