Objective To investigate the effects of desflurane and sevoflurane on cerebral oxygen metabolism in elderly patients undergoing robotic-assisted radical cystectomy for bladder cancer . Methods Sixty elderly patients who received robotic-assisted radical cystectomy for bladder cancer in the First Affiliated Hospital of Zhengzhou University from December 2017 to July 2018 were selected and randomly divided into desflurane group ( group D) and sevoflurane group ( group S) , with 30 cases in each group .Patients in group D were given 1.0 to 1.5 MAC desflurane combined with remifentanil for the maintenance anesthesia , while patients in group S used 1.0 to 1.5 MAC sevofluraneon combined with remifentanil for the maintenance anesthesia .The heart rate (HR), arterial hemoglobin (Hb), arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2), arterial blood glucose (Glu), arterial blood lactic acid ( Lac) , hemoglobin in internal jugular vein bulb ( Hbjv) , oxygen saturation in internal jugular vein bulb ( SjvO2 ) , partial pressure of oxygen in internal jugular vein bulb ( PjvO2 ) , blood glucose in internal jugular vein bulb ( Glujv ) , blood lactate level in internal jugular vein bulb ( Lacjv ) were observed and recorded immediately after induction of anesthesia ( T0 ) , 30 min after inducing Trendelenburg position ( T1 ) , 90 min after inducing Trendelenburg position ( T2 ) and 20 min after desufflation in a supine position ( T3 ) .Then cerebral arterio-venous difference in the oxygen content ( Da-jO2 ) was calculated .The cerebral extraction rate of oxygen ( CERO2 ) , cerebral lactate production rate (CLP) and cerebral glucose uptake rate (CGU) were calculated.Results Compared with group S, HR, Hba, Hbjv, CGU, CLP had no significant difference in group D at each time point (P>0.05);while CERO2 at T1 and T2 were (17.78 ±7.82)％, (12.52 ±5.78)％in group D, respectively, which were lower than (28.56 ±7.11 )％ and ( 27.45 ±9.07 )％ in group S ( P <0.01 ) .Compared with index at T0, CERO2 decreased significantly at T2 in the both groups (P<0.01).Conclusions Both desflurane and sevoflurane can reduce cerebral oxygen metabolism rate in elderly patients undergoing robotic-assisted radical cystectomy , and desflurane has more obvious effects .

Objective To investigate the effects of lumbar plexus-sciatic nerve block combined with general anesthesia on postoperative outcome in elderly patients after total hip arthroplasty.Methods Seventy elderly patients who were scheduled for total hip arthroplasty were randomly divided into two groups:group LPSN (n =35) and group GA (n =35),lumbar plexus-sciatic nerve block combined with general anesthesia were performed in patients of group LPSN,patients in group GA were performed with general anesthesia.saturation of pulse oximetry (SpO2),Visual analogue scale (VAS) before anesthesia (T0),at 3 h (T1),24 h (T2),48 h (T3) after anesthesia,operation time,the remifentanil consumption,time to remove the tracheal tube,the incidence of respiratory events and the length of stay were recorded.Results As compared with group GA,the VAS of group LPSN was reduced at T1,T2[(2.5 ± 1.4)vs.(3.2 ± 1.4),(1.9 ± 1.2) vs.(2.7 ± 1.2),P ＜ 0.05],The dosages of remifentanil were significantly decreased [(0.6±0.1) mg/h vs.(0.8 ±0.1) mg/h,t=-8.823,P＜0.01],the time to remove the tracheal tube was shorter too [(18.2 ± 2.9) min vs.(24.9 ± 3.9) min,t =-8.821,P ＜0.01],the incidence rate of respiratory events was less than that in group GA (8.57％ vs.28.57％,x2 =4.838,P ＜0.05);and the average length of stay in two groups were no significant difference[(15.1 ±1.8) d vs.(15.9±1.9) d,t =-1.676,P＞0.05].Conclusion lumbar plexus-sciatic nerve block combined with general anesthesia could decrease the use of remifentanil in elderly patients after total hip arthroplasty,have a fewer incidence of respiratory events,and it is beneficial to the early postoperative rehabilitation.

