OBJECTIVE:To investigate the effects of pregabalin combined with tramadol/paracetamol on acute pain in patients with CT-guided puncture localization of pulmonary nodules. MATERIALS AND METHODS:In this randomized, placebo-controlled and single-center study, 120 patients were allocated randomly to four groups: the control group (Group P), the pregabalin-placebo group (Group BP), the tramadol/paracetamol-placebo group (Group AP), and the pregabalin-tramadol/paracetamol group (Group AB). The primary outcome was the NRS (Numerical Rating Scale) score. Other outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2), the incidence of moderate to severe pain, the analgesia recovery ratio, the incidence of adverse drug reactions and patients' satisfaction. RESULTS:No significant interaction was detected between the interventions (P = 0.752). The NRS score of the Taking pregabalin group and the Taking tramadol/paracetamol group were significantly lower than those of the Not-taking pregabalin group and the Not-taking tramadol/paracetamol group respectively (P < 0.05). There was significant difference in the NRS scores among the four groups (P < 0.001). The NRS score of Group AB was significantly lower than that of Group P (P < 0.001), Group BP (P < 0.001) and Group AP (P = 0.001). At the same time, the NRS scores of Group BP (P < 0.001) and Group AP (P < 0.001) were significantly lower than those of Group P, but there was no significant difference between Group BP and Group AP (P = 1.000). The SBP, DBP, HR, the incidence of moderate to severe pain and the analgesia recovery ratio of Group AB were significantly lower than those of Group P (P < 0.05), while the SpO2 and the number of people who were very satisfied were significantly higher than those of Group P (P < 0.05). There was no significant difference in the incidence of adverse drug reactions among the four groups (P = 0.272). CONCLUSIONS:The combination or single use of pregabalin and tramadol/paracetamol can effectively relieve the acute pain after localization. Pregabalin combined with tramadol/paracetamol has the best analgesic effect and significantly reduces the hemodynamic fluctuations, with high safety and low incidence of adverse drug reactions, which has a certain clinical popularization and application value.
Perioperative fluid management is an important part of patient care, and appropriate volume is a prerequisite for ensuring tissue perfusion and maintaining organ function. In recent years, increasing interest has been drawn on the use of ultrasound to monitor the carotid blood flow spectrum and estimate the carotid corrected flow time (FTc) to assess the volume. Carotid FTc has its own characteristics when applied for different age groups or after different anesthesia methods during the perioperative period, and its efficiency in predicting fluid responsiveness is also different. This review introduces the definition, measurement methods and efficiency of carotid FTc in predicting fluid responsiveness under different conditions, and summarizes its research progress on real-time continuous monitoring, in order to provide reference for perioperative fluid management.
Objective:To explore the effect of psychological intervention for gastroscopy on anxiety in obese patients during conscious sedation.Methods:A total of 84 obese inpatients who were scheduled for gastroscopy were included. According to the random number table method, they were divided into two groups ( n=42): a psychological intervention group (group T) and a routine monitoring group (group C). Patients in group C received routine health education during the examination. In addition to the routine management, group T underwent comprehensive psychological intervention three days before gastroscopy, which continued until the end of the examination. During gastroscopy, both groups used remifentanil for conscious sedation. Then, their general information were recorded. Their State-Trait Anxiety Inventory (STAI) scores were evaluated three days before the examination (T 1), 30 min before the examination (T 2), and 30 min after the examination (T 3), including scores of State-Anxiety Inventory (S-AI), scores of Trait-Anxiety Inventory (T-AI), the variation of State-Anxiety Inventory (ΔS-AI) and Trait-Anxiety Inventory (ΔT-AI) for the last time compared to the first time. The mean arterial pressure (MAP) and heart rate were recorded 1 min before tube insertion (before examination), immediately after the gastroscope entered into most of the stomach (during the examination), and 5 min after the examination (after the examination). The duration of gastroscopy, the number of endoscopists with satisfaction and the number of patients with comfort, the induction dose and supplementary dose of remifentanil, the results of gastroscopy, the incidences of hypotension, bradycardia and hypoxemia during the examination, and the incidences of nausea, vomiting and dizziness 15 min after the operation were recorded. Results:There was no statistical difference in general information, the induction dose of remifentanil and gastroscopy results between the two groups ( P>0.05). There was no statistical difference in S-AI and T-AI scores between the two groups at T 1 ( P>0.05), but S-AI and T-AI scores in group T were significantly lower than those in group C at T 2 and T 3 ( P<0.05). Compared with those at T 1, S-AI and T-AI scores in group T at T 2 and T 3 remarkably decreased ( P<0.05), and S-AI and T-AI scores in group C at T 3 significantly decreased ( P<0.05). Compared with ΔT-AI, ΔS-AI in group T was significantly elevated ( P<0.05), while there was no statistical difference in group C ( P>0.05). There was no statistical difference in MAP and heart rate between the two groups before and after examination ( P>0.05). During the examination, group T showed lower MAP and heart rate than group C ( P<0.05). Compared with group C, group T presented shortened duration of examination ( P<0.05), and increases in the number of endoscopists with satisfaction and the number of patients with comfort ( P<0.05), with a decreased supplementary dose of remifentanil ( P<0.05). There was no statistical difference in the incidences of hypotension, bradycardia and hypoxemia between the two groups ( P>0.05). The incidences of nausea, vomiting and dizziness in group T were lower than those in group C ( P<0.05). Conclusions:For obese patients who underwent gastroscopy, psychological interventions can improve their anxiety, reduce stress response, and reduce the consumption of drugs during conscious sedation.
