Quantification of reservoir bags as airway pressure-limiting devices in a nonrebreathing system

ObjectiveTo evaluate the influence of reservoir bag types, volumes and previous use on the peak pressures (Pmax) and the times to develop 30 cmH₂O pressure (P30) within a nonrebreathing system with a closed adjustable pressure-limiting (APL) valve.Study designIn vitro study using three-way factorial design with repeated measure on one factor.SubjectsA total of 75 new anesthesia reservoir bags (five types, three volumes, five bags from each type × volume). The bag types were reusable latex (RL), disposable latex (DL) and three disposable neoprene (DN-1, DN-2 and DN-3).MethodsEach bag was tested three times (treatments): new, after prestretching and 1 week later. The bags were attached to a Bain system and anesthesia machine with closed APL valve and patient port with O₂ flow 2 L minute^–1 until Pmax was reached. The Pmax and time to reach P30 values were determined from recorded pressure traces. General linear mixed model analysis was used to examine the effects of bag type, volume and treatment. One-sided 95% upper prediction limits of Pmax were calculated to test the null hypothesis that predicted Pmax of new bags would be ≥ 50 cmH₂O for each factor combination.ResultsRL bags were the least and DN-3 bags were the most compliant. Prestretching increased compliance in all bag types. Smaller bags of RL, DL and DN-1 were less compliant than larger ones. The predicted Pmax values were < 50 cmH₂O only for DN-3 bags after prestretching. The time to reach P30 was critically low when using 0.5 L bags (median 17 seconds).Conclusions and clinical relevanceTo minimize the risk of barotrauma, highly compliant reservoir bags (e.g. DN-3) are recommended and reusable bags should be avoided. Bags should be prestretched before first use, 0.5 L bags should be avoided and fresh gas flow minimized.     

水牛脾切除术的研究

近3年来成功地作了20例水牛的脾切除术,没有1例因手术而招致死亡。成功地探索出适合于水牛脾切除术的麻醉方法、切口部位和大小、手术操作方法。     

Activation of repair pathways after neuronal DNA damage induced by bupivacaine

AIM To investigate the activation of related repair pathways after bupivacaine-induced neuronal DNA damage by cDNA gene screening. METHODS The bupivacaine-induced SH-SY5Y neuronal damage and DNA damage model was established. The technique of cDNA microplate array was used to screen the 21 important regulatory factors in the DNA damage repair pathway. Post-analysis of these differentially expressed repair genes for the repair pathway enrichment and distribution was performed. The data were analyzed by GraphPad Prism 6 statistical software to compare differences between groups. RESULTS The viability of SH-SY5Y cells treated with bupivacaine at different concentrations （detected by CCK-8 assay） showed that the IC₅₀ value of bupivacaine was 1.5 mmol/L. The comet assay related index （the comet tail） was increased （P<0.05）, the phosphorylation level of γH2AX protein was increased （P<0.05）, indicating that DNA damage in the SH-SY5Y cells was significantly aggravated after bupivacaine treatment. The results of cDNA microplate assay showed that compared withcontrol group, the differentially expressed genes after bupivacaine treatment were DNA-PKcs, PTEN, NTH1, RAD9, CSB, GADD45, XPD, XPC-HR23B and P53. The analysis showed that these repair genes were mainly concentrated in the following 3 repair mechanisms： base excision repair, nucleotide excision repair, and non-homologous reconstitution. CONCLUSION The repair genes differentially expressed after neuronal DNA damage caused by local anesthetics are mainly concentrated in the pathways of non-homologous end-joining, base excision repair and nucleotide excision repair.     

麻醉剂MS-222对金鱼体内AKP、CAT和ACP活性的影响

在实验室条件下,采用4个浓度0mg/L、30mg/L、60mg/L和90mg/L,分析了麻醉剂MS-222对金鱼鳃、肝脏和肌肉组织中碱性磷酸酶(AKP)、酸性磷酸酶(ACP)和过氧化氢酶(CAT)活性的影响。试验结果表明:ACP明显出现一个先增后降的趋势,呈抛物线状;在低浓度(≤60mg/L)下,酶活性在各组织中呈现一定的稳定状态,而当麻醉剂浓度升高和麻醉时间增长,酶活性逐渐下降。AKP在低浓度麻醉剂溶液中,酶活性有明显的增加,随着浓度的升高(≥60mg/L)和时间的增长,酶活性呈抑制状态。而在肌肉中这种情况并不明显。CAT在一定阶段(30mg/L～60mg/L)呈现稳定的状态、而后抑制逐渐明显,当麻醉剂MS-222浓度达到一定量(≥60mg/L)以后,对鱼体的刺激就不再增加了,酶活性也相对处于较稳定的状态;当麻醉剂随着时间的增长和浓度的增大时,在鱼体内富集的麻醉剂破坏鱼体内的过氧化氢酶的分子构象,使酶体失去活性。     

小型猪乳化异氟醚全身麻醉效果监测

为探讨乳化异氟醚进行小型猪全身麻醉麻醉效果,选取14头巴马猪以2.80 mL· kg-1·h-1进行静脉麻醉,在麻醉过程中对生理反射、镇痛、镇静、肌松,呼吸和循环系统进行监测.结果表明,乳化异氟醚可以使小型猪维持良好外科麻醉状态,麻醉过程中小型猪一般生理指标、循环系统指标未发生显著变化(P＞0.05),呼吸系统指标与正常比较有显著性改变(P＜0.05或P＜0.01),但均在安全范围内,小型猪麻醉过程无异常表现.乳化异氟醚能满足临床手术麻醉需要,可以作为小型猪全身麻醉药物推广应用.     

