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ABSTRACT: Abstract We present 2 cases of fulminant malignant hyperthermia (MH), complicated with massive rhabdomyolysis. The patients were successfully treated in the intensive care unit of our university teaching hospital, despite the lack of availability of dantrolene in our country, by early application of continuous veno-venous hemofiltration (CVVH). Both male patients developed fulminant malignant hyperthermia during anesthesia for oromaxillofacial surgery. CVVH was employed when the values of creatine phosphokinase (CPK), myoglobin (Mb), and lactate dehydrogenase (LDH) increased significantly. After emergency treatment and CVVH therapy, the values of CPK, Mb, and LDH in the blood plasma of the patients decreased significantly. The complications, including acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome were also treated without any obvious organ damage. Early detection and management are the keys to treat MH successfully. CVVH is a valuable therapeutic application in the initial/critical management of severe rhabdomyolysis. If these complications occur even with initial treatment with dantrolene, our experiences may be useful adjunctive treatments to consider.
Anesthesia Progress 01/2013; 60(1):21-24.
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ABSTRACT: Ischemia/reperfusion is an initial triggering event that leads to gut-induced acute lung injury (ALI). In this study, we investigated whether hypoxia inducible factor-1α (HIF-1α) played a role in the pathogenesis of lung injury induced by trauma and hemorrhagic shock (T/HS).
Male Wistar rats underwent laparotomy and hemorrhagic shock for 60 min. Sham-shock animals underwent laparotomy but without hemorrhagic shock. After resuscitation for 3 hr, the rats were sacrificed. Morphologic changes of the lungs and intestines were examined. Bronchoalveolar lavage fluid (BALF) was collected. Lung water content, pulmonary myeloperoxidase (MPO) activity and the levels of malondialdehyde (MDA), nitrite/nitrate, TNF-α, IL-1β, and IL-6 in the lungs were measured. The gene expression of pulmonary HIF-1α and iNOS, and HIF-1α transcriptional activity in the lungs were also assessed. The apoptosis in the lungs was determined using TUNEL assay and cleaved caspase-3 expression.
Lung and intestinal injuries induced by T/HS were characterized by histological damages and a significant increase in lung water content. Compared to the sham-shock group, the BALF cell counts, the pulmonary MPO activity and the MDA, nitrite/nitrate, TNF-α, IL-1β, and IL-6 levels in the T/HS group were significantly increased. Acute lung injury was associated with a higher degree of pulmonary HIF-1α and iNOS expression as well as apoptosis in the lungs. Intratracheal delivery of HIF-1α inhibitor YC-1 (1 mg/kg) significantly attenuated lung injury, and reduced pulmonary HIF-1α and iNOS expression and HIF-1α transcriptional activity in the T/HS group.
Local inhibition of HIF-1α by YC-1 alleviates the lung injury induced by T/HS. Our results provide novel insight into the pathogenesis of T/HS-induced ALI and a potential therapeutic application.
Acta Pharmacologica Sinica 04/2012; 33(5):635-43. · 1.95 Impact Factor
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ABSTRACT: Recent studies have shown that isoflurane protects against ischemic injury via inducible nitric oxide synthase (iNOS). Hypoxia inducible factor (HIF)-1α is a transcriptional factor that activates after cerebral ischemia. However, whether iNOS gene containing the sequence of the hypoxia response element (HRE) is a HIF-1α target during tolerance against ischemic neuronal injury induced by isoflurane post-conditioning remains unknown. In this study, we report that HIF-1α and iNOS gene expression were augmented after cerebral ischemia in rats. Furthermore, isoflurane post-conditioning resulted in greater accumulation of HIF-1α and iNOS gene expression, following by HIF-1α transcriptional activity enhancement and co-localization of HIF-1α and iNOS. Accordingly, in the primary cortical neuron cultures, silencing of HIF-1α attenuated the accumulation of iNOS and the protective effects of isoflurane post-conditioning. Our results suggest the involvement of HIF-1α in the regulation of iNOS during tolerance against cerebral ischemia induced by isoflurane post-conditioning, which provide a mechanistic basis of novel therapeutic strategies for ischemic stroke.