Objective:To discuss the effect of pregabalin on postoperative mood and sleep in patients with non-small cell lung cancer.Methods:A total of 60 patients who underwent thoracoscopic pneumonectomy in the Affiliated Hospital of Xuzhou Medical University from September 2022 to October 2022 were selected. According to the random number table method, they were divided into two groups ( n=30): an observation group and a control group. After surgery, all the patients were given patient-controlled intravenous analgesia. Patients in the control group orally took placebo, while those in the observation group orally took 150 mg pregabalin 1-2 h before operation and 75 mg pregabalin 1-5 days after operation, twice a day. The incidences of anxiety and depression were recorded before operation and on days 1, 2, 3, 7, and 30 after operation. The Athens Insomnia Scale (AIS) scores and Visual Analogue Scale (VAS) scores were recorded before operation and on days 1, 2, 3 and 7 after operation. Meanwhile, their Pittsburgh sleep quality index (PSQI) and VAS scores were recorded on day 30 after operation. The Identity-Consequence Fatigue Scale (ICFS) was used to record patients' fatigue scores before operation and on days 1, 3, 7 and 30 after operation. The incidences of adverse events on days 1, 2 and 3 after operation were compared between the two groups. Results:Compared with the control group, the observation group showed decreases in the incidences of anxiety and depression and AIS scores on days 1, 2 and 3 after operation, VAS scores on days 1, 2, 3 and 7 after operation, and the scores of ICFS on days 1, 3, 7 and 30 after operation ( P<0.05). Both groups exhibited reduced incidences of anxiety on days 3, 7 and 30 after operation, compared with those before operation ( P<0.05). Moreover, the VAS scores on days 1, 2, 3, 7 and 30 after operation and the scores of ICFS on days 1, 3, 7 and 30 after operation were higher in both groups than those before operation ( P<0.05). There was no statistical difference in PSQI score on day 30 after the operation between the two groups ( P>0.05). For the observation group, the incidence of anxiety on day 2 after operation, and the incidence of depression on day 30 after operation were lower than those before operation ( P<0.05). The observation group showed increases in the incidence of depression on day 1 after operation and AIS scores on days 1, 2 and 7 after operation, compared with those before operation ( P<0.05). For the control group, the incidence of depression on days 1 and 2 after operation and AIS scores on days 1, 2 and 3 after operation were higher than those before operation ( P<0.05). There was no statistical difference in other indexes ( P>0.05). Conclusions:Perioperative use of pregabalin can relieve postoperative anxiety and depression in patients with non-small cell lung cancer, improve postoperative sleep quality, and reduce postoperative pain and fatigue without increasing the incidence of side effects.
