Effects Of Different General Anesthetics And Acupuncture Intervention On Oxidative Stress In Patients Undergoing Cardiopulmonary Bypass

Background:CPB in open heart surgery can lead to special pathological and physiological changes. It prolonged CPB non pulsatile perfusion, low temperature, blood dilution and ischemia-reperfusion which can produce a strong stimulation, resulting in OS, thereby creating tissue and organ damage in perioperative period. Effect of propofol, etomidate and sevoflurane in protecting the body from surgically induced OS were reported. But these three agents who can play a better role in patients in CPB with perioperative OS is not clear. In modern anesthesia, acupuncture also plays an important role. Our experiments were devided into 2 parts. 1st part is effects of different general anesthetics of OS in patients undergoing CPB, 2nd part is effect of electroacupuncture with etomidate on perioperative OS in patients undergoing CPB.1.Effects of different general anesthetics of OS in patients undergoing cardiopulmonary bypassObjective: To evaluate effects of different general anesthetics of OS in patients undergoing CPB. Methods:75 patients,49 to 74 years old, who undergone CABG surgery were ramdomly divided into 3 groups(n=25): propofol group(group P),etomidate group(group E) and sevoflurane group(group S). Anesthesia was induced with intravenous injection of midazolam 0.05~0.3 mg/kg, sufentanyl 0.2~0.4 μg/kg, cis-atracurium 0.15 mg/kg and etomidate 0.3 mg/kg. Ttracheal intubation after muscle relaxated, then IPPV. Group P was maintained with propofol by TCI.The target plasma concentration was 2~4μg/ml.Group E was maintained with etomidate 0.3~0.6 mg/(kg·h).Group S was maintained with sevoflurane(1MAC). 3 groups were all maintained with remifentanil in 0.1~0.3 μg/(kg·min) and cisatracurium. At the time of before anesthesia, incision, before CPB, end of operation, 6 h, 24 h,48 h,72h after operation(T0-7). At T0, T4 to T7, the activity of SOD,CAT were measured. Data records, test of blood samples were taken double blindly.Patients were followed up single blindly recorded,so as the VAS scores postoperatively. Results:The activity of SOD、CAT and GSH-Px at T5 and T6 in 3 groups is lower than T0(P <0.05).The activity of SOD and GSH-Px at T7 in group S also lower than T0(P<0.05). The activity of SOD at T4~T7 in group E and S is lower than group P(P <0.05).The activity of CAT at T5 and T6 in group E is significantly lower than group P(P <0.05). The activity of CAT at T4 and T5 in group S obviously lower than group P(P <0.05). The activity of GSH-Px at T4、T5 and T6 in group E and S is obviously lower than group P(P <0.05). Comparaed to group E, the activity of SOD in group S is significantly increased at T7(P <0.05); and the activity of CAT in group S is higher at T4,T5 and T6(P <0.05); the values of GSH-Px in group P is higher at T4,T5 and T6(P <0.05).Compared to group P, the ICU residence time in group E were significantly increased(P <0.05).Conclusion:Compared with etomidate and sevoflurane, Propofol can provide better effct on OS of CABG.2.Effect of Electroacupuncture on etomidate on perioperative OS in patients undergoing CPBObjective: To investigate effect of electroacupuncture on etomidate on perioperative OS in patients undergoing cardiopulmonary bypass. Methods:45 patients, male or female, aged from 50 to 72, ASA II or IV,who undergone CPB were randomly divided into 3 groups(n = 15): etomidate group(Group E), etomidate + EA group(EEA group) and ENA group. EEA group keep electroacupuncture stimulation from pre- to post- operation.We set dilatational wave(2/50 Hz), wave width of 300 ms, stimulated from 0 to 0.1 m A gradually increased, until maximum level toleranted. In ENA group, 1cm besides the acupoints was acupunctured. The 3 groups were intravenous infusion of remifentanil in 0.1~0.3mg/(kg · min) and cisatracurium. Venous blood samples were taken at just before anesteshesia T0,2 hours after start of opertation(T1), at the end of opertation(T2) and 2 hours after operation(T3). The activity of SOD, CAT and GSH-Px were detected. Results:Compared with group E, SOD,CAT and GSH-Px activity were significantly increased at T1-3(P<0.05) in EEA group.Conclusion:Electroacupuncture can reduce etomidate in the perioperative period of oxidative stress in patients undergoing cardiopulmonary bypass reaction.