OBJECTIVES:The modified Peyton 4-step teaching method is widely acknowledged for its efficacy in procedural skills training within medical education. In this study, the authors further modified the Peyton teaching method by shifting the instructor's role to a facilitative one and emphasizing a student-centered, peer-assisted learning structure. This randomized controlled study therefore aimed to compare the effectiveness of this further modified peer-assisted Peyton 4-step teaching method against a traditional instructor-led approach for teaching defibrillation to surgical residents. DESIGN:A randomized, single-blind, controlled study. SETTING:The study was conducted in the simulation training center of a university-affiliated tertiary hospital. PARTICIPANTS:Eighty-four surgical residents participating in American Heart Association basic cardiac life support training at the authors' hospital between January 2019 and December 2023. INTERVENTIONS:Participants were randomly assigned to either the experimental group (n = 42), which underwent training using the modified Peyton 4-step method featuring peer-guided practice, or the control group (n = 42), which received standard instructor-led training. MEASUREMENTS AND MAIN RESULTS:The effectiveness of the two methods was evaluated by comparing scores from theoretical knowledge tests, skills assessments, and questionnaire surveys. The theoretical knowledge test scores were 99.3 ± 2.6 for the experimental group of physicians and 98.3 ± 4.4 for the control group, with no statistically significant difference (p = 0.229). The experimental group demonstrated a higher correct recognition rate of shockable rhythms (92.9% v 76.2%) and more appropriate administration of resuscitation drugs (92.9% v 76.2%) than the control group, as well as fewer deviations from the standard algorithm during defibrillation compared with the control group (median [interquartile range (IQR)], 0.0 [0.0-1.0] v 1.0 [0.8-2.0]). In addition, the questionnaire survey results indicated that the experimental group reported higher levels of teaching satisfaction (median [IQR], 5 [5-5] v 4 [4-5]), greater learning interest (median [IQR], 5 [5-5] v 4 [4-5]), and stronger willingness to perform defibrillation promptly (median [IQR], 5 [5-5] v 4 [4-5]). These differences were all statistically significant (p < 0.05). CONCLUSIONS:The findings suggest that the modified Peyton 4-step approach enhances residents' proficiency in defibrillation and improves their learning experience, suggesting its value in clinical skills training.

INTRODUCTION:Minimally invasive direct coronary artery bypass grafting (MIDCABG) requires prolonged one-lung ventilation (OLV), increasing postoperative pulmonary complications (PPCs) risk. We investigated whether protective lung ventilation (PLV) throughout intubation benefits MIDCABG patients. METHODS:In this single-center randomized study, MIDCABG patients received PLV (low tidal volume of 6-8 mL·kg-1, PEEP of 6 cm H2O, alveolar recruitment maneuvers) or conventional mechanical ventilation (CMV, tidal volume of 8-10 mL·kg-1, without PEEP or maneuvers) from tracheal intubation to extubation. The primary outcome was perioperative oxygenation, assessed by the PaO2/FiO2 ratio. RESULTS:Sixty patients (n = 30 per group) were enrolled. Compared with CMV, PLV improved PaO2/FiO2 ratios (mean difference at OLV60: 34.56 mmHg; 95% CI: 11.78-57.33; p < 0.01), shortened median durations of postoperative mechanical ventilation (median difference: -4.5 h, 95% CI: -8.5 to -0.5; p = 0.013) and hospital stay (median difference: -3.0 days, 95% CI: -5.0 to -1.0; p = 0.019). PLV also reduced driving pressure, airway pressure and intrapulmonary shunt during OLV (all p < 0.05). Desaturation occurred in 23.3% of CMV patients and 13.3% of PLV patients (p = 0.506). Hemodynamic parameters were generally comparable between groups, except for lower MPAP and PVRI in the PLV group during OLV and after ICU admission (p < 0.05). The incidence of PPCs did not differ between groups. CONCLUSIONS:In patients undergoing MIDCABG, PLV applied throughout intubation improved perioperative oxygenation and shortened the duration of postoperative mechanical ventilation and hospital stay, but did not reduce PPCs. CLINICAL TRIAL REGISTRATION:ChiCTR1900022005.