Objective:To observe the applied effect of artificial intelligence patient-controlled analgesia (Ai-PCA) in postoperative pain management of patients undergoing lower limb surgery.Methods:A total of 80 patients who underwent internal fixation for double tibia and fibula fractures were divided into 2 groups using the random number table method: intelligent analgesic management system group (group A) and traditional electronic intravenous analgesic pump group (group P), with 40 cases in each group. The methods of anesthesia and additional analgesia were the same in the two groups. Group A utilized the intelligent analgesic management mode, while the Group P used the traditional analgesic management mode. Pain scores were evaluated using the Numerical Rating Scale (NRS) scores at 4, 8, 12, 24 h, and 48 h after the operation in both groups. The Pittsburgh sleep quality index (PSQI) scores were recorded 1 d before the operation, as well as one and 2 d after the operation. Additionally, the total frequency of compressions, effective compressions, total consumption of sufentanil, incidence of postoperative vertigo, nausea and vomiting, patient satisfaction within 48 h after surgery were also recorded.Results:Compared to group P, the NRS scores at rest and during movement were significantly reduced at each time point ( P<0.05). The PSQI scores at 1 and 2 days after the operation also showed a decrease ( P<0.05), while patient satisfaction increased in group A ( P<0.05). There were no significant differences between the two groups in terms of the total pressing times of the analgesic pump, the effective pressing times, the total consumption of sufentanil, and the incidence of vertigo, nausea and vomiting within 48 h after the operation ( P>0.05). Conclusions:Ai-PCA can improve the effect of postoperative pain management, improve sleep quality, and increase patient satisfaction in patients with lower limb fractures.
Fentanyl and sufentanil are commonly used analgesic drugs in clinical practice, most of which are administered intravenously instead of intranasally. Based on the experience of nasal application of opioids in the medical security work of the Skiing Competition in the 2022 Beijing Winter Olympic Games and the Winter Paralympic Games, this paper reviewed the current situation and progress of nasal application of fentanyl and sufentanil for the treatment of trauma and emergency pain, intraoperative and postoperative pain relief, cancer pain relief, and sedation and analgesia in children.
Objective:To investigate the clinical effect of 10°reverse-Trendelenburg position combined with dolasetron on preventing postoperative nausea and vomiting (PONV) in female patients undergoing thyroid surgery.Methods:A total of 150 female patients who underwent thyroid surgery at the Affiliated Hospital of Xuzhou Medical University from January 2021 to February 2021 were selected using convenience sampling method. According to the random number table methods, they were divided into two groups ( n=75): a control group (group D) and an observation group (group T). Patients in group D received dolasetron alone for preventing PONV, while those in group T received 10°reverse-Trendelenburg position combined with dolasetron. Then, their incidences of PONV within 48 h after surgery were compared. The blood loss, incidence of intraoperative hypotension, Visual Analog Scale (VAS) scores, incidences of dizziness and headache, use of rescue antiemetics, length of hospitalization stay, scores of the quality of recovery, and surgeon satisfaction were recorded. Results:The incidence of PONV was 34.7% (25/72) for group D and 12.5% (9/72) for group T, with statistical difference. The relative risk of PONV incidence between group T and group D was 0.36 [(95% confidence interval (CI) 0.18, 0.72), P=0.002]. Group T had significantly less blood loss than group D ( P=0.001). No statistical difference was found in the incidence of intraoperative hypotension, VAS scores, and the incidences of dizziness and headache between the two groups ( P>0.05). Patients in group T required less rescue antiemetics than group D ( P=0.002). There was no statistical difference in the length of hospitalization stay between the two groups ( P>0.05), and the scores of the quality of recovery was significantly higher in group T than those in group D ( P<0.001). There was no statistical difference in surgeon satisfaction between the two groups ( P>0.05). Conclusion:The 10°reverse-Trendelenburg position combined with dolasetron is more effective than dolasetron alone in preventing postoperative nausea and vomiting in female patients undergoing thyroid surgery.
