Remifentanil Research Articles

Remifentanil repairs cartilage damage and reduces the degradation of cartilage matrix in post-traumatic osteoarthritis, and inhibits IL-1β-induced apoptosis of articular chondrocytes via inhibition of PI3K/AKT/NF-κB phosphorylation.

BackgroundRemifentanil (RFT) is an opioid analgesic with a unique pharmacokinetic profile, and plays an important role in the intra- and post-operative periods. Post-traumatic osteoarthritis (PTO) is a particular type of osteoarthritis (OA) that occurs secondary to a traumatic injury. In the present study, we investigated the effects of RFT both in vivo and in vitro.MethodsIn vivo, 50 Sprague Dawley (SD) rats (7 weeks old) were randomly divided into five groups. Four groups of rats received RFT (0.2, 0.5, and 1 µg) or vehicle (PTO group), while the remaining group served as the control. A PTO model in rats was established using the Hulth method. The cartilage damage, articular cartilage formation, and the degradation of cartilage matrix were evaluated. The effects of RFT on cell proliferation, apoptosis, and nuclear factor (NF)-κB phosphorylation were also examined.ResultsThe results indicated that RFT improved cartilage damage, enhanced articular cartilage formation, and inhibited the degradation of cartilage matrix in PTO model rats. Compared with the control group, the protein levels of Osterix (OSX), Collagen type I alpha 1 (COL1A1), and osteocalcin (OC) were down-regulated in PTO model rats. RFT also inhibited the interleukin-1β (IL-1β)-induced apoptosis of chondrocytes in vitro. Furthermore, the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/NF-κB pathway was inhibited both in vitro and in vitro.ConclusionsRFT has significant potential as a therapeutic intervention to ameliorate PTO and provides a foundation for further clinical studies.

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study.

BackgroundThe use of sedation to noninvasive ventilation (NIV) patients remains controversial, however, for intolerant patients who are uncooperative, administration of analgesics and sedatives may be beneficial before resorting to intubation. The aim of this study was to evaluate the efficacy of remifentanil (REM) versus dexmedetomidine (DEX) for treatment of cardiac surgery (CS) patients with moderate to severe NIV intolerance.MethodsThis prospective cohort study of CS patients with moderate to severe NIV intolerance was conducted between January 2018 and March 2019. Patients were treated with either REM or DEX, decided by the bedside intensivist. Depending on the treatment regimen, the patients were allocated to one of two groups: the REM group or DEX group.ResultsA total of 90 patients were enrolled in this study (52 in the REM group and 38 in the DEX group). The mitigation rate, defined as the percentage of patients who were relieved from the initial moderate to severe intolerant status, was greater in the REM group than DEX group at 15 min and 3 h (15 min: 83% vs. 61%, P=0.029; 3 h: 92% vs. 74%, P=0.016), although the mean mitigation rate (81% vs. 85%, P=0.800) was comparable between the two groups. NIV failure, defined as reintubation or death over the course of study, was comparable between the two groups (19.2% vs. 21.1%, respectively, P=0.831). There were no significant differences between the two groups in other clinical outcomes, including tracheostomy (15.4% vs. 15.8%, P=0.958), in-hospital mortality (11.5% vs. 10.5%, P=0.880), ICU length of stay (LOS) (7 vs. 7 days, P=0.802), and in-hospital LOS (17 vs. 19 days, P=0.589).ConclusionsREM was as effective as DEX in CS patients with moderate to severe NIV intolerance. Although the effect of REM was better than that of DEX over the first 3 h, the cumulative effect was similar between the two treatments.