Objective To evaluate the effect of dexmedetomidine on postoperative pain in rats with preoperative sleep deprivation. Methods Fifty healthy adult male Sprague-Dawley rats, aged 12 - 14 weeks, weighing 200-300 g, were divided into 5 groups ( n = 10 each) using a random number table:control group (group C), sleep deprivation group (group SD), incisional pain group (group IP), sleep deprivation plus incisional pain group ( group SD + IP) and sleep deprivation plus incisional pain plus dexmedetomidine group (group SD+IP+DEX). Sleep deprivation was induced by the flower pot technique, and then the incisional pain model was carried out on first day after completion of sleep deprivation. Dexme-detomidine 50 μg∕kg was intraperitoneally injected for 3 consecutive days before establishing the model of in-cisional pain in group SD+IP+DEX, and the equal volume of normal saline was given in the other groups. The mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal threshold ( TWT) were measured before operation or at 1 day before sleep deprivation and after operation or at 12, 24 and 72 h af-ter sleep deprivation. Blood samples were collected and spinal cord tissues were removed after the end of be-havior test for determination of serum corticosterone concentrations (by enzyme-linked immunosorbent assay and content of 5-hydroxytryptamine (5-HT) in spinal dorsal horns (by high-performance liquid chromatogra-phy). Results Compared with group C, the MWT and TWT were significantly decreased, and the serum corticosterone concentrations and content of 5-HT in spinal dorsal horns were increased in the other 4 groups(P<0. 05). Compared with group IP, the MWT and TWT were significantly decreased, and the serum cor-ticosterone concentrations and content of 5-HT in spinal dorsal horns were increased in group SD+IP, and the MWT and TWT were significantly increased (P<0. 05), and no significant change was found in the ser-um corticosterone concentrations or content of 5-HT in spinal dorsal horns in group SD + IP + DEX ( P >0. 05). Compared with group SD+IP, the MWT and TWT were significantly increased, and the serum cor-ticosterone concentrations and content of 5-HT in spinal dorsal horns were decreased in group SD+IP+DEX (P<0. 05). Conclusion Dexmedetomidine can reduce postoperative pain in rats with preoperative sleep deprivation, and the mechanism may be related to inhibiting stress responses and levels of 5-HT in spinal dorsal horns.

Objective To evaluate the efficacy of dexmedetomidine mixed with sufentanil for patient-controlled intravenous analgesia (PCIA) in the patients undergoing transcatheter hepatic arterial chemoembolization (TACE).Methods One hundred and twenty patients of both sexes,aged 40-65 yr,weighing 45-80 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective TACE under monitored anesthesia care,were divided into 2 groups (n =60 each) using a random number table:sufentanil group (S group) and dexmedetomidine mixed with sufentanil group (DS group).At 15 min prior to surgery,0.1 μg/kg sufentanil and 5 mg tropisetron were intravenously injected in both groups.In addition,dexmedetomidine 0.6 μg/kg was intravenously infused for 15 min in DS group,while the equal volume of normal saline was given instead in S group.PCIA solution contained sufentanil 2 μg/kg and tropisetron 5 mg in 100 ml of normal saline in S group.PCIA solution contained sufentanil 2 μg/kg,dexmedetomidine 2.μg/kg and tropisetron 5 ng in 100 ml of normal saline in DS group.The PCIA pump was programmed to deliver a 0.5 ml bolus dose with a lockout interval of 15 min and background infusion of 2 ml/h.Observer's Assessment of Alertness/Sedation Scale scores and scores for patient's satisfaction with analgesia were recorded at 30 min and 2,6,12,24 and 48 h after surgery.The pressing times of PCIA,total consumption of sufentanil and requirenent for morphine as rescue analgesics were recorded.The development of requirement for antiemetics,nausea and vomiting,bradycardia,respiratory depression and agitation was also recorded during analgesia.Results Compared with S group,the pressing times of PCIA,total consumption of sufentanil and requirement for morphine were significantly reduced,scores for satisfaction with analgesia were increased,and Observer's Assessment of Alertness/Sedation Scale scores were decreased (P＜0.05),and no significant change was found in the incidence of nausea and vomiting,additional requirement for antiemetics,bradycardia,respiratory depression or agitation in DS group (P＞0.05).Conclusion Dexmedetomidine mixed with sufentanil produces better efficacy than sufentanil alone when used for PCIA in the patients undergoing TACE.

