Propofol Research Articles

Effect of remifentanil on MACBAR of sevoflurane in patients with hepatic dysfunction undergoing laparoscopic surgery

Objective To evaluate the effect of remifentanil on the minimum alveolar concentration of sevoflurane required to blunt the adrenergic response (MACBAR) in the patients with hepatic dysfunction undergoing laparoscopic surgery. Methods The patients, aged 18-64 yr, with body mass index < 30 kg/m2, undergoing elective laparoscopic hepatobiliary surgery, were selected.Patients with normal liver function were selected as control group (C group), and patients with liver dysfunction (Child-Pugh grade B) were selected as test group and divided into 3 subgroups by a random number table method: no remifentanil group (R0 group) and different target plasma concentrations of remifentanil groups (R1 group and R2 group). Anesthesia was induced by intravenously injecting propofol 2-3 mg/kg, remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg.After endotracheal intubation, mechanical ventilation was performed.The end-tidal sevoflurane concentration was adjusted to the preset concentration in each group and maintained at the level for 20 min before the pneumoperitoneum was established.Anesthesia was maintained as follows: remifentanil was not used in C group and R0 group, and the target plasma concentration of remifentanil was 1 and 2 ng/ml in group R1 and group R2, respectively, and sevoflurane was inhaled.The MACBAR of sevoflurane was determined using the sequential method.The initial end-tidal sevoflurane concentrations were 5.0%, 4.6%, 2.6% and 2.4% in group C, group R0, group R1 and group R2, respectively.MAP and HR were recorded and blood samples were collected before and after pneumoperitoneum, and the plasma epinephrine and norepinephrine concentrations were measured by enzyme-linked immunosorbent assay, and the difference in MAP and HR before and after pneumoperitoneum was calculated. Results A total of 14 cases in group C, 19 cases in group R0, 19 cases in group R1 and 15 cases in group R2 completed the study.Compared with group C, the MACBAR of sevoflurane and plasma adrenergic concentration before and after pneumoperitoneum were significantly decreased (P 0.05). Compared with group R0, the MACBAR of sevoflurane was significantly decreased in group R1 and group R2, and HR before and after pneumoperitoneum and the difference were significantly decreased in group R2(P<0.05). The MACBAR of sevoflurane was significantly lower in group R2 than in group R1 (P<0.05). Conclusion Remifentanil can decrease the MACBAR of sevoflurane and enhance the efficacy in inhibiting the stress responses in the patients with hepatic dysfunction undergoing laparoscopic surgery. Key words: Anesthetics, inhalation; Piperidines; Hepatic insufficiency; Dose-response relationship, drug

Protective effect of propofol on neurological function in rats after traumatic brain injury and related mechanism

Objective To investigate the protective effect of propofol on neurological function in rats after traumatic brain injury (TBI) and its possible mechanism. Methods A total of 96 SD rats were randomly divided into sham operation group, sham operation+ propofol group, TBI group and TBI + propofol group, with 24 rats in each group. The TBI model was prepared by modified Feeney method. The sham operation+ propofol group and the TBI+ propofol group were given 50 mg/kg of propofol once daily. The sham operation group and the TBI group were injected with the same amount of normal saline. Modified neurobehavioral functional scores (mNSS) were evaluated at 1, 3, 7 and 14 days after injury; dry-wet specific gravity method was used to detect brain water content in injured area; TUNEL staining was used to detect neuronal apoptosis; chemiluminescence was used to detect activity of Oxygen cluster (ROS) content; Western blot was used to determine the expressions of inositol requirement enzyme 1 (IRE-1), enhancer binding protein homolog protein (CHOP), heme oxygenase 1 (HO-1), quinone oxidoreductase 1 (NQO1) and nuclear factor E2 related factor 2 (Nrf2) protein. Results Compared with the sham operation group and the sham operation + propofol group, the mNSS, brain tissue water content, apoptosis number and ROS increased at 1, 3, 7 and 14 days after TBI in the TBI group and TBI + propofol group (P<0.05). Compared with TBI group, mNSS in TBI+ propofol group decreased significantly [(9.3±1.4)points ∶(10.9±1.2)points] 7 days after injury (P<0.05); the brain tissue water content decreased significantly [(81.0±0.8)%∶(82.1±0.8)%] 3 days after injury (P<0.05); the number of apoptotic cells decreased significantly 7 days after injury[(14.1±1.4)%∶(15.6±1.6)%], with the most significant decrease at 14 days after injury [( 10.4±1.5)%∶(13.2±1.4)% (P<0.05); and ROS decreased significantly 7 days after injury [(61.5±4.0)RFU∶(77.3±5.5)RFU](P<0.05). Compared with the sham operation group and the sham operation+ propofol group, the expressions of IRE-1 and CHOP were significantly up-regulated in the TBI group and the TBI+ propofol group (P<0.05); the expressions of HO-1, NQO1 and Nrf2 in the TBI group were significantly decreased (P<0.05); the expressions of HO-1 and NQO1 in TBI+ propofol group were increased (P<0.05) while the expression of Nrf2 were decreased slightly (P<0.05). Compared with the TBI group, the expressions of IRE-1 and CHOP in TBI+ propofol group were decreased (P<0.05), while the expressions of HO-1, NQO1 and Nrf2 were significantly increased (P<0.05). Conclusion After TBI in rats, propofol can reduce oxidative stress by activating the Nrf2-antioxidant element (ARE) pathway, reduce brain edema, and inhibit neuronal apoptosis, thus playing a neuro-protective role. Key words: Brain injuries; Oxidative stress; Nuclear factor-E2-related factor 2

