Objective:To evaluate the efficacy of sugammadex for the reversal of residual neuromuscular blockade after laparoscopic radical gastrectomy in elderly patients.Methods:Sixty patients of both sexes, aged 65-85 yr, with body mass index of 20-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=30 each) by a random number table method: sugammadex group (S group) and neostigmine group (N group). Rocuronium 0.3-0.6 mg·kg -1·h -1 was intravenously infused during operation, and the muscle relaxation was monitored by a Veryark-TOF monitor, maintaining TOF ratio=0 and counting 1 or 2 after tonic stimulation.Rocuronium was discontinued when the peritoneum was closed.The patients were admitted to the PACU after operation.When the muscle relaxation monitoring T 2 appeared, sugammadex 2 mg/kg was intravenously injected in S group, and neostigmine 0.03 mg/kg plus atropine 0.015 mg/kg was intravenously injected in N group.The tracheal tube was removed after the patient′s consciousness and spontaneous breathing recovered.Before anesthesia (T 1) and 5 and 30 min after tracheal extubation (T 2, 3), arterial blood samples were collected for blood gas analysis, PaO 2 and PaCO 2 were recorded, and ultrasound was used to measure the diaphragm end-inspiratory thickness, end-expiratory thickness and mobility of diaphragm muscle at the above time points.The diaphragm thickening fraction was calculated.The time of T 2 appeared, time of extubation, time of postanesthesia care unit (PACU) stay, postoperative hospital stay, and residual neuromuscular blockade (TOF ratio <0.9) and hypoxemia occurred within 30 min after extubation were recorded.The pulmonary complications within 7 days after operation were recorded. Results:Compared with group N, PaO 2 was significantly increased and PaCO 2 was decreased at T 2, 3, the mobility of diaphragm muscle and diaphragm thickening fraction were increased at T 2, the tracheal extubation time, time of PACU stay and postoperative hospital stay were shortened, the residual neuromuscular blockade and hypoxemia occurred after extubation and incidence of pulmonary complications after operation were decreased ( P<0.05), and no significant change was found in the time of T 2 appeared in group S ( P>0.05). Conclusion:Sugammadex can quickly and effectively reverse the residual neuromuscular blockade after laparoscopic radical gastrectomy, which is helpful for early postoperative recovery in elderly patients.

Objective:To evaluate the modified efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia in the patients undergoing laparoscopic radical nephrectomy.Methods:Eighty patients, aged 38-64 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic radical nephrectomy, were selected and randomly divided into 2 groups ( n=40 each) using a random number table method: general anesthesia group (group GA) and TPVB combined with general anesthesia group (group TPVB+ GA). A paravertebral catheter was placed at T 8 and T 10 under ultrasound guidance before induction of anesthesia, and 0.5% ropivacaine 10 ml was administered via the catheter in group TPVB+ GA.Anesthesia was induced with propofol, sufentanil, etomidate and rocuronium and maintained by intravenous infusion of propofol and remifentanil.Patient-controlled intravenous analgesia was performed with sufentanil, ketorolac tromethamine and tropisetron at the end of surgery.When postoperative visual analog scale score≥4, tramadol 50 mg was intravenously injected as rescue analgesic.Immediately before anesthesia induction (T 0), at 5 min after establishing pneumoperitoneum (T 1), at 2 h of pneumoperitoneum (T 2), and immediately after the end of pneumoperitoneum (T 3), and at 24 h after operation (T 4), venous blood samples were collected for determination of plasma norepinephrine concentrations (by enzyme-linked immunosorbent assay), plasma cortisol level (using radioimmunoassay), and blood glucose concentrations were measured.The intraoperative consumption of sufentanil and remifentanil was recorded.The intraoperative hypertension, hypotension, and bradycardia were recorded, and the nausea and vomiting, pruritus, and requirement for rescue analgesia occurred within 24 h after surgery were recorded. Results:Compared with group GA, the plasma concentrations of norepinephrine, cortisol and blood glucose were significantly decreased at T 1-4, the intraoperative consumption of sufentanil and remifentanil was reduced, and the postoperative requirement for rescue analgesia was decreased in group TPVB+ GA ( P<0.05). There was no significant difference in the incidence of intraoperative and postoperative adverse reactions between the two groups ( P>0.05). Conclusion:TPVB combined with general anesthesia is helpful in carrying out the anesthetic model of low-consumption opioids and is more helpful in inhibiting intraoperative and postoperative stress responses and postoperative pain responses than general anesthesia alone when used for laparoscopic radical nephrectomy.