Objective:To investigate the protective effect of hydrogen on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in septic mice and the effect on the expression of the NOD-like receptor thermal protein domain associated protein 3 (NLRP3)/tissue factor (TF) signaling pathway.Methods:A total of 64 male C57BL/6J mice were tested in two batches. According to the random number table method, mice in each batch were divided into four groups ( n=8): a control group (group C), a LPS group (group L), a LPS+ hydrogen group (group LH) and a hydrogen group (group H). Mice in groups C and H were intraperitoneally injected with normal saline at 10 ml/kg. Meanwhile, those in groups L and LH were intraperitoneally injected with 10 mg/kg LPS to establish an ALI model in septic mice. Groups C and L were conventionally housed for 12 h, while groups LH and H were inhaled with 4% hydrogen for 12 h. Then, 12 h after modeling, mice in batch 1 were used for lung histopathology, lung function tests and scattered Doppler flow imaging, while those in batch 2 were used for bronchoalveolar lavage and Western blot analysis. hematoxylin-eosin (H-E) staining was performed to observe lung histopathology and evaluate lung injury score. Whole-body plethysmography system was used to detect lung function indicators in mice: minute ventilation volume (MV), expiratory flow 50 (EF50), peak expiratory flow (PEF), and enhanced pause (Penh). Scattered Doppler flow imaging was conducted to detect blood flow in the right lung and the left hind foot of mice. The levels of NLRP3 inflammatory vesicles and TF in the lungs were measured by Western blot. The levels of inflammatory factors tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 in bronchoalveolar lavage fluid (BALF) of mice were detected by enzyme-linked immunosorbent assay (ELISA). Results:According to H-E staining, the lung tissue structure of mice in group C and group H was normal. The lung tissue structure of mice in group L was disorganized, with a large number of neutrophils infiltrating. The lung tissue of mice in group LH showed reduced neutrophils infiltrating and relieved edema. Compared with group C, the lung tissue damage score was significantly elevated in groups L and LH ( P<0.05). MV, EF50 and PEF were significantly declined, and Penh was significantly elevated (all P<0.05). Blood flow in the right lung and the left hindfoot significantly decreased ( P<0.05). The relative content of NLRP3 and TF in lung tissue significantly increased ( P<0.05). The concentrations of TNF-α and IL-6 in BALF significantly increased ( P<0.05). Compared with group C, there was no statistical differences in all indicators in group H ( P>0.05). Compared with group L, the lung tissue injury score of mice in group LH was significantly reduced ( P<0.05). MV and PEF significantly increased, Penh was significantly elevated (all P<0.05). The difference in EF50 was not statistically significant ( P>0.05). Blood flow in the right lung and the left hindfoot was significantly higher ( P<0.05). The relative content of NLRP3 and TF in lung tissue was significantly lower ( P<0.05). The concentrations of TNF-α and IL-6 in BALF were significantly lower ( P<0.05). Conclusions:Hydrogen alleviates LPS-induced ALI in septic mice, which may be related to inhibition of the NLRP3/TF expression and reduction of secretion of inflammatory factors by hydrogen.
Objective:To evaluate the advantage of pericapsular nerve group block (PENGB) combined with unilateral lumbar anesthesia in elderly patients undergoing total hip arthroplasty (THA).Methods:A total of 74 elderly patients who were scheduled for unilateral THA were enrolled. According to the random number table method, they were divided into two groups ( n=37): an ultrasound-guided PENGB group (group P), and an ultrasound-guided fascia iliaca compartment block (FICB) group (group F). Nerve block in both groups was administered 30 min before unilateral subarachnoid anesthesia. The static and dynamic Numerical Rating Scale (NRS) scores were recorded before nerve block (T 0), 5 min (T 1), 15 min (T 2), and 30 min (T 3) after nerve block, and 6 h (T 4), 12 h (T 5), and 24 h (T 6) after surgery. The analgesia condition within 24 h after surgery, including the first pressing time of patient-controlled intravenous analgesia (PCIA), the effective pressing times of PCIA, the total consumption of sufentanil, and the rate of rescue analgesia, as well as the satisfaction of patients toward analgesia were recorded. Quadriceps muscle strength at T 4, T 5 and T 6, as well as the time of first postoperative off-bed activity, the distance of first postoperative walking, and the length of postoperative hospitalization stay were recorded. Both groups were compared for their Pittsburgh sleep quality index (PSQI) scores 1 day before surgery and 1, 3, 7 d and 30 d after surgery as well as the incidence of adverse reactions 24 h after surgery. Results:Compared with group F, group P showed decreases in the static and dynamic NRS scores at T 1-T 5, and PSQI scores at postoperative 1, 3 d and 7 ( P<0.05). For group P, the first pressing time of PCIA was prolonged, the effective pressing times of PCIA was decreased, the total consumption of sufentanil was reduced, the satisfaction of patient toward analgesia was enhanced, the time of first off-bed activity and the length of hospitalization stay were shortened, and the first walking distance was extended ( P<0.05). Furthermore, enhanced quadriceps muscle strength was seen in group P at T 4 and T 5 ( P<0.05). Compared with those at T 0, the static NRS scores were reduced in group P at T 1-T 3 and in group F at T 2-T 3 ( P<0.05), while both groups showed lower dynamic NRS scores at T 1-T 3 than those at T 0 ( P<0.05). There was no statistical difference in other indexes ( P>0.05). Conclusions:Ultrasound-guided PENGB combined with unilateral lumbar anesthesia has significant analgesic effect in the elderly patients after THA, which is helpful to improve postoperative sleep quality and promote early postoperative recovery.
