Wen Ouyang

The application of dexmedetomidine in patient sedation is generally accepted, though its clinical application is limited because of the lack of information detailing the specific properties among diverse populations of patients. The aim of this study was to compare the pharmacokinetic and pharmacodynamic characteristics of dexmedetomidine between elderly and young patients during spinal anesthesia.

Summary: Aim: Postoperative cognitive dysfunction (POCD) is a growing and largely underestimated problem without defined etiology. Herein, we sought to determine the relationship between cognitive decline, blood–brain barrier (BBB) permeability, and inflammation, namely high mobility group box‐1 (HMGB1), after surgery in aged rats.Methods: Aged rats were randomly assigned as surgery group (n = 45, splenectomy under general anesthesia), anesthesia (n = 45, 2% isoflurane for 2 h), and naïve control (n = 15). Markers of inflammation were measured in plasma and brain. Blood–brain barrier ultrastructure and permeability were measured by transmission electron microscope (TEM) and IgG immunohistochemistry. Cognitive function was assessed in a reversal learning version of the Morris water maze (MWM).Results: Surgical trauma under general anesthesia caused distinct changes in systemic and central proinflammatory cytokines. Levels of HMGB1 and the receptor for advanced glycation end products (RAGE) were significantly upregulated in the hippocampus of operated animals. Immunohistochemistry and TEM showed BBB disruption induced by surgery and anesthesia. These molecular changes were associated with cognitive impairment in latency with the MWM up to postoperative day 3.Conclusions: HMGB1 and RAGE signaling appear pivotal mediators of surgery‐induced cognitive decline and may contribute to the changes in BBB permeability after peripheral surgical trauma.

To investigate the delayed alteration of hippocampus proteome after anesthesia with isoflurane in adult and aged rats. Ten 8-month-old SD rats were randomly divided into group C adult and group I adult (5 in each group), and another ten 22-month-old SD rats were randomly divided into group C aged and group I aged (5 in each group).The rats in group I adult and group I aged received 2 h anesthesia with 1.2% isoflurane. The rats in group C adult and group C aged inhaled 40% oxygen for contrast. The hippocampal proteome of each rat was measured by 2-dimensional gel electrophoresis and mass spectrometry. The vital signs of the rats in group I adult and group I aged were stable. There were 878+/-34 protein spots in group C adult, 864+/-49 protein spots in group I adult, 834+/-47 in group C aged, and 819+/-24 in group I aged. There were 12(4/8)different protein spots between group I adult and group C adult. There were 11(3/8)different protein spots between group I aged and group C aged. All of the protein spots were identified by MALDI-TOF-MS. Most of the different proteins were related to metabolism, anti-oxidation, and signal conditioning of synapse. Isoflurane may cause the alteration of hippocampal proteome in rats, which is age-related.

To compare the effect of three different anesthesias on gastrointestinal motility after laparoscopic cholecystectomy (LC). Forty-two patients undergoing LC were randomly allocated to the combined epidural-general anesthesia group (Group A, n = 14), propofol-based total intravenous anesthesia group (Group B, n = 14) and isoflurane-based inhalational-intravenous general anesthesia group (Group G, n = 14). The concentration of plasma motilin was measured; the incidence of postoperative nausea and vomiting and the first flatus time were observed; and the in-hospital day was recorded. 1. The concentration of plasma motilin increased significantly during the first 1 h postoperatively (P < 0.05), but it had no significant difference in the 48 h after operation (P > 0.05) in comparison with the preoperative data in the three groups. The concentration of plasma motilin in Group C was much higher than that in the other two groups during the first 1 h postoperatively (P < 0.05). 2. The incidence of postoperative nausea and vomiting was much higher in Group C than that in the other two groups during the first 6 h postoperatively (P < 0.05), but there was no significant difference in the 6 h after operation in the three groups (P > 0.05). 3. The first flatus time and in-hospital day postoperatively had no statistical difference in the three groups (P > 0.05). Different anesthesias do not influence the recovery of intestinal motion and in-hospital day postoperatively; the combined epidural-general anesthesia and propofol-based total intravenous anesthesia may be ideal anesthesias because of the lower incidence of postoperative nausea and vomiting.