BACKGROUND: The most important reason for pre-operative administration of medication is to reduce anxiety. Alleviation of fear and anxiety about surgery enables patients to remain comfortable during treatment. Dexmedetomidine (DEX) is a fast-acting drug that is used as a premedication in different circumstances because it has sedative and anti-anxiolytic effects, and stable hemodynamics. It also has the advantage of intranasal administration. The aim of this study was to investigate the effects and hemodynamic stability of DEX by retrospectively analyzing cases in which DEX was administered nasally as a premedication. METHODS: Ten patients treated at Dankook University Dental Hospital, recruited between February and April 2015, received intranasal delivery of 2 µg/kg DEX, 30 minutes prior to general anesthesia. Anesthesia records of anxiety, blood pressure, respiration, pulse, estimated arterial oxygen saturation (SpO2), and partial pressure, or maximum concentration, of carbon dioxide (ETCO2) were analyzed. RESULTS: Administration of DEX prior to a general anesthetic effectively relieved anxiety. Respiratory depression, the most severe adverse effect of other sedatives, was not observed. Hemodynamic stability under general anesthesia was maintained during treatment and a reduction in emergence delirium was observed upon completion of treatment. CONCLUSIONS: Premedication administration of DEX is safe for pediatric patients undergoing dental treatment under general anesthesia.
Administration, Intranasal* ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Anxiety ; Blood Pressure ; Carbon Dioxide ; Delirium ; Dexmedetomidine* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Oxygen ; Partial Pressure ; Premedication* ; Respiration ; Respiratory Insufficiency ; Retrospective Studies

Curcumin-ethyl-cellulose (EC) sustained-release composite particles were prepared by using supercritical CO2 anti-solvent technology. With drug loading and yield of inclusion complex as evaluation indexes, on the basis of single factor tests, orthogonal experimental design was used to optimize the preparation process of curcumin-EC sustained-release composite particles. The experiments such as drug loading, yield, particle size distribution, electron microscope analysis (SEM) , infrared spectrum (IR), differential scanning calorimetry (DSC) and in vitro dissolution were used to analyze the optimal process combination. The orthogonal experimental optimization process conditions were set as follows: crystallization temperature 45 degrees C, crystallization pressure 10 MPa, curcumin concentration 8 g x L(-1), solvent flow rate 0.9 mL x min(-1), and CO2 velocity 4 L x min(-1). Under the optimal conditions, the average drug loading and yield of curcumin-EC sustained-release composite particles were 33.01% and 83.97%, and the average particle size of the particles was 20.632 μm. IR and DSC analysis showed that curcumin might complex with EC. The experiments of in vitro dissolution showed that curcumin-EC composite particles had good sustained-release effect. Curcumin-EC sustained-release composite particles can be prepared by supercritical CO2 anti-solvent technology.
Carbon Dioxide ; chemistry ; Cellulose ; administration & dosage ; analogs & derivatives ; chemistry ; Curcumin ; administration & dosage ; chemistry ; Delayed-Action Preparations ; Solubility ; Solvents ; Technology, Pharmaceutical

INTRODUCTIONSedation or anaesthesia is recommended for all patients undergoing bronchoscopy unless absolute contraindications exist. However, the widely used combination of propofol and opiates for moderate sedation (MS) in bronchoscopy results in a high incidence of hypoxaemia and a relatively high cough score during the procedure. In this study, we evaluated the efficacy and safety of target-controlled infusion (TCI) of propofol and remifentanil, together with the use of high frequency jet ventilation (HFJV), to achieve general anesthesia (GA) in diagnostic fibre-optic bronchoscopy.

METHODSA total of 92 consecutive patients scheduled for flexible bronchoscopy were randomly assigned to receive either MS using TCI-delivered propofol and remifentanil (n = 46), or GA using TCI-delivered propofol and remifentanil with HFJV (n = 46). The following were compared between the MS and GA groups: incidence of hypoxaemia, cough score, haemodynamic parameters, partial pressure of carbon dioxide in arterial blood, duration of bronchoscopy and patient satisfaction score.

RESULTSThe average and minimum oxygen saturation values in the MS group were lower than those in the GA group. The MS group showed a higher incidence of hypoxaemia. There was no significant difference in the partial pressure of carbon dioxide between the two groups. Cough score and duration of the bronchoscopy were markedly lower in the GA group, and patient satisfaction score was higher in the GA group.

