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The present study aimed to elucidate the effects of dexmedetomidine on kidney injury of parturients with preeclampsia (PE) undergoing cesarean section. Total 134 cesarean delivery women with PE were randomly divided into intervention group (IG) and control group (CG). Both groups underwent combined spinal and epidural anesthesia (CSEA), the IG was treated with 0.4 μg/(kg·min) dexmedetomidine for 10 min before surgery. The CG was treated with equivalent saline. Heart rate (HR), blood pressure, oxygen saturation (SpO2) of the two groups were measured at different time point after administration. Level of inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). Visual analogue score (VAS), Ramsay sedation score (RSS), and kidney injury related indexes were evaluated at different time points. The plasma-drug concentration of patients was determined by High Performance Liquid Chromatography (HPLC) method. Compared with CG, HR, PE, and diastolic blood pressure (DBP) showed lower level while SpO2 showed higher level in IG. Furthermore, expression of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and IL-10 in IG was decreased after drug administration, the contents of β2-MG, KIM-1 and urine protein were also decreased in contrast to the CG (all P

To observe the sedative and analgesic effects of dexmedetomidine (Dex) and its influence on respiration and blood pressure, evaluate electrophysiological monitoring and explore the optimal dose of Dex for brain nuclei lesion in Parkinson's disease (PD) patients.Approved by hospital ethics committee, 60 PD patients undergoing brain nuclei lesion ablation were randomly allocated into 3 groups (n = 20 each). No sedative anesthetic was used in group A; In group B, Dex 0.3 µg/kg intravenously for initial bolus (duration 15 min) and then 0.3 µg·kg(-1)·h(-1) continuous infusion; In group C, Dex 0.5 µg/kg intravenously (duration 15 min) for initial load and then 0.3 µg·kg(-1)·h(-1) continuous infusion. The parameters of mean arterial pressure (MAP), heart rate (HR), pressure of end-tidal carbon dioxide (P ETCO2), respiratory rate, blood oxygen saturation (SpO2), observer's assessment of alertness/sedation (OAA/S) and verbal rating score (VRS) were recorded at 0 min (baseline), 5 min (T1), 10 min (T2), 15 min (T3), 20 min (T4), 30 min (T5) and 60 min (T6) after the dosing of Dex.HR and respiratory rate decreased in groups B and C compared with baseline. In group C, P ETCO2 was much higher, compared with baseline (P0.05). Blood pressures of three groups were well-controlled. The incidence of pain (VRS ≥ 1) in group A was significantly higher than those of groups B and C (P0.05). And the incidence of sedation (OAA/S1) in group C was much higher than those of groups A and B. The electrophysiological signal of two patients in group C was severely affected.At an initial intravenous dose of Dex 0.3 µg/kg and a maintenance dose of 0.3 µg ·kg(-1)·h(-1), electrophysiological monitoring for surgery is not affected in PD patients undergoing brain nuclei lesion ablation. With a minimal interference of breath, Dex has not only well-controlled effects on sedation, analgesia and blood pressure, but also makes patients comfortable.

Myocardial injury following carotid endarterectomy (CEA) is a common cause of morbidity and mortality, and its risk varies depending on the severity and extent of disease. However, when patients with sympotomatic severe carotid stenosis undergo CEA, the frequency and potential predictors of myocardial injury remain unknown. A total of 40 patients (32 men and 8 women) who underwent successful standard CEA were observed. Cardiac troponin I (cTnI) concentrations were assessed before surgery and on postoperative days 1, 2, and 3 in all patients. Myocardial injury was defined as the peak cTnI concentration > 0.04 ng/mL. In all, 42.5% patients had postoperative myocardial injury. Previous ischemic stroke and abnormal ST-segment changes were the preoperative predictors of myocardial injury after CEA, with odds ratios of 4.1 (95% confidence interval, 1.1-16.1; P = .04) and 5.9 (95% confidence interval, 1.3-27.7; P = .04), respectively. Sympotomatic patients with those conditions should receive more attention to myocardial injury, when presented for CEA.