Objective To evaluate the effect of sevoflurane preconditioning on high-mobility group box 1 protein ( HMGB1) ∕Toll-like receptor 4 ( TLR4) ∕nuclear factor kappa B ( NF-κB) signaling pathway during lung ischemia-reperfusion ( I∕R) in rats. Methods Thirty-six clean-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group ( group S) , lung I∕R group ( group I∕R) and sevoflu-rane preconditioning group ( group SP ) . The right pulmonary hilum was only isolated but not ligated in group S. Lung I∕R was induced by clamping the right pulmonary hilum for 60 min followed by 120 min of reperfusion in anesthetized rats in group I∕R. In group SP, 2. 1％ sevoflurane was inhaled for 30 min to per-form sevoflurane preconditioning, and the lung I∕R model was established at 10 min after the end of inhala-tion. The rats were sacrificed at 120 min of reperfusion, and the lungs were removed for examination of the pathological changes which were scored and for determination of wet to dry weight ratio ( W∕D ratio) , con-tent of tumor necrosis factor-alpha ( TNF-α) in lung tissues ( by enzyme-linked immunosorbent assay) and expression of HMGB1, TLR4 and NF-κB protein in lung tissues (by Western blot). Results Compared with group S, the pathological scores, W∕D ratio and content of TNF-α were significantly increased, and the expression of HMGB1, TLR4 and NF-κB was up-regulated in I∕R and SP groups ( P<0. 05) . Compared with group I∕R, the pathological scores, W∕D ratio and content of TNF-αwere significantly decreased, and the expression of HMGB1, TLR4 and NF-κB was down-regulated ( P<0. 05) , and the pathological changes of lung tissues were significantly attenuated in group SP . Conclusion Sevoflurane preconditioning reduces lung I∕R injury probably through inhibiting HMGB1∕TLR4∕NF-κB signaling pathway in rats.

Objective To investigate the effects of perioperative parecoxib sodium on serum surfactant protein A and inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy,Methods Sixty-two ASA Ⅰ or Ⅱ elderly patients,aged 65-78 years,weighing 51-79 kg,scheduled for elective video-assisted thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 3 groups:0.3 mg/kg parecoxib sodium group (group P1,n=21),0.6 mg/kg parecoxib sodium group (group P2,n =21) and control group (group C,n =20).The patients were given intravenous parecoxib sodium of 0.3 mg/kg immediately before induction of anesthesia and at 12 h after operation in group P1,and also parecoxib sodium of 0.6mg/kg immediately before induction of anesthesia and at 12 h after operation in group P2,while the equal volume of normal saline was given in group C.Blood samples were taken from the central vein before the induction of anesthesia(T0),after operation(T1),12 h after operation(T2) and 24 h after operation(T3).The concentration of serum surfactant protein A (SP-A),TNF-α,IL-6 and IL-8 were determined by ELASA.The incidence of pulmonary complications at 72 h after operation were also recorded.Results Compared with T0,the concentration of serum SP-A,TNF-α,IL-6 and IL-8 increased significantly in all groups at T1-T3 (P＜0.05).Compared with C group,the concentration of serum SP-A,TNF-α,IL-6 and IL-8 in groups P1 and P2 decreased significantly at T1-T3 (P＜0.05),there were no significant differences between groups P1 and P2.The incidence of postoperative pulmonary complications had no statistically significant differences between the three groups.Conclusion Parecoxib sodium can significantly reduce the concentration of serum SP-A and alleviate the inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy.