Brain research 03/2012; 1451:1-9. · 2.46 Impact Factor
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ABSTRACT: More and more data show isoflurane, a commonly used volatile anesthetic has dual effects on neuron fate. However, the underlying mechanisms that can explain the apparent paradox are poorly understood. Hypoxia inducible factor (HIF)-1α, a transcription factor, has been found regulating both prosurvival and prodeath pathways in the CNS. Previously, we found that isoflurane can activate HIF-1α under normoxic conditions in vitro and HIF-1α has been found to be involved in the pre-conditioning effect of isoflurane in various organs. Here, we investigated whether HIF-1α is a contributing factor in the neurodegenration in rodent primary cultured neurons and in developing rat brain. Isoflurane dose-dependently induced apoptotic neurodegeneration in neonatal rats as assessed by S100β, cleaved caspase 3 and poly-(ADP-ribose) polymerase (PARP), respectively. Notably, isoflurane up-regulates HIF-1α protein levels in vivo and in vitro during induction of neurodegeneration. Likewise, isoflurane resulted in a significant elevation of cytosonic calcium levels in neuron cultures. Furthermore, knockdown of HIF-1α expression in cultured neurons attenuated isoflurane-induced neurotoxicity. Finally, Morris water maze (MWM) test showed neonatal exposure to isoflurane impaired juvenile learning and memory ability in rats. These findings indicate that HIF-1α is involved in the neurodegeneration induced by isoflurane in the brain of neonatal rats, suggesting HIF-1α may be a candidate for the dual effects of isoflurane on neuron fate.
Journal of Neurochemistry 11/2011; 120(3):453-60. · 4.06 Impact Factor
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ABSTRACT: We hypothesised that the Blind Intubation Device (BID) would be effective for nasotracheal intubation (NTI) in anaesthetised adults with Mallampati class 3. We also hypothesised that BID may cause less haemodynamic changes due to the avoidance of direct stimulation induced by the Macintosh blade.
The purpose of the study was to compare the effectiveness of the BID with the Macintosh laryngoscope for NTI in anaesthetised adults with Mallampati class 3.
A prospective randomised controlled study.
Operation unit in a University Hospital in Shanghai. Period of the study was from September to November 2010.
Mallampati class 3 adults requiring NTI for elective oral and maxillofacial surgery were randomly assigned to a BID group (n = 25) or a Macintosh laryngoscope group (ML group) (n = 25).
After anaesthesia induction, patients were intubated by a single anaesthesiologist experienced in using both devices.
The mean arterial pressure (MAP) and heart rate (HR) were recorded at specific time points. NTI duration and success rate was compared. Epistaxis-associated and NTI-associated postoperative complications were assessed.
Compared with baseline values, there was a significant increase in MAP in both the BID and ML groups which persisted significantly longer in the ML group. The BID group showed a significantly attenuated MAP value within 30-60 s. The difference between the maximum MAP and the post-induction value was significantly greater in the ML group than in the BID group (64.4 ± 16.1 vs. 45.9 ± 16.1 mmHg, P = 0.0003). Compared with baseline values, there was a significant increase in HR in both groups which persisted longer in the ML group. There was a significantly higher first attempt success rate in the BID group compared with the ML group (100 vs. 76%, respectively, P = 0.022). The NTI duration was 36 s [interquartile range (IQR) 32-40] in the BID group and 33 s (IQR 25.5-41.5) in the ML group. Epistaxis during NTI was less frequent and less severe in the BID group (P = 0.031).
In adults with Mallampati class 3, NTI using the BID caused an attenuated haemodynamic response and showed a higher success rate on the first attempt without increasing adverse events. The BID is an effective alternative to the Macintosh laryngoscope for NTI in anaesthetised adults with Mallampati class 3.