Effects of ultrasound-guided paravertebral nerve block combined with general anesthesia on hemodynamics and recovery in thoracic surgery

Objective To compare the effects of combined paravertebral nerve block and general anesthesia on hemodynamics and recovery period in thoracic surgery. Methods Eighty patients undergoing elective thoracic surgery with American Society of Anesthesiologists(ASA) Ⅱ or Ⅲ were randomly divided into 2 groups with 40 cases in each group. Paravertebral nerve block combined general anesthesia group (TPVB group) and traditional general anesthesia control group (C group). Two groups of patients were induced with the same procedure. Sevoflurane inhalation, propofol, and remifentanil were administered intravenously to maintain anesthesia. Hemodynamic parameters before surgery (T0), after induction (T1), 3 min after the operation (T2), after the end of surgery (T3) and the number of interventions requiring vasoactive drugs and dosage of analgesic drugs were measured. The time of anesthesia, operation time, and recovery time, extubation time and pain score were recorded. The recovery of consciousness was assessed by using Observer′s Assessment of Alertness/Sedation Scale (OAA/S) score. Results Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were significantly lower in TPVB group than in group C at the T2 timepoint. SBP and DBP were significantly higher, and heart rate was significantly lower in TPVB group than in group C at the T3 timepoint (P<0.05). The number of 4 vasoactive drugs and remifentanil dosage were significantly less in TPVB group than in group C (P<0.05). The time of blinking, extubating time and pain score of TPVB group were significantly better than those of group C (P<0.05). Postoperative opening the eyes by prompting time, extubating time, and pains cores were significantly better in TPVB group than in group C (P<0.05). The OAA/S scores before and after extubating were significantly higher in TPVB group than in group C (P<0.05). Conclusions Combination of paravertebral nerve block with general anesthesia leads to more stable hemodynamics, earlier time for extubation, and less postoperative pain scores in patients undergoing thoracic surgery. Key words: Paravertebral nerve block; Anesthesia, general; Hemodynamics

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome

Objective To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) in C group were measured at 8∶00 a. m.the next day. Results The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P 0.05). The levels of CD8+ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD4+/CD8+ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05). Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol. Key words: Respiratory distress syndrome, Adult; Ventilators, mechanical; T-Lymphocytes; Dexmedetomidine; Propofol; Midazolam

Efficacy of butorphanol combined with propofol in elderly patients undergoing gastroenteroscopy

Efficacy of butorphanol combined with propofol in elderly patients undergoing gastroenteroscopy

Effects of propofol on the expression of B-cell lymphoma-2 assaciated protein and B-cell lymphoma-2 in the hippocampus of neonatal rats