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway in propofol-induced reduction of lung ischemia-reperfusion (I/R) injury in aged rats.Methods Thirty-two clean healthy male Sprague-Dawley rats,aged 18-22 months,weighing 450-600,were divided into 4 groups (n =8 each) using a random number table:sham operation group (group S),I/R group (group I/R),I/R plus propofol group (group I/R+P) and all-trans retinoic acid (ARTA) plus I/R plus propofol group (group ARTA+I/R+P).Lung I/R was induced by occlusion of the right hilum of lung for 60 min followed by 120 min of reperfusion in anesthetized rats.In group ATRA+I/R+P,Nrf2/ARE signaling pathway blocker ARTA 6 mg/kg was intraperitoneally injected once a day for 3 consecutive days,and the model of lung I/R injury was established at 2 h after the last administration.In group I/R+P and group ARTA+I/R+P,while the model of lung I/R injury was established,propofol 30 mg · kg-1 · h-1 was infused via the caudal vein until 120 min of reperfusion.The rats were sacrificed at 120 min of reperfusion and then the lungs were removed for examination of the pathological changes which were scored and for measurement of wet/dry weight ratio (W/D ratio),superoxide dismutase (SOD) activity (by xanthine oxidase method),malondialdehyde (MDA) content (using thiobarbituric acid method) and expression of Nrf2 and heme oxygenase-1 (HO-1) protein (by Western blot).Results Compared with group S,the pathological scores,W/D ratio and MDA content were significantly increased,and the activity of SOD was decreased in I/R and ATRA+I/R+P groups,and the expression of Nrf-2 and HO-1 was significantly up-regulated in I/R,I/R+P and ATRA+I/R+P groups (P＜0.05).Compared with group I/R,the pathological scores,W/D ratio and MDA content were significantly decreased,the activity of SOD was increased,and the expression of Nrf-2 and HO-1 was up-regulated in group I/R+P (P＜0.05),and no significant change was found in the indexes mentioned above in group ARTA+I/R+P (P＞0.05).Compared with group I/R+P,the pathological scores,W/D ratio and MDA content were significantly increased,the activity of SOD was decreased,and the expression of Nrf-2 and HO-1 was down-regulated in group ARTA+ I/R+P (P＜0.05).Conclusion Nrf2/ARE signaling pathway activation is involved in propofol-induced reduction of lung I/R injury in aged rats.

Objective To evaluate the effect of ketamine on the expression of tryptophan hydroxylase 2 (TPH2) in the median raphe nuclei of mentally depressed mice.Methods Thirty-six healthy SPF male C57BL/6J mice,aged 8-12 weeks,weighing 20-26 g,were divided into 3 groups (n=12 each) using a random number table:control group (C group),depression group (D group) and depression plus ketamine group (D+K group).Mental depression was induced by forcing the animals to swim in a narrow cylinder from which they can not escape.Ketamine 15 mg/kg was intraperitoneally injected once a day for 7 consecutive days starting from 1 day after successful establishment of the model in group D+K.The equal volume of normal saline was given instead of ketamine in C and D groups_ Forced swimming test was performed again at 30 min after the last administration,and the immobility time was recorded.Open field test was also performed at 30 min after the last administration,and the total horizontal distance and the number of standing on the back legs were recorded.The mice were sacrificed after the end of the behavioral testing,and the hippocampi and median raphe nuclei were isolated.High-performance liquid chromatography-electrochemical detection assay was used to measure the content of 5-hydroxytryptamine (5-HT) in hippocampi.The expression of TPH2 protein and mRNA in the median raphe nuclei was detected using Western blot and real-time polymerase chain reaction,respectively.Results Compared with group C,the immobility time was significantly prolonged,the total horizontal distance was shortened,the number of standing on the back legs and content of 5-HT in hippocampi were deceased,and the expression of TPH2 protein and mRNA in the median raphe nuclei was down-regulated in group D,and the total horizontal distance was significantly shortened,the number of standing on the back legs was decreased (P＜0.05),and no significant change was found in the immobility time,content of 5-HT in hippocampi or expression of TPH2 protein and mRNA in the median raphe nuclei in group D +K (P＞0.05).Compared with group D,the immobility time was significantly shortened,the content of 5-HT in hippocampus was increased,the expression of TPH2 protein and mRNA in the median raphe nuclei was up-regulated (P＜0.05),and no significant change was found in the total horizontal distance or the number of standing on the back legs in group D+K (P＞0.05).Conclusion The mechanism by which ketamine produces anti-depressant effect may be related to up-regulation of TPH2 expression in the median raphe nuclei and increase in the synthesis of 5-HT in hippocampi of mice.