Objective:To explore the influence of glatiramer acetate (GA) on perioperative neurocognitive disorder (PND) in mice and its mechanism.Methods:Fifty-four aged male C57BL/6J mice were divided into 3 groups ( n=18) using a random number table method: control group (group C), operation group (group S), and glatiramer acetate group (group GA). Group S and group GA mice underwent abdominal surgery, group C only underwent anesthesia and disinfection. Mice in the group GA received four subcutaneous injections of GA 200 μg/d from 1 d before to 2 d after surgery; group C and group S were subcutaneously injected with equal volume of physiological saline. Each group of 6 mice was subjected to a 5-day Morris water maze training. Subsequently, the escape latency and the frequency of crossing the platform were recorded 3 d after the operation. Venous blood was drawn from remaining mice in each group after 3 d postoperative execution, and the serum inflammatory factors interleukin (IL)-1β and IL-6 levels were measured by enzyme-linked immunosorbent assay (ELISA). 6 mice in each group were selected and sacrificed, and the hippocampus tissue was collected to detect the activation state of microglia by immunohistochemistry. The gene expression level of C-C motif chemokine ligand 2 (CCL2) was detected by real-time quantitative polymerase chain reaction (PCR) in the remaining mice. Results:Compared with group C, group S had an extended escape latency and a reduced number of crossing platforms ( P<0.05); the concentration of IL-1β, and IL-6 increased ( P<0.05); the number of activated microglia increased ( P<0.05); the expression of CCL2 increased ( P<0.05). Compared with group S, group GA had a shorter escape latency and an increase in the number of crossing platforms ( P<0.05); the concentration of IL-1β, and IL-6 decreased ( P<0.05); the number of activated microglia decreased ( P<0.05); the expression of CCL2 decreased ( P<0.05). Conclusions:Glatiramer acetate could ameliorate cognitive deficits in perioperative neurocognitive disorders in mice after abdominal surgery. The possible mechanism is related to reducing the neuroinflammatory response through reducing the systemic inflammatory response, inhibiting choroid plexus CCL2 expression, and reducing microglia activation.
Breastfeeding benefits mothers and newborns in the short and long-term health, but currently, the breastfeeding rate in our country has not yet reached international standards. With the wide use of neuraxial labor analgesia, its impact on breastfeeding has also been gradually concerned. In this review, we summarized the effect of neuraxial labor analgesia on breastfeeding and the possible mechanism, also the relevant strategies for breastfeeding promotion to provide a guide for improving breastfeeding in mothers with labor analgesia.
Sarcopenia is defined as progressive, generalized muscle loss associated with aging or disease. In recent years, sarcopenia has been widely recognized as one of the crucial factors in predicting adverse outcomes following surgery for gastrointestinal tumors. Elderly patients undergoing esophageal cancer surgery often experience sarcopenia due to malnutrition, which leads to increased postoperative adverse events. This review provides an overview of the clinical definition, diagnosis, and evaluation measures of sarcopenia, as well as the postoperative complications and postoperative short-term and long-term survival outcomes in elderly esophageal cancer patients undergoing surgical treatment.