Objective To investigate the effects of propofol on the expression of B-cell lymphoma-2 assaciated protein (Bax) and B-cell lymphoma-2(Bcl-2) in the hippocampus of neonatal rats. Methods A total of 112 male newborn Sprague Dawley (SD) rats aging 7 d were randomly divided into 8 groups (n=14): control group (Con1 group, intraperitoneally given normal saline for 5 d), and P50, P100 and P150 groups which received 50, 100 mg/kg and 150 mg/kg propofol once per day for 5 d, respectively; and control 2 group (Con2 group, intraperitoneallyl receiving normal saline for 5 d, and appendectomy was performed under propofol anesthesia for the last day) and SP50, SP100 and SP150 groups which received 50, 100 mg/kg and 150 mg/kg propofol for 5 d respectively, and appendectomy was performed under propofol anesthesia for the last day). Two months after the experiments, the level of Bcl-2 (inhibitor of apoptosis proteins) and Bax (the proapoptotic protein) were detected using immunohistochemical methods. Results Compared with the Con1 group, the levels of Bax in the P50, P100 and P150 groups increased, while the amounts of Bcl-2 gradually decreased in the P100 and P150 groups(P<0.05). Compared with the P50 group, the levels of Bax increased (P<0.05), while the amounts of Bcl-2 decreased in the P100 and P150 groups. Compared with the Con2 group, the level of Bax in the SP50, SP100 and SP150 groups gradually increased (P<0.05), while the amount of Bcl-2 in the SP50 and SP150 groups gradually decreased (P<0.05). Compared with the SP50 group, the level of Bax in the SP100 and SP150 groups increased (P<0.05), while the amounts of Bcl-2 was decreased in the SP150 group (P<0.05). Conclusions Repeated administration of propofol can inhibit the activation of Bcl-2 and enhance the expression of Bax. It can promote the apoptosis of hippocampal neurons of newborn rats in a dose-dependent manor. Key words: Propofol; Neonatal rat; Hippocampus; Apoptosis

Propofol prevents oxidative stress and apoptosis by regulating iron homeostasis and targeting JAK/STAT3 signaling in SH-SY5Y cells

The present study aimed to test the hypothesis that propofol (PRO) could exert a neuroprotective effect via inhibiting oxidative stress induced by iron accumulation. Human SH-SY5Y cells were pretreated with ferric citrate (FAC), and then were protected by PRO. Cell viability was measured by MTT method. Iron levels were assayed by ICP-MS. Cell apoptosis was examined by TUNEL and digital holographic technique. Malondialdehyde (MDA), reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) depolarization were measured by MDA, DCFH-DA and JC-1 kits, respectively. The expression of proteins or genes involved in iron metabolism such as ferritin, TfR1, DMT1, Fpn1 and hepcidin, and other apoptosis-related proteins including Bcl2, Bax, Bid, Cox2, IL-6, JAK1 and STAT3 were detected by western blot. Our results showed low concentration of PRO (5 μM) could significantly prevent FAC induced apoptosis via inhibiting oxidative stress and iron accumulation. PRO suppressed the increase of ROS and MDA and decrease of MMP induced by FAC. PRO significantly down-regulated the expression of ferritin and up-regulated the expression of TfR1and Fpn1, but had no effect of DMT1. Furthermore, this effect was not done by PRO chelating iron. Meanwhile, PRO suppressed the inflammatory response through inhibiting IL-6 and Cox2 expression and activating JAK/STAT3 signaling induced by iron overload. In conclusion, here we demonstrated a new antioxidation mechanism of PRO. PRO could protect against nerve cell injury induced by overload of iron through regulating iron metabolism and inhibiting stress oxidative and inflammation reaction pathways by targeting JAK/STAT3 signaling.

Fentanyl-Induced Chest Wall Rigidity as a Cause of Acute Respiratory Failure in the Intensive Care Unit

We aim to report a case of chest wall rigidity induced by high-dose fentanyl infusion sedation and analgesia in the intensive care unit (ICU) for management of pneumonia and asthma. The patient is an 80-year-old woman, who presented to the hospital with complaints of fever and productive cough with yellowish expectoration of 2 days duration. She also had lethargy over the same time period and had sick contacts in the form of two daughters who both had recently recovered from a “flu-like” illness. She was known to have bronchial asthma treated with seretide 25/250 two puffs ON + PO monteleukast 10 mg ON, hypertension treated with PO losartan 50 mg BD, type 2 diabetes mellitus controlled with PO linagliptin 5 mg OM and a previous right thalamic ischemic stroke 5 years ago for which she was on PO clopidogrel 75 mg OM and PO simvastatin. She developed severe ventilator desynchrony characterized by dramatic sudden onset of severe hypercarbia, severely decreased pulmonary compliance and episodic breath holding. She was empirically treated for asthma exacerbation and treated with steroids, bronchodilators and manual ventilation but despite doing so during this episode the patient failed to respond. The patient was clinically evaluated and dynamic hyperinflation was excluded as a cause of the respiratory failure. There was no evidence of pneumothorax and worsening pneumonia. Considerations of insufficient sedation and analgesia led to deepening sedation and analgesia without good response. Ventilation was dramatically improved after small doses of neuromuscular relaxation. This cycle was repeated many times. The patient was kept on high-dose propofol and fentanyl, but there were repeated cycles of sudden persistent severe hypercarbia, severely decreased pulmonary compliance and episodic breath holding. Eventually a suspicion of fentanyl-induced chest wall rigidity was made after excluding causes of airway resistance and reduction in pulmonary compliance. Gradual reduction in fentanyl infusion was associated with a reduction of episodes of reduced lung compliance and improvement in ventilation. Fentanyl is often used for analgesia and sedation in the ICU. It has a good side effect profile but it is not without harm. High doses of fentanyl can lead to dramatic worsening of respiratory mechanics that may be life threatening. Fentanyl-induced chest wall rigidity is an important side effect that needs to be considered in the differential diagnosis of respiratory failure in the ICU. J Med Cases. 2019;10(8):249-252 doi: https://doi.org/10.14740/jmc3351

