Background: Glycopyrrolate injection is an anticholinergic drug. The pharmacoeconomic advantages of glycopyrrolate, approved for marketing under the current Chinese health insurance payment model, are significant. The aim of this research was to characterize its pharmacokinetic properties and safety in Chinese adult patients after general anesthesia surgery. Methods: An open-label, single-dose pharmacokinetics, safety and population pharmacokinetics of glycopyrrolate was performed in Chinese adult patients after general anesthesia surgery. Chinese adult patients after general anesthesia surgery were single intravenously administered by glycopyrrolate. Venous blood samples were drawn before and after administration and further quantified by a validated HPLC-MS/MS method. Safety was monitored during the whole stages. Population pharmacokinetics were performed by non-linear mixed-effects modelling. Results: A total of 18 subjects were enrolled and evaluated. The principle pharmacokinetic parameters of Cmax, t1/ 2, AUC0-t, AUC0-infinity, Vz and CL of glycopyrrolate were 45.8 f 28.9 ng/mL, 1.7 f 0.4 h, 10.3 f 2.3 h*ng/mL, 10.6 f 2.4 h*ng/mL, 1.9 f 0.6 L/kg and 0.8 f 0.2 L/h/kg, respectively. Safety was acceptable and no serious adverse events were detected. A three-compartment model and fitted concentration-time curve for glycopyrrolate were represented and validated, which was constant with published literatures. Conclusions: Pharmacokinetics and safety of glycopyrrolate were investigated systemically with the help of this open-label, single-dose study in Chinese adult patients after general anesthesia surgery. Results of present study provide systemic data basis for improving the accessibility of the drug to Chinese patients and individualized and precise medication. Clinical trial registration: No. CTR20170001 (Chinese Clinical Trial Registry, https://db.yaozh.com/linchuangsh iyan/bJaRbmNnaGljlWRilJaYmA.html, Time of initial registration: 18 Feb 2017)

cognitive dysfunction (POCD) is characterized by impaired cognitive function, such as decreased learning and memory after anesthesia and surgery. This study aimed to explore the effect of luteoloside, a flavonoid extracted from natural herbs, on sevoflurane-induced cognitive dysfunction. Aged Sprague-Dawley male rats (20 months old) were treated with luteoloside for 7 days prior to sevoflurane exposure. After evaluation using an open field, novel object recognition, and Y-maze tests, it was determined that luteoloside effectively prevented sevoflurane-induced cognitive dysfunction. Sevoflurane exposure led to hippocampal neuron apoptosis in vivo (n = 6) and in vitro (n = 3), while this injury was prevented by luteoloside in a dosedependent manner. Mechanistically, luteoloside maintained mitochondrial function and dynamics, as evidenced by the restored adenosine triphosphate (ATP) production and mitochondrial membrane potential as well as the upregulated levels of mitochondrial fission (optic atrophy protein 1 (Opa1) and mitofusin1 (Mfn1)) and downregulated mitochondrial fusion (mitochondrial fission 1 (Fisl) and dynamin-related protein 1 (Drp1)) factors. Notably, silencing Opa1 blocked the protective effect of luteoloside on hippocampal neurons and mitochondrial function. In summary, luteoloside prevented sevoflurane-induced cognitive dysfunction in aged rats, which may be achieved by regulating mitochondrial dynamics. Our study reveals the potential of luteoloside in preventing POCD in aged patients.(c) 2023 IBRO. Published by Elsevier Ltd. All rights reserved.

This study aimed to investigate possible changes in the spatial memory of rats and the expression or activity of EGR-1, c-Fos, PKA, and PKC after propofol anesthesia.Thirty-six Sprague-Dawley rats aged 20 months and 36 Sprague-Dawley rats aged three months were each randomly divided into three groups: the control group, the Morris Water Maze (MWM) group, and the propofol group.In the propofol groups of both young and aged rats, the rats were anesthetized by propofol for two or four hours and then performed the MWM test two days or two weeks after anesthesia to assess cognitive function.EGR-1, c-Fos, PKA, and PKC expressions in the rat hippocampus were determined via immunohistochemistry.For the older rats, the escape latency in the P 4h/2d group was significantly prolonged (P < 0.05), and the learning curve was right-shifted in the P 4h/2w group (P < 0.05).The expression levels of EGR-1, c-Fos, PKA, and PKC in the MWM groups were significantly higher than those in the control groups (P < 0.05).In the P 4h/2d group of aged rats, the expression levels of both PKA and PKC were decreased compared with those of the MWM groups.The decreased expression of both protein kinases may be responsible for the observed impairment after propofol anesthesia.