The palpation method is widely used in clinical practice to identify the puncture site of combined spinal-epidural (CSE) blocks, but it is usually difficult to accurately locate the puncture site in obese parturients. Accurate identification of the puncture site is crucial for successful CSE block. The objective of this study was to evaluate the impact of ultrasound imaging on the success rate of CSE puncture in obese parturients.Sixty obese parturients with a body mass index ≥ 30 kg/m(2) who were scheduled for caesarean section were randomized into two equal-sized groups for location of the puncture site: an ultrasound group and a palpation group. The success rate of puncture at the first puncture site, the number of puncture attempts, duration of CSE procedure, time taken to determine the puncture site, and the depth of the epidural space were compared between groups. The frequencies of complications such as puncture site hemorrhage, neurological damage, and inadvertent dural puncture were also studied.There were no differences in age, body weight, height, body mass index, or gestational age between the two groups. The success rate of puncture at the first puncture site was significantly higher in the ultrasound group than the palpation group (100.00% vs. 70.00%, P = 0.004). The number of puncture attempts was significantly lower in the ultrasound group than the palpation group (χ(2) = 6.708, P = 0.035). The time taken for determining the puncture site was (0.30 ± 0.12) minutes in the palpation group and (2.60 ± 0.61) minutes in the ultrasound group (P0.001). The duration of CSE procedure was (7.67 ± 1.52) minutes in the palpation group and (9.37 ± 1.35) minutes in the ultrasound group (P0.001). The depth of the epidural space was similar in both groups (P = 0.586). Puncture site hemorrhage was observed in 6 (20.00%) patients in the palpation group and 2 (6.67%) patients in the ultrasound group (P = 0.255).Ultrasound imaging improves the rate of successful puncture at the first puncture site and decreases the number of puncture attempts. It facilitates CSE puncture in obese parturients.

As a new electroencephalogram (EEG) signal processing technique for monitoring the depth of anesthesia, entropy consists of two indices: reaction entropy (RE) and state entropy (SE). Our study compared entropy with classical bispectral index (BIS) in reduction of myoelectrical interference and noxious stimuli with EEG signals.Two hundred and eighty patients (ASA I-II, 18-60 years old) undergoing scheduled surgeries from seven medical centers were enrolled. Anesthesia induction was managed with propofol via the target-controlled infusion (TCI) system. The results of BIS, RE, SE, mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction, at the moment of unconsciousness, before and 2 minutes after administration of muscle relaxant, and before and one and three minutes after the tracheal intubation.The values of half maximum effective concentrations (EC50), 5% effective concentrations (EC05) and 95% effective concentrations (EC95) of propofol effect-site concentration at the onset of unconsciousness were 1.2 (1.1-1.3 µg/ml), 2.5 (2.4-2.5 µg/ml) and 3.7 (3.7-3.8 µg/ml), while those of the predicted plasma propofol concentration were 2.8 (2.7-2.9 µg/ml), 3.9 (3.8-3.9 µg/ml) and 4.9 (4.8-5.0 µg/ml), respectively. The values of BIS, SE and RE were 62, 59 and 63 when 50% of patients lost consciousness, and 79, 80, 85 and 42, 37, 44, respectively, when 5% and 95% of patients were unconscious. The values of BIS, RE and SE dropped two minutes after the injection of muscle relaxant, but there were no significant differences between RE and SE. MAP and HR increased visibly, which indicated a reaction to tracheal intubation; the values of BIS, RE and SE, however, did not display any significant changes.This large-sample multicentric study confirmed the values of RE and SE as approximating BIS value, at the onset of unconsciousness during propofol TCI anesthesia. After elimination of myoelectrical activation, all values of RE, SE and BIS decreased significantly and the three indices were less sensitive to noxious stimuli than cardiovascular responses.

To evaluate the value of wavelet index (WLI) in general anesthesia through a comparison of WLI with bispectral index (BIS).A total of 53 patients scheduled for elective surgery with ASA (American Society of Anesthesiologists) I-II were selected to undergo general anesthesia. The monitoring probes of BIS, WLI and muscle relaxation were connected in awaking patients. The values of WLI and BIS were recorded at 10 min (T₁) entering OR (operating room), immediate before anesthesia induction (T₂), when the OAA/S (observer's assessment of alertness/sedation) score declined gradually to 5(T₃), 4(T₄), 3(T₅), 2(T₆), 1(T₇) after the infusion of propofol, after vecuronium given when the TOF value decreased to 100 (T₈), 75(T₉), 50 (T₁₀), 25 (T₁₁), 0 (T₁₂) after the injection of vecuronium, tracheal intubation (T₁₃), 1 min (T₁₄), 3 min (T₁₅) and 5 min (T₁₆) after the completion of tracheal intubation, immediate before initiating surgical procedure (T₁₇), beginning the operation (T₁₈), 1 min (T₁₉), 3 min (T₂₀), 5 min (T₂₁) post-operation, skin suturing (T₂₂), end of surgery (T₂₃), tracheal extubation (T₂₄), 1 min (T₂₅) and 5 min (T₂₆)cd post-extubation, immediate before exiting OR (T₂₇).The value of WLI at T₁₀-T₁₃, T₂₂-T₂₇ was more than BIS (P0.05). The Bland-Altman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia. The bias was -2.99, 95% limits of agreement -29.97% to 21.56%. The correlation coefficients of OAA/S score with BIS and WLI were: r(BIS) = 0.884, r(WLI) = 0.757 (P = 0.000).WLI index is feasible for monitoring the depth of general anesthesia.