Effect of anesthesia management based on rSO2-BIS-goal-directed hemodynamic multi-modal monitoring on acute kidney injury after cardiac valve replacement

Objective To evaluate the effect of anesthesia management based on regional cerebral oxygen saturation (rSO2)-bispectral index (BIS)-goal-directed hemodynamic multi-modal monitoring on acute kidney injury (AKI) after cardiac valve replacement. Methods A total of 238 patients of both sexes, aged 18-75 yr, weighing 45-95 kg, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ (New York Heart Association class Ⅱ or Ⅲ ), undergoing elective cardiac valve replacement, were assigned into routine experience group (group C, n=122) and multi-mode monitoring group (group M, n=116) using a random number table method.After admission to the operating room, the invasive blood pressure of radial artery, central venous pressure, electrocardiogram, SpO2 and end-tidal pressure of carbon dioxide were recorded in group C, and rSO2, BIS, stroke volume variation, cardiac index and stroke volume index were monitored based on the monitoring in group C. The patients were tracheally intubated when BIS value was about 50.BIS value was maintained between 45 and 55, rSO2 was maintained not less than 20% of the baseline value or the absolute value not less than 55%, and fluctuation in mean arterial pressure did not exceed 20% of the baseline value, and stroke volume index was maintained >25 ml/m2 and cardiac index>2.5 L·min-1 ·m-2, maintaining not lower than the baseline value before induction in special conditions.The intraoperative volume of fluid infused, infusion of allogeneic blood, consumption of propofol, time of cardiopulmonary bypass, aortic cross-clamping time, anesthesia time, operation time, occurrence of AKI within 48 h after operation, renal replacement therapy, extubation time, duration of intensive care unit stay, postoperative length of hospital stay, development of other serious postoperative complications and fatality rate at day 30 after operation were recorded. Results Compared with group C, the incidence of AKI was significantly decreased, the volume of plasma infused and consumption of propofol were reduced, the extubation time, duration of intensive care unit stay and postoperative length of hospital stay were shortened (P 0.05). Conclusion Anesthesia management based on rSO2-BIS-goal-directed hemodynamic multi-modal monitoring can decrease the occurrence of AKI after cardiac valve replacement. Key words: Heart valve prosthesis implantation; Acute kidney injury; Monitoring, intraoperative; Brain; Oxygen; Electroencephalography; Hemodynamics

Efficacy of TEAS for general anesthesia preserving spontaneous breathing in patients undergoing thoracoscopic surgery

Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery. Methods Forty patients of both sexes, aged 18-67 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Mallampati physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy, were divided into 2 groups (n=20 each) using a random number table method: general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+ GS). Anesthesia was routinely induced and maintained, a laryngeal mask was placed, and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation, and visual analogue scale score was maintained<4 points.In group TE+ GS, Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave, frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia, immediately after start of operation, during thoracic exploration, immediate after lobectomy , and at 30 min and 1 h after lobectomy.The intraoperative MAP, HR, and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol, norepinephrine, epinephrine, and blood glucose in serum (by enzyme-linked immunosorbent assay). The highest value of PETCO2, the lowest value of SpO2, and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay, time to first flatus, ambulation time, occurrence of nausea and vomiting, chest tube drainage time, development of surgical complications, length of postoperative hospital stay and hospitalization expenses were recorded. Results MAP, HR and RR all fluctuated within the normal range, and no clinically significant events occurred in two groups.Compared with group GS, the highest value of PETCO2 was significantly decreased, the lowest value of SpO2 was increased, the MAP and HR were decreased, the consumption of propofol and remifentanil was decreased, the cortisol, norepinephrine, epinephrine, and blood glucose concentrations in serum were decreased, the time to first flatus, ambulation time, chest tube drainage time and length of postoperative hospital stay were shortened, and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE+ GS (P<0.05). Conclusion TEAS can reduce the amount of opioids consumed in the perioperative period, effectively inhibits intraoperative stress responses, and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery. Key words: Electric stimulation therapy; Anesthesia, general; Thoracoscopy

