To investigate the protective effect of propofol on ischemia/reperfusion induced spinal cord injury in rabbits and its influence on excitatory amino acid (EAA). Methods Sixty New Zealand white rabbits weighing 2.0-2.5 kg, half males and half females, were selected. The infrarenal circumaortic clamping model was used. And 6 mL/kg different fluids were continuously infused through a catheter into the aorta distal to the clamping site at a speed of 12 mL/(kg•h) during the 30 minutes ischemia period. According to the different infusing l iquids, the rabbits were randomized into 6 groups(n=10 per group): group A, normal sal ine; group B, 10% intral ipid; group C, propofol 30 mg/kg; group D, propofol 40 mg/kg; group E, propofol 50 mg/kg; group F, propofol 60 mg/kg. At 0, 6, 24, and 48 hours after reperfusion, neurologic outcomes were scored on a Tarlov scale system. At 48 hours after reperfusion, the number of normal neurons in the anterior spinal cord was counted, and concentration of EAA in the lumbar spinal cord was measured by high performance l iquid chromatography. Results The neuroethological score was better in groups C, D, E and F than that of groups A and B (P lt; 0.05), the score of group E was the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The number of normal neurons in the anterior spinal cord of groups C, D, E and F was greater than that of groups A and B (P lt; 0.05), and group E was greater than groups C, D and F (P lt; 0.05). The concentration of EAA in groups A, B, C, D, E and F was greater than that of normal tissue, the group E was the lowest (P lt; 0.05), the groups A and B were the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). Concentrations of glutamate and aspartic acid were negatively correlated to normal neuron numbers in the anterior spinal cord and neuroethological scores 48 hours after reperfusion, and the corresponding correlation coefficient was — 0.613, — 0.536, — 0.874 and — 0.813, respectively (P lt; 0.01). Conclusion Propofol can significantly inhibit the accumulation of EAA in spinal cord and provide a protective effect against the ischemia/reperfusion injury induced spinal cord in rabbits.
Objective To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in preventing propofol injection induced pain. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2012), CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that: a) the incidence of propofol injection induced pain in the 5-HT3 group was obviously lower than the control group (RR=0.14, 95%CI 0.09 to 0.21, Plt;0.000 01); b) as to the severity of pain, there was no statistical difference between the two groups (RR=0.84, 95%CI 0.56 to 1.26, P=0.39); the 5-HT3 group was obviously lower that the control group in the incidence of both moderate pain (RR=0.25, 95%CI 0.19 to 0.34, Plt;0.000 01) and severe pain (RR=0.16, 95%CI 0.10 to 0.24, Plt;0.000 01); and c) as to the incidence of postoperative adverse reaction: the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting (RR=0.19, 95%CI 0.11 to 0.34, Plt;0.000 01) and shivering (RR=0.20, 95%CI 0.12 to 0.33, Plt;0.000 01) as well. Conclusion 5-HT3 receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
Objective To investigate the changes of interleukin-17 ( IL-17) and the effects of propofol in rats with acute lung injury ( ALI) . Methods ALI model was established by hydrochloric acid ( HCl) inhalation in a dose of 2 mL/kg. 35 adultmale SD rats were randomly divided into seven groups, ie.a control group, a HCl group, and five propofol groups ( T24b , T12b , T0 , T1a , T3a groups, respectively) . The T0 ,T24b and T12b groups were pretreated with intraperitoneal propofol injection 0, 24 and 12 hours respectively before HCl inhalation. The T1a and T3a groups were managed by intraperitoneal propofol injection 1 and 3 hours respectively after HCl inhalation. Immunohistochemistry was used to determine the expression of IL-17 in lung tissue. ELISA was adopted to detect the levels of IL-17 and IL-8 in lung tissue homogenate as well as in bronchoalveolar lavage fluid ( BALF) , meanwhile arterial partial pressure of oxygen ( PaO2 ) and myeloperoxidase ( MPO) were measured. Results Those rats in the HCl group appeared respiratory distress, cyanosis, pulmonary edema, and inflammatory cells infiltration in lung tissues after HCl inhalation.The IL-17 levels in lung tissue homogenate as well as in BALF were higher in the HCl group than those in the control group( all P lt; 0. 01) . IL-17 was mainly expressed in alveolar epithelial cells and mononuclear cells in the ALI rats and its expression level was higher than that in the control group. IL-17 concentration in lung tissue homogenate was both correlated with IL-8 concentration in lung tissue homogenate ( r=0. 98, P =0.003) and with the activity of MPO in lung tissue( r=0. 981, P =0. 003) in the HCl group. Mainwhile, a same significant correlation was found between IL-8 level in lung tissue homogenate and the MPO activity in the HCl group( r =0. 961, P =0. 009) . Propofol attenuated lung injury induced by HCl inhalation, especially in T24b group. The concentrations of IL-17 in lung tissue homogenate and in BALF were lower in T24b group when compared with the HCl group( P = 0. 011, P =0. 003, respectively) . Conclusions The expression of IL-17 increases in ALI rats. Pretreatment with propofol by 24 hours has obvious inhibiting effects on inflammatory reaction. Inhibiting IL-17 expression may be one of the mechanisms through which propofol inhibits the inflammatory reaction of ALI.