Effects of Different Systemic Opioid Doses on Subareas of the Ventral Respiratory Column

BackgroundThe Parabrachial Nucleus (PBN)/Kölliker‐Fuse (KF) complex are important subareas of the ventral respiratory column (VRC) that regulate inspiratory on‐ ( 1) and off‐switch ( 2). We have shown in vagus‐intact rabbits that respiratory rate depression caused by clinical opioid concentrations was in part mediated by the PBN ( 3), and that systemic opioid effects on respiratory phase timing could be partially reversed in the preBötzinger complex (preBC) albeit without reversing respiratory rate depression ( 4). The present study was to determine how much the combination of local microinjections of naloxone into the KF, PBN and preBC could reverse respiratory depression from intravenous remifentanil (REMI).MethodsThe study was approved by the local Animal Care Committee and conformed to NIH standards. Adult New Zealand White rabbits (3–4kg) were anesthetized, tracheotomized, ventilated, decerebrated and vagotomized. Phrenic nerve activity was recorded from the c5 rootlet, time averaged and used to calculate inspiratory and expiratory duration and peak phrenic activity (PPA). Gridwise localized pressure microinjections of α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA, 50 μM, 70 nl) utilizing a multibarrel glass pipette into the VRC caudal to the inferior collicle identified the PBN where AMPA injection caused significant tachypnea and the KF where AMPA caused transient bradypnea and a decrease in PPA. The tachypneic response to AMPA injection in the medulla was used to identify the preBC area. After functional identification of the PBN, KF and preBC areas, we injected a bolus of 10mcg REMI IV, which resulted in apnea. On return of the breathing pattern, a REMI infusion was started to achieve a steady‐state respiratory rate depression of 50% of control rate. After reaching steady‐state, we injected naloxone (1mM, 700nl) into the bilateral KF, PBN and preBC. We then repeated the REMI bolus injection with the apneic dose of 10mcg. In a subset of animals, the 10 mcg REMI bolus was repeated after naloxone injection into the KF/PBN and after injection into the preBC. Residual respiratory depression was reversed at the end of the protocol with IV naloxone (300μM). Drug effects were compared with one‐way RM ANOVA. Data are expressed as mean±SD.ResultsIn 11 animals, IV REMI depressed respiratory rate from 39±7 to 18±6 breaths per minute (BPM). Naloxone injection recovered respiratory rate to 20±9 in the KF (p=0.36), to 26±9 after additional injection into the PBN (p<0.001), and to 28±7 bpm after injection into the preBC area (p=0.54). The IV REMI bolus caused apnea >30s at control but only depressed respiratory rate to 12±6 bpm after naloxone injection into the KF/PBN (p<0.001) and to 16±7 after additional naloxone reversal in the preBC area (p=0.21, n=5).ConclusionRespiratory rate depression from IV opioids is mostly mediated by the PBN, however, higher opioid doses may also affect other brainstem areas.Support or Funding InformationSupported by NIH R01GM112960701A1 (Dr. Stucke) and VA merit grant I01BX000721 (Dr. Zuperku)Figure 1

Comparison of thoracic paravertebral nerve block and transverse abdominal plane block for multiple costal margins in anal-gesia after open liver surgery

Objective To evaluate the analgesic application of thoracic paravertebral blockade (TPVB) and transverse abdom-inal plane block (TAPB) for multiple costal margins after open liver surgery. Methods A total of sixty patients [American Society Anesthesiologists (ASA) Ⅰ-Ⅲ ]who were scheduled for open liver surgery (with a classical reverse L-shaped incision) were enrolled. The patients were divided into two groups according to the random number table method (n=30): a TPAB group (group TP) and a group of TAPB for multiple costal margins (group TA). Both groups received ultrasound guided nerve block before surgery. Group TP under-went bilateral TPVB at T7-T8 and T8-T9, while group TA underwent TAPB under bilateral costal margins and the classical site between the costal margin and the anterior inferior iliac spine, with a total of four block points. Then, both groups were compared and recorded for the duration of block procedures; the mean arterial pressure (MAP) and heart rate before incision (T0), after incision (T1), and at the times of block of the superior vena cava (T2), liver removal (T3) and stitching (T4); surgical duration, the inflow of liquid during surgery, the consumption of remifentanil, and the length of post-anesthesia care unit (PACU) stay after surgery; the Visual Analogue Scale (VAS) scores at resting and during movement immediately after surgery (when patients were awaken after extubation and able to communicate normally), and 2 h and 6 h after surgery; and the number of patients requiring opioids within 6 h after surgery and the time when opioids were first given after surgery. Results Group TA presented shorter duration of block procedures than group TP (P 0.05). Conclusions During open liver surgery, compared with TAPB for multiple costal margins, TPVB can maintain more stable hemody-namics, require less doses of opioids and improve perioperative analgesia. Key words: Open liver surgery; Thoracic paravertebral nerve block; Transverse abdominal plane block; Postoperative analgesia