A historical cohort study of anesthetic methods for percutaneous left atrial appendage closure

Objective To explore the appropriate anesthetic method of percutaneous left atrial appendage closure by comparing the safety and feasibility of the different anesthetic methods. Methods Ninety nine patients with percutaneous left atrial appendage closure were divided into three groups according to anesthetic scheme by using a method of Historical Cohort Research: laryngeal mask general anesthesia without muscle relaxant (L group, n=19), endotracheal intubation general anesthesia with muscle relaxation antagonist (S group, n=40), and endotracheal intubation general anesthesia without muscle relaxation antagonist (G group, n=40). Target controlled infusion(TCI) of propofol and remifentanil for anesthesia induction and maintenance were used in L group and S group. The laryngeal mask was used in L group without muscle relaxants. Rocuronium was used for endotracheal intubation in S group, but the muscle relaxation was antagonized by sugammadex at the end of operation. Endotracheal intubation was performed after TCI propofol, intravenous sufentanil and cisatracurium in G group, but the muscle relaxation was not antagonized at the end of the operation. The outcome indexes were as follows: the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the time of staying at the postanesthesia care unit (PACU), the successful rate of esophageal ultrasonic probe placement, the incidence of displacement and air leakage of laryngeal mask, the incidence of replacement of a laryngeal mask with tracheal intubation during operation, and the adverse events after awakening. Results The recovery time of autonomic respiration in S group and L group were significantly shorter than that in G group[(2.5±0.5), (1.9±0.6) min vs (22.2±7.1) min, P<0.05]. The recovery time of consciousness was (3.4±0.6), (2.7±0.6) min in L group and S group respectively, both which were significantly shorter than that in G group[(28.8±12.9) min, P<0.05]. The time of extubation in L and S group was (4.5±1.0), (3.6±1.0) min respectively, both which were significantly shorter than that in G group [(34.6±16.0) min, P<0.05]. The time of staying at PACU in L group and S group was (28±4), (26±5) min respectively, which were significantly shorter than that in G group[(65±20) min, P<0.05]. The successful rate of one-time placement of TEE was 42.1% in L group, but that in S group and G group was more than 95% respectively(P<0.05). The intraoperative displacement rate in L group was 36.8%. The incidence of replacement of a laryngeal mask with tracheal intubation during operation was 21.1% in L group(P<0.05). The incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention were lower in S group and L group than in G group after awakening(P<0.05). Conclusions Endotracheal intubation general anesthesia was performed by combined intravenous injection of rocuronium with TCI propofol and remifentanil and reversal of rocuronium by sugammadex, which have the advantages of safe airway controllability, recovery rapidly after operation, extubation earlier, the lower incidence of hypoxemia and the lower incidence of agitation. Therefore, this anesthetic pattern is an ideal anesthetic method for percutaneous left atrial appendage closure. Key words: Left atrial appendage closure; General anesthesia; Sugammadex

Accuracy of different anatomic landmark methods in determining size of nasopharyngeal airway

