Background: Cardiovascular surgeries often require deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB), which can disrupt blood clotting and lead to excessive bleeding. Traditional treatments involve transfusing blood and blood products, which can have adverse effects and place significant strain on the global blood supply. Research suggests that autologous platelet-rich plasmapheresis (aPRP) may reduce the need for transfusions by preserving blood components. However, the impact of aPRP on postoperative blood loss and clinical outcomes in cardiovascular surgery remains controversial. This study aimed to examine the effects of aPRP on postoperative blood loss and recovery in patients undergoing heart valve surgery. Methods: A total of 183 patients were divided into either aPRP or control groups. The aPRP group received aPRP before CPB, whereas the control group did not. The primary endpoint was postoperative bleeding between the groups. The secondary endpoints were postoperative bleeding risk factors and clinical outcome assessment. Logistic regression analysis with covariate adjustment was used to calculate these risk factors. Results: A total of 76 patients (41.5%) in the aPRP group and 107 patients (58.5%) in the control group were included in the analysis. No significant difference was found in the occurrence of postoperative bleeding [odds ratio (OR) =0.53, 95% confidence interval (CI): 0.28-1.00, P=0.05], and the aPRP group had fewer complications than the controls (OR =0.28, 95% CI: 0.10-0.68, P=0.009). However, after adjusting for the New York Heart Association (NYHA) classification, diabetes, arrhythmology, mean activated clotting time (ACT mean ), CPB, bleeding, thoracotomy, and body mass index (BMI), there was a significant difference in postoperative bleeding (adjusted OR =0.47, 95% CI: 0.22-0.98, P=0.04) and complications (adjusted OR =0.23, 95% CI: 0.07-0.64, P=0.008) between the two groups. Conclusions: Preoperative aPRP can improve postoperative outcomes and reduce complications in patients undergoing heart valve surgery.

目的:分析艾司氯胺酮、右美托咪定联合布托啡诺用于腰椎手术术后镇痛的效果.方法:检索复旦大学附属中山医院厦门医院麻醉科术后镇痛记录系统,回顾性分析2021年1月至2022年12月期间的119例腰椎手术术后镇痛记录.根据镇痛配方不同,分为对照组(51例)和观察组(68例).对照组采用阿片类药物镇痛(氢吗啡酮6 mg、地佐辛10 mg、托烷司琼10 mg溶于0.9％氯化钠注射液,配至150mL),观察组采用少阿片类药物镇痛(艾司氯胺酮25 mg、右美托咪定100 µg、利多卡因200 mg、硫酸镁5 g、布托啡诺8 mg溶于0.9％氯化钠注射液,配至120 mL).比较两组术后患者自控镇痛(PCA)情况及疼痛数字评价量表(NRS)评分、不良反应发生情况.结果:术后,两组患者静息和动态NRS评分比较,差异无统计学意义(P＞0.05).观察组患者PCA有效次数及总次数均多于对照组,差异具有统计学意义(P＜0.05).观察组患者恶心呕吐发生率低于对照组,差异具有统计学意义(P＜0.05).两组患者低血压、头晕、瘙痒、呼吸抑制的发生率比较,差异无统计学意义(P＞0.05).结论:艾司氯胺酮、右美托咪定等非阿片类药物联合布托啡诺用于腰椎手术术后镇痛,其镇痛效果确切,能够降低术后恶心呕吐的发生率.

We investigated the effect of propofol on the tissue plasminogen activator (tPA) release in developing hippocampal neurons, and explored the effects of exogenous tPA on the propofol-induced neuron apoptosis.

Several animal and observational studies have evaluated the effects of neuraxial anesthesia on the recurrence and survival of cancer surgery; studies reported benefit, whereas others did not. To provide further evidence that neuraxial anesthesia(combined with or without general anesthesia (GA))may be associated with reduced cancer recurrence and long-term survival after cancer surgery, we conducted this meta-analysis. A total of 21 studies were identified and analyzed, based on searches conducted using PubMed, Web of Science, EMBASE database and the Cochrane Database of Systematic Reviews. After data abstraction, adjusted hazard ratios (HR) with 95% confidence intervals (CIs) were used to assess the impact of neuraxial anesthesia (combined with or without GA) and GA on oncological outcomes after cancer surgery. For overall survival (OS), a potential association between neuraxial anesthesia and improved OS (HR 0.853, CI 0.741-0.981, P = 0.026, the random-effects model) was observed compared with GA. Specifically, we found a positive association between neuraxial anesthesia and improved OS in colorectal cancer (HR 0.653, CI 0.430-0.991, P = 0.045, the random-effects model). For recurrence-free survival (RFS), a significant association between neuraxial anesthesia and improved RFS (HR 0.846, CI 0.718-0.998, P = 0.047, the random-effects model) was detected compared with GA. Our meta-analysis suggests that neuraxial anesthesia may be associated with improved OS in patients with cancer surgery, especially for those patients with colorectal cancer. It also supports a potential association between neuraxial anesthesia and a reduced risk of cancer recurrence. More prospective studies are needed to elucidate whether the association between neuraxial use and survival is causative.

