Objective To compare the change of BIS under the TCI of different concentrations of sufentanil combined with propofol and to measure the EC_(50) of propofol、BIS_(50) at the end-points of loss of consciousness and movement.Methods Forty-five female patients with ASA Ⅰ or Ⅱ,were scheduled to undergo elective operation by general anesthesia.All patients were randomly allocated into three groups of 15 patients each,namely group A,B,C.In group A,no sufentanil was given.In group B and C,EC of 0.12 μg/L and 0.24 μg/L sufentanil were given respectively.Propofol was started with target concentration of 0.6 mg/L in all groups after calculated sufentanil effect-site concentrations was reached,and was increased 0.3 mg/L step by step until observation was over.Following parameters were recorded or calculated:(1)the basic values of BIS,and the BIS after sufentanil target concentrations were reached;(2) BIS,OAA/S and response to painful triangular muscle squeeze were recorded in order;(3) the absolute difference during the course of painful triangular muscle squeeze at propofol concentrations as 0.9、1.5、2.1 mg/L;(4) the pain scale on the site of propofol injection;(5) EC_(50)、EC_(95)、BIS_(50)、BIS_(95) at different clinical end-points.Results There are no significant differences in group B and C between the BIS before and after sufentanil infusion(P0.05).At the clinical end-point of loss of consciousness,the propofol EC_(50)/EC_(95) of group A、B、C was 1.9/2.4,1.6/2.1,1.4/1.9 mg/L respectively;the BIS_(50)/BIS_(95) was 64/55,69/61,72/59.At the clinical end-point of loss of response to movement,the propofol EC_(50)/EC_(95) of group A,B,C was 3.0/3.7,1.4/2.0,0.9/1.4 mg/L respectively;the BIS_(50)/BIS_(95) was 49/40,74/62 as 84/75.At three different points of propofol EC such as 0.9,1.5 and 2.1 mg/L,the increment of BIS(△BIS) with that in group B and C in group A was significantly different(P0.01).The pain scales on the site of propofol injection were significantly different between group A and C.(P0.05).Conclusions 0.12 and 0.24 μg/L sufentanil can not affect BIS obviously.However,sufentanil combined with propofol can cause loss of consciousness and movement in the fashion of a lower propofol EC_(50) and a higher BIS_(50).Sufentanil can significantly suppress the increment of BIS after noxious stimulus,and reduce pain scales on the site of propofol injection.
Objective To measure the medium effective concentration (EC50) of remifentanil for blunting cardiovascular response to placement of LMA-Fastrach, LMA-Proseal and tracheal intubation, and to compare the change of brain bispectral index (BIS) during these procedures. Methods Sixty-three patients (ASA I-II) scheduled for cholecystectomy under general anesthesia were enrolled. According to different options of intubation, all the patients were randomly allocated into three groups (n=21 each): group T by laryngoscope and tracheal intubation, group F by LMA-Fastrach and group P by LMA-Proseal.Initially, a target plasma concentration of 4 mg/L propofol was chosen, and was adjusted to maintain BIS between 45 and 55. Then, the effect-site concentration of remifentanil was started at designed concentration according to Minto's pharmacokinetic model. Five minutes later, 0.6 mg/kg (2 ED95) rocuronium was given, and intubation was performed 2 min after rocuronium administration. The pre- and post-induction mean arterial pressure (MAP), heart rate (HR) and BIS were compared among these groups. MAP and HR at 1 and 2 min pre-intubation and at 5 min post-intubation were also recorded to evaluate whether there was a cardiovascular response in these patients. Subsequently, the EC50 of remifentanil for blunting the cardiovascular response to 3 options of intubation was calculated using the Dixon-Mood up- and down- sequence. Results Compared with pre-induction, all the patients in 3 groups experienced significantly lower post-inductive MAP and HR [MAP of pre- and post-induction in T, F, P groups were (87.9±10.5) mm Hg vs (71.6±9.0) mm Hg, (91.8±8.8)mm Hg vs (73.5±9.9) mm Hg, (87.2±10.2) mm Hg vs (70.9±8.6) mm Hg, HR of pre- and post-induction in T, F, P groups were (78.8±11.6) min-1 vs (68.7±8.5) min-1,(74.8±10.3) min-1 vs (64.1±6.7) min-1, (76.7±8.2) min-1 vs (67.3±8.3) min-1,1 mm Hg=0.133 kPa, P 0.05). The EC50 of remifentail for blunting cardiovascular response to intubation was 4.47 μg/L for group T, 4.78 μg/L for group F and 2.05 μg/L for group P, respectively. Conclusion EC50 of remifentail for blunting cardiovascular responses to intubation as shown by Minto's model appears slightly higher in LMA-Fastrach than that in tracheal intubation, and the lowest is in LMA-Proseal intubation.