Objective:To explore the value and effect of using microlearning-based flipped classroom teaching mode in teaching ultrasound-guided arteriovenous puncture in undergraduate anesthesia.Methods:Sixty-one newly admitted undergraduate students in the Department of Anesthesiology from September 2021 to October 2022 were selected and divided into traditional teaching group ( n=31) and micro-class flipped classroom group ( n=30) according to the time of admission using the random number table method. The traditional teaching group adopted the traditional teaching mode, while the micro-lesson flipped classroom group adopted the micro-lesson video learning, flipped classroom and after-class consolidation for learning. Both groups were given theoretical tests and skill tests after training. Record the results of theory examination and skill assessment, and evaluate the total results, and questionnaires were distributed to record the self-evaluation of learning outcomes and training satisfaction of all training students. Results:Students in micro-class flipped classroom group scored significantly higher than students in traditional teaching group in the skills assessment and subjective learning experience questionnaire ( P<0.05), while there was no significant difference in theoretical test scores ( P>0.05); students in micro-class flipped classroom group rated their scores mainly in the excellent and good categories, with more students rated as excellent than those in traditional teaching group ( P<0.05). Conclusions:The microlearning-based flipped classroom teaching mode in ultrasound-guided arterial puncture teaching can significantly improve the learning enthusiasm of undergraduate anesthesia students, improve self-learning ability, enhance students' clinical skills of ultrasound-guided arterial puncture, and exercise students' communication and expression ability.
Perioperative anesthesia management in patients with multiple organ dysfunction is challenging for anesthesiologists. Preoperative evaluation and preparation as well as intraoperative anesthesia management are of great significance for improving the safety of surgery and postoperative recovery. This patient suffered from severe infection with severe acute respiratory SARS-CoV-2, which resulted in renal allograft dysfunction. Before surgery, the patient presented cardiac insufficiency, severe mitral insufficiency, pulmonary hypertension, respiratory failure, renal insufficiency, sepsis and renal anemia. Through comprehensive management, including circulation management, cardiac function support, volume management, protective ventilation strategy, anti-inflammatory and anti-stress treatment and heat preservation, the patient successfully completed the surgery.
Objective:To Improve the medical service capabilities of municipal and county hospitals or below levels through exploring a new model of medical counterpart assistance.Methods:The department of anesthesiology, the Affiliated Hospital of Yangzhou University provided counterpart technical assistance to the department of anesthesiology of Traditional Chinese Medicine Hospital of Yizheng from 2020 to 2023. With the aim of subject construction, it was a problem-directed process, guided by organizational structure and system construction. Moreover, standardization of anesthetic technology and comfort medical treatment, and the clinical development of multi-modal analgesia techniques were used as the effective means.Results:Based on innovative work modes, the department of anesthesiology of Traditional Chinese Medicine Hospital of Yizheng established a management structure where the director acted as the leader and the management staff assumed responsibilities for their corresponding work. Furthermore, they improved system construction, strengthened institutionalization and process management, and enhanced clinical application and development of core anesthesiology technology. Through establishing a learning department, their capabilities and workloads were greatly elevated.Conclusions:The problem-directed model effectively improves the comprehensive service capabilities of the anesthesiology department for counterpart assistance, and improves the abilities of the clinical diagnosis and treatment and research thinking of anesthesiologists. The ordinary people are able to enjoy homogeneous anesthesia services.
Objective:To compare the safety and efficacy of remimazolam and propofol in sedation for outpatient minor surgery by meta-analysis.Methods:PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP databases were searched, and the retrieval time was from the establishment of the databases to July 2022. Randomized controlled trial (RCT) that compared the safety and efficacy of remimazolam and propofol for procedural sedation in outpatient minor surgery was included. The remimazolam group used remimazolam as an anesthetic, with or without other analgesics, and the propofol group used a sedation regimen in the same combination. Two researchers selected the trials according to the inclusion and exclusion criteria, extracted data, and evaluated the quality of the included studies according to the quality evaluation criteria provided by the Cochrane System Manual. RevMan 5.3 software was used for meta-analysis.Results:A total of 19 RCT involving 2 633 patients were included, including 1 322 in the remimazolam group and 1 311 in the propofol group. Compared with the propofol group, remimazolam showed significant increases in mean arterial pressure (MAP) [mean difference ( MD) 7.50 [95% confidence interval (CI) 3.77, 11.22], P<0.001], heart rate [ MD 4.37 (95%CI 2.36, 6.38), P<0.001), prolonged drug onset time [ MD 0.19 (95%CI 0.03, 0.35), P=0.020]. Meanwhile, the incidence of hypotension [odds ratio ( OR) 0.23 (95%CI 0.18, 0.29), P<0.001], the incidence of hypoxemia [ OR 0.16 (95%CI 0.07, 0.39), P<0.001], the incidence of injection pain [ OR 0.03 (95%CI 0.01, 0.10), P<0.001], the incidence of respiratory depression [ OR 0.18 (95%CI 0.12, 0.27), P<0.001], the incidence of bradycardia [ OR 0.38 (95%CI 0.24, 0.60), P<0.001], and shortened recovery time after surgery [ MD -0.81 (95%CI -1.56, -0.06), P=0.030] and the time of leaving the chamber [ MD -2.17 (95%CI -3.64, -0.70), P=0.004]. There was no significant difference in sedative effect [ OR 0.68 (95%CI 0.09, 4.96), P=0.700], SpO 2 [ MD 0.45 (95%CI -0.05, 0.94), P=0.080], dizziness [ OR 0.60 (95%CI 0.34, 1.06), P=0.080], nausea and vomiting [ OR 0.83 (95%CI 0.42, 1.62), P=0.580] between the two groups. Conclusions:Remimazolam is a safe and effective sedative drug for outpatient minor surgery, with sedative effect not inferior to propofol, and the incidence of adverse reactions such as hypotension, hypoxemia, injection pain, respiratory depression, and bradycardia is lower. The incidence of postoperative nausea, vomiting and dizziness is similar to that of propofol, and the postoperative recovery is faster, but the onset time after induction is significantly prolonged.
