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Chen SH, Yuan TM, Zhang J, Bai H, Tian M, Pan CX, Bao HG, Jin XJ, Ji FH, Zhong TD, Wang Q, Lv JR, Wang S, Li YJ, Yu YH, Luo AL, Li XK, Min S, Li L, Zou XH, Huang YG. Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial. J Gastroenterol Hepatol 2021; 36:474-481. [PMID: 32677707 DOI: 10.1111/jgh.15188] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Remimazolam tosilate (RT) is a new short-acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. METHODS This positive-controlled, non-inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. RESULTS The success rate of sedation in the RT group was non-inferior to that in the propofol group (97.34% vs 100.00%; difference in rate -2.66%, 95% CI -4.96 to -0.36, meeting criteria for non-inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment-related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). CONCLUSION This trial established non-inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.
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Affiliation(s)
- Shao-Hui Chen
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Tang-Mi Yuan
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Jiao Zhang
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Hua Bai
- Clinical Pharmacology Research Center, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chu-Xiong Pan
- Department of Anesthesiology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing, China
| | - Xiao-Ju Jin
- Department of Anesthesiology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Fu-Hai Ji
- Department of Anesthesiology, The First Hospital of Soochow University, Suzhou, China
| | - Tai-Di Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian-Rui Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yu-Juan Li
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai-Lin Luo
- Department of Anesthesiology, Tongji Hospital, Wuhan, China
| | - Xiang-Kui Li
- Department of Anesthesiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Li
- Department of Anesthesiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiao-Hua Zou
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu-Guang Huang
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
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He FF, Li L, Liu MJ, Zhong TD, Zhang QW, Fang XM. Targeted Epidural Blood Patch Treatment for Refractory Spontaneous Intracranial Hypotension in China. J Neurol Surg B Skull Base 2017; 79:217-223. [PMID: 29765818 DOI: 10.1055/s-0037-1606312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 07/26/2017] [Indexed: 10/18/2022] Open
Abstract
Objective An epidural blood patch (EBP) is the mainstay of treatment for refractory spontaneous intracranial hypotension (SIH). We evaluated the treatment efficacy of targeted EBP in refractory SIH. Methods All patients underwent brain magnetic resonance imaging (MRI) with contrast and heavily T2-weighted spine MRI. Whole spine computed tomography (CT) myelography with non-ionic contrast was performed in 46 patients, and whole spine MR myelography with intrathecal gadolinium was performed in 119 patients. Targeted EBPs were placed in the prone position one or two vertebral levels below the cerebrospinal fluid (CSF) leaks. Repeat EBPs were offered at 1-week intervals to patients with persistent symptoms, continued CSF leakage, or with multiple leakage sites. Results Brain MRIs showed pachymeningeal enhancement in 127 patients and subdural hematomas in 32 patients. One hundred fifty-two patients had CSF leakages on heavily T2-weighted spine MRIs. CSF leaks were also detected on CT and MR myelography in 43 and 111 patients, respectively. Good recovery was achieved in all patients after targeted EBP. No serious complications occurred in patients treated with targeted EBP during the 1 to 7 years of follow-up. Conclusions Targeted and repeat EBPs are rational choices for treatment of refractory SIH caused by CSF leakage.
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Affiliation(s)
- Fei-Fang He
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Li
- Department of Family Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min-Jun Liu
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tai-Di Zhong
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiao-Wei Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiang-Ming Fang
- Department of Anesthesiology, The first affiliated hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
BACKGROUND A retrospective analysis of patients undergoing cancer surgery suggested that using local anesthetics could reduce cancer recurrence and improve survival rate. Previous studies have indicated that local anesthetics may induce apoptosis in several kinds of cells in vitro, but the mechanism is unclear. METHODS Cell viability was analyzed by MTS; reactive oxygen species (ROS), mitochondrial membrane potential (MMP, ∆Ψm), cell cycle distribution, and cell apoptosis assay were detected by flow cytometry; DNA damage was measured by comet assay; cell invasion and migration were observed by microscopy; The expression level of related proteins was detected by western blot assay. RESULTS The results indicated that lidocaine and ropivacaine could decrease viability, induce G0/G1 phase arrest and apoptosis in human non-small cell lung cancer (NSCLC) cells A549 and H520. Invasion and migration were suppressed. Western blot indicated the related apoptotic pathways proteins changed accordingly. Additionally, lidocaine and ropivacaine downregulated ∆Ψm, provoked DNA damage, upregulated ROS production and activated mitogen-activated protein kinase (MAPK) pathways in A549 and H520 cells. CONCLUSIONS The cytotoxic effect of amide-linked local anesthetics on NSCLC cells were mainly due to apoptosis. The antitumor mechanism of lidocaine and ropivacaine may involve apoptotic pathways and MAPK pathways.