Background: Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI. Methods: The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through August 2016. We searched for all eligible randomized controlled trials with regard to the role of early initiation of renal replacement treatment in mortality among patients with AKI. We extracted the following information from each study: mortality, length of stay in intensive care unit (ICU), and length of stay in hospital. Random and fixed effect models were used for pooling data. Results: Twelve trials including 1756 patients were included. The results of this meta-analysis showed that there was no significant difference between the mortality of early and delayed strategy for the initiation of renal replacement treatment using the random effect model (odds ratio = 0.78; 95% confidence interval [CI], 0.52–1.19; P = 0.25), with wild heterogeneity (chi2 = 33.50; I2 = 67%). Analyses from subgroup sepsis and postsurgery came to similar results. In addition, compared with delayed initiation strategy, early initiation showed no significant advantage in length of stay in ICU (mean difference = −0.80; 95% CI, −2.59 to 0.99; P = 0.56) and length of stay in hospital (mean difference = −7.69; 95% CI, −16.14 to 0.76; P = 0.07). Conclusion: According to the results from present meta-analysis, early initiation of renal replacement treatment showed no survival benefits in patients with AKI. To achieve optimal timing of renal replacement treatment, further large multicenter randomized trials, with widely accepted and standardized definition of early initiation, are still needed.

Background: Perioperative respiratory adverse events (PRAEs) are a major cause of morbidity and mortality associated with pediatric anesthesia. Topical lidocaine administration reduces risk of PRAE in children undergoing elective endotracheal intubation. However, definitive evidence of its efficacy remains elusive, due, in part, to the wide variability in the methodology for spraying topical lidocaine. In this randomized controlled double-blind clinical trial, we sought to evaluate the effect of site-directed topical airway lidocaine, sprayed directly onto supraglottic, glottis, and subglottic areas, on the incidence of PRAE.Methods: The study population consisted of 322 children (age range, 6 mo-12 y), who were scheduled for an elective surgical procedure under general anesthesia with endotracheal intubation. Patients were randomly assigned to receive topical spray of lidocaine (group L) or saline (group S) over the supraglottic, glottis and subglottic areas under direct vision before tracheal intubation. Incidence of PRAE and time to extubation was recorded.Results: There were no statistically significant intergroup differences with regard to baseline demographics, patient characteristics, and surgical parameters. Group L was associated with a significantly lower incidence of PRAE as compared with group S (12.80% versus 38.13%, respectively; P < 0.001). Similarly, the incidence of laryngospasm (1.7% versus 8.1%; P = 0.01), excessive coughing (4.3% versus 13.2%; P = 0.005), and oxygen desaturation < 95% (6.8% versus 16.9%; P = 0.005), respectively, was significantly lower in group L. However, time to extubation was longer in group L as compared with that in group S (18.6 +/- 7.7 min versus 21.3 +/- 8.9 min; P = 0.03).Conclusions: Site-directed topical spray of lidocaine over supraglottic, glottis, and subglottic areas before tracheal intubation significantly reduced the incidence of PRAE and a prolongation of extubation time in children. (C) 2016 Elsevier Inc. All rights reserved.

Objective To investigate the effects of nasal spray of dexmedetomidine (Dex) 30 min before the ophthalmic surgery on the analepsia quality in children under general anesthesia with propofol.Methods Ninety children undergoing ophthalmic operation were randomly divided into three groups (with30 cases in each group).Patients in the three groups received nasal spray with Dex 0.5 μg/kg (group A),Dex 1.0 μg /kg (group B) and saline (group C) respectively.Propofol dosage,awake time and complications in the recovery period were observed.Results Propofol dosage in group A and B was significantly less than that of group C (P ＜ 0.05),and the recovery time was significantly shorter in group A and group B than that in group C (P ＜ 0.05),and the complications in the recovery period were significantly less than that of group C (P ＜ 0.05).There was no statistically significant difference between group A and group B (P ＞ 0.05).Conclusion Nasal spray of Dex 0.5 g/kg 30 min before the operation can reduce the dosage of anesthetic medicine during the operation,improve the quality of analepsia,which is safe and feasible.