Objective To evaluate the accuracy of different anatomic landmark methods in determining the size of nasopharyngeal airway. Methods Fifty-two patients of both sexes, aged 16-60 yr, of American Society of Anesthesiologists physical status Ⅰ to Ⅲ, with body mass index of 18-30 kg/m2, scheduled for elective awake craniotomy for supratentorial tumors under sedation-awake-sedation anesthesia, were included. For each patient, the distance from the apex of nose to the right tragus (NT), distance from apex of nose to the right mandibular angle (NM), and thyro-mental distance (TM) were measured and marked on a transnasal tube correspondingly. The patients were placed in supine position without pillow, topical anesthesia (nasal mucosal surface) was performed with 2% lidocaine, and patients were sedated with midazolam, propofol and dexmedetomidine. When Observer′s Assessment of Alertness/Sedation Scale score was 2 or 3 points, the tube was transnasally inserted to each marked depth. When the three marked depths mentioned above were reached, the positions of the tube′s tip were checked using a fiberoptic bronchoscope and recorded as: above epiglottis (the tip of the tube was placed between the epiglottis and the free edge of soft palate) or below epiglottis (the tip of the tube placed at or beyond the epiglottis). Results When the depth reached the NT mark, the tube′s tip was above epiglottis in 14 cases (27%), and the tube′s tip was below epiglottis in 38 cases (73%). When the depth reached the NM mark, the tube′s tip was above epiglottis in 31 cases (60%), and the tube′s tip was below epiglottis in 21 cases (40%). When the depth reached the TM mark, the tube′s tip was above epiglottis in 52 cases (100%). Compared with the NM and NT methods, the TM method had a higher probability with the tube′s tip above epiglottis when used to determine the depth of insertion (P<0.01). Conclusion TM anatomic landmark method provides higher accuracy in determining the size of nasopharyngeal airway. Key words: Anatomic landmarks; Airway management

Investigation on development of bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China

Objective To investigate the development of painless bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China. Methods From December 2018 to February 2019, a self-designed electronic questionnaire was sent to related personnels in a department of anesthesiology in hospitals within the range of survey through the WeChat platform.The survey mainly included three aspects: basic information of hospital, development of bronchoscope diagnosis and treatment under general anesthesia and the specific management plan. Results Questionnaires were sent to 326 hospitals in total, and 261 hospitals responded with a response rate of 80.06%.Among the 261 hospitals involved in the survey, 34 hospitals responded that no related diseases were found, and thus the number of valid questionnaires was 227, and the rate of valid questionnaires was 87.0%.Among the 261 hospitals, 161 hospitals were tertiary hospitals, and 66 hospitals were secondary hospitals, with a constituent ratio of 70.9% to 29.1%.The average development rate of painless bronchoscopy was 34.8%, the highest rate was 54.0% in Beijing, and the lowest rate was 27.5% in Hebei province.The average development rate of painless bronchoscopy was significantly higher in tertiary hospitals than in secondary hospitals (P 0.05); the number of hospitals applying sevoflurane was larger as compared with that of hospitals applying desflurane(P 0.05). Conclusion At present, the development rate of painless bronchoscopy in China is lower, and the greatest difficulty in further development is the shortage of personnel.Bronchoscope diagnosis and treatment under laryngeal mask or under monitoring anesthesia is the most commonly used method in clinic, and general anesthesia under tracheal intubation is more suitable for highly difficult bronchoscope diagnosis and treatment.Opioids combined with propofol is the most commonly used anesthesia method. Key words: Bronchoscopy; Surveys and questionnaires

Propofol upregulates the expressions and secretions of brain derived neurotrophic factor in rat hippocampal astrocytes via extracellular signal-regulated kinase signaling pathway

Objective To detect the expression level and secretion change of brain derived neurotrophic factor (BDNF) in rat hippocampus and hippocampal astrocytes induced by propofol and address its mechanism. Methods According to the treatment time of propofol, 24 rats were randomly divided into three groups, i.e. 0, 45 min and 90 min groups. Rats were administrated intraperitoneally with propofol (10 g/L, 100 mg/kg body weight). The levels of BDNF mRNA and glial fibrillary acidic protein (GFAP) in rat hippocampus were evaluated by real time polymerase chain reaction (PCR) and immunohistochemistry respectively. Primary cultured hippocampal astrocytes in vitro were divided into 3 groups: Control group (group Ctrl), Propofol group (group Pro), and Inhibitor PD98059+ Propofol group (group Pro-PD). In group Pro-PD, astrocytes were pretreated with 10 μmol/L extracellular signal regulated kinase (ERK) inhibitor PD98059 for 2 h, then incubated with 10 μmol/L propofol for 24 h. Finally cell apoptosis and the expression and secretion levels of BDNF were examined. Results Forty-five min and 90 min after injection of propofol, the mRNA levels of BDNF in the hippocampal tissue were 1.20±0.05 fold and 0.86±0.04 of the expression level in group 0 min respectively (P 0.05). The BDNF mRNA level of hippocampal astrocytes in group Pro was 1.15±0.04 fold of that in group Ctrl (P<0.05). The BDNF mRNA level in group Pro-PD was 0.92±0.05, which was significantly lower than that of group Pro (P<0.05). The BDNF secretion level of hippocampal astrocytes in group Pro was (62±4) ng/L, which was higher than(49±3) ng/L in group Ctrl. The BDNF secretion level in group Pro-PD was (44±3) ng/L, which was significantly lower than that of group Pro(P<0.05). Conclusions Propofol activated the rat hippocampal astrocytes and enhanced the expression level and secretion of BDNF in astrocytes through ERK signaling pathway. Key words: Propofol; Astrocyte; Extracellular signal-regulated kinase; Brain derived neurotrophic factor