Remifentanil protects neurological function of rats with cerebral ischemia-reperfusion injury via NR2B/CaMKIIα signaling pathway.

The effects of remifentanil were studied on cerebral ischemia-reperfusion injury (IRI) in rats, and its regulatory effect was explored on the N-methyl D-aspartate receptor subtype 2B (NR2B)/calcium/calmodulin-dependent protein kinase type II subunit alpha (CaMKII) signaling pathway in cerebral tissues. A total of 40 Sprague-Dawley rats were randomly assigned into sham group, model group, low-dose group (remifentanil injected into the caudal veins at 2 μg/kg) and high-dose group (remifentanil injected into the caudal veins at 10 μg/kg). Then, in the model, low-dose and high-dose groups, the rat model of cerebral IRI was established through middle cerebral artery occlusion (namely, ischemia for 1 h and reperfusion for 2 h), while no thread was inserted into the rats in the sham group. Neurological function of rats in each group was evaluated, and the cerebral infarct size was measured using 2,3,5-triphenyltetrazolium chloride (TTC) staining. Moreover, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was performed to determine the neuronal apoptosis level, and mitochondrial membrane potential was measured via JC-1 assay. Moreover, the reactive oxygen species (ROS) level in neurons and the malondialdehyde (MDA) content in cerebral tissues were determined using 2',7'-dichlorofluorescin diacetate (DCFH-DA) assay and enzyme-linked immunosorbent assay (ELISA), respectively. Finally, the expression levels of apoptosis-associated proteins and the NR2B/CaMKIIα signaling pathway-associated proteins in cerebral tissues were measured by Western blotting. Remifentanil preconditioning substantially decreased the neurological score of rats (p<0.01), cerebral infarct size (p<0.01), neuronal apoptosis level (p<0.01), ROS level in neurons (p<0.01), MDA content (p<0.01) and expression levels of cysteinyl aspartate specific proteinase-3 (Caspase-3), NR2B, phosphorylated CaMKIIα (p-CaMKIIα) and p-cAMP responsive element binding protein (p-CREB) (p<0.01), but it increased the mitochondrial membrane potential (p<0.01) and B-cell lymphoma 2 (Bcl-2)/Bcl-2-associated X protein (Bax) ratio (p<0.01). Remifentanil can repress the NR2B/ CaMKIIα signaling pathway in the neurons of rats with cerebral IRI to decrease the p-CREB expression, ROS level and MDA content in neurons, neuronal apoptosis level and cerebral infarct size, and increase the mitochondrial membrane potential, thereby protecting the neurological function.

Awake fiberoptic intubation in patients with stenosis of the upper airways: Utility of the laryngeal nerve block.

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.

SJOV prevents desaturation during bronchoscopy under moderate-to-deep sedation with propofol and remifentanil

SJOV prevents desaturation during bronchoscopy under moderate-to-deep sedation with propofol and remifentanil

Comparison of the effects of two anesthetic methods on laparoscopic surgery in children