Background: Although some studies have investigated the potential predictors of perioperative mortality, there are few specifically for pediatrics.Objective: The aim of the retrospective study was to analyze potential preoperative risk factors and to develop a pediatric preoperative risk prediction score (PRPS), and to predict postoperative ICU admission and the incidence of perioperative death in pediatric patients.Methods: Patients who postoperatively admitted to ICU or died (occurred within 30 days after the surgery) from 263 607 pediatric surgical patients with age from 1 day to 14 years old in eight centers in China from October 2010 to September 2013 were retrospectively analyzed. About 5500 non-ICU admission and death patients were randomly selected from those 263 607 patients as controls for analysis comparison. Independent risk factors and a risk model were derived from these analyses, and were further assessed with the likelihood ratio test and the area under the receiver operating characteristic (ROC) curve.Results: There were 1812 ICU admission or death patients but 187 patients' records are incomplete. There were 487 patients with incomplete records among 5500 controls. Collectively, data from 6626 patients were enrolled in final analyses. With multiple logistic regression analysis, age, ASA physical status, SpO(2), prematurity, and unfasted status were found to be independent predictors for critical patients. The AUC value of 0.905 indicated excellent predictive performance between critical and noncritical predictors.Conclusions: Our study revealed that age, ASA physical status, SpO(2), prematurity, and unfasted status are risk factors to predict postoperative ICU admission and death in pediatric patients.

Background: Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI.Methods: The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through August 2016. We searched for all eligible randomized controlled trials with regard to the role of early initiation of renal replacement treatment in mortality among patients with AKI. We extracted the following information from each study: mortality, length of stay in intensive care unit (ICU), and length of stay in hospital. Random and fixed effect models were used for pooling data.Results: Twelve trials including 1756 patients were included. The results of this meta-analysis showed that there was no significant difference between the mortality of early and delayed strategy for the initiation of renal replacement treatment using the random effect model (odds ratio = 0.78; 95% confidence interval [CI], 0.52-1.19; P = 0.25), with wild heterogeneity (chi(2) = 33.50; I-2 = 67%). Analyses from subgroup sepsis and postsurgery came to similar results. In addition, compared with delayed initiation strategy, early initiation showed no significant advantage in length of stay in ICU (mean difference = -0.80; 95% CI, -2.59 to 0.99; P = 0.56) and length of stay in hospital (mean difference = -7.69; 95% CI, -16.14 to 0.76; P = 0.07).Conclusion: According to the results from present meta-analysis, early initiation of renal replacement treatment showed no survival benefits in patients with AKI. To achieve optimal timing of renal replacement treatment, further large multicenter randomized trials, with widely accepted and standardized definition of early initiation, are still needed.

Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient?controlled intravenous analgesia ( PCIA) after Nuss procedure in pedi?atric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical statusⅠorⅡ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table:different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups ( SD1-3 groups) . Postopera?tive analgesia was as follows: group SD1 received sufentanil 1 μg∕kg + dexmedetomidine 2 μg∕kg; group SD2 received sufentanil 1 μg∕kg + dexmedetomidine 3 μg∕kg; group SD3 received sufentanil 1 μg∕kg +dexmedetomidine 4 μg∕kg. A mixture of tropisetron 0?1 mg∕kg and dexamethasone 0?1 mg∕kg ( in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0?5 ml with a lockout interval of 15 min and background infusion at 2 ml∕h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0?1μg∕kg was used as a rescue analgesic within 48 h post?operatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over?sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over?sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1 , the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after oper?ation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg∕kg mixed with sufentanil 1μg∕kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum.

Objective This study investigated the influence of laparoscopic carbon dioxide (CO 2 ) pneumoperitoneum on neonate circulation and respiration. Methods The study included neonates undergoing elective laparoscopic abdominal surgery. CO 2 insufflation pressure was maintained within 8–14 mmHg for pneumoperitoneum creation. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO 2 ), partial pressure of end-tidal carbon dioxide ( P ET CO 2 ) and maximum inspiratory pressure were monitored continuously. Arterial blood samples were collected: 5 min before pneumoperitoneum creation (baseline); 5, 10, and 20 min after CO 2 insufflation; 10 min after CO 2 exsufflation; 10 min after surgery. pH, partial pressure of CO 2 (PaCO 2 ) and arterial oxygen saturation (SaO 2 ) were also measured. Results Thirty-six neonates were included. HR and MAP significantly increased after pneumoperitoneum creation, then decreased to baseline after CO 2 exsufflation. PaCO 2 and P ET CO 2 were significantly higher after pneumoperitoneum creation, whereas pH was significantly lower 20 min after pneumoperitoneum creation compared with baseline. No significant differences were observed in SpO 2 and SaO 2 . Conclusion CO 2 pneumoperitoneum had a significant effect on neonatal circulation and respiration, suggesting that the pneumoperitoneal pressure should be limited within a certain range in neonates undergoing laparoscopic surgery.