目的 探讨血清β2微球蛋白(β2-microglobulin,β2-MG)数值参考范围在判断肝移植术后急性肾损伤(acute kidney injury,AKI)的价值和AKI各分级的意义.方法 选取2003年6月至2013年12月首都医科大学附属北京朝阳医院、解放军总医院第三医学中心和首都医科大学附属北京佑安医院完成肝移植手术的患者697例,分别定义β2-MG≤3mg/L组、β2-MG＞3 mg/L组和非AKI组、AKI(1级、2级、3级)组.收集患者性别、年龄、体质量、终末期肝病模型(model ofend-stage liver disease,MELD)评分、Hb、SCr、β2-MG、合并症、病因、术式、肾脏替代治疗(model of end-stage liver disease,RRT)和28 d病死率.结果 697例患者肝移植术后AKI的总体发生率为40.9％,其中AKI 1级、2级、3级分别占21.5％、8.8％和10.6％.与β2-MG≤3 mg/L组比较,β2-MG＞3 mg/L组体质量、MELD评分、Hb、SCr、β2-MG、AKI分级、贫血、腹水、肺部感染、肝肾综合征、乙型肝炎肝硬化、丙型肝炎、肝癌和28d病死率均增多,差异有统计学意义(P＜0.05).AKI分级后,AKI3级组的β2-MG水平[(4.80±4.12)mg/L]与非AKI组[(2.95±1.68)mg/L]、AKI 1 级组[(3.15±1.65)mg/L]和 AKI2 级组[(2.78±1.70)mg/L]比较,差异均有统计学意义(P＜0.001).进一步按β2-MG数值分组后,β2-MG≤3mg/L的AKI2级组与非AKI组比较[(1.98±0.46)mg/L比(2.17±0.49)mg/L],差异有统计学意义(P=0.036);β2-MG＞3 mg/L的AKI 3级组与非AKI组和β2-MG＞3 mg/L的 AKI 1 级组比较[(6.97±4.38)mg/L 比(4.44±1.54)mg/L、(4.64±1.55)mg/L],差异均有统计学意义(P＜0.001,P=0.001).β2-MG＞3mg/L的AKI 3级组β2-MG水平最高,为(6.97±4.38 mg/L).体质量(OR=1.010,95％CI:1.010～1.037,P=0.001)和贫血(OR=1.571,95％CI:1.056～2.338,P=0.026)是肝移植术后 AKI 的危险因素.结论 β2-MG用于评价肝移植术后AKI各级有一定的参考价值,尤其在AKI 3级.虽然只验证到体质量和贫血为肝移植术后AKI的独立危险因素,但3 mg/L以上β2-MG的意义仍值得进一步探讨.

目的 探讨血β2-微球蛋白(β2-MG)数值范围在肝移植急性肾损伤(AKI)的分级价值和意义.方法 本研究通过回顾性队列研究,选取2009年6月至2019年12月在首都医科大学附属北京朝阳医院、解放军总医院第三医学中心和首都医科大学附属北京佑安医院行肝移植手术的病例纳入研究.共收集肝移植病例1636例,546例纳入分析.根据发生AKI的情况将其分为AKI组(n=219)和非AKI组(n=327).定义AKI(1、2、3级)组和β2-MG≤3 mg/L组、β2-MG>3 mg/L组.收集非AKI组与AKI组性别、年龄、体重、终末期肝病模型(MELD)评分、血红蛋白(Hb)、Cr、β2-MG、合并症、病因、术式、肾脏替代疗法(RRT)、28 d死亡率数据.比较AKI组各级β2-MG均值及β2-MG≤3 mg/L、β2-MG>3 mg/L分布.用COX多变量回归分析AKI的影响因素.结果 与非AKI组比较,AKI组血滤(P<0.001),28 d死亡率(P=0.006)明显增加.219例AKI患者1、2、3级分别为120、49、50例.β2-MG在AKI 3级均值为(4.81±4.11)mg/L,明显高于非AKI组(P=0.001)、AKI 1级(P=0.012)、AKI 2级(P=0.002).按β2-MG≤3 mg/L和β2-MG>3 mg/L进行分组后,在AKI各级的人群分布差异有统计学意义(P=0.007).COX多变量回归分析显示体重(OR:1.031;95％CI:1.015～1.046;P=0.001)和贫血(OR:1.651;95％CI:1.050～2.598;P=0.031)为肝移植术后AKI的独立危险因素.结论 β2-MG评价肝移植术后AKI各级有一定的参考价值,尤其在AKI 3级.虽然只验证到体重和贫血为肝移植术后AKI的独立危险因素,但3 mg/L以上β2-MG的意义仍值得进一步探讨.