Objective To compare the effects of two anesthetic schemes on pediatric laparoscopic surgery, and the influence on stress response and hemodynamics. Methods From November 2016 to November 2017, 100 children underwent laparoscopic surgery in the Affiliated Hospital of Medical College of Ningbo University were selected and divided into two groups by odd even number of beds, with 50 cases in each group.The control group was treated with general anesthesia.The observation group received total intravenous anesthesia with remifentanil and propofol.The anesthesia effect, stress response and hemodynamic indexes were compared between the two groups. Results The postoperative waking time[(31.48 ±4.19)min], the time of disappearance of mascara reflex[(2.32±1.62)min], the recovery time of spontaneous respiration [(1.96±1.45)min], the incidence of adverse reactions[4.00%(2/50)], Ramsay score[(3.69±0.43)points], VAS score[(1.96±1.42)points], immediate Ramsay score[(2.11±0.82)points] and immediate VAS score[(2.31±0.43)points] in the observation group were better than those in the control group (t=15.623, 1.436, 5.436, χ2=5.432, t=1.187, 1.528, 2.136, 2.431, all P<0.05). At different time points, the MAP, HR and stress response(cortisol, blood glucose, PaO2, MAP) in the observation group were better than those in the control group(all P<0.05). Conclusion General anesthesia has higher risk in children undergoing laparoscopic surgery and can prolong the time of conscious consciousness.Remifentanil combined with propofol, total intravenous anesthesia can stabilize hemodynamics, improve the safety of anesthesia and alleviate stress reaction in children undergoing laparoscopic surgery. Key words: Anesthesis, general; Anesthesis, intravenous; Laparoscopes; Stress response; Hemodynamics; Efficacy; Safety; Child

Effect of perioperative intravenous lidocaine infusion on postoperative early recovery quality in patients undergoing upper airway surgery

Objective To investigate the effect of perioperative intravenous lidocaine infusion on postoperative early recovery quality in patients undergoing upper airway surgery. Methods One hundred and twenty patients undergoing upper airway surgery were divided into two groups according to a random number table: a lidocaine group (group L) and a control group (group C), with 60 patients in each group. Group L was administered with 2.0 mg/kg lidocaine over 10 min before induction of anesthesia, followed by intravenous infusion at 2 mg·kg-1· h-1 until the end of surgery. Group C was given the same volume of normal saline. The 40-item Quality of Recovery Score (QoR-40 score) as well as the consumption of sufentanil and remifentanil during surgery and the incidence of postoperative nausea and vomiting (PONV) were recorded before surgery (T0), 24 h after surgery (T1) and 48 h after surgery (T2). Results The global QoR-40 scores and the scores for physical comfort, physical independence, psychological support and pain at T1 and T2 in two groups as well as the score for emotional state at T1 in group C were significantly lower than those at T0 (P<0.05). Compared with those in group C, the global QoR-40 scores and the scores for physical comfort, emotional state, and pain significantly increased in group L at T1 and T2 (P<0.05), where the score for physical independence in group L was superior to that in group C at T1 (P<0.05). Compared with those in group C, the dosage of remifentanil used during surgery and the incidence of PONV within 48 h in group L significantly reduced (P<0.05). Conclusions Perioperative intravenous lidocaine infusion can improve QoR-40 scores in patients two days after upper airway surgery, reduce the dosage of opioids and the incidence of PONV and improve postoperative early recovery quality. Key words: Lidocaine; Upper airway surgery; 40-item Quality of Recovery Score; Postoperative nausea and vomiting

Comparison of the Effects of Dexmedetomidine and Remifentanyl on Haemodynamics, Awakening and Recovery in Tympanoplasty and Tympanomasteidectomy

Comparison of the Effects of Dexmedetomidine and Remifentanyl on Haemodynamics, Awakening and Recovery in Tympanoplasty and Tympanomasteidectomy

Comparing the premedication effects of dexmedetomidine, remifentanil and labetalol before electroconvulsive therapy on haemodynamic responses and seizure duration in psychotic patients: A double-blinded clinical trial