BACKGROUND:The 'out of hours effect' applies to patients undergoing surgery during night shifts, weekends or holidays, who face higher risks of complications and mortality. The 7-day service policy was implemented to ensure consistent healthcare delivery. OBJECTIVE:To assess the association between surgical time and incidence of major peri-operative adverse cardiac and cerebral events (MACCE) and also the length of hospital stay, and whether this has changed following the implementation of the 7-day service. DESIGN:Nested case-control study. SETTING:Single-centre university hospital. Retrospective enrolment from January 2018 to December 2021. PATIENTS:The study included 2543 cases and 10 683 controls. MAIN OUTCOME MEASURES:The primary outcome was peri-operative MACCE. Patients who developed MACCE after noncardiac surgery were compared with controls randomly selected from those without MACCE (1 : 4 ratio). RESULTS:Night-shift procedures were associated with higher incidence of peri-operative MACCE (28.7 vs. 18.2%, P < 0.001), longer hospital stays (172 vs. 155 h, P < 0.01), and higher costs (48 529 vs. 37 962 yuan, P < 0.001). In multivariable logistic regression, night-shift surgery remained independently associated with MACCE [fully adjusted odds ratio (OR) 1.54, 95% confidence interval (CI), 1.3 to 1.8; P < 0.001]. Weekend surgery was not significantly associated with MACCE after full adjustment (OR 1.15, 95% CI, 0.96 to 1.38; P = 0.13), and results were consistent in a sensitivity model including both night-shift and weekend surgery (night shift OR 1.54, 95% CI, 1.3 to 1.82, P < 0.001; weekend OR 1.17, 95% CI, 0.97 to 1.4, P = 0.09). Following implementation of the 7-day service policy, night-shift procedures decreased [16.1% prepolicy vs. 3.7% postpolicy; standardised mean difference (SMD) 0.42] and weekend procedures increased (5.5 vs. 13.3%; SMD 0.27). In the postpolicy period, weekend surgery was associated with a shorter hospital stay (139 vs. 160 h, P < 0.001) without an increase in MACCE (18.7 vs. 19.4%, P = 0.53). CONCLUSION:Night-shift surgery was an independent risk factor for peri-operative MACCE in noncardiac surgery patients. The 7-day service policy reduced night-shift procedures and increased those at weekends, without increasing the risk of MACCE. It was also associated with shorter hospital stays. TRIAL REGISTRATION:Chinese Clinical Trial Registry identifier: ChiCTR1900024645.

BACKGROUND:We identified significant gaps in perioperative pain management for sports medicine surgery at our hospital, including a high incidence of severe postoperative pain possibly due to a lack of preemptive analgesia. OBJECTIVE:We aimed to improve pain management outcomes by optimizing multimodal analgesia, which was implemented by the "Pain-Free Hospital" project at Peking University Third Hospital. STUDY DESIGN:A single-center retrospective observational study. SETTING:Peking University Third Hospital. METHODS:A total of 6,610 sports medicine surgery patients seen from July 2022 through August 2023 were divided into baseline (the first 3 months) and intervention (the subsequent 11 months) phases. Data on postoperative Numeric Rating Scale (NRS-11) pain scores and analgesic utilization were extracted from the hospital information system. Analgesic consumption was measured by the Analgesic Use Rate (AUR) and Number of Defined Daily Doses (DDDs). The DDD value of each drug is provided by the World Health Organization (WHO). The proportion of Days with Severe Pain (DSP, NRS-11 ≥ 7) was assessed on the first postoperative day and over the first 3 days. RESULTS:We addressed the gap in preemptive analgesia, with its implementation rate increasing from 0% to 53.8%. Etoricoxib (not approved for use in the United States by the FDA) use increased significantly (AUR: 13.4% to 53.2%; DDDs: 116.0 to 433.1), while pethidine use decreased significantly (AUR: 48.5% to 19.6%; DDDs: 47.1 to 17.0). These changes were accompanied by significant reductions in severe postoperative pain: DSP declined from 21.3% to 8.8% on the first postoperative day and from 10.8% to 4.8% over the first 3 days. LIMITATION:As a single-center retrospective study in a tertiary hospital in the People's Republic of China's capital, the regional patient pool may limit the generalizability of our findings. Additionally, the study did not account for the potential effect of COVID-19 on patient severity, surgical patterns, and analgesic prescription diversity during the pandemic. CONCLUSION:Our study demonstrates that implementing a structured perioperative protocol emphasizing preemptive analgesia and multimodal analgesia resulted in pain management effects, including decreased incidences of severe postoperative pain and reduced analgesic opioid consumption.