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Affiliation(s)
- Hong-Wei Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Le-Yi Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Li Jiang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Su-Ming Tian
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Tai-Di Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Xiang-Ming Fang
- Department of Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Wang HW, Liu M, Zhong TD, Fang XM. Saikosaponin-d attenuates ventilator-induced lung injury in rats. Int J Clin Exp Med 2015; 8:15137-15145. [PMID: 26628997 PMCID: PMC4658886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/27/2015] [Indexed: 06/05/2023]
Abstract
Saikosaponin-d is one of the main bioactive components in the traditional Chinese medicine Bupleurum falcatum L and possesses anti-inflammatory and immune-modulatory properties. The current study aimed to investigate the protective effects of saikosaponin-d on ventilator-induced lung injury (VILI) in rats. We found that saikosaponin-d treatment significantly attenuated the pathological changes of lungs induced by mechanical ventilation. Administration of saikosaponin-d reduced the pulmonary neutrophil infiltration as well as the MPO concentrations. Saikosaponin-d also decreased the expression of pro-inflammatory cytokines including MIP-2, IL-6 and TNF-α. Meanwhile, the expression of anti-inflammatory mediators, such as TGF-β1 and IL-10, was obviously elevated after saikosaponin-d administration. Saikosaponin-d remarkably reduced the oxidative stress and apoptosis rate in lung tissues. On the molecular level, saikosaponin-d treatment obviously downregulated the expression of caspases-3 and the pro-apoptotic protein bax, and promoted the expression level of anti-apoptotic protein bcl-2. Collectively, our study demonstrated that saikosaponin-d may attenuate ventilator induced lung injury through inhibition of inflammatory responses, oxidative stress and apoptosis.
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Affiliation(s)
- Hong-Wei Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine3 Eastern Qingchun Road, Hangzhou, Zhejiang, 310016, P. R. China
| | - Ming Liu
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine3 Eastern Qingchun Road, Hangzhou, Zhejiang, 310016, P. R. China
| | - Tai-Di Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine3 Eastern Qingchun Road, Hangzhou, Zhejiang, 310016, P. R. China
| | - Xiang-Ming Fang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine79 Qingchun Road, Hangzhou, Zhejiang, 310012, P. R. China
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Wang P, Wang HW, Zhong TD. Effect of stroke volume variability- guided intraoperative fluid restriction on gastrointestinal functional recovery. ACTA ACUST UNITED AC 2013; 59:2457-60. [PMID: 22626878 DOI: 10.5754/hge12283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To investigate the effect of stroke volume variability(SVV)-guided intraoperative fluid restriction on gastrointestinal functional recovery and postoperative outcome after gastrointestinal surgery. Forty ASA I-II patients undergoing elective gastrointestinal surgery were randomly divided into 2 groups (n=20 each):group A routine fluid administration and group B restricted fluid administration. SW value was maintained at 5-7 in group A and 11-13 in group B. All patients received general anesthesia, tracheal catheterized and mechanical ventilation. Hemodynamic monitoring parameters (MBP, HR, CVP, CO) were noted at 5 time points. The hemodynamic parameters were maintained within normal limits during operation in both groups. The intraoperative intravenous fluid volume in group B was significant less than in group A (p<0.01).Urine output in group A was significant less than in group B (p<0.05). Stroke volume variation measured from Edwards Flotrac sensor and Edwards Vigileo monitor could be a security and sensitive parameter as an index of volume administration. In elective gastrointestinal surgery, volume resuscitation with a goal SVV of11-13 not only reduced intravenous fluid volume but also maintained the stable hemodynamic and tissue perfusion, enhanced gastrointestinal functional recovery and reduced the length of hospital stay