To explore the feasibility and safety of sedation with a low dose of dexmedetomidine (DEX) during intrathecal anesthesia in the elderly patients.Thirty elderly patients were randomly divided into the DEX group (n = 15) and the control group (n = 15). There were 13 males and 17 females with a mean age of 77 years old (range: 65 - 89 years old). After an induction of intrathecal anesthesia, the patients in the DEX group received an infusion of 0.4 µg×kg(-1)×h(-1) for 10 min. Then the infusion speed was adjusted between 0.2 and 0.4 µg×kg(-1)×h(-1) to maintain the values of bispectral index (BIS) at around 80. An equivalent volume of normal saline was administered in the control group. Blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (P(ET)CO(2)) and BIS were recorded at the beginning of DEX infusion, 10, 20, 30 and 60 min after DEX infusion beginning and at the end of surgery. The observer's assessment of alertness/sedation (OAA/S) scores and the clinical responses were also recorded. A statistical analysis was performed.All intraoperative hemodynamic and respiratory parameters were within the normal range in both groups. Compared with the beginning after infusion, blood pressure at the point of 10 min after infusion decreased about 10% - 15% (P0.05) in the DEX group. But there was no such change in the control group. The values of BIS also decreased significantly at each time point after 10 min infusion versus the beginning of administration (P0.05); as compared with the control group, the values of BIS also decreased significantly at 30, 60 min and the end of infusion (P0.05). The 95%confidence interval (CI) of BIS values were 70 - 95 in the DEX group and 80 - 100 in the control group (P0.05). In the DEX group, the OAA/S scores were significantly lower at the points of 20, 30, 60 min and the end of infusion versus the beginning after infusion. And it was also lower in the DEX group than that in the control group (95%CI: 3 - 4 vs 4 - 5, P0.05). No bradycardia occurred in the DEX group. Two of three patients with concurrent atrial fibrillation were converted to sinus rhythm after the administration of DEX. Patients with severe lung diseases (pulmonary fibrosis, asthma or chronic obstructive pulmonary disease) maintained normal cardiopulmonary functions in the DEX group. DEX showed a good sedation effect in 1 patient with mental diseases.Sedation with a small dose of DEX during intrathecal anesthesia in elderly patients is both feasible and efficacious. But studies of larger sample sizes are warranted to confirm its safety.

To explore the feasibility of guiding the volume management during orthotopic liver transplantation by right ventricular end-diastolic volume index(RVEDVI).Thirty-two patients who accepted OLT were studied during operation. A modified pulmonary artery catheter equipped with a fast response thermistor (774HF75)was used to determine RVEDVI, EF, CCI, CVP, MPAP, PAOP and SVI. The above-mentioned hemodynamic measures were taken in 9 phases: T0, before induction of anesthesia; T1, before operation; T2, pre-anhepatic phase; T3, 30 minutes after PV occlusion; T4, 10 minutes after graft reperfusion; T5, 30 minutes after graft reperfusion; T6, 60 minutes after graft reperfusion; T7, 120 minutes after graft reperfusion; and T8, at the end of surgery. The linear regression analyses of SVI and CVP, SVI and PAOP, SVI and RVEDVI in each phase were calculated, and the best measure of representing the volume of the OLT patient was selected.The variation of the RVEF value was (42.04+/-9.40)%. Linear regression analyses showed a significant correlation between RVEDVI and stroke volume index (SVI) in each phase(P0.05). No relationships were found between PAOP and SVI, CVP and SVI.RVEDVI may be the best hemodynamic measure of evaluating the volume of the OLT patients.