Objective To evaluate the efficacy of high frequency two-lung ventilation (TLV) with low tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.Methods Thirty patients of both sexes,aged 48-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic radical resection of esophagus cancer,were divided into 2 groups (n =15 each) using a random number table:onelung ventilation group (group O) and TLV group (group T).A left-sided double-lumen tube was inserted orally in group O,and a single-lumen tube was placed orally in group T.During thoracoscopic surgery,the left lung was ventilated,with tidal volume 8 ml/kg and respiratory rate 14 breaths/min in group O.In group T,artificial pneumothorax was induced by continuous CO2 insufflation with CO2 pressure at 10 mmHg,and bilateral lungs were ventilated,with tidal volume 5 ml/kg and respiratory rate 20 breaths/min.Mean arterial pressure and heart rate were recorded before induction of anesthesia,immediately after intubation (T1),at 10 min after intubation (T2),at 30 min after the start of thoracoscopic surgery (T3),immediately after the end of thoracoscopic surgery (T4) and at 30 min of TLV (T5).Arterial blood samples were collected for blood gas analysis at T2,T3,T4 and T5.The exposure of the surgical field and the number of lymph node dissection in the left recurrent laryngeal nerve chain were recorded during surgery.The emergence time,extubation time and time for recovery of consciousness were recorded.Results Arterial oxygen partial pressure was significantly lower at T3,4 than at T2 in the two groups,and arterial carbon dioxide partial pressure was significantly higher,and the pH value was lower at T3,4 than at T2 in group T (P＜0.05).Compared with group O,arterial carbon dioxide partial pressure was significantly increased,the pH value was decreased,and the number of lymph node dissection in the left recurrent laryngeal nerve chain was increased at T3,4 in group T (P＜0.05).There were no significant differences between the two groups in the good exposure of the surgical field,emergence time,extubation time and time for recovery of consciousness (P＞0.05).Conclusion High frequency TLV with low tidal volume when assisted by CO2 pneumothorax can serve as a feasible mode for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.

Objective To observe the effect of patient-controlled intravenous analgesia (PCIA)with dezocine combined with sufentanil on inflammatory response and pain after laparoscopic hepatectomy for hepatocellular carcinoma.Methods Sixty patients (43 males,17 females,aged 18-60 years,ASA grade Ⅰ or Ⅱ) scheduled for laparoscopic hepatectomy for hepatocellular carcinoma were divided into sufentanil group (group S) and dezocine+sufentanil group (group DS) according to the random number table,n=30 each.Patients in group S were given 100 ml normal saline containing sufentanil 2.0 μg/kg and tropisetron 5 mg.Patients in group DS were given 100 ml normal saline containing sufentanil 2.0 μg/kg,dezocine 0.5 mg/kg and tropisetron 5 mg.VAS scores and numeric sedation scale (NSS) scores were recorded at 4,24,48 h after operation and patients' satisfaction scores were recorded at 48 h after operation.The levels of serum tumor necrosis factor-α (TNF-α),interleukin-2 (IL-2),interleukin-6 (IL-6) in blood samples harvested before induction of anesthesia and 0,4,24 and 48 h after operation were measured by ELISA.The times of efficient injection and incidence of adverse effect within 48 h after operation were recored.Results Compared with group S,the VAS scores in group DS were decreased significantly while the satisfaction of patients to analgesia were increased significantly at 4,24,48 h after operation (P<0.05).There were no obvious differences in NSS scores between two groups.Compared with before induction of anesthesia,the concentrations of TNF-α and IL-6 were increased significantly while the concentrations of IL-2 was decreased significantly in both groups at 4,24,48 h after operation (P<0.05).Compared with group S,the concentrations of TNF-α and IL-6 were decreased significantly while the concentrations of IL-2 was increased significantly in group DS at 24,48 h after operation (P<0.05).The times of efficient injection in group DS were less than that in group S significantly within 48 h after operation [(2.0±0.7) times vs.(7.2±1.3) times] (P<0.05).There were no obvious differences in adverse effects between two groups.Conclusion PCIA with dezocine 0.5 mg/kg combined with sufentanil 2.0 μg/kg can alleviate the inflammatory response to some extent in patients after laparoscopic hepatectomy for hepatocellular carcinoma,and it can offer a safe and effective analgesic effect.