The nervous system regulates liver function, and liver diseases can in turn cause neurological dysfunction. Recent research has revealed the intricate relationship between the nervous system and liver, presenting the importance in maintaining homeostasis and regulating various physiological and pathological processes. This article focuses on the ways in which the nervous system regulates liver diseases in innervation, immune system and hepatic metabolism, and the specific mechanisms by which liver diseases affect the nervous system, in order to offer a theoretical basis and new insights for future disease management.
Objective:To construct a clinical teaching quality evaluation index system for anesthesia nursing undergraduates.Methods:Using the three-dimensional quality structure model as the theoretical framework, the indicators of clinical teaching quality evaluation system for anesthesia nursing undergraduates were determined through searching domestic and foreign literature, group discussion and Delphi expert correspondence. The weight of eac indicator at all levels were determined by hierarchical analysis.Results:The effective recall rate of the questionnaires of the two rounds of expert correspondence was 100%, and the authority coefficient of experts was 0.931. In the second round of expert correspondence, the Kendall harmony coefficient was 0.306 for the secondary indicators and 0.339 for the tertiary indicators ( P<0.001). The final evaluation indexes of clinical teaching quality of anesthesia nursing undergraduates included 3 primary indexes, 13 secondary indexes and 67 tertiary indexes. Conclusions:The constructed clinical teaching quality evaluation index system for anesthesia nursing undergraduates is highly reliable and scientific, and can provide evidence for evaluating the clinical teaching quality of training bases for undergraduate anesthesia nursing trainees.
Objective:To test whether the combined use of propofol and bupivacaine leads to cellular injury in dorsal root ganglion (DRG) neurons via a non-selective cation permeable channel, the transient receptor potential channel A1 (TRPA1).Methods:Wild type (WT) mice and TRPA1 knockout (TRPA1 -/-) mice with C57B6/J background were used as research subjects. DRG (L 3-L 5) from the lumbar segment of mice were collected for primary cell culture, and cultured for 24 h before conducting in vitro experiments. To observe the morphological changes of DRG cells in WT mice treated with different drugs, cells were randomly divided into 4 groups ( n=9) using a random number table method: control group (no treatment), propofol group (10 μmol/L), bupivacaine group (2 mmol/L), propofol+bupivacaine group (propofol 10 μmol/L, bupivacaine 2 mmol/L). Using HC-030031 to specifically block TRPA1, the effects of HC-030031 on the cell activity and viability of WT mouse DRG cells induced by propofol combined with bupivacaine [cell counting kit 8 (CCK-8)], mitochondrial reactive oxygen species (ROS) levels (MitoSOX Red superoxide indicator detection), and membrane potential polarization (JC-1 method) were measured. For this purpose, cells were divide into 3 groups using a random number table method ( n=9): control group (no treatment), and propofol+bupivacaine group (propofol 10 μmol/L, bupivacaine 2 mmol/L), HC-030031+propofol+bupivacaine group (propofol 10 μmol/L, bupivacaine 2 mmol/L, HC-030031 1 μmol/L). Furthermore, we compared the changes in mitochondrial ROS levels and membrane potential of DRG cells between WT mice (WT group) and TRPA1 -/- mice (TRPA1 -/- group) ( n=9) when using propofol (10 μmol/L) combined with bupivacaine (2 mmol/L). Results:Compared with the control group, propofol group, and bupivacaine group, the DRG cells in the bupivacaine+propofol group showed morphological changes and even cell destruction. Compared with the control group, the cell survival rate of the propofol+bupivacaine group decreased ( P<0.05), the ROS level increased ( P<0.05), and the mitochondrial membrane potential level decreased ( P<0.05); Compared with the propofol+bupivacaine group, the HC-030031+propofol+bupivacaine group showed an increase in cell survival rate ( P<0.05), a decrease in ROS level ( P<0.05), and an increase in mitochondrial membrane potential level ( P<0.05). Compared with the WT group, the TRPA1 -/- group showed a decrease in mitochondrial ROS levels ( P<0.05) and an increase in mitochondrial membrane levels in DRG cells treated with propofol combined with bupivacaine ( P<0.05). Conclusions:The combination of bupivacaine and propofol can cause injury to the cultured DRG neurons from mice, in which TRPA1 is involved. This effect is related to mitochondrial ROS and membrane potential level.