To investigate the effect of propofol intra-aortic and intravenous infusion on the concentration of propofol for an ischemia-reperfusion spinal cord injury in rabbits. Methods Forty-six healthy adult New Zealand white rabbits were randomly divided into 3 groups: sal ine infusion group (group N, n=10), propofol intra-aortic infusion group (group A, n=16) and propofol intravenous infusion group (group V, n=16). The infrarenal abdominal aorta was occluded for 30 min during which propofol 50 mg/kg was infused continuously intra-aortic or intravenous with a pump in group A and V. In group N, the same volume of normal sal ine was infused in the same way and at the same rate as in group A. Upon reperfusion, propofol concentration of the spinal segments of L4-6 and T6-8 was examined in group A and V. At 48 hoursafter reperfusion, the neurological outcomes were recorded in each group. Results Mean blood pressure in group V from the time of 5 minutes after occlusion decreased more than in group N (P lt; 0.05) and than in group A from the time of 10 minutes after occlusion(P lt; 0.05). The mean blood pressure in group N increased more than in group A from 15 minutes after occlusion (P lt; 0.05). The heart rate increased more in group V from 10 minutes after occlusion than in group N and A (P lt; 0.05) in which no difference was observed. The propofol concentration in L4-6 of group A (26 950.5 ± 30 242.3) ng/g was higher than that in T6-8 of group A (3 587.4 ± 2 479.3) ng/g and both L4-6 (3 045.9 ± 2 252.9) ng/g and T6-8 (3 181.1 ± 1 720.9) ng/g of group V(P lt; 0.05). The paraplegia incidence was lower (30%) and the median of normal neurons was higher (8.4) in group A than in group N (80%, 2.2) and group V(100%, 1.9), (P lt; 0.05). There was no significant difference in group N and V in paraplegia incidenceand the median of normal neurons (P gt; 0.05). Conclusion Intra-aortic infusion shows a better neurological outcome than intravenous infusion and could contribute to higher concentration of propofol in the ischemia spinal cord.
Objective To systematically review the effects of lidocaine for preventing pain on injection of propofol. Methods Databases including The Cochrane Library (Issue 4, 2012), PubMed, MEDLINE, Ovid, HighWire, EMbase, CBM and CNKI were searched electronically to collect literature published from January, 1985 to December, 2012. Randomized controlled trials (RCTs) were indentified about lidocaine for preventing injection pain of propofol. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Fifteen trials involved 1 332 patients were included. The results of meta-analysis indicated that, adding lidocaine into propofol lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.36, 95%CI 0.30 to 0.44, Plt;0.000 01); using different doses of lidocaine before injection lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.59, 95%CI 0.47 to 0.75, Plt;0.000 1); using different doses of lidocaine after venous occlusion lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.44, 95%CI 0.37 to 0.52, Plt;0.000 01). Conclusion Lidocaine could reduce the pain on injection of propofol. Using lidocaine 40 mg after venous occlusion is a relatively effective method to lower the incidence of pain on injection which is more suitable for outpatient who receive intravenous anesthesia without preoperation medication.
ObjectiveTo evaluate the effects of sevoflurane and propofol on preoperative implicit and explicit memories in general anaesthesia patients of elective surgery. MethodsThe surgical inpatients in Sichuan Provincial People's Hospital were enrolled from December 2013 to May 2014, and were randomly divided into three groups (S, P, M). In Group S, anesthesia was induced and maintained with sevoflurane. In Group P, anesthesia was induced and maintained with propofol. Midazolam was not utilized throughout the whole anaesthesia for the above groups. Patients in Group S and Group P were given a list of test materials to remember and listen before the anesthesia. Within 12 to 36 hours after operation, memory was assessed, based on the Buchner's model applied on the process dissociation procedure (PDP) using a phrases task. The Group M was given the same test materials, and received test with the PDP in 12 to 36 hours before surgery. Value A and value R were used to represent the implicit memory score and the explicit memory score, respectively. ResultsA total of 150 patients were included, and 50 cases were included in each group. During testing, 2 cases were excluded, 3 cases were loss to follow-up, so finally 49 cases were included in the Group S, 47 cases in the Group P and 49 cases in the Group M. The results showed that there were significant differences in the implicit memory score (A) and the explicit memory score (R) among the three groups (all P values <0.05). The explicit memory score (R) of the Group M was higher than those of the Group P and Group S (all P values <0.05), the implicit memory score (A) in the Group M was higher than those of the Group S and Group P (all P values <0.05), and the implicit memory score (A) in the Group S was higher than that of the Group P (P<0.05). ConclusionPropofol and sevoflurane can decrease the score of explicit memory after anesthesia within 12 to 36 hours, and there are no significant differences in explicit memory between the two drugs. Both propofol and sevoflurane can decrease the score of implicit memory, but the influence of sevoflurane on the implicit memory is less than propofol within 12 to 36 hours.
ObjectiveTo study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients, and compare its efficacy with brachial plexus block anesthesia. MethodsSeventy elderly patients (American Sociaty of Anesthesiologist physical statusⅠ-Ⅱ) who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups, each group having 35 cases. Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset, while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction. After successful anesthesia, two groups of patients were treated with traction and foot pedal method (Hippocrates) to reset. We observed the two groups of patients in the process of reduction, and recorded their hemodynamic changes, reset time, discharge time, postoperative satisfaction, intra-operative memory, breathing forgotten (breathing interval was longer than 15 seconds) and visual analogue scale (VAS) scores, and then comparison was made between the two groups. ResultsPatients in both the two groups successfully completed manipulative reduction. Compared with group A, patients in group B had more stable hemodynamic indexes during the process of reduction, shorter reduction time, better anesthesia effect and higher postoperative satisfaction degree, and the differences were statistically significant (P<0.05). There was no significant difference in terms of time of leaving the operation room between the two groups (P>0.05). VAS score was higher in group A than that in group B (P<0.05). The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B, but they did not occur in patients in group A. ConclusionRemifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients for shoulder joint dislocation reconstructive surgery, and it functions quickly with complete analgesia and stable hemodynamic indexes.
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.