The successful placement of Laryngeal Mask Airway (LMA) Supreme in adults largely depends on right selection of its size. Most anesthesiologists determine the size of LMA according to patients' body weight, which does not always work well. An alternative method should be established to guarantee higher efficacy of ventilation through LMA Supreme placement. This controlled study was designed to compare the efficacy of LMA Supreme placement, when the size of it is determined by body weight or by thyromental distance.Eighty healthy individuals with American Society of Anesthesiologists physical status 1 to 2 scheduled for elective ambulatory surgery were randomly allocated into 2 groups: thyromental distance-based group (n = 40) and weight-based group (n = 40). Efficacy of controlled ventilation through LMA, easy of device placement, and pharyngeal sealing were evaluated between the groups.The tidal volume under 10cm H2O pressure-controlled ventilation in thyromental distance-based group was significantly higher than that in weight-based group (523.9 +/- 135.4 vs 477.1 +/- 185.6; P = 0.031). The number of patients who achieved "excellent'' tidal volume (>8 mL/kg) were significantly more in the thyromental distance-based group (24/40 vs 13/40; P = 0.019). Among overweight patients (body mass index >23), those who achieved "excellent'' tidal volume (>8 mL/kg) under 10 cm H2O pressure-controlled ventilation were also more in thyromental distanced-based group than in weight-based group (11/24 vs 2/24; P = 0.031). The time taken for successful insertion was shorter with the thyromental distance-based group compared with the weight-based group (54.6 +/- 33.6 vs 87.8 +/- 98.9; P = 0.021). Oropharyngeal leak pressure was pretty close between the 2 groups (26.4 +/- 5.1 vs 25.0 +/- 5.7 cm H2O; P = 0.180).In terms of guaranteeing better positive pressure ventilation, facilitating device placement, and reliable pharyngeal sealing, thyromental distance-based method can be a better option compared with the weight-based method for LMA Supreme size selection.

Background: Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA).Methods: Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patient-controlled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1st and 3rd day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-alpha level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery.Results: Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-alpha levels before and after analgesia at T-1 and T-2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05).Conclusions: Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain.

The antioxidant property of dimethyl sulfoxide (DMSO) was formerly attributed to its direct effects. Our former study showed that DMSO is able to induce heme oxygenase-1 (HO-1) expression in endothelial cells, which is a potent antioxidant enzyme. In this study, we hypothesized that the antioxidant effects of DMSO in cardiomyocytes are mediated or partially mediated by increased HO-1 expression. Therefore, we investigated whether DMSO exerts protective effects against H2 O2 -induced oxidative damage in cardiomyocytes, and whether HO-1 is involved in DMSO-imparted protective effects, and we also explore the underlying mechanism of DMSO-induced HO-1 expression. Our study demonstrated that DMSO pretreatment showed a cytoprotective effect against H2 O2 -induced oxidative damage (impaired cell viability, increased apopototic cells rate and caspase-3 level, and increased release of LDH and CK) and this process is partially mediated by HO-1 upregulation. Furthermore, our data showed that the activation of p38 MAPK and Nrf2 translocation are involved in the HO-1 upregulation induced by DMSO. This study reports for the first time that the cytoprotective effect of DMSO in cardiomyocytes is partially mediated by HO-1, which may further explain the mechanisms by which DMSO exerts cardioprotection on H2 O2 injury. J. Cell. Biochem. 115: 1159-1165, 2014. © 2013 Wiley Periodicals, Inc.

Objective To investigate the influence of anesthesia methods and anesthetics on bronchial mucociliary clearance(MCC) in human.Methods Sixty patients undergoing selective lower abdominal surgery under general anesthesia were divided randomly into four groups with 15 cases each.The patients in group Ⅰ were given total intravenous anesthesia(TIVA) with target-controlled infusion(TCI) of propofol 3-4 μg/ml,those in group Ⅱ were given epidural block combined with TCI propofol of 3-3.5 μg/ml,those in group Ⅲ received inhalation anesthesia with sevoflurane 1 MAC,and those in group Ⅳ received epidural block combined with inhalation anesthesia with 0.6 MAC sevoflurane.Propofol concentration,MAC,theconsumotions of fentanyl and epidural anaesthetics were recorded.The MCC was calculated by measuring the actual movement of the tracer(the distance was controlled by 1 cm epidural catheter extended out of the fiberoptic bronchoscope for 2 cm).Results Compared with Group Ⅲ,MCC was significantly slower at 60 min in Group Ⅰ,Ⅱ,Ⅳ(P<0.05).Conclusion Inhalation anesthesia with 1 MAC sevoflurane could significantly inhibit MCC,which can be reduced by propofol infusion and 0.6 MAC sevoflurane inhalation.