To evaluate the efficacy of an innovative teaching model combining flipped classroom methodology with digital virtual simulation software in improving neuraxial anesthesia-related learning outcomes among medical undergraduates, compared with traditional lecture-based teaching. Prospective, randomized, controlled study. Peking University Third Hospital, Beijing, China. Thirty-eight clinical medical students undertaking anesthesiology internships were enrolled and randomly allocated to an intervention group (n=19) or a control group (n=19). All participants completed the study. The intervention group underwent a flipped classroom approach supplemented with 3D body anatomy software for pre-class learning and in-class discussion. The control group received conventional lecture-based teaching using slides and two-dimensional anatomical charts. The intervention lasted throughout the clinical rotation module. The primary outcome was student satisfaction with teaching effectiveness, assessed using a self-developed 5-point Likert scale questionnaire. Secondary outcomes included post-class quiz scores (10-item test, maximum 10 points), theoretical knowledge scores (end-of-rotation examination, 100-point scale), and practical skill performance (100-point assessment). The intervention group showed significantly higher theoretical knowledge scores (71.1 ± 11.9 vs 64.2 ± 5.6, P=0.034) and practical skill scores (85.9 ± 4.1 vs 80.4 ± 2.5, P<0.001) compared with the control group. Satisfaction scores were also significantly higher in the intervention group across multiple domains, including understanding of theoretical knowledge (P<0.001) and practical skills (P=0.002). The integration of flipped classroom with 3D virtual simulation software significantly improves theoretical and practical learning outcomes and increases student satisfaction in neuraxial anesthesia education. This model offers a promising alternative to traditional teaching in medical undergraduate training. Further research should explore its long-term retention effects and applicability to other clinical skills. 1. This study adopted a prospective, randomized controlled design, reducing selection bias and enhancing internal validity. 2. Skill assessments were performed by two instructors blinded to group allocation, minimising observer bias. 3. Sample size was calculated a priori, though the power was limited to 70

This study aimed to explore the efficacy and safety of remimazolam vs. propofol for sedation during video laryngoscopy in cervical spondylosis patients with suspected difficult laryngoscopy. In this single-center, prospective, randomized controlled study, 85 patients with Modified Mallampati class III or IV and limited cervical spine mobility were recruited and randomly assigned (1:1 ratio) to receive either remimazolam or propofol sedation. The primary outcome was the incidence of hypoxemia (SpO₂< 90