Objective:To explore the risk factors of postoperative pulmonary complication (PPC) in adult patients with pancreatic cancer.Method:A total of 1 162 patients were selected according to the inclusion and exclusion criteria. Retrospective retrieval was conducted using the clinical electronic system database to collect their clinical data during the perioperative period. The systemic inflammatory index (SII), prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were calculated to determine the inflammatory and nutritional conditions of patients before operation. Logistic regression analysis was performed to determine risk factors. A receiver operating characteristic (ROC) curve was plotted to evaluate its predicting value. Multivariate Cox regression was used to explore the survival of patients 30 days after surgery.Result:According to the presence of PPC, the patients were divided into two groups: a PPC group ( n=39, 3.4%) and a Non-PPC group ( n=1 123, 96.6%). Compared with the Non-PPC group, patients in the PPC group had increased age ( P<0.05), with an elevated proportion of male patients ( P<0.05). The PPC group presented increases in the duration of anesthesia and operation, the time to withdraw gastric tube after surgery, postoperative feeding time, the total length of hospitalization stay, the length of intensive care unit (ICU) treatment and the total duration of postoperative treatment ( P<0.05). The PPC group presented increases the proportion of re-insertion after gastric tube withdrawal, the proportion of re-stop after postoperative feeding, the proportion of abandonment of treatment (no death in hospital) and the proportion of in-hospital death ( P<0.05), as well as decreases in the proportion of exhaust and defecation within 2 days after surgery, and the proportion of recovery and discharge and the survival rate 30 days after surgery ( P<0.05). The PPC group consumed increased volumes of colloidal liquid ( P<0.05), with elevated blood loss ( P<0.05), and an increased proportion of patients underwent blood transfusion ( P<0.05). The PPC group showed decreases in pre-operative albumin and albumin, low density lipoprotein cholesterol, LMR and PNI ( P<0.05), as well as increases in neutrophil percentage, neutrophil count, monocyte count, lymphocyte count, erythrocyte distribution width, serum procalcitonin, CEA, SII, NLR, alkaline phosphatase, cystatin C and creatinine (Cr) ( P<0.05). There was no statistical difference in other indexes between the two groups ( P>0.05). The risk factors of PPC were modeled through logistic regression analysis. The results indicated that blood loss, SII, NLR, PLR, neutrophils count and percentage were independent risk factors. ROC curve analysis showed that the area under curve (AUC) was 0.948 [95% confidence interval (CI) 0.919, 0.978], the sensitivity was 0.846, the specificity was 0.914, and the Yoden index was 0.760. Cox survival analysis showed that blood loss [odds ratio ( OR) 1.616 (95%CI 1.045, 2.500), P=0.031], SII [ OR 1.004 (95%CI 1.000, 1.007), P=0.047], and PLR [ OR 0.961 (95%CI 0.931, 0.993), P=0.016] and postoperative pulmonary complications [ OR 0.018 (95%CI 0.002, 0.138), P<0.001] were positively correlated with the mortality 30 days after surgery. Conclusions:Intraoperative blood loss, preoperative SII, preoperative NLR, preoperative PLR, and preoperative neutrophil count and percentage are the independent risk factors for PPC.