Clinicaltrials.gov identifier: NCT 01170455.
European Journal of Anaesthesiology 08/2011; 28(11):774-80. · 2.23 Impact Factor
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ABSTRACT: Accumulating data suggested that hypoxia inducible factor (HIF)-1alpha plays an important role in the evolution and propagation of the inflammatory process. To characterize the activation of HIF-1alpha in rats with chronic obstructive pulmonary disease (COPD) and examine the possible role of nuclear factor (NF)-kappaB in this process, rats were challenged by introtracheal instillation of lipopolysaccharide (LPS) and exposure to cigarette smoke. Pyrrolidine dithiocarbamate (PDTC) was administered via the oral route 1 h before LPS or cigarettes administration. Four weeks later, pulmonary function and histology were tested; bronchoalveolar lavage fluid (BALF) and arterial blood gases were assayed. Activation of pulmonary NF-kappaB was assessed by quantitative PCR, immunoblot analysis, and electrophoretic mobility shift assay, respectively. Results showed that LPS and smog induced the characteristics of COPD seen in human. PDTC alleviated the development of COPD and the levels of cytokines in BALF of PDTC+COPD group were significantly decreased compared with that of COPD group. The activation of pulmonary NF-kappaB was inhibited by PDTC and the accumulation of HIF-1alpha gene expression in the COPD group was attenuated by PDTC pretreatment. Furthermore, the mRNA levels of HIF-1alpha target genes heme oxygenase-1 (HO-1) and vascular endothelial growth factor (VEGF) were parallel to the attenuation of HIF-1alpha by PDTC. These findings indicated that the activation of HIF-1alpha pathway via NF-kappaB contributes to the development of COPD, and administration of NF-kappaB inhibitor may attenuate the development of COPD.
Acta Biochimica et Biophysica Sinica 07/2010; 42(7):483-8. · 1.38 Impact Factor
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ABSTRACT: The blind intubation device (BID) was introduced for awake nasotracheal intubation recently. The aim of this study was to compare the cardiovascular responses and associated airway complications of fibreoptic bronchoscope (FOB) with those of BID. The intubation attempts and intubation time were also compared.
Forty-one ASA grade I or II normotensive adult patients with difficult airways, requiring nasotracheal intubation for elective oral and maxillofacial or plastic surgery, were randomly assigned to intubation with either FOB (n = 21) or BID (n = 20). The cardiovascular values were invasively measured at specific time points. Postoperative airway complications were assessed using a questionnaire.
Nasotracheal intubation was successful in both groups (100%). After sedation, blood pressure (BP) decreased significantly compared with baseline values in both groups (P < 0.05). Compared with baseline or postsedation values, both devices led to significant increases in BP when we inserted the endotracheal tube or the oesophagus airway through the nasal cavity (P < 0.05), while heart rate did not change significantly. Passing the FOB or light-guided catheter through the vocal cord and advancing the endotracheal tube into the trachea caused significant increases in both BP and heart rate compared with baseline or postsedation values (P < 0.05). No significant difference in BP or heart rate between the two groups was found. The intubation time was similar (P = 0.13). Blood detected on the intubation devices was similar in both groups (P = 0.73). Nasal pain, sore throat and hoarseness observed after 24 h was also similar (P = 0.49, 0.36, 0.51, respectively).
Both FOB and BID caused similarly slight cardiovascular responses during awake nasotracheal intubation in normotensive adults. The intubation-associated airway complications were similar.