Objective: The study addressed the comparable effects of premedication with dexmedetomidine (DEX), remifentanil (REM) and labetalol (LAB) before electroconvulsive therapy (ECT) on haemodynamic responses and seizure duration in psychotic patients. Materials and Methods: A double-blinded trial recruited four randomised groups of patients undergoing ECT (N = 144), including 0.5 μg/kg DEX, 0.2 mg/kg LAB, 1 μg/kg REM and 20 ml normal saline, respectively. The mean arterial pressure (MAP), heart rate (HR) and saturated oxygen were recorded every 5 min until the patient was transferred to the department. Besides, the recovery time, seizure duration and satisfaction were recorded. Data were analysed in SPSS software using analysis of variance and repeated measurement tests. Results: The MAP and HR were lower in the DEX (P

Effect of sevoflurane maintenance anesthesia on liver ischemia-reperfusion injury in patients undergoing partial hepatectomy

Objective To investigate the effect of sevoflurane anesthesia on hepatic ischemia-reperfusion injury in patients undergoing partial hepatectomy. Methods A total of 86 patients undergoing partial hepatectomy were divided into sevoflurane group and isoflurane group according to random number table with 43 patients in each group. Both groups received continuous epidural block combined with general anesthesia, sevoflurane group took sevoflurane combined with remifentanil to maintain anesthesia, while isoflurane group took isoflurane remifentanil to maintain anesthesia. The mean arterial pressure (MAP) and heart rate(HR) of different moments, awakening (open-eye time, extubation time, listening to instruction time, orientation recovery time, time of Aldrete score up to 9 minutes), the serum levels of tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), alpha glutathione S transferase (α-GST) levels at different moments were compared between the two groups. Results The MAP and HR at T1, T2, T3 and T4 in both groups were significantly lower than those at T0 (P<0.05). The HR at T1 and T4 in sevoflurane group were significantly higher than those in isoflurane group (P<0.05). The open-eye time, extubation time, listening to instruction time, orientation recovery time in sevoflurane group were significantly shorter than the isoflurane group (P<0.05). The levels of serum TNF-α, IL-1, AST, ALT, GLDH and α-GST in the two groups at T2 and T3 were significantly higher than those at T0 (P<0.05), and began to fall back to T4. The levels of serum TNF-α, IL-1, AST, ALT, GLDH and α-GST in the sevoflurane group at T2 and T3 were significantly lower than those in the isoflurane group (P<0.05). Conclusions The hepatic hemodynamics in patients undergoing partial hepatectomy with sevoflurane is more stable better than isoflurane during operation, which has faster postoperative recovery and relieved hepatic ischemia-reperfusion injury. Key words: Hepatectomy; Sevoflurane; Reperfusion injury; Hemodynamics

Effect of thoracic paravertebral block combined with general anesthesia on early postoperative recovery of patients undergoing laparoscopic cholecystectomy

Objective To evaluate the effect of thoracic paravertebral block (PVB) combined with general anesthesia on the early postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Sixty patients of both sexes, aged 45-64 yr, with body mass index of 18.5-32.0 kg/m2, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups (n=30 each) using a random number table method: general anesthesia group (group GA) and thoracic PVB combined with general anesthesia group (group TPGA). Thoracic PVB was performed under ultrasound guidance at the right vertebral level T7 at 30 min before operation, and 0.375% ropivacaine 0.4 ml/kg was intermittently injected when air or blood was not found after withdrawing from the catheter at the angle between the T7 transverse process and the pleura in group TPGA.Lidocaine was injected for local infiltration anesthesia, and patients received no thoracic PVB at 30 min before operation in group GA.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil after operation in two groups.When the visual analogue scale score ≥4 points, tramadol 1-2 mg/kg or dizocin 0.1 mg/kg was intravenously injected for rescue analgesia.The intraoperative consumption of remifentanil, postoperative effective pressing times of PCIA, consumption of sufentanil within 2 days after operation, requirement for rescue analgesia, and development of nausea and vomiting were recorded.Quality of Recovery-15 was used to assess the early postoperative quality of recovery at 1 and 2 days after operation. Results Compared with group GA, the intraoperative consumption of remifentanil, postoperative effective pressing times of PCIA, consumption of sufentanil within 2 days after operation, rate of rescue analgesia and incidence of nausea and vomiting were significantly decreased, and Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group TPGA (P<0.05). Conclusion Compared with general anesthesia, thoracic PVB combined with general anesthesia is helpful in promoting early postoperative recovery when used for the patients undergoing laparoscopic cholecystectomy. Key words: Nerve block; Anesthesia, general; Recovery