CONCLUSIONGA, achieved via TCI-delivered propofol and remifentanil with HFJV, provides better conditions for diagnostic bronchoscopy - it decreases the occurrence of hypoxaemia, shortens the duration of bronchoscopy and increases patient satisfaction.

Adult ; Aged ; Anesthesia, General ; Bronchoscopy ; methods ; Carbon Dioxide ; chemistry ; Conscious Sedation ; methods ; Female ; Fiber Optic Technology ; Hemodynamics ; High-Frequency Jet Ventilation ; methods ; Humans ; Hypnotics and Sedatives ; administration & dosage ; Hypoxia ; Male ; Middle Aged ; Oxygen ; chemistry ; Patient Satisfaction ; Piperidines ; administration & dosage ; Propofol ; administration & dosage ; Young Adult

INTRODUCTIONPulse oximetry (SpO2) measures oxygen saturation but not alveolar ventilation. Its failure to detect alveolar hypoventilation during sedated endoscopy under oxygen supplementation has been reported. The aim of this study was to measure the masking effect of oxygen supplementation in SpO2 when alveolar hypoventilation develops during sedated endoscopy.

METHODSA total of 70 patients undergoing sedated diagnostic colonoscopy were randomly divided into two groups - oxygen supplementation group (n = 35) and room air breathing group (n = 35). SpO2 and end-tidal carbon dioxide (etCO2) were measured by non-intubated capnography during the procedure for all the patients.

RESULTSThe rise of etCO2 caused by alveolar hypoventilation was comparable in the two groups after sedation. SpO2 was significantly higher in the oxygen supplementation group than in the room air breathing group (98.6% ± 1.4% vs. 93.1% ± 2.9%; p < 0.001) at peak etCO2, and oxygen supplementation caused SpO2 to be overestimated by greater than 5% when compared with room air. SpO2 at peak etCO2 was reduced from the baseline before sedation for the oxygen supplementation and room air breathing groups by 0.5% ± 1.1% and 4.1% ± 3.1%, respectively (p < 0.001).

CONCLUSIONSpO2 alone is not adequate for monitoring alveolar ventilation during sedated endoscopy under oxygen supplementation due to possible delays in detecting alveolar hypoventilation in patients. Even if SpO2 decreases by only 1% during the procedure and its level remains near 100%, physicians should consider the onset of severe alveolar hypoventilation, which requires immediate intervention.

Adult ; Aged ; Carbon Dioxide ; analysis ; Colonoscopy ; Conscious Sedation ; Endoscopy ; Female ; Humans ; Hypoventilation ; diagnosis ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Oximetry ; methods ; Oxygen ; administration & dosage ; Respiration, Artificial

OBJECTIVETo accurately calculate the protein requirements in Chinese young adults using the indicator amino acid oxidation technique.

METHODSNine women and ten men received a restricted daily level of protein intake (0.75, 0.82, 0.89, 0.97, and 1.05 g/kg), along with L-[1-13C]-leucine. Subjects' protein requirement was determined by a biphasic linear regression crossover analysis of F13CO2 data. In doing so, a breakpoint at the minimal rate of appearance of 13CO2 expiration specific to each level of dietary protein was identified. This trial was registered with the Chinese clinical trial registry as ChiCTR-ONC-11001407.

RESULTSThe Estimated Average Requirement (EAR) and the Recommended Nutrient Intake (RNI) of protein for healthy Chinese young adults were determined to be 0.87 and 0.98 g/(kg•d), respectively, based on the indicator amino acid oxidation technique.

CONCLUSIONThe EAR and RNI of mixed protein are 5% and 16% that are lower than the current proposed EAR and RNI (0.92 and 1.16 g/(kg•d), respectively), as determined by the nitrogen balance method. The respective EAR and RNI recommendations of 0.87 and 0.98 g/(kg•d) of mixed protein are estimated to be reasonable and suitable for Chinese young adults.

Adult ; Amino Acids ; metabolism ; Body Composition ; Body Weight ; Breath Tests ; Carbon Dioxide ; analysis ; Dietary Proteins ; administration & dosage ; Female ; Humans ; Male ; Nutritional Requirements ; Oxidation-Reduction ; Young Adult

OBJECTIVETo investigate the protective effect of low-dose ketamine against intestinal ischemia reperfusion injury following pneumoperitoneum with carbon dioxide in rats.