Objectives. This multicenter retrospective study aimed to compare the effects of HES and gelatin (GEL) on the risk of post-OLT AKI. Method. A total of 1,672 patients undergoing OLT were enrolled from major transplant centers in China between 2005 and 2013. These patients were divided into three groups: GEL, hydroxyethyl starch (HES), and GEL + HES group. Results. There was no significant difference in the incidence of post-OLT AKI among the GEL, HES, and GEL + HES groups. The GEL + HES group had a lower incidence of stage II post-OLT AKI than the other two groups. Compared with patients receiving GEL, patients receiving HES did not harbor an increased risk of AKI. Our results showed that MELD score (adjusted odds ratio [OR], 1.579; 95% confidence interval [CI], 1.123-2.219; P = 0.009) and preoperative anemia ( adjusted OR, 1.533; 95% CI, 1.212-1.939; P < 0.001) were independent risk factors for post-OLT AKI, and normal preoperative Scr level (vs abnormal; adjusted OR, 0.402; 95% CI, 0.222-0.729; P = 0.003) was independent protective factors for post-OLT AKI. Conclusion. This large-scale multicenter retrospective study found that the intraoperative use of HES did not increase the overall incidence of post-OLT AKI in patients when compared with GEL, and whether to increase the risk of post-OLT AKI needs to be further explored.

Objective: With atropine as a positive control, randomized controlled clinical trials were conducted to verify the efficacy of glycopyrrolate injection in preventing bradycardia caused by neostigmine. Method: Patients undergoing elective general anesthesia and non-cardiac surgery were randomly divided into an experimental group (129 cases) and control group (127 cases) (ChiCTR2100046022, http://www.chictrorg.cn/showproiaspx?proj=126075) . At the end of the operation, the test group was given glycopyrrolate 6 ug/kg + neostigmine 0.04 mg/kg, and the control group was given atropine 0.016 mg/kg + neostigmine 0.04 mg/kg, bolus time 1 min, to antagonize muscle residual effects of relaxants. We compared the area under the time curve (AUC) of the difference between heart rate and baseline heart rate within 15 minutes of administration, the measured value of heart rate per minute, and the change in heart rate compared with baseline. We verified the safety of glycopyrrolate injection through laboratory tests, clinical symptoms, signs, and adverse events/serious adverse events. Results: The AUC of the experimental group's heart rate within 15 minutes after the administration was lower than the baseline heart rate change value, (P<005). The measured value of the heart rate at each time changed less than the control group; the experimental group's heart rate remained at the baseline level for longer than the control group (P<005). There was no significant difference in the incidence of adverse reactions between the two groups of patients (P>005). Conclusion: Glycopyrrolate and atropine are safe to prevent heart rate slowing induced by the non-depolarizing muscle relaxant antagonist neostigmine, and glycopyrrolate is more conducive to maintaining a stable heart rate in patients.

BACKGROUND:Intraoperative awareness is a serious adverse event under general anesthesia. Midazolam has a good anterograde amnesia-inducing effect, can prevent and reduce the occurrence of intraoperative awareness. However, if the dosage of midazolam is improperly controlled, it may not produce forgetting effect, or bring obvious adverse side effects, such as respiratory depression, and delay of recovery. However, the half maximal effective dose (ED50 ) of midazolam for amnesia, the duration of amnesia and the factors affecting the duration of amnesia are still inconclusive. Therefore, it is of great clinical significance to observe and determine the dose, duration and influencing factors of amnesia induced by midazolam METHODS: A total of 106 patients who underwent ASA grades I-II elective operation under spinal-epidural anesthesia were intravenously injected with different doses of midazolam at 10 minutes after spinal-epidural anesthesia, every 5 minutes, the patient was presented with pictures or sounds as memory content, and heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), blood oxygen saturation (SpO2), bispectral index (BIS), OAA/S and adverse events were recorded. The patient's forgetfulness was followed up in the early morning after operation. RESULTS:ED50 (the dose for amnesia in half of the subjects) was 0.031 mg/kg (95% CI: 0.027-0.036 mg/kg); ED95 (the dose for amnesia in 95% of the subjects) was 0.044 mg/kg (95% CI: 0.038-0.071 mg/kg). After the patients were injected intravenously with 0.04 mg/kg of midazolam, the respiratory and circulatory systems were basically stable, no serious adverse events occurred, and the forgetting rate was 88.5%. ET50 (the time for half of the subjects in a state of forgetfulness) was 23.77 minutes (95% CI: 20.18-27.07 min), and the corresponding BIS was 83.22; ET05 (the time for 5% of the subjects in a state of forgetfulness) was 53.90 minutes (95% CI: 48.54-61.47 min) and the corresponding BIS was 91.38. The amnesia-inducing effect of midazolam was correlated to sedation grade, BIS and age, and was not correlated to visual memory or auditory memory. CONCLUSION:In this study, the ED50 , ED95 and maintenance time of the forgetting effect of intravenous midazolam were preliminarily determined. KEY WORDS:Amnesia, Duration of amnesia, ED50, Midazolam.