European Journal of Anaesthesiology 05/2010; 27(5):461-7. · 2.23 Impact Factor
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ABSTRACT: The transcription factor hypoxia-inducible factor (HIF)-1 plays a central physiological role in oxygen and energy homeostasis, and is activated during hypoxia by stabilization of the subunit HIF-1α. Recent studies have demonstrated that non-hypoxic stimuli can also activate HIF-1α in a cell-specific manner. Here, we demonstrate that stimulation of BEAS-2B cells and primary human bronchial epithelial cells by proinflammatory cytokines TNFα/IL-4 strongly induced expression and transcriptional activity of HIF-1α under normoxic conditions and amplified hypoxic HIF-1α activation. TNFα/IL-4 stimulated de novo HIF-1α gene transcription and translation rather than affected HIF-1α protein degradation and mRNA decay process. The activation of HIF-1α by TNFα/IL-4 was countered by the phosphoinositol 3-kinase (PI3K) inhibitor LY-294002 and rapamycin, an antagonist of mammalian target of rapamycin (mTOR), but not by inhibition of the MAPK pathway. In line, TNFα/IL-4 also activated NF-κB, whereas blocking of NF-κB by an inhibitor or silencing NF-κB subunit p65 attenuated HIF-1α activation by TNFα/IL-4. We also found the collaborative induction of VEGF, a potent angiogenic factor required for airway remodeling, by TNFα/IL-4 and hypoxia partially via HIF-1α pathway in BEAS-2B cells. This study reports the previously unsuspected collaborative regulation of HIF-1α by TNFα/IL-4 and hypoxia in bronchial epithelial cells partially via PI3K-mTOR and NF-κB pathway, and thereby will lead to the elucidation of the importance of HIF-1 in integrating inflammatory and hypoxic response in the pathogenesis of airway diseases.
AJP Lung Cellular and Molecular Physiology 02/2010; 298(5):L660-9. · 3.66 Impact Factor
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ABSTRACT: The effects of isoflurane pretreatment on pulmonary proinflammatory cytokines and survival in severe endotoxin-induced acute lung injury (ALI) have not been studied systemically. We investigated the effect of preadministration of isoflurane on ALI induced by lipopolysaccharide (LPS) in rats.
Male Sprague-Dawley rats weighing 250-300 g were randomly assigned to 1 of 4 groups: sham rats (injected intraperitoneally [IP] with saline) pretreated with vehicle (100% O(2)) (sham-vehicle); sham rats pretreated with isoflurane (sham-ISO); LPS rats (injected IP with LPS) pretreated with vehicle (vehicle-LPS); and LPS rats pretreated with isoflurane (ISO-LPS). Endotoxemia was induced by IP injection of LPS. Isoflurane 1.4% was administered 30 min before LPS injection. The animals were then observed for 6 h. We monitored arterial blood pressure, heart rate, and blood gas. The extent of ALI was evaluated by lung wet/dry ratio, Evans blue dye extravasation, and histologic examination. We also measured pulmonary nitric oxide (NO), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 levels. In addition, survival statistics and pulmonary inducible NO synthase (iNOS) gene expression were also determined.
LPS caused systemic hypotension and severe ALI, as evidenced by the increases in the extent of ALI, impairment of pulmonary functions, and increases in pulmonary NO, TNF-alpha, IL-1beta, and IL-6. Isoflurane preconditioning mitigated systemic hypotension and the development of ALI. Isoflurane preconditioning also attenuated the LPS-induced increases in pulmonary nitrate/nitrite and proinflammatory cytokine release and improved survival of rats with severe sepsis. The expression of iNOS was upregulated by LPS and reduced by isoflurane pretreatment.
Isoflurane preconditioning can attenuate pulmonary proinflammatory cytokine release and decrease the mortality induced by severe sepsis. Early protection seems to be mediated partly through inhibition of iNOS-NO pathway activation.
Anesthesia and analgesia 11/2009; 109(5):1591-7. · 3.08 Impact Factor
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ABSTRACT: The blind intubation device is a newly developed light-guided intubation device for difficult nasotracheal intubation. The aim of this study was to evaluate its performance in adult patients with anticipated difficult airways.