Effects of dexmedetomidine on the inflammatory factors in sepsis patients under mechanical ventilation

Objective To investigate the effects of dexmedetomidine (Dex) on the inflammatory factors in sepsis patients under mechanical ventilation. Methods A total of 60 sepsis patients under mechanical ventilation were enrolled. They were randomly divided into a dexmedetomidine group and a propofol group (n=30), and treated with dexmedetomidine or propofol to maintain a range of -2 to 0 of Richmond Agitation-Sedation Score (RASS). Then, blood samples were taken and the levels of interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were detected before (T0), 24 h (T1), 48 h (T2), and 72 h (T3) after treatment. Both groups were compared for the score of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) on Days 5 and 10 after sedation. Meanwhile, the incidence of adverse reactions in the two groups were calculated. Results There were no significant differences in gender, age, SOFA score, APACHEⅡ score between the two groups (P>0.05). Before treatment, the levels of IL-6, PCT and CRP were abnormally increased, which were remarkable decreased after treatment (P 0.05). Conclusions Dex and propofol have good anti-inflammatory effects on sepsis patients under mechanical ventilation. Dex has stronger anti-inflammatory effect and rare adverse reactions. Key words: Dexmedetomidine; Propofol; Sepsis; Inflammatory factor

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron&#x0D; pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada&#x0D; tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve&#x0D; propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta&#x0D; memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi&#x0D; amaçlanmaktadır.Gereç-yöntem:&amp;nbsp;Sedo-analjezi ile endoskopik ultrasonografi işlemi&#x0D; planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve&#x0D; 0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5&#x0D; mg.kg-1 Propofol, 1 mg.kg-1 Ketamin, Propofol+fentanil&#x0D; grubuna (Grup F) da 1,5 mg.kg-1 Propofol, 1 mcg. kg-1&#x0D; Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond&#x0D; Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı,&#x0D; periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam&#x0D; propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı&#x0D; skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten&#x0D; ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.Bulgular:&amp;nbsp;Her iki grupta demografik veriler ve total operasyon&#x0D; süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha&#x0D; düşüktü (p&amp;lt;0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa&#x0D; gözlendi (p&amp;lt;0.001). Endoskopist memnuniyetinde herhangi bir fark&#x0D; gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da&#x0D; İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar&#x0D; gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi&#x0D; giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.Sonuç:&amp;nbsp;Endoskopik girişim yapılan hastaların büyük&#x0D; çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda&#x0D; anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu&#x0D; açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil&#x0D; propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz.

Comparision of desflurane and propofol for maintaining general anaesthesia in cataract surgery of elder patients

Objective To compare the application of desflurane and propofol as maintenance anesthetics to maintain intraoperative haemodynamics and quality of recovery in elder patients during cataract surgery. Methods After consent form obtained, 60 elder patients, from Jan.2017 to Dec.2017 scheduled for cataract surgery were randomized into 2 groups, 30 cases in each group.The desflurane group (D group) received desflurane inhalation and the propofol group (P group) received propofol using effect-site target-controlled infusion (TCI). The adequate depth of anaesthesia were monitored with narcotrend to ensure equipotency of anaesthetic administration in both groups. The Narcotrend Index maintained between 40 and 55 by titrating the anaesthetic agents. Cardiovascular drug intervention, the time of spontaneous breathing, the time of awakening and recovery adverse events were analysed. Results There was no difference of the time of spontaneous respiration or awakening between the two groups(P>0.05). The times of cardiovascular drug intervention in D group were fewer than that of P group (t=2.32, P=0.03). However, the adverse events of nausea and vomiting in lucid interval in D group were significantly more than those of P group (t=2.47, P=0.04). Conclusion Application of desflurane maintains general anaesthesia in elder patients during cataract surgery. There is no difference in spontaneous respiration or awakening between the two groups. However, desflurane inhalation anesthesia provides more stable haemodynamics during the operation. Propofol total intravenous anesthesia provides significantly better quality of recovery than desflurane inhalation anesthesia. Key words: Desflurane; Propofol; Cataract surgery, elder patients; General anaesthesia; Recovery