BACKGROUND: Damage-associated molecular patterns (DAMPs) generated by major surgery can induce global inflammation response and may degrade the vascular endothelial glycocalyx layer (EGL); in turn, the resulting EGL fragments can act as DAMPs, in a destructive positive feedback loop, to promote exacerbation of inflammation. Ulinastatin (UTI) may attenuate EGL shedding by inhibiting serine proteases and hyaluronidase. OBJECTIVE: This trail evaluates whether EGL shedding elicited by Traditional Whipple Procedure (TWP) could be decreased by using UTI. METHODS: We divided 60 patients undergoing TWP into a control group and a UTI group (n = 30 for both). Blood samples were collected before (T-0), near the end (T-1), and 1 hour after (T-2) surgery. Levels of syndecan-1, ICAM-1, VCAM-1, IL-6, C-reactive protein, thrombomodulin, Hbg and serum albumin were measured and plasma albumin leakage was estimated. RESULTS: IL-6 levels significantly elevated at T-1 and T-2 in the control group compared with T-0, but not the UTI group. Syndecan-1 levels significantly elevated at T-1 and T-2 in the control group but only T-2 in the UTI group compared with T-0. CONCLUSIONS: We found global inflammation reaction and EGL degradation during TWP. Perioperative UTI treatment can attenuate this EGL shedding and might alleviate plasma albumin leakage.

Objective:To evaluate the efficacy and safety of ibuprofen injection for postoperative analgesia in the patients undergoing general anesthesia.Methods:This prospective, multicenter, randomized, double-blind, negative-controlled trial was conducted in 360 patients of both sexes, aged 18-75 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled to undergo elective abdominal or orthopedic surgery under general anesthesia.All the patients were assigned to one of 3 groups ( n=120 each) using a random number tale method: control group (group C), ibuprofen injection 400 mg group (group B1), and ibuprofen injection 800 mg group (group B2). At 30 min before the end of surgery, ibuprofen injection 400 and 800 mg (in 0.9% sodium chloride injection 200 ml) were intravenously infused over 30 min in B1 and B2 groups, respectively, and 0.9% sodium chloride injection 200 ml was intravenously infused over 30 min in group C, and then infusion was performed every 6 h until 48 h after operation.The analgesic pump was connected after operation to perform patient-controlled intravenous analgesia (PCIA), and the PCIA solution contained 0.5 mg/ml morphine in 0.9% sodium chloride injection.The PCA pump was set up with a 2 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 0.25 ml/h.The analgesia lasted for 48 h after operation, and the visual analog scale score was maintained ≤ 4 points.Effectiveness index: the consumption of morphine within 24 and 48 h after operation, the total pressing times of PCA and effective pressing times of PCA, the requirement for rescue analgesia within 48 h after operation and patient′s overall evaluation of the analgesia effect at 48 h after operation were recorded.Safety index: the occurrence of adverse reactions (nausea, vomiting, pruritus, injection pain, dizziness, etc.) within 48 h after medication were recorded; the laboratory examinations including blood biochemical examination, blood routine examination, blood coagulation function examination and urine routine examination were performed at 48 h after medication, and abnormal conditions were recorded. Results:Compared with group C, the postoperative consumption of morphine, total pressing times of PCA, effective pressing times of PCA, and requirement for rescue analgesia were significantly decreased, and the rates of excellent and excellent+ good evaluation of analgesic effects by patients were increased in B1 and B2 groups ( P<0.05). There was no significant difference in the parameters mentioned above between B1 group and B2 group ( P>0.05). There was no significant difference in the incidence of nausea, vomiting, pruritus, injection pain and dizziness and rates of abnormalities in laboratory examinations among the three groups ( P>0.05). Conclusion:Ibuprofen injection can be safely and effectively used for postoperative analgesia in the patients undergoing general anesthesia.