One hundred consecutive patients who required general anaesthesia with nasotracheal intubation for elective oral and maxillofacial surgery between March 2008 and August 2008 were recruited. In each case, the time for oesophagus airway successful placement, the attempts of the light-guiding catheter insertion into the trachea, the attempts of the endotracheal tube intubation over the light-guiding catheter and the time from the oesophagus airway placement to the completion of endotracheal intubation were recorded. The associated complications were also recorded.
Fifty-nine male and 41 female patients were studied. Each of the patients had at least temporomandibular joint ankylosis, maxillary and mandibular fracture, oral cancer, obstructive sleep apnoea syndrome, mandibular hypoplasia and micrognathia and cervical tumour. The oesophagus airway was directly inserted into the trachea in six patients. The placement of the oesophagus airway was successful in remaining 94 patients. The median (interquartile range) time for the oesophagus airway placement was 47 (25-178) s. The overall success rate of the light-guiding catheter insertion was 95.0%. The overall success rate of the ETT intubation over the light-guiding catheter was 95.0%. The median (interquartile range) time for complete tracheal intubation process was 194 (22-380) s. There was no episode of hypoxaemia during tracheal intubation. In 28 (29.5%) of our patients, there was a small amount of blood present in the tip of the oesophagus airways or around the inner wall of the endotracheal tubes. No serious epistaxis was found either.
We have demonstrated the safe and effective use of the blind intubation device in 100 adult patients with anticipated difficult airways. The overall success rates of the oesophagus airway placement, the light-guiding catheter insertion and nasotracheal intubation over the light-guiding catheter were really satisfied. This technique could improve the success of blind nasal intubation, especially in situations in which fibreoptic equipment was unavailable. However, further studies are still required.
European Journal of Anaesthesiology 06/2009; 26(9):746-51. · 2.23 Impact Factor
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ABSTRACT: The aim of this study was to investigate the anti-inflammatory action of isoflurane preconditioning in a model of lipopolysaccharide (LPS)-induced inflammation in RAW 264.7 macrophages and examine the role of heme oxygenase (HO)-1 in this process.
Murine 264.7 macrophages were pretreated with or without 1%-3% isoflurane for 1 h. Thirty minutes later, the cells were incubated with or without LPS for 24 h. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and cell injury was assessed by measuring the release of lactate dehydrogenase (LDH). HO-1 and inducible nitric oxide synthase (iNOS) protein expression was analyzed by Western blotting. Tumor necrosis factor (TNF)-alpha levels, nitrite production and HO activity were also determined.
Pretreatment with the nontoxic and clinically approved anesthetic isoflurane potently attenuated the cell injury and the decrease in cell viability that was induced by LPS. Treatment or pretreatment with 2% isoflurane induced HO-1 protein expression and caused an induction of HO activity. This result correlated with a decrease in iNOS expression, a decrease in the production of nitric oxide (NO) and impaired release of TNF-alpha in LPS-stimulated macrophages. Blockade of HO activity with tin protoporphyrin (SnPP) reversed these effects.
Isoflurane preconditioning exerts its anti-inflammatory activity through the HO-1 pathway in an in vitro inflammation model.
Acta Pharmacologica Sinica 02/2009; 30(2):228-34. · 1.95 Impact Factor
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ABSTRACT: Heme oxygenase (HO) is the rate-limiting enzyme in the degradation of heme to produce bile pigments and carbon monoxide. The HO-1 isozyme is induced by a variety of factors such as heat, heme, ischemia, and hydrogen peroxide. In recent years, mounting findings have suggested that HO-1 has a neuroprotective activity against ischemic injury. The neuroprotective role of isoflurane, a commonly used anesthetic, has been well documented, but little is known about the underlying mechanisms involved. Recently, isoflurane has been shown to up-regulate HO-1 in the liver. In this study, we show that isoflurane preconditioning promotes the survival of cultured ischemic hippocampal neurons by increasing the number of surviving neurons and their viability. Further study by reverse transcription-polymerase chain reaction and Western blot analysis showed that isoflurane preconditioning significantly increases HO-1 expression in oxygen glucose deprivation (OGD)-induced neuronal injury. Furthermore, inhibition of HO activity by tin protoporphyrin partially abolishes isoflurane preconditioning's protective effect as measured by lactate dehydrogenase release in OGD neurons. These findings indicated that the neuroprotective role of isoflurane preconditioning against OGD-induced injury might be associated with its role in up-regulating HO-1 in ischemic neurons.