To investigate the changes in hemodynamics and oxygen metabolism of different Child-grade patients during orthotopic liver transplantation (OLT) without veno-venous bypass.Forty patients with end-stage liver disease undergoing non veno-venous OLT under general anesthesia were enrolled in this research. Swan-Ganz catheter was placed in the pulmonary artery via right internal jugular vein and right radial artery was cannulated to monitor mean pulmonary artery pressure (mPAP) and artery blood pressure (ABP) continuously. Pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) were also recorded. Cardiac output (CO) was recorded at several time points, such as, 30 min after induction (T1), when inferior vena cava and portal vein were clamped (T2), 30 min after portal vein was clamped (T3), 10 min after unclamping of portal vein (T4), 60 min after graft reperfusion (T5) and at the end of the operation (T6). Blood samples were taken from radial and pulmonary artery for blood gas analysis and hemodynamic parameters, such as, cardiac index (CI), stroke volume index (SVI), pulmonary vascular resistance index (PVRI), and system vascular resistance index (SVRI); oxygen delivery (DO2) and oxygen consumption (VO2) were also calculated at these time points.(1) The mPAP values were much higher in group C than in group A or B at all time points. CVP was significantly increased at T1 or T2 in group C as compared with those points of Child's B or C. PCWP was increased significantly after unclamping of portal vein in all three groups and was much higher at several points in Child's C than in Child's A or B. The SVRI value of T1 and the PVRI value of T3 were much lower in group C than those points in group A and the value of SVRI/PVRI was less than normal except at T3 point. And blood gas analysis elucidated that PaO2 was higher than 400 mm Hg at any points. (2) Oxygen consumption was significantly decreased during the operation due to less blood supply and was reverted to normal at the end point of the operation in all patients. Oxygen delivery was all at least 1,000 mL/min during OLT and there was no significant difference between different groups or different points.The hemodynamic state of high cardiac output with low peripheral resistance deteriorated when patients' Child-grade shifted from A to C. VO2 was less than normal value during OLT until the end point.

To study the influences of different anesthesia techniques on stress response, coagulation and fibrinolytic function.Thirty patients undergoing hysterectomy were randomized into three groups: Group E (continuous epidural anesthesia, n=10), Group G+E (epidural anesthesia combined general anesthesia, n=10) and Group G (general anesthesia, n=10). The blocking level with epidural anesthesia was maintained between T(6)-L(3) with 0.75% bupivacaine followed by Patient Controlled Epidural Analgesia (PCEA). General anesthesia was finished with convention followed by Patient-Controlled Analgesia (PCA). Blood samples were taken at pre-anesthesia (T(0)), the end of operation (T(1)) and postoperative 24 h (T(2)), 72 h (T(3)) to determine catecholamine concentration, coagulation and fibrinolysis variables.The nonepinephrine (NE) levels in Group E and Group G+E were not changed throughout the procedure, but obviously elevated in Group G (P0.01) as compared with the baseline and those in the other Groups (P0.05). The epinephrine (E) levels at T(1) in all groups were markedly increased as compared with those at T(0) and peaked (P0.01), and then returned to the baseline at T(3). Fibrinogen (FIB) levels in all groups were obviously decreased at T(1), postoperatively elevated rapidly and peaked at T(3) (P0.01). FIB levels at T(3) in groups G+E and G were much higher than that in Group E (P0.05). The thrombin-anti-thrombin III complex (TAT) levels at T(1) in Group G+E and G were significantly increased as compared with those at Group E (P0.01), and subsequently recovered to pre-anesthesia following surgery. TAT level in Group E was more decreased postoperatively than the baseline and those in the other groups (P0.05). The D-dimer level in Group E over time was remarkably increased as compared with the baseline (P0.05), and the D-dimer levels peaked at T(2) in all groups (P0.01). The tissue-type plasminogen activator (t-PA) was more elevated than T(0) at T(1) (P0.01) in all groups, and then returned to normal in Group E. But the marked decrease of t-PA in Groups G+E and G was revealed 72 h after surgery and became much lower than that in Group E (P0.01). The plasminogen activating inhibitor-1(PAI-1) in Group G and Group G+E was more elevated perioperatively and became higher than that in Group E (P0.01).Epidural anesthesia can preserve fibrinolytic function after lower-abdomen surgery by the inhibitory effects on surgical stress, PAI-1 and other mechanisms. The thromboprophylactic effects are revealed only following epidural anesthesia.