BackgroundThere are multiple studies that have revealed that hypercapnia possessed neuroprotection, the conclusive cognitive impacts of permissive hypercapnia in medicine is still unclear.MethodsA total of 102 patients registered for this research work had accomplished cognitive tests; with 64 patients possessing moderate hypercapnia all through bronchoscope intervention (BI). Thirty-six patients completed collection of blood specimens. Every patient underwent the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) a day before the surgery (T0), as well as at 7 days (T7). Serum specimens were used to measure levels of S100B, neuron-specific enolase (NSE), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD) prior to the administration of anesthesia (T0), one day (T1) and seven days (T7) after surgery.ResultsIn comparison with the preoperative MMSE scores, Group Hypercapnia (Group H) on 7 days after surgery, exhibited a significant increased score (P=0.00). In comparison with the preoperative MoCA scores, Group H on 7 days after surgery exhibited a significant increased score (P=0.00). Meanwhile, the MoCA scores in Group H exhibited considerably higher elevation as compared with that in the Group Control (Group C) (P=0.01). No substantial differences were observed in serum S100B and NSE levels between Group H and Group C (P=0.23, P=0.14). Serum IL-6, TNF-α, SOD and MDA levels shared similarity between two groups.ConclusionsMild and moderate hypercapnia augmented cognitive activity with the help of MMSE tests and MoCA tests, whereby the latent reasons were not sure. As suggested by this study, hypercapnia up to 100 mmHg during BI was less likely to affect cognitive function adversely.

Introduction: Anaesthetics can lead to cognitive impairment and partly recover. Whether this process is related to NG2 cells has not been reported. The present study aims to investigate the effects of propofol on the proliferation and differentiation of NG2 cells in the hippocampus of aged rats. Material and Methods: A total of 80 healthy SD rats were used for the investigation. These rats were randomly divided into two groups: control group (group C, n = 20) and anesthetic group (group A, n = 60). Rats in group A were continuously anesthetized by intravenous infusion of propofol for three hours, and underwent shuttle box test at seven days (A7), 14 days (A14) and three months (A3m) after anesthesia. Then, these rats were further divided into two groups: POCD group (three sub-groups: P7 group, P14 group and P3m group) and non-POCD group (three sub-groups: groups NP7, NP14 and NP3m). Results: Compared with group C, NG2 and PCNA cells in group A were upregulated at seven and 14 days after anesthesia. Compared with group C, MAP2 expression was downregulated, and OX42 and GFAP expression was upregulated in the POCD group, while MAP2 expression in the non-POCD group was upregulated. Compared with the non-POCD group, in the NG2 positive cells, MAP2 expression was downregulated, while OX42 and GFAP expression was upregulated in the POCD group, MAP2 expression was urelugated gradually during the 14th days after anesthesia (P < 0.05 or P < 0.01). Conclusions: Propofol induces neuronal apoptosis and the proliferation of NG2 cells. The direction of NG2 cell differentiation may be correlated to the recovery of cognitive dysfunction.