Objective To investigate the effect of sevoflurane anaesthesia on the cognitive function and phosphorylation of tau protein in hippocampal neurons in amyloid precursor protein (APP) transgenic mice.Methods Male APP gene mutation mice,weighing 18-22 g and aged 8-12 weeks,were used in this study.Forty-four APP positive mice were randomly divided into two groups:sevoflurane group (group AS,n =28) and control group (group AC,n =16).And other forty-four APP negative mice were randomly divided into two groups:sevoflurane group (group S,n =28) and control group (group C,n =16).The animals in groups S and AS inhaled 3％ sevoflurane for 4 hours.While in groups C and AC,the animals inhaled pure oxygen for 4 hours.Morris water maze was performed 24 hours after sevoflurane or pure oxygen inhalation.The phosphorylation of tau protein at Ser262 and Ser396 sites was detected by Western blotting on 1 day after pure oxygen inhalation in groups AC and C,and on 1,3 and 7 days after sevoflurane inhalation in groups AS and S.Results Compared with group C,the escape latency was significantly prolonged and the duration of staying at the original platform quadrant was shortened in groups S and AC,and the phosphorylation of tau protein at Ser262 site in group S and phosphorylation of tau protein at Ser262 and Ser396 sites in group AS were increased (P ＜ 0.05).Compared with group S,the escape latency was significantly prolonged,the duration of staying at the original platform quadrant was shortened,and the phosphorylation of tau protein at Ser262 and Ser396 sites was increased in group AS (P ＜ 0.05).Compared with group AC,the escape latency was significantly prolonged,the duration of staying at the original platform quadrant was shortened,and the phosphorylation of tau protein at Ser262 and Ser396 sites was increased in group AS (P＜0.05).Conclusion Sevoflurane anesthesia can aggravate the impairment of cognitive function in APP positive mice and the increase in the phosphorylation of tau protein at Ser262 and Ser396 sites is involved in the mechanism.

Objective To evaluate the role of glycogen synthase kinase-3 beta (GSK-3β) in spinal cord ischemia/reperfusion (I/R) injury in rats.Methods Forty-eight male Sprague-Dawley rats,aged 3 months,weighing 250-300 g,were randomly divided into 3 groups (n =16 each) using a random number table:sham operation group (group S),group I/R and I/R+ GSK-3β inhibitor LiCl group (group LiCl).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg/kg.Spinal cord ischemia was induced by 45 min occlusion of the abdominal aorta followed by reperfusion.In I/R and LiCl groups,normal saline 5 ml and LiCl 15 mg/kg were injected,respectively,via the caudal vein at 30 min before ischemia.The animals were sacrificed at 48 h of reperfusion and the lumbar segment (L4-6) of spinal cords was removed for microscopic examination and for determination of neuronal apoptosis in the anterior horn of the spinal cord (by TUNEL),and the expression of interleukin-6 (IL-6),IL-8 and IL-10 was detected (by immunohistochemistry).The apoptosis rate was calculated.Results Compared with group S,the apoptosis rate was significantly increased,IL-6 and IL-8 expression was upregulated,and IL-10 expression was down-regulated in I/R and LiCl groups.Compared with group I/R,the apoptosis rate was significantly decreased,IL-6 and IL-8 expression was down-regulated,IL-10 expression was up regulated,and the pathological damage was attenuated in LiCl group.Conclusion Activated GSK-3β is involved in the development of spinal cord I/R injury possibly by promoting synthesis and release of inflammatory factors in rats.