Relationship between prefrontal cortex and propofol-induced cognitive dysfunction in rats

Objective To evaluate the relationship between prefrontal cortex and propofol-induced cognitive dysfunction in rats. Methods SPF healthy male Sprague-Dawley rats, weighing 300-350 g, aged 16 weeks, were used in this study.Thirty rats in which catheters were successfully implanted into the prefrontal lobe were divided into 2 groups (n=15 each) using a random number table method: control group (group C) and propofol group (group P). In group P, 50 μmol/L propofol 0.5 μl was microinjected into the prefrontal cortex at day 7 after operation, and the equal volume of normal saline was given instead in group C. T-maze test and open field test were performed at 15 min after administration. Results Compared with group C, the correct rate of selection in T-maze was significantly decreased (P 0.05). Conclusion Prefrontal cortex may be involved in propofol-induced cognitive dysfunction in rats. Key words: Propofol; Prefrontal cortex; Cognition disorders

Application of brachial plexus and suprascapular nerve block combined with general anesthesia in shoulder arthroscopy

Objective To investigate the value and advantage of ultrasound guided intermuscular groove and suprascapular nerve block combined with general anesthesia in shoulder arthroscopy. Methods 40 American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ patients undergoing elective arthroscopic shoulder surgery were randomly divided into two groups. Patients in group A were treated with general anesthesia, while patients in group B were treated with brachial plexus and suprascapular nerve block combined with general anesthesia. Mean arterial pressure (MAP), heart rate (HR) and visual analogy score ( VAS) were measured at preoperative (T0), 5 min after the beginning of the surgey (T1), 30 min after the beginning of the surgey (T2), at the end of the surgery (T3), and 30 min after removing laryngeal mask (T4). Bispectral index (BIS) was recorded at T1 and T2. The operation time, extubation time, dosage of opioids (sufentanyl), dosage of propofol, visual analogue scale (VAS) scores at awake time in post anesthesia care unit (PACU), and 6 h, 12 h, 24 h after surgery. Results There were no significant differences in the BIS between two groups at T1 and T2 (P>0.05). Both the MAP and HR had no statistical significance at T0 (P>0.05). MAP and HR in group B were significantly lower than those in group A from T1 to T4 (P<0.05). Compared with group A, patients in group B had significantly shorter extubation time (P<0.05), smaller dosages of sufentanyl and propofol (P<0.05), lower VAS scores at awake time 6 h and 12 h after surgery (P<0.05). Conclusions Brachial plexus and suprascapular nerve block combined with general anesthesia can offer better anesthesia status, reduce dosage of opioids and propofol, and can provide effective analgesia in shoulder arthroscopy. Key words: Brachial plexus block; Anesthesia, general; Ultrasonography; Arthroscopy; Shoulder joint

Effect of PEEP on lung atelectasis in pediatric patients without high risk factors: evaluation using lung ultrasound

Objective To evaluate the effect of positive end-expiratory pressure (PEEP) on lung atelectasis using lung ultrasound (LUS) in the pediatric patients without high risk factors. Methods One hundred American Society of Anesthesiologists physical statusⅠor Ⅱ patients of both sexes, aged 1-6 yr, with body mass index in the normal range, scheduled for elective non-abdominal surgery, were divided into no PEEP group (group C, n=50) and PEEP group (group P, n=50) using a random number table method.The animals were mechanically ventilated in volume-controlled mode after intravenously injecting propofol, with PEEP 5 cmH2O, tidal volume 8 ml/kg, inspiratory/expiratory ratio 1∶2, respiratory rate 20-25 breaths/min in group P. In group C, the animals received no PEEP, and the other treatments were similar to those previously described in group P. Lung ultrasound was carried out after anesthesia induction and at the end of surgery.The severity and development of lung atelectasis were recorded. Results Compared with group C, the severity of lung atelectasis was significantly reduced after anesthesia induction and at the end of surgery, and the incidence of lung atelectasis was decreased in group P (P<0.05). Conclusion Early application of PEEP 5 cmH2O can reduce the occurrence of atelectasis for the pediatric patients without high risk factors for atelectasis. Key words: Child; Pulmonary atelectasis; Positive-pressure respiration