METHODSThirty healthy male adult SD rats (body weight 280-320 g) were randomized into sham-operated group, model group and ketamine group and subjected to pneumoperitoneum for 120 min with carbon dioxide (not in sham-operated group). The rats in ketamine group received an intraperitoneal injection of 10 mg/kg ketamine 10 min before pneumoperitoneum, and those in the other two groups received saline injection. Fifteen minutes after pneumoperitoneum or sham operation, the small intestines were sampled to detect the content of malondialdehyde (MDA) and fore pathological testing. ELISA was used to detect the serum levels of I-FABP, TNF-α IL-6 and IL-8.

RESULTSPneumoperitoneum caused a significant increase in intestinal MDA content (P<0.05), which was lowered by ketamine pretreatment (P<0.05). Serum I-FABP, TNF-α, IL-6 and IL-8 levels all significantly increased following pneumoperitoneum (P<0.05) and were obviously lowered by ketamine pretreatment (P<0.05). Pneumoperitoneum also caused obvious pathologies in intestinal mucosa, which were ameliorated by ketamine pretreatment.

CONCLUSIONLow-dose ketamine preconditioning can reduce the inflammatory reaction and lessen oxidative damage in the intestinal mucosa following pneumoperitoneum in rats.

Animals ; Carbon Dioxide ; Dose-Response Relationship, Drug ; Fatty Acid-Binding Proteins ; blood ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Intestine, Small ; blood supply ; metabolism ; pathology ; Ketamine ; administration & dosage ; therapeutic use ; Male ; Malondialdehyde ; metabolism ; Pneumoperitoneum ; chemically induced ; complications ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; blood ; etiology ; metabolism ; pathology ; prevention & control ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND: The chemical reaction of carbon dioxide absorbent and sevoflurane is known to produce compound A. However, carbon dioxide absorbents are not controlled by the Food and Drug Administration, but are treated as industrial products in some nations. Moreover, carbon dioxide absorbents differ in their capacities to produce compound A, because their chemical compositions differ. In this study, we compared the renal safety between carbon dioxide absorbent products in patients under sevoflurane anesthesia. METHODS: Eighty patients with no preexisting renal disease undergoing elective gynecologic surgery were randomly assigned to receive sevoflurane or isoflurane anesthesia with one of four carbon dioxide absorbent products (Sodasorblime(R), Sodalyme(R), Sodasorb(R), Spherasorb(R)) at the same fresh gas flow of 2 L/min. The renal safety was evaluated by changes of blood urea nitrogen (BUN), creatinine and urine N-acetyl-b-glucoseaminidase (NAG)-creatinine ratio at 24 hours and 72 hours after surgery from preoperative level. RESULTS: There was no significant difference in the renal safety indicators between carbon dioxide absorbents during sevoflurane anesthesia (P > 0.05). However, the BUN and urine NAG-creatinine ratios at 72 hours after surgery were higher in isoflurane anesthesia in some carbon dioxide absorbent groups (P = 0.03 and 0.04, respectively). CONCLUSIONS: We could not find significant differences of renal safety indicators with carbon dioxide absorbents. Although the adverse effect of carbon dioxide absorbents on renal function was not proved, consideration should be given to their contol by the regulation on their efficacy and safety because carbon dioxide absorbents can produce compound A.
Anesthesia ; Anesthetics ; Blood Urea Nitrogen ; Carbon ; Carbon Dioxide ; Creatinine ; Female ; Gynecologic Surgical Procedures ; Humans ; Inhalation ; Isoflurane ; Kidney ; Methyl Ethers ; Pilot Projects ; United States Food and Drug Administration

Ibuprofen/ethyl-cellulose (EC)-polyvinylpyrrolidone (PVP) sustained-release composite particles were prepared by using supercritical CO2 anti-solvent technology. With drug loading as the main evaluation index, orthogonal experimental design was used to optimize the preparation process of EC-PVP/ibuprofen composite particles. The experiments such as encapsulation efficiency, particle size distribution, electron microscope analysis, infrared spectrum (IR), differential scanning calorimetry (DSC) and in vitro dissolution were used to analyze the optimal process combination. The orthogonal experimental optimization process conditions were set as follows: crystallization temperature 40 degrees C, crystallization pressure 12 MPa, PVP concentration 4 mgmL(-1), and CO2 velocity 3.5 Lmin(-1). Under the optimal conditions, the drug loading and encapsulation efficiency of ibuprofen/EC-PVP composite particles were 12.14% and 52.21%, and the average particle size of the particles was 27.621 microm. IR and DSC analysis showed that PVP might complex with EC. The experiments of in vitro dissolution showed that ibuprofen/EC-PVP composite particles had good sustained-release effect. Experiment results showed that, ibuprofen/EC-PVP sustained-release composite particles can be prepared by supercritical CO2 anti-solvent technology.
Calorimetry, Differential Scanning ; Carbon Dioxide ; chemistry ; Cellulose ; administration & dosage ; analogs & derivatives ; chemistry ; Crystallization ; Delayed-Action Preparations ; Drug Carriers ; Drug Compounding ; Ibuprofen ; administration & dosage ; chemistry ; Microscopy, Confocal ; Particle Size ; Povidone ; administration & dosage ; chemistry ; Solubility ; Spectrophotometry, Infrared ; Technology, Pharmaceutical ; methods