Acta Biochimica et Biophysica Sinica 10/2008; 40(9):803-10. · 1.38 Impact Factor
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ABSTRACT: Difficult airway is one of the main problems which attract much attention from the anesthesiologists, many clinical standards are used to predict the patient's airway, but the investigation of using radiological measurements to predict difficult intubation is seldom carried out. This study combined the previous researches to establish a system of using cephalometrics to predict difficult intubation.
Patients who underwent general anesthesia were involved with preoperative cephalometric examination. The way to take radiographs was as follows: X-ray cephalometric were casted from left to right, parameters were 80kV, 10mA, the time of exposal was 2 seconds. All of the X-ray cephalometric radiographs were scanned into computer, then measured with the software of "CASSOS 2001".
22 cephalometric parameters including soft tissues, hard tissues, airway space and hyoid could be measured.
X-ray cephalometric radiography may achieve difficult intubation prediction, but the efficiency and accuracy of this technique need further evaluation.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 09/2008; 17(4):434-7.
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ABSTRACT: To assess the relationship between GABAA receptor in rats's medulla and injury of rats's trigeminal nerve by using real-time polymerase chain reaction(PCR).
Twenty SD rats were divided into four groups randomly, five rats in each group. Group A and group C were surgical groups, Group B and group D were sham surgical groups. In the surgical group, right unilateral chronical constriction injury(CCI) of rat was produced by placing loose chromic gut ligature around the infraorbital nerve(ION). In the sham surgical group, the ION was only exposed using the same procedure but not ligated. Mechanical response threshold was observed before operation and 3, 6, 9, 12, 15 days after operation. Medullas of rats in group A and B were taken to measure the quantity of GABA(Aalpha1),GABA(Aalpha2),GABA(Aalpha3) receptor by real-time PCR 9 days after operation, and medullas of rats in group C and D were done 15 days after operation. The data were analysed by Students's t test by SAS6.12 software package.
Compared with the sham surgical group, an allodynia to mechanical stimulation on the territory of ligated ION was found from the 9th to 15th day after operation in the surgical group(P<0.05).There was no difference in GABA(Aalpha1) receptor, GABA(Aalpha2) receptor, GABA(Aalpha3) receptor between group A and group C, also there was no difference in GABA(Aalpha1) receptor, GABA(Aalpha2) receptor, GABA(Aalpha3) receptor between group B and group D.
CCI-ION can result in trigeminal neuralgia on rat. Trigeminal neuralgia of rat may not be associated with GABA(Aalpha1) receptor, GABA(Aalpha2) receptor and GABA(Aalpha3) receptor.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 06/2007; 16(3):303-6.
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ABSTRACT: A male patient, aged 7 years, was intended to undergo plastic surgery under general anesthesia with tracheal intubation for his severe facial abnormities as a result of 5, 6, 7 combined facial clefts. Because of his severe facial abnormities and preoperative undetected bilateral antiadoncus, during the period of induction, dyspnoea and dysventilation took place, which were relieved by inserting a medium-sized oropharyngeal airway with difficulty; during euthyphoirally exploring his endolarynx with direct laryngoscope, laryngospasm occurred, which was relieved through inserting airway and pressurizing ventilation; repetitively attempted to blindly insert tracheal intubation through nostril, but failed. Finally, his intubation was achieved by blindly intubating through oral cavity under the assistance of direct laryngoscope.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 11/2004; 13(5):471-2.