The pharmacological effects of the anesthetic alfaxalone after intramuscular administration to dogs

The pharmacological effects of the anesthetic alfaxalone were evaluated after intramuscular (IM) administration to 6 healthy beagle dogs. The dogs received three IM doses each of alfaxalone at increasing dose rates of 5 mg/kg (IM5), 7.5 mg/kg (IM7.5) and 10 mg/kg (IM10) every other day. Anesthetic effect was subjectively evaluated by using an ordinal scoring system to determine the degree of neuro-depression and the quality of anesthetic induction and recovery from anesthesia. Cardiorespiratory variables were measured using noninvasive methods. Alfaxalone administered IM produced dose-dependent neuro-depression and lateral recumbency (i.e., 36 ± 28 min, 87 ± 26 min and 115 ± 29 min after the IM5, IM7.5 and IM10 treatments, respectively). The endotracheal tube was tolerated in all dogs for 46 ± 20 and 58 ± 21 min after the IM7.5 and IM10 treatments, respectively. It was not possible to place endotracheal tubes in 5 of the 6 dogs after the IM5 treatment. Most cardiorespiratory variables remained within clinically acceptable ranges, but hypoxemia was observed by pulse oximetry for 5 to 10 min in 2 dogs receiving the IM10 treatment. Dose-dependent decreases in rectal temperature, respiratory rate and arterial blood pressure also occurred. The quality of recovery was considered satisfactory in all dogs receiving each treatment; all the dog exhibited transient muscular tremors and staggering gait. In conclusion, IM alfaxalone produced a dose-dependent anesthetic effect with relatively mild cardiorespiratory depression in dogs. However, hypoxemia may occur at higher IM doses of alfaxalone.     

Comparison of bupivacaine femoral and sciatic nerve block versus bupivacaine and morphine epidural for stifle surgery in dogs

ObjectiveTo evaluate the efficacy of combined femoral and sciatic nerve blocks as an alternative to epidural anesthesia and analgesia in dogs undergoing stifle surgery under general anesthesia.Study designProspective, blinded, randomized, clinical comparison.AnimalsTwenty dogs weighing 37 ± 11 (mean ± SD) kg, aged 3 (1–8) [median (minimum–maximum)] years undergoing elective unilateral tibial-plateau leveling osteotomy.MethodsDogs were assigned randomly to receive either epidural anesthesia (bupivacaine 0.5%, 0.5 mg kg^?1 + morphine 0.1%, 0.1 mg kg^?1, in 0.2 mL kg^?1; EPID) or femoral and sciatic nerve blocks (Bupivacaine 0.5%, 0.1 mL kg^?1, was administered at each site; F + S) guided by electrolocation. All patients received a standard general anesthesia technique. Pain and sedation were scored (on scales of 0–10 and 0–3, respectively) pre-operatively, at extubation, and at 1, 4 and then every 4 hours thereafter up to 24 hours. Postoperatively, hydromorphone was administered to any patient with a pain score of >5 or whenever the blinded caregiver determined that more hydromorphone was necessary. Intraoperative heart rate (HR), mean arterial pressure (MAP), end tidal isoflurane (FE′ISO), body temperature, post-operative pain scores, time to first hydromorphone dose after surgery, time to first feeding, time to first drinking, time to first urination, time to first ambulation (walk on a lead) and cumulative dose of hydromorphone were recorded.ResultsIntra-operatively, FE′ISO and MAP were significantly lower in the EPID group (p = 0.05 and p = 0.04, respectively). Postoperatively, the cumulative hydromorphone consumption (p = 0.04) and the incidence of urinary retention (p = 0.03) were higher in the EPID group.Conclusion and clinical relevance F + S is a practical alternative to EPID that produces less urine retention and reduces opioid consumption in the 24 hours after surgery. EPID might be associated with a lower isoflurane requirement and lower systemic blood pressure.     

小型猪复合麻醉剂对大鼠不同脑区突触体Na+,K+-ATP酶活性的影响

研究Na+,K+-ATP酶与小型猪复合麻醉剂全麻作用的关系,以判断该酶是否为该制剂作用的靶位之一.试验选取84只SD大鼠,先随机抽取12只为对照组,其余随机均分为高剂量小型猪复合麻醉剂组(腹腔注射(ip) 7.5 mg/kg)和低剂量小型猪复合麻醉剂组(5mg/kg),每个剂量组又随机均分为麻醉组、恢复Ⅰ组和恢复Ⅱ组等3个亚组.对照组注射生理盐水10 mL/kg,5 min后断头取材;麻醉组、恢复Ⅰ组和恢复Ⅱ组分别在翻正反射消失即刻、翻正反射恢复即刻和大鼠可直线爬行后断头取材.迅速分离双侧大脑皮层、海马、小脑、脑干、丘脑,立即液氮冷冻.制备脑粗突触体,采用比色法测定Na+,K+-ATP酶活性.结果表明:2个剂量麻醉组大脑皮层、脑干和丘脑突触体Na+,K+-ATP酶活性受到明显抑制(P＜0.01或P＜0.05),高剂量组小脑该酶也发生明显变化(P＜0.05).在恢复期上述脑区的该酶活性呈现不同程度恢复,与对照组相比,差异不显著(P＞0.05),海马在2剂量组未发生明显的变化.小型猪复合麻醉剂的全麻作用与抑制小脑和丘脑突触体Na+,K+-ATP酶活性相关,说明此酶可能是小型猪复合麻醉剂全麻作用的靶位之一.