OBJECTIVE: The study was aimed to investigate the effects of different levels of pressure and duration of carbon dioxide and saline in the neck of rabbits on metabolic, hemodynamic, serum sodium concentrations and hematocrit changes. METHOD: Twenty-one New Zealand rabbits were randomly divided into 7 groups according to the following pressure of CO2 or saline: 0 kPa, 0.67 kPa CO2, 1.33 kPa CO2, 2.00 kPa CO2, 0.67 kPa saline, 1.33 kPa saline, and 2.00 kPa saline. In order to make a space for the endoscopic thyroidectomy, we filled the neck of rabbits with carbon dioxide and saline. Arterial partial pressure of CO2 (PaCO2), pH, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), serum sodium concentration and hematocrit were measured at baseline, 45 min and 90 min after filling with gas or saline and 30 min post-filling. RESULT: Insufflation of CO2 at 0.67 kPa did not have any significant effect on the parameters, PaCO2 increased significantly 45 min and 90 min after insufflation of 1.33 kPa CO2 (P < 0.01). Marked changes in PaCO2, pH and CVP occurred 45 min and 90 min after insufflation of 2.00 kPa CO2 (P < 0.01), and the parameters did not return to baseline in 30 min after desufflation (P < 0.05). In animals receiving saline irrigation no significant changes occurred in PaCO2, pH and serum sodium concentrations at any time point. There was a tendency of decrease in HCT, but no statistically significant changes were found (P > 0.05). CVP increased significantly 90 min after saline irrigation at 1.33 kPa (P < 0.05). A significant increase in CVP occurred 45 min and 90 min after saline irrigation at 2.00 kPa (P < 0.05). No significant changes in HR and MAP occurred in all animals. CONCLUSION Filling with saline which does not cause hypercapnia, acidosis or dilutional hyponatremia can be used in endoscopic neck surgery to create and maintain a working space.
Animals ; Carbon Dioxide ; administration & dosage ; therapeutic use ; Endoscopy ; Insufflation ; Rabbits ; Sodium Chloride ; administration & dosage ; therapeutic use ; Thyroidectomy ; methods

OBJECTIVETo investigate the influence of CO(2) and He insufflation administered at different pressures on the migration and cytoskeleton of cultured human gastric cancer cells.

METHODSThe cultured gastric cancer cells MKN-45 were exposed to a CO(2) or He environment maintained at different pressures (12, 15 mm Hg). After 0, 2, 4, 6, 8 hours exposure to CO(2) or He environment, pH of the MKN-45 cells culture media was measured with blood gas analysis. The cell migration was detected with Transwell technology. The cell cytoskeleton was observed with laser confocal microscope.

RESULTSThe media pH was acid after exposure to CO(2) environment, while it was basic in the He group. The number of cells passing millipore in 12 mm Hg CO(2) or He insufflation pressure were not significantly different with control group (P>0.05), however in 15 mm Hg pressure CO(2) group, it was significantly decreased as compared to control group (P<0.01). The microfilament and microtubule in gastric cancer cell were ambiguous in 15 mm Hg pressure CO(2) group.

CONCLUSIONSThere are no obvious effects on the migration and cytoskeleton of MKN-45 cells under 12 mm Hg CO(2) insufflation pressure. The migration and cytoskeleton of MKN-45 cells can be inhibited in 15 mm Hg CO(2) pneumoperitoneum environment.

Carbon Dioxide ; administration & dosage ; Cell Line, Tumor ; Cell Movement ; Cell Survival ; Cytoskeleton ; Humans ; Pneumoperitoneum, Artificial ; Pressure ; Stomach Neoplasms ; ultrastructure