Etomidate has been advocated to be used in anesthesia for the elderly and the critically ill patients due to its faint effect on cardiovascular system. But the dose-dependent suppression of etomidate on adrenal cortex function leads to the limitation of its clinical application. Clinical research showed that dexmedetomidine could reduce the dose requirements for intravenous or inhalation anesthetics and opioids, and the hemodynamics was more stable during the operation. The objective was to observe the effect of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients. 180 elderly patients scheduled for elective ureteroscopic holmium laser lithotripsy were randomly allocated to PR group anesthetized with propofol-remifentanil, ER group anesthetized with etomidate-remifentanil, and ERD group anesthetized with dexmedetomidine combined with etomidate-remifentanil. Patients in each group whose operation time was less than or equal to 1 h were incorporated into short time surgery group (PR1 group, ER1 group and ERD1 group), and whose surgical procedure time was more than 1 h were incorporated into long time surgery group (PR2 group, ER2 group and ERD2 group). The primary outcome was the serum cortisol and ACTH concentration. The secondary outcomes were the values of SBP, DBP, HR and SpO2, the time of surgical procedure, the dosage of etomidate and remifentanil administered during surgery, the time to spontaneous respiration, recovery and extubation, and the duration of stay in the PACU. The Serum cortisol concentration was higher at t1~2   in ERD1 group compared to ER1 group (P < 0.05). The Serum cortisol concentration at t1~3   was higher in ERD2 group than in ER2 group (P < 0.05). The Serum ACTH concentration was lower at t1~2  in ERD1 group compared to ER1 group (P < 0.05). The Serum ACTH concentration at t1~3  was lower in ERD2 group compared to ER2 group (P < 0.05). The SBP at T1 and T3 were higher in ER2 and ERD2 group than in PR2 group (P < 0.05). The DBP in ER1 and ERD1 group were higher at T1 compared to PR1 group (P < 0.05). The dosage of etomidate was significantly lower in ERD1 group and ERD2 group than in ER1 group and ER2 group (P < 0.05), respectively. The administration of dexmedetomidine combined with etomidate can attenuate the inhibition of etomidate on adrenocortical function in elderly patients and maintain intraoperative hemodynamic stability.

Background Our objective was to observe the effects of extracorporeal circulation (ECC) with different time on platelet count in patients undergoing cardiac surgery. Methods A total of 427 patients who underwent elective cardiac surgery under ECC in affiliated hospital of north Sichuan medical college from January 1, 2018 to July 31, 2021 were divided into three groups according to ECC time. Their data were collected from the Do care and electronic medical record information system. All authors confirm that all methods were performed in accordance with the relevant guidelines and regulations. Results At the end of operation, platelet count was significantly lower in group C than in group A (p< 0.05); on the first day after operation, platelet count was significantly higher in groups A and B than in group C (p< 0.05); compared with group A, platelet count on the second day and the fifth day after operation were significantly lower in groups B and C (p< 0.05). The mean platelet volume (MPV) was significantly reduced at the end of operation in each group (p< 0.05). The absolute monocyte count at the end of operation was significantly higher in group C than in groups A and B (p< 0.05). The volume of blood loss and plasma transfusion were significantly lower in group A than in groups B and C (p< 0.05). Conclusion Platelet count in patients undergoing cardiac surgery after ECC was reduced significantly, which was more serious with the extension of ECC time. The recovery level and speed of platelet count in patients with long ECC time were lower than those with short ECC time.

The level of endothelial glycocalyx (EG) shedding is associated with morbidity and mortality, and vascular endothelial barrier dysfunction is one of the pivotal clinical problems faced by critically ill patients, so research on the protective effects of EG is of great clinical significance for the treatment of critically ill diseases. Studies have illustrated that clinical anesthesia has different degrees of effects on vascular EG. Therefore, we reviewed the effects of distinct anesthesia methods and diverse anesthetic drugs on EG, aiming to provide a brief summary of what we know now, and to discuss possible future directions for investigations in this area. So as to provide a theoretical basis for future research on potential EG-positive drugs and targets, to minimize perioperative complications and improve the prognosis of surgical patients.

Study objective: To investigate the effects of epidural dexmedetomidine infusion on perioperative hemodynamics in patients. Design: Randomized, interventional, blinded clinical trial. Setting: An operating room and postoperative period in university-affiliated teaching hospital. Patients: 90 patients aged 18~65 years, of ASA status I/II, posted for elective saphenous vein peeling or aspiration surgery. Interventions: Patients were randomly divided into 0.5 μg/kg dexmedetomidine combined with 0.67% ropivacaine epidural infusion group (ED group), 0.5 μg/kg dexmedetomidine intravenous infusion combined with 0.67% ropivacaine epidural infusion group (VD group), and 0.67% ropivacaine plus isovolumic saline epidural infusion group (NS group), with 30 cases in each group. Measurements: The primary outcome was the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) at before dexmedetomidine infusion (T0), 5 min (T1), 15 min (T2), 30 min (T3), 1 h (T4), 2 h (T5), 4 h (T6), 6 h (T7), 8 h (T8) after the start of dexmedetomidine infusion. The secondary outcomes included plasma norepinephrine (NE) concentration, myocardial oxygen consumption (MVO2), the Ramsay sedation score, the Visual Analogue Scale (VAS) score, anesthetic efficiency between three groups, patient's satisfaction with postoperative anesthesia and the occurrence of adverse reactions. Main results: Compared with NS group, SBP at T3-7 and DBP at T4-5 and T7 were significantly decreased in ED group (P＜0.05 or 0.005), SBP and DBP at T1-8 were lower in VD group (P＜0.05 or 0.005). SBP and DBP at T1-2 in ED group were higher than that in VD group (P＜0.05 or 0.005). The heart rate at T3-4 and T6-7 was lower in ED group than in NS group (P＜0.05 or 0.005). Compared with VD group, the heart rate in ED group at T7 was significantly decreased (P＜0.001). The plasma NE concentration in ED and VD groups at T3-7 was dramatically decreased compared with NS group (P＜0.05 or 0.005). The plasma NE concentration in ED group was considerably increased at T3-4 and reduced at T6 compared with VD group (P＜0.005). MVO2 was lower in both ED and VD groups than in NS group (P＜0.05 or 0.005). The anesthesia efficiency was significantly enhanced in ED group compared with VD and NS groups (P＜0.05 or 0.005). Compared with NS group, the anesthesia satisfaction score was higher in ED and VD groups (P＜0.001). The incidence of dizziness in ED group and the incidence of hypotension and dizziness in VD group were higher than that in NS group (P＜0.05 or 0.005), and the occurrence of hypotension was less common in ED group than in VD group (P=0.003). Conclusion: 0.5 μg/kg dexmedetomidine epidural infusion can provide more stable perioperative hemodynamics for patients with varicose vein surgery under epidural anesthesia, with lower incidence of hypotension and significantly advanced efficiency of epidural anesthesia.