Objective To observe the effects of endotracheal tube with injecting medicine to endotracheal and laryngopharynx for topical anesthesia, transcutaneous electrical acupoint stimulation (TEAS), and endotracheal-laryngopharynx for topical anesthesia combined with TEAS on hemodynamics during intubation. Methods One hundred patients that belonged to American Society of Anesthesiologists (ASA) grade Ⅰ or Ⅱ, in accordance with the random number table, were categorized into four groups (n=25). They were endotracheal tube (group A), endotracheal tube with injecting medicine to endotracheal and laryngopharynx (group B), TEAS combined with endotracheal tube (group C) and endotracheal tube with injecting medicine to endotracheal and laryngopharynx combined with TEAS (group D). All patients were monitored continuously on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and bispectral index (BIS) respectively in the calm state at timepoints of entering the operation room (T0), before tracheal intubation after intravenous induce anesthetics (T1), immediately after tracheal intubation (T2), 3 min after tracheal intubation (T3), 5 min after tracheal intubation (T4) and 10 min after tracheal intubation (T5). Results ① Compare with timepoint T0, SBP was decreased markedly (P< 0.05) at T1 in each group. At T2, T3 and T4, SBPs were increased 26%, 36% and 34%(P<0.01) in group A. SBPs were increased 28%(P<0.01), 20%(P<0.01) and 9%(P<0.05) in group B. SBPs were increased 25%, 27% and 21%(P<0.01) in group C. SBPs were increased 16%(P<0.01), 16%(P<0.01) and 9%(P<0.05) than T1 respectively. Among groups at same time, SBPs at T3 and T4 were decreased 12%(P<0.05) and 19%(P<0.01) in group B, were decreased 9%(P<0.05) and 12%(P<0.01) in group C, were decreased 14%(P<0.05) and 19%(P<0.01) in group D. At T2, SBP of group D were 8%(P<0.05), 8%(P<0.05) and 4%(P<0.05) lower than the SBP values of group A, B and C respectively. At T4, the value of SBP in group D was 7%lower than the value in group C (P<0.05).②HR: in all groups, the HR values at T1 (P<0.05) were markedly lower than the values at T0. The HR values of group A at T2, T3 and T4 were 30%, 49%and 44%higher than the value at T1(P<0.01). The HR values of group B were 36%, 21%and 11%higher than the value at T1(P<0.01). The HR values of group C are 19%(P<0.01), 35%(P<0.01) and 17%(P<0.05) higher than the value at T1. The HR values of group D were 14%, 17%(P<0.01) and 9%(P<0.05) higher than the value at T1. The extent of increasing in group D was smaller than the extents in other groups. ③CI: in all groups, CI values at T1 were lower than the values at T0 (P<0.01). The values at T2 were 18% (P<0.01), 8%, 8%(P<0.05) and 6%lower than the value at T0. CI values in groupB, C and D at T3 were close to values at T0. But the value at T3 in group A was 15%lower than the value at T0 (P<0.01). There were no significant differences of CI values at T0 and T1 among groups. At T2, T3, CIs in group D were 13%and 12%lower (P<0.05) than A.④SVRI: in all groups, SVRI values at T1 were lower than values at T0 (P<0.05). The SVRI value of group C at T3 was 27%higher than the SVRI value at T1 of group C. The SVRI values of group D at T2 and T3 were 15%and 12%(P<0.05) higher than the values at T1 of group D respectivley. CI values of group D at T2 and T3 were 14% and 10% (P<0.05) higher than values in of group A at T2 and T3 respectively. ⑤ BIS: compared with T0, the differences among four groups at T1-T5 were statistically significant (P<0.01). There was no significant differences among four groups at each time point (P＞0.05). Conclusions Both endotracheal tube with injecting medicine to endotracheal and laryngopharynx for topical anesthesia and TEAS can reduce excessive hemodynamic responses during the intubation to some extent, but combination of them will has better effect.

The performance of a new monitor for the depth of anesthesia (DOA), the Depth of Anesthesia Index (Ai) based on sample entropy (SampEn), 95% spectral edge frequency (95%SEF), and burst suppression ratio (BSR) was evaluated compared to Bispectral Index (BIS) during total intravenous anesthesia (TIVA). 144 patients in six medical centers were enrolled. General anesthesia was induced with stepwise-increased target-controlled infusion (TCI) of propofol until loss of consciousness (LOC). During surgery propofol was titrated according to BIS. Both Ai and BIS were recorded. Primary outcomes: the limits of agreement between Ai and BIS were -17.68 and 16.49, which were, respectively, -30.0% and 28.0% of the mean value of BIS. Secondary outcomes: prediction probability (Pk) of BIS and Ai was 0.943 and 0.935 (p=0.102) during LOC and 0.928 and 0.918 (p=0.037) during recovery of consciousness (ROC). And the values of BIS and Ai were 68.19 and 66.44 at 50%LOC, and 76.65 and 78.60 at 50%ROC. A decrease or an increase of Ai was significantly greater than that of BIS when consciousness changes (during LOC: -9.13±10.20 versus -5.83±9.63, p<0.001; during ROC: 10.88±11.51 versus 5.32±7.53, p<0.001). The conclusion is that Ai has similar characteristic of BIS as a DOA monitor and revealed the advantage of SampEn for indicating conscious level. This trial is registered at Chinese Clinical Trial Registry with ChiCTR-IOR-16009471.