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Affiliation(s)
- Ping Wang
- Department of Anesthesiology, Zhejiang University, Hangzhou, China
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Qiao Q, Gu XJ, Xu J, Zhong TD. [Effect of intravenous esmolol on BIS index and anesthesia emergence during sedation anesthesia for ambulatory surgery]. Zhonghua Yi Xue Za Zhi 2010; 90:1631-1634. [PMID: 20979754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this research is to observe whether esmolol infusion as an adjunct to propofol can affect BIS index, reduce anesthetic dose and decrease emergence time. METHOD Sixty ASA I-II patients, age 18-35, undergoing uterine dilatation and curettage surgery were studied. They were randomized into two groups. Before induction, patients in esmolol group (Group E) were received 1 mg/kg esmolol intravenously and followed by esmolol 150 microg x kg(-1) x min(-1) intravenous infusion; patients in group C received normal saline instead of esmolol. Fentanyl (1 microg/kg) and propofol (2 mg/kg) were used as induction drugs. The change of BIS index, heart rate and MAP during operation; total amount of propofol; time when patients opened eyes and time when patients reached the standard for discharge from hospital were recorded. RESULTS BIS and heart rate of Group C at 1,2,3 minute after surgery started, increased significantly compared with the time after induction and those in Group E (P < 0.05). The time patients reached the score of discharging from hospital in Group C is longer than that in Group E (P < 0.05). CONCLUSION Esmolol combined with propofol administering in minor ambulatory operations can control the increase of BIS index caused by surgical nociceptive stimulus. Meanwhile the combination could reduce the dose of sedatives and decrease anesthesia emergence time.
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Affiliation(s)
- Qing Qiao
- Department of Anesthesiology, SIR RUN RUN SHAW Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
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Ge YL, Lv R, Zhou W, Ma XX, Zhong TD, Duan ML. Brain damage following severe acute normovolemic hemodilution in combination with controlled hypotension in rats. Acta Anaesthesiol Scand 2007; 51:1331-7. [PMID: 17944636 DOI: 10.1111/j.1399-6576.2007.01448.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM The reduced oxygen content and perfusion pressure during acute normovolemic hemodilution (ANH) and controlled hypotension (CH) raise concerns about hypoperfusion and ischemic injury to the brain. In this study on rats, we examined the brain damage following four different degrees of ANH combined with CH. METHODS Forty rats were randomly assigned to receive a sham operation or CH and ANH [with a hematocrit (Hct) of 30, 25, 20 or 15%]. ANH was performed after baseline physiological parameters had been monitored for 20 min; 30 min later, CH was induced using sodium nitroprusside, and the mean arterial blood pressure was maintained at 50-60 mmHg for 1 h. Rats were killed 3.5 h after hemodilution. Ultrastructural alterations in the CA1 region of the rat hippocampus were observed, and serum concentrations of S100B and neuron-specific enolase (NSE) were measured before and after ANH. RESULTS The serum S100B concentration increased significantly in the Hct 20% + CH and Hct 15% + CH groups. However, there were no significant differences in the serum levels of NSE between the groups. In the CA1 region of the rat hippocampus, marked ultrastructural alterations, such as mitochondrial denaturalization and nucleus distortion, were observed in the Hct 20% + CH and Hct 15% + CH groups. CONCLUSION Severe ANH (Hct < or = 20%) combined with CH may induce cerebral damage, as confirmed by marked ultrastructural alterations in the CA1 region of the rat hippocampus and significantly increased serum levels of S100B, and should be avoided.
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Affiliation(s)
- Y L Ge
- Department of Anesthesiology, Subei People's Hospital, Xuzhou Medical College, Xuzhou, China
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