Objective To investigate the effects of acute normovolemic hemodilution ( ANH) with crystalloid and/or colloid on the extravascular lung water (EVLW) and oxygenation in patients undergoing orthopedic surgery. Methods Forty - eight ASA Ⅰor Ⅱ patients of either sex aged 18-70 yrs weighing 55-79 kg undergoing extensive orthopedic surgery were included in the study. The preoperative hematocrit (Hct) of the patients was 35% and Hb 120 g·L-1. The estimated intraoperative blood loss was 1 000-1 500 ml. The patients were randomly divided into 3 groups ( n = 16 each): group Ⅰ lactated Ringer's solution (LR); group Ⅱ LR-6% HES and group Ⅲ colloid (6% HES). Blood was removed from radial artery after induction of anesthesia. The target Hct was 28% . The volume of blood removed = body weight (kg)×7.5 × (preop Hct -target Hct) / 0.5×(preop Hct + target Hct). The removed whole blood was replaced with lactated Ringer's solution in a three to one ratio in group Ⅰ or with 6% HES in a one to one ratio in group Ⅲ. In group Ⅱ half of the removed whole blood was replaced with LR and the other half with 6% HES. The EVLW, HR, BP, Cardiac index (CI) and dp/dtmax were monitored by PiCCO and recorded before induction of anesthesia (T0), immediately after induction of anesthesia (T1), immediately after and 15 min after ANH (T2,3), immediately before and after reinfusion (T4,5) . Hct, colloid osmotic pressure and blood gases were also measured and recorded. Results The 3 groups were comparable with respect to M/F ratio, age, body weight and the volume of whole blood removed. MAP, HR, SpO2 and CVP were stable during operation in all 3 groups. Hct was significantly decreased after ANH as compared with the baseline at T0 in all 3 groups. The osmotic pressure was significantly decreased after ANH in group Ⅰ and Ⅱ and was significantly higher in group Ⅱ and Ⅲ than in group Ⅰ after ANH. CI and dp/dtmax were significantly decreased after ANH as compared to the baseline at T0 in all 3 groups. There was no significant difference in EVLW, PaO2 and [ HCO3- ] among the 3 groups. Conclusion Moderate ANH with crystalloid or colloid has little effect on EVLW and oxygenation in patients with normal cardio-pulmonary function.

Objective Elderly patients with reduced cardiac function are not considered good candidates for acute isovolemic hemodilution ( AIH) and acute hypervolemic hemodilution ( AHH) significantly increases preload in these patients. We tried to develop an in-between technique, acute non-isovolemic hemodilution (ANIH). The purpose of this study was to evaluate the effectiveness and safety of ANIH in the elderly patients in comparison with AHH.Methods Thirty-eight ASA Ⅰ -Ⅱ patients of both sexes, aged between 65-80 yr, undergoing elective surgery were enrolled in this study. Their preoperative Hct was 35 % and the intraoperative blood loss was expected to be 800-1 600 ml. The operations were performed under combined general-epidural anesthesia. General anesthesia was induced with fentanyl 2-4 μg·kg-1 , thiopentone 5 mg·kg-1 and succinylcholine 1.5mg· kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of vecuronium. Epidural anesthesia was performed at T5-6 (thoracic surgery), T10-11 (upper abdominal surgery) or L3-4 (lower abdominal surgery) . A mixture of 0.1% lidocaine +0.2% dicaine was used for epidural block during operation. The patients were randomly divided into 2 groups: (1) ANIH group ( n = 18) and (2) AHH group ( n = 20) . Blood volume (BV) was calculated according to following formula: BV (ml) (male) = Height (cm)× 28.5 + Body weight (kg) × 31.6 - 2 820,BV(ml) (female) = Height(cm)× 16.25 + Body weight (kg) × 38.46 - 1 369. 1 000-1 200 ml of 6% HES (200/0.5) and 500 ml of lactated Ringer's solution (about 25%-30% of BV) were infused at a rate of 50ml·min-1 when induction of anesthesia was started in both groups. In group I (ANIH) 400-600 ml of blood (about 10%-15% of BV) was removed through radial artery before induction of anesthesia. The removed blood was reinfused at the end of surgery. Vital signs (BP,HR,CVP and ST-T changes) , Hct, oncotic pressure and arterial blood lactate concentration were monitored during operation. Results The vital signs were fairly stable during perioperative period in both groups. Transient hypotension developed in 16.7% (3/8 in group Ⅰ ) and 15.0% (3/20 in group Ⅱ ) of patients during induction of anesthesia. CVP was significantly elevated in both groups but the increase in CVP was significantly higher in group Ⅱthan that in group Ⅰ . In group Ⅰ (AN1H) moderate hemodilution was achieved (Hct = 29.9% 2.9%) while in group Ⅱ (AHH) only mild hemodilution was achieved (Hct = 32.9% ±2.9%) .Hct was significantly higher in group Ⅰ(31.5% ±5.1%) than that in group Ⅱ (27.7% ±3.6%) at the end of surgery. Blood loss was comparable between the two groups, and oncotic pressure and blood lactate level were within normal range in both groups. Conclusion ANIH is more effective and safer than AHH without obvious adverse effects, and can avoid exceedingly high CVP commonly seen in AHH. ANIH is a hemodilution technique of choice in the elderly patients.