目的 研究淫羊藿次苷Ⅱ(ICSⅡ)对野百合碱(MCT)所致大鼠肺动脉重构的作用,并探讨其对ERK1/2-NF-κB信号通路的影响.方法 SD大鼠随机分为对照组(Control)、ICS Ⅱ单纯给药组(Control+ICSⅡ-H,16 mg/kg)、模型组(Model)、ICS Ⅱ低、中、高剂量组(ICS Ⅱ-L、ICS Ⅱ-M、ICS Ⅱ-H,4、8、16 mg/kg),每组6只.Model组和ICSⅡ低、中、高剂量组经颈背部一次性皮下注射MCT(50 mg/kg)诱导肺动脉重构模型.造模后第1天开始给药至第28天结束.H&E染色观察肺小动脉病理改变;免疫组织化学法检测肺小动脉PCNA、p-ERKl/2、p-NF-κB蛋白的表达.结果 与Control组比较,Model组肺小动脉中膜明显肥厚;PCNA、p-ERK1/2、p-NF-κB蛋白的水平明显升高(P＜0.05).与Model组相比,ICSⅡ-M、ICSⅡ-H剂量组肺动脉中膜肥厚显著改善;PCNA、p-ERK1/2、p-NF-κB蛋白的水平明显降低(P＜0.05).结论 ICSⅡ具有抗MCT所致大鼠肺动脉重构的作用,其机制可能与抑制ERK1/2-NF-κB信号通路有关.

目的 探讨肝硬化门脉高压患者脾切除术中应用特利加压素对围术期肾功能的潜在保护作用.方法 42例静脉注射复合吸入麻醉下择期行脾切除加贲门周围血管离断术的乙/丙肝后肝硬化患者,年龄18～ 65岁,未行静脉-静脉转流术,ASAⅡ或Ⅲ级,按数字表法随机分为试验组和对照组2组(每组n =21).试验组手术开始即刻静脉输注特利加压素[2 mg溶于50 mL0.9％(质量分数)氯化钠注射液] 10 mL/h至术毕.对照组以等容量0.9％(质量分数)氯化钠注射液代替.测定术后3d急性肾损伤(acute kidney injury,AKI)发病率和肾功能指标,包括麻醉前即刻(T1)、术毕(T2)、术后第1天(rI3)和术后第3天(T4)的尿N-乙酰-β-D-葡萄糖苷酶(N-acetyl-β-D-glucosidase,NAG)和尿β2微球蛋白(β2-microglobulin,β2-MG)、尿微量白蛋白(microalbuminuria,Malb)、尿α1微球蛋白(α1-microglobulin,α1-MG)、血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、血β2-MG、血清胱抑素C(serum cystatin C,CysC)、肾小球滤过率(glomerular filtration rate,GFR)、尿量、利尿剂用量等.结果 两组患者术后3d均未发生AKI.各项肾功能指标,除试验组术后利尿剂用量较对照组明显减少(P＜0.05)外,两组组间比较均差异无统计学意义.但是组内分别比较时,两组还是存在不同.试验组GFR在术后T4时点比麻醉前(T1)显著升高(P＜0.01),而对照组差异无统计学意义;对照组尿β2-MG在术后T2、T3时点比麻醉前(T1)显著升高(P＜0.01),但是在试验组内各时间点差异没有统计学意义.结论 肝硬化门脉高压脾切除患者术中静脉输注特利加压素可能有潜在的改善术后GFR的作用,但本研究结果尚不能确定其对围术期肾功能的明确保护作用.

Objective This study aimed to identify the median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block (ACB). Methods Thirty-two patients received ultrasound-guided ACB for knee arthroscopic meniscectomy. The criterion for successful ACB was the loss of pinprick sensation in the saphenous area (medial knee, leg, and foot). The volume of ropivacaine 0.5% in each case was determined using the up-down method and used for calculating the median effective dose. Results The mean age, weight, and height of patients were 28.6 ± 7.1 years, 68.2 ± 10.6 kg, and 172.5 ± 6.4 cm, respectively. Among patients who received 18- and 15-mL doses, ACB was successful in all four cases. Among patients who received a 12-mL dose, ACB was effective in eight and ineffective in two cases. Among patients who received a 10-mL dose, ACB was successful in six and unsuccessful in seven cases. In patients who received an 8-mL dose, ACB was ineffective in all five cases. The median effective volume of ropivacaine 0.5% was 10.4 mL (95% confidence interval, 9.1–11.4 mL). In all effective cases, the median quadriceps strength was grade 5. Conclusions The median effective volume of ropivacaine 0.5% is 10.4 mL for ultrasound-guided ACB.

