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BackgroundIntranasal dexmedetomidine, a well-tolerated and convenient treatment option, has been shown to induce a favorable perioperative anxiolysis in children. We investigate intranasal dexmedetomidine as a sedative premedication for anesthesia recovery in an adult population.MethodsA prospective randomized controlled trial; 81 adult patients scheduled for elective suspension laryngoscopy received intranasal dexmedetomidine (1 μg∙kg–1) or a placebo 45–60 min before anesthetic induction. Extubation time was used as the primary outcome measure. Secondary variables included the levels of sedation (Observer’s Assessment of Alertness/Sedation scale, OAA/S) and anxiety (4-point anxiety score), anesthetic and analgesic requirements, hemodynamic fluctuations, and anesthesia recovery as well as side effects.ResultsThe levels of sedation and anxiety differed significantly between the two groups at anesthesia pre-induction (p < 0.001 and = 0.001, respectively). Repeated-measure general linear model determined no significant interaction effect between group and time on the targeted concentration of propofol (F = 1.635, p = 0.200), but a significant main effect of group existed (F = 6.880, p = 0.010). A moderate but significant decrease in the heart rate was recorded in the dexmedetomidine group at pre-induction. Episodes of tachycardia and hypertension after tracheal intubation and extubation were more frequent in the placebo group.ConclusionsIntranasal dexmedetomidine as a sedative premedication induced a favorable perioperative anxiolysis without prolongation in anesthesia recovery; the hemodynamic effect was modest.Trial RegistrationClinicalTrials.gov NCT 02108171

Abstract. Septic encephalopathy (SE) is a diffuse cerebral dysfunction resulting from a systemic inflammatory response, and is associated with an increased risk of mortality. The pathogenesis of SE is complex and multifactorial, but unregulated immune imbalance may be an important factor. The current retrospective study examined the clinical data of 86 patients with severe sepsis who were admitted to the Intensive Care Unit at Zhongshan Hospital, Xiamen University (Xiamen, China) from January, 2014 to January, 2015. The patients were assigned to SE and non-SE patient groups according to the presence or absence of SE. The proportion of T-lymphocyte subsets and natural killer (NK) cells in the immune cell population, representing the function of the immune system, were analyzed for their association with SE and compared with other clinical predictors and biomarkers. + T-lymphocytes were demonstrated to be independently associated with SE (respectively, P=0. 012 and OR, 4.763; P=0.005 and OR, 0.810). An area under the curve analysis of a receiver operating characteristic curve of the two indicators revealed that these were equally powerful measures in prediction of SE (Z=1.247, P>0.05). The present results confirm that SE leads to higher mortality in patients with severe sepsis, and demonstrate that immune imbalance is important in the development of SE. The proportion of CD4 + T-lymphocytes present were revealed in the current study to be a powerful predictor of SE in patients with severe sepsis.

Heat stroke often leads to multiple organ dysfunction syndrome (MODS) with a neurological morbidity of 30%. Current studies suggested that pathophysiological responses to heat stroke may be due to a systemic inflammatory response syndrome and a series of peptidergic nerve reactions. The mechanisms underlying the high neurological morbidity in heat stroke have remained largely elusive. In recent years, calcitonin gene-related peptide (CGRP) has been considered to have a positive role in central nervous system injury. The present study investigated the influence of CGRP on brain injury induced by heat stroke. A rat model of heat stroke was established in a pre-warmed artificial climate chamber with a temperature of 35.5±0.5°C and a relative humidity of 60±5%. The rectal core temperature (Tc) was monitored. Heat stress was halted at a Tc of no more than 41°C A bolus injection of CGRP was administered to each rat in the HS+CGRP group and a bolus injection of CGRP8-37 was administered to each rat in the HS+CGRP8-37 group after heat stress. After 2 h, electroencephalograms were recorded and the pathological morphology of brain tissue as well as brain cell apoptosis and caspase-3 protein levels in the brain were measured. The EEG of rats in the HS+CGRP group was characterized by a short- to long-term α-wave and low-voltage β-waves as well as a large amount of intermittent δ- and θ-waves. Compared with the HS group, the θ-wave decreased and the α-wave increased significantly (P<0.05). Slight pathological damage of nerve cells appeared in the HS+CGRP group. Greater damage was observed in HS+CGRP8-37 group with neural cell shrinkage, volume reduction, nuclear pyknosis, disappearance of part of the nuclear membrane and cell necrosis. In the HS+CGRP group, apoptotic cells and caspase-3 protein in the brain were significantly decreased when compared with those in the HS group (P<0.05), while they were significantly increased in the HS+CGRP8-37 group (P<0.05 vs. HS group). The results of the present study reflected that CGRP has a protective effect on early-stage brain injury induced by heat stroke in rats.

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BackgroundTraditional cardiac surgical anesthesia is characterized by the use of large doses of opioids, accompanied by side effects such as oversedation, respiratory depression, long ventilator duration, prolonged ICU stay, opioid tolerance, addiction, and postoperative delirium. Fast track cardiac anesthesia under the Enhanced Recovery After Surgery (ERAS) concept requires quick recovery, rapid extubation, reduced perioperative opioid dosage and shorter ICU stay. An emerging regional block technique, transverse thoracic muscle plane block (TTPB) covers the Thoracic 2-6 (T2-T6) intercostal nerves and recluse sheath block (RSB), which can effectively relieve perioperative pain during median sternotomy. Bilateral TTPB plus RSB is expected to be a new analgesic mode in perioperative thoracotomy.MethodsThis is a single-center, randomized, double-blind, parallel controlled clinical trial. Eighty patients planning to undergo coronary artery bypass grafting or heart valve surgery via median sternotomy were randomly assigned 1:1 to the experimental group or control group. After general anesthesia, all subjects were injected with 0.3% ropivacaine (experimental group) or 0.9% normal saline (control group) 15ml (TTPB)and 10ml (RSB) on each side after insertion guided by B-ultrasound by anesthesiologist. The main outcomes were the threshold of incision pain and the total amount of analgesics used during the operation and 48h after the operation. Secondary outcomes were as follows: postoperative VAS score, duration of mechanical ventilation, length of stay in ICU, and hospitalization cost. In addition, random assignment is a computer program that generates random results. Patients, operators, and evaluators were grouped in a blind manner.DiscussionThe TTPB plus RSB on transthoracic median incision heart surgery is just a ramification of nerve block anesthesia. Thanks to the visualization development of ultrasound, the safety factor of TTPB and RSB is greatly improved and the block effect is more accurate, which provides a guarantee for the application. This study will provide evidence-based medical evidence and clinical data support for the application of TTPB and RSB in cardiac surgery.Trial registrationClinicalTrials.gov, NCT04838132. Registered 8 April 2021.Verson1.2. https://clinicaltrials.gov/ct2/show/NCT04838132?term=NCT04838132&draw=2&rank=1

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