| ObjectiveThe study is to observe the effects of different ansthetics and transcutanclus electrical acupoint stimulation (TEAS) on skin dynorphin and kappa receptor (KOR) expression. Skin samples were collected from the surgical site during operation in patients undergoing deadline breast cancer surgery. The aim is to deepen the understanding of peripheral mechanism of the opioid system.MethodsEighty female cases with breast cancer undergoing unilateral radical operation were included in the study. According to the different of anesthetic administration they were randomly divided into the following groups, each has 20 cases. Groupl was propofol-fentanyl, group2 propofol-ketamine, group3 propofol-sevoflurane, and group4 was propofol-sevoflurane-TEAS. Nei Guan, He Gu, Tai Chong and San Yinjiao points group were used. All the patients received luminal 0. 1g, atropine 0.5mg intramuscular injection 1h before anethesia. After entering into operation, blood pressure, SpO2,ECG,and BIS were monitored. LH402 electric stimulator was used in group 4 with stimulus waveform 2/100Hz. The accupiont stimulation stard 30min before anesthesia induction and continued to the end of surgery. After propofol 2mg/kg infusion in all patients, followed were fentanyl 3μg/kg in group 1, ketamine lmg/kg in group 2, and sevoflurane inhalation in group 3 and group 4 during the induction. After loss of consciousness, the patients received artificial ventilation with mask. Three minutes later a laryngeal mask was inserted into oropharynx and IPPV ventilation was performed. Anesthesia were maintained with propofol infusion in all patients. The initial infusion rates were 8mg·kg-1 ·h-1 in group land 2, and4mg·kg-1·h-1 with sevoflurane inhalation in group 3 and 4. The doses of anesthetics were adjusted according to the body movement response to the surgical incision stimulation. The BIS values were maintained within 50±5 during surgery. Before axillary dissection cis atracurium 0.15mg/kg were given in all patients. Sevoflurane administration were stopped during skin closure in Group 3 and 4. All of the propofol infusion were stopped at the end of surgery. The duration of surgery and anesthesia, the volume of fluid infusion, urine output and blood loss were recorded. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), pulse blood oxygen saturation (SpO2) and BIS were also recorded at the following timepionts:before anesthesia (T1), after induction intubation (T2), after skin incision (T3),15mins after skin incision (T4),30mins after skin incision (T5),45mins after skin incision (T6),60mins after skin incision (T7), and at the end of surgery (T8). Skin samples with size of 0.5cm×2cm were taken at the beginning and end operation, respectively, ten cases each group. Skin dynorphin and KOR were detected with immunohistochemistry. The levels of dynorphin and KOR were measured by optical density analysis. After data collecting and observation form sorting the database was established. SPSS 13.0 statistic software is applied to statistic analysis and all the data present with the form of mean±standard deviation. P<0.05 indicates the difference has statistic significance.Results1. The level of the SBP, DBP, MAP and SpO2 of these four groups within group comparison has no statistic significance(P>0.05).2. The BIS level of these four groups is at time points of T1-T7; the BIS level of Group2 is higher than that of other three groups. The difference has statistic significance(P<0.05).3. The dynorphin/KOR immunohistochemistry positive protein in the skin biopsy is mainly located in the cuticular base layer, prickle cell layer, and basal cell, Spines cell cytoplasm. There is no statistic significance when comparing the numerical value of light dense of KOR at the same time points of these four groups (P> 0.05). Before and after operation in the group contrast, at the initial outset of the procedure, a small amount of KOR expression occurring in the cuticular base layer, basal cell and spines cell cytoplasm was observed in the cut edge of immunohistochemistry of skin. After operation, in the immunohisto- chemistry of incision edge, the expression of KOR increased in the cuticular base layer, skin prickle and cell layer stratum spinosum, basal cell, spines cells within cytoplasm. The two have statistic significance(P<0.01).ConclusionAfter the inflammatory stimulation in the injury, dynorphin and KOR present the increased expression after operation. The different anesthetics and TEAS in the operation have no difference when it comes to the increase of dynorphin and KOR level. The increased level of the anesthetics and KOR in the damaged skin is probably related with harmful inflammatory stimulation. And the anesthetics and TEAS may have less significant effect on it.
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