Background Intravenous infusion of remifentanil (REM) is commonly used for labor analgesia. However, its appropriate usage poses challenges in obstetrics which requires balancing analgesia sufficiency and safety of mothers and neonates. Objective The purpose of this review is to provide information to optimize intravenous administration of REM for labor analgesia. Content Rapid onset, fast clearance, and non-effect on uterine contraction are demanding properties of analgesics to reduce suffering of puerperants during labor.Either pethidine or inhaled anesthetics has adverse effects on neonates and mothers. Intrathecal analgesia has minor effects on neonates but may cause low back pain in mothers. REM has many beneficial pharmacological properties, such as, high potency and selectivity to μ-opioid receptors, high lipophilicity, and fast metabolism. Compared with other analgesics, REM has better analgesia efficiency and higher levels of satisfaction. It is, however, not rarely reported that REM has similar side-effects as other opioid agents, such as, nausea, vomiting, muscle stiffness, and respiration and circulation inhibition, etc. Note that these side-effects of REM are dose-dependent and can be reversed by adjusting drug administration. Therefore, real-time monitoring of respiratory parameters, etc. is necessary to use remifentanil for labor analgesia. Trend Intravenous administration of REM for labor analgesia can obtain high degree of satisfaction, but further investigations are warranted to evaluate its safety and effectiveness before it is routinely applied in clinical practice.

Aim To investigate the effects of IcarisideⅡ ( ICS Ⅱ) on myocardial fibrosis in spontaneously hypertensive rat( SHR) . Methods Twenty male SHR rats were randomly divided into the model group (group SHR) , ICS Ⅱ low ( ICS Ⅱ-L) , middle ( ICSⅡ-M) and high ( ICS Ⅱ-H) group, and male WKY rats were set as control group ( group WKY) . ICS Ⅱ-L, ICSⅡ-M and ICSⅡ-H groups were intragastrically administered with ICS Ⅱ for 12 weeks. After that the blood pressure was measured in rats. Then, the rats were sacrificed and the left ventricles were separated in order to calculate the left ventricular mass index. Mas-son staining was used to detect the occurrence of inter-stitial fibrosis in cardiac tissues. Real time PCR was used to observe the gene expression of MMP-2, MMP-9 and TIMP-1 in the left ventricle in SHRs. The protein expression levels of MMP-2, MMP-9, TIMP-1, Colla- gen Ⅰ and Collagen Ⅲ were measured by Western blot. Results Compared with SHR group, the myo-cardial fibrosis was reduced after ICS Ⅱ (8, 16 mg· kg-1) treatment. The blood pressure and left ventricu-lar mass index decreased(P<0.05). The expressions of MMP-2, MMP-9, CollagenⅠand CollagenⅢwere down-regulated in left ventricular tissues( P <0.05 ) , while the expression of TIMP-1 was up-regulated( P<0.05) . Conclusion Icariside Ⅱ ameliorates myocar-dial fibrosis in SHR, and the mechanisms might be re-lated to the decrease of blood pressure and down-regu-lation of MMP-2, MMP-9 expression and up-regulation of TIMP-1 expression.

Objective To evaluate the validity of the depth of anesthesia index (Ai), based on sample entropy of electroencephalogram, in identifying the status of the consciousness during total intravenous anesthesia. Methods EEG electrode strips for recording Ai and BIS were randomly positioned on the left or right side of each patient′s forehead. Target-controlled infusion of propofol was increased by 0.5 mg/L per minute in a stepwise manner until loss of consciousness (LOC) was achieved. Values of Ai, BIS and estimated effect-site concentration (Ce) of propofol were recorded and analyzed during induction and emergence of general anesthesia. Logistic regression was used to analyze the relationship between consciousness state and values of Ai or BIS. Results One hundred and forty four patients in six medical centers were enrolled and have accomplished this protocol safely. In patients at LOC, the values of Ai and BIS were 61±12 and 62±11, which were respectively reduced by 15.0% and 9.3% one minute after LOC. When patients regained consciousness (ROC), Ai and BIS respectively reached 74±14 and 76±8, and increased by 15.0% and 7.0%, correspondingly, one minute after ROC. The estimated values of Ai and BIS were 48.3 and 52.3 for 95% LOC, and were 55.7 and 63. 1 for 5% ROC. Conclusions At LOC, ROC, estimated 50% LOC and 50% ROC, the values of Ai and BIS were close to each other and they are equivalent for clinical monitoring. When consciousness states altered, changes of Ai were significantly greater than those of BIS. It suggests that Ai is a better parameter to estimate alterations of consciousness state.