Effects of anesthetics on postoperative sleep disturbances and research progresses

Sleeping is a process where the body rests and repairs. Surgical trauma can cause stress and change the original sleep patterns, and postoperative sleep disturbances appear. It may seriously affects patients′ postoperative rehabilitation and the quality of life, and gradually becomes a perioperative complications with great concern. In recent years, there are an increasing number of articles which report postoperative sleep disturbances are closely related to perioperative anesthesia management, including the use of anesthetics. Based on clinical trials and basic experimenttal data, this paper briefly summarizes the effects of different anesthetics on postoperative sleep disturbances and their possible regulatory mechanisms, so as to provide reference for determining the occurrence or development mechanisms and prevention and control strategies. Key words: Anesthesia; Postoperative sleep disturbances; Propofol; Sevoflurane; Remifentanil

Clinical application of ultrasound-guided fascia iliaca compartment block and proximal popliteal sciatic nerve block on patients undergoing total knee arthroplasty

Objective To observe the application of ultrasound-guided fascia iliaca compartment block(FICB) and proximal popliteal sciatic nerve block(PPSNB) on patients undergoing total knee arthroplasty. Methods From January 2015 to January 2018, 60 patients scheduled for total knee arthroplasty undergoing laryngeal mask airway(LMA) general anesthesia in the People′s Hospital of Langfang were divided into three groups by the random number table, with 20 cases in each group.Before general anesthesia, every patient received dezocine 5mg iv, group A received FICB, group B received FICB combined with PPSNB(extraparaneural), group C received FICB combined with PPSNB(subparaneural).40mL of 0.375% ropivacaine was injected guiding by ultrasound.The dosage of propofol and remifentanil, time of awake, awake visual analogue scale(VAS), mean arterial blood pressure(MAP) and heart rate(HR) at pre-block(T1), LMA insert(T2), skin incision(T3), femoral bone cutting(T4), LMA remove(T5), and awake stage(T6) were recorded.The incidence of using vasoactive drugs and adverse reaction were also recorded. Results The dosage of propofol and remifentanil, the time of awake and awake VAS in group A, group B and group C were: group A (768.0±8.5)mg, (977±21)μg, (18.4±2.1)min, (4.2±0.7)points; group B (554.0±7.1)mg, (775±12)μg, (12.3±1.6)min, (2.4±0.6)points; group C (530±8.2)mg, (738±15)μg, (11.8±1.7)min, (1.3±0.5)points.The dosage of propofol and remifentanil, time of awake, awake VAS in group B and group C were significantly lower than those in group A (F=29.23, 42.56, 32.42, 19.31, all P<0.05). The awake VAS in group C was lower than that in group B (q=8.12, P<0.05). MAP and HR at T2, T3, T4, T5 and T6 in group B or group C were significantly lower than those in group A (MAP: F=85.66, 78.46, 86.04, 62.75, 61.31; HR: F=26.03, 42.75, 38.04, 29.31, 31.50, all P<0.05). The number of patients who required vasoactive drugs and adverse reaction in group B or group C were significantly lower than those in group A (χ2=11.32, 12.81, 15.24, 15.24, 10.15, all P<0.05). The incidence rates of incision pain at awake stage in group A, group B and group C were: group A(30%), group B(20%), group C(0%), that in group C was lower than group B (χ2=9.87, P<0.05). Conclusion The ultrasound-guided FICB and PPSNB(subparaneural) can obviously reduce the dosage of general anaesthetic and maintain the stability of hemodynamics in patients undergoing total knee arthroplasty.It has effective analgesia and less adverse reactions during sober. Key words: Ultrasonography; Anesthesia and analgesia; Neuromuscular blockade; Arthroplasty, replacement, knee; Comparative study

Anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale and Ramsay sedation score after operation

Objective To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation. Methods A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9% normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups. Results The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P < 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statistically significant (all P < 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1 485±425) mg and (4.8±0.8) mg], the differences were statistically significant (t = 9.913, P < 0.01; t = 9.834, P < 0.01). Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value. Key words: Stomach neoplasms; Gastrectomy; Laparoscopy; Lymph node excision; Hemodynamics; Dexmedetomidine; Pain measurement; Ramsay sedation score

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

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

Efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in infants undergoing lobectomy under general anesthesia

Objective To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Methods Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T6, 7 interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents. Results Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05). Conclusion Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Key words: Analgesia, epidural; Analgesia, postoperative; Ultrasound-guided; Child; Pneumonectomy

Role of NL-1 in trafficking of GluR1-containing AMPA receptor to cell membrane in spinal cord dorsal horn during remifentanil-induced hyperalgesia in mice with incisional pain

Objective To evaluate the role of neuroligin 1 (NL-1) in trafficking of GluR1-containing AMPA receptor to cell membrane in spinal cord dorsal horns during remifentanil-induced hyperalgesia in mice with incisional pain. Methods Forty SPF healthy male C57BL/6J mice, aged 8-10 weeks, weighing 18-22 g, were divided into 5 groups (n=8 each) using a random number table method: control group (group C), NL1-shRNA plasmid group (group NL), incisional pain plus remifentanil group (group I+ R), incisional pain plus remifentanil plus blank vector group (group I+ R+ B), and incisional pain plus remifentanil plus NL-1-shRNA plasmid group (group I+ R+ NL). Negative lentivirus was intrathecally injected in group I+ R+ B.In NL and I+ R+ NL groups, 10 μl NL-1-shRNA lentivirus at 1×108 IFU/ml was intrathecally injected once a day for 3 consecutive days.Normal saline 10 μl was intrathecally injected at the same time point in C and I+ R groups.After transfection was stable, normal saline 0.1 ml was injected via the caudal vein for 4 consecutive times at 15 min intervals in C and NL groups.In I+ R, I+ R+ B and I+ R+ NL groups, 0.1 ml remifentanil 10 μg/kg was injected via the caudal vein for 4 consecutive times at 15 min intervals, and the model of incisional pain was established after the first administration.The mechanical paw withdrawal threshold (MWT) and tail-flick latency (TFL) were measured at 24 h before normal saline or remifentanil administration (T0) and at 3, 6, 24 and 48 h after the end of administration (T1-4). The animals were sacrificed after measurement of pain threshold at T4, and L4-6 segments of the spinal dorsal horn were then collected for determination of the expression of NL-1 protein and mRNA and AMPA receptors, and the ratio of AMPA receptor expression in the membrane protein to that in the total protein (m/t ratio) was calculated. Results Compared with group C, the MWT was significantly decreased, and TFL was shortened at T1-4, the expression of NL-1 protein and mRNA and GluR1-containing AMPA receptors in membrane and total proteins was up-regulated, and m/t ratio was increased in I+ R and I+ R+ B groups (P<0.05). Compared with I+ R and I+ R+ B groups, the MWT was significantly increased and TFL was prolonged at T1-4, the expression of NL-1 protein and mRNA and GluR1-containing AMPA receptors in membrane and total proteins was down-regulated, and m/t ratio was decreased in group I+ R+ NL (P<0.05). Conclusion NL-1 in spinal cord dorsal horns can promote the trafficking of GluR1-containing AMPA receptors to cell membrane, which is involved in the development and maintenance of remifentanil-induced hyperalgesia in mice with incisional pain. Key words: Connexins; Pain, postopertive; Piperidines; Hyperalgesia; Spinal cord dorsal horn; Receptors, glutamate; Receptors, AMPA