Key words:
Target-controlled infusion; Bispectral index; Propofol; Remifentanil; Medium effective concentration
To study the effects of recombinant human erythropoietin on inflammatory factors in rats with traumatic brain injury is the main objective. A total of 45 specific-pathogen-free grade male Sprague-Dawley rats were randomly assigned into sham operation group (sham group), model group and recombinant human erythropoietin intervention group (treatment group) (n=15). Model and treatment groups were prepared into traumatic brain injury model by hitting the head through the modified Feeney’s free-fall impact method, while the head of sham group was not hit. After modeling, treatment group was intraperitoneally injected with recombinant human erythropoietin at 5000 IU/kg daily and sham and model groups were intraperitoneally injected with the same dose of normal saline. The rats were killed after 7 d of continuous administration. The changes of brain mitochondrial membrane potential were detected through rhodamine 123 staining and immunocytochemistry and Western blotting were separately employed to measure the expressions of interleukin-1β, interleukin-6 and tumor necrosis factor-α in brain tissues and the expression levels of dynamin-related protein 1, fission 1, mitofusin 2 and optic atrophy 1, mitochondrial dynamics related proteins in brain tissues. Compared with sham group, model group exhibited significantly weakened rhodamine 123 fluorescence intensity, increased expressions of interleukin-1β, interleukin-6 and tumor necrosis factor-α, dynamin-related protein 1 and fission 1 and reduced expressions of mitofusin 2 and optic atrophy 1 in brain tissues (p<0.05). In comparison with model group, treatment group had significantly enhanced rhodamine 123 fluorescence intensity, reduced expressions of interleukin-1β, interleukin-6 and tumor necrosis factor-α, dynamin-related protein 1 and fission 1 and elevated expressions of mitofusin 2 and optic atrophy 1 in brain tissues (p<0.05). Recombinant human erythropoietin can protect the brain after traumatic brain injury by relieving the inflammatory response and mitochondrial injury after traumatic brain injury.
ABSTRACT Introduction : We investigated a novel application of phrenic nerve stimulation (PNS) in diaphragm dysfunction induced by mechanical ventilation (MV). Methods : Twenty‐one Sprague‐Dawley rats were assigned randomly to 3 groups: spontaneous breathing, 18‐h controlled MV, and 18‐h controlled MV with PNS. Upon completion of the experimental protocol, diaphragm contractility, gene expression of insulin‐like growth factor‐1 (IGF‐1) and ubiquitin ligases, and serum IGF‐1 levels were analyzed. Results : Compared with the spontaneously breathing rats, impaired diaphragm contractile function, including force‐related properties and force‐frequency responses, were pronounced with MV. Furthermore, MV suppressed IGF‐1 and induced muscle ring finger 1 mRNA expression in the diaphragm. In contrast, PNS counteracted MV‐induced gene expression changes in the diaphragm and restored diaphragm function. Conclusions : PNS exerted a protective effect against MV‐induced diaphragm dysfunction by counteracting altered expression of IGF‐1 and ubiquitin ligase in the diaphragm. Muscle Nerve 48 : 958–962, 2013
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