Background:Chronopharmacology is an important but underexplored aspect of propofol administration. Despite the implementation of propofol administration models, none have yet incorporated temporal variables. This study aims to investigate the impact of temporal variations on propofol administration during sedated gastrointestinal (GI) endoscopy. Moreover, we aim to develop regression models to predict manually-controlled propofol administration that integrate temporal variables. Methods:This prospective single-center cohort study enrolled patients undergoing sedated GI endoscopy. For analysis, patients were categorized into 4 groups based on the anesthesia start time: Group 1 (8:00-10:00), Group 2 (10:00-12:00), Group 3 (13:00-15:00), and Group 4 (15:00-17:00). Perioperative characteristics and propofol doses were compared across groups. Correlation analysis was conducted to evaluate the relationship between propofol dose and the anesthesia start time. Subsequently, linear regression models were developed for manually-controlled propofol administration. Results:A total of 146 cases were included in the statistical analysis. Significant differences were found for all parameters related to propofol dose across the 4 different groups, including induction dose, maintenance dose, total dose and these doses per kilogram per hour. Furthermore, there were positive correlations between the anesthesia start time and all parameters. In the linear regression models, the induction dose equation incorporated the anesthesia start time, age and weight as variables. The model of the maintenance dose per kilogram per hour included the anesthesia start time, duration and weight as variables. Conclusion:The results suggest that propofol dose increases with later anesthesia start times. Therefore, further clinical administration of propofol should incorporate a heightened consideration of temporal factors. Trial registration:This prospective study has been registered in the Chinese Clinical Trial Registry (Registration date: December 3, registry number ChiCTR2400093328).

Purpose:Maternal Advanced Cardiovascular Life Support (ACLS) training is crucial for effective maternal cardiopulmonary resuscitation education. Traditional lecture-based approach for maternal cardiopulmonary resuscitation falls short in providing opportunities for adequate practice and active participating. Peyton's four-step teaching method shows advantages in the acquisition of procedural skills. Its effectiveness is constrained in group settings due to the 1:1 teacher-student ratio requirement. This study aims to evaluate the effectiveness of a modified Peyton's four-step teaching method in maternal ACLS training, with the objective of optimizing clinical training strategies. Methods:Sixty physicians participating in ACLS training at our hospital from October 2023 to December 2024 were enrolled and randomly divided into an experimental group (n = 30) and a control group (n = 30). The experimental group received the modified Peyton's four-step teaching method, while the control group underwent traditional lecture-based training. Teaching effectiveness was compared through knowledge assessments, skill evaluations, and feedback questionnaires. Results:No significant difference was observed in knowledge scores between the two groups (experimental group: 94.6 ± 4.1 vs control group: 94.3 ± 3.9, P > 0.05). However, the experimental group demonstrated significantly higher accuracy in skill operations, including uterine displacement maneuvers, peripartum cesarean section decision-making, defibrillation, and resuscitation drug administration (P < 0.05). Teamwork performance and adherence to maternal cardiac arrest (CA) protocols were also superior in the experimental group (P < 0.05). Questionnaire results indicated higher satisfaction (4.5 ± 0.7 vs 4.1 ± 0.5, P < 0.05) and greater learning engagement (4.5±0.6 vs 4.0±0.6, P < 0.05) in the experimental group. Conclusion:The modified Peyton's four-step teaching method significantly enhances physicians' mastery of maternal ACLS skills, improves teamwork capabilities, and elevates both teaching quality and learner satisfaction.

Objective The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).Design A retrospective nested case-control study.Setting A tertiary hospital in China.Participants A total of 13 523 patients within a single-centre longitudinal ACSS cohort were identified from March 2013 to February 2022. Patients with postoperative haematoma after ACSS were enrolled as the haematoma group, and others in the cohort without haematoma were randomly selected as the non-haematoma group by individually matching with the same operator, same gender, same surgery year and similar age (±5 years) at a ratio of 4:1. Subsequently, patients with haematoma were included in a subgroup for analysis.Primary outcome measures Postoperative haematoma and difficult intubation prior to haematoma evacuation.Results The incidence of postoperative haematoma out of all ACSS was 0.4% (55/13 523). A total of 275 patients were enrolled in the study, including 55 patients in the haematoma group and 220 patients in the non-haematoma group. Anterior cervical corpectomy and fusion (ACCF) (OR 2.459; 95% CI 1.302 to 4.642; p =0.006) and the maximum mean arterial pressure (MAP) during recovery (OR 1.030; 95% CI 1.003 to 1.058; p =0.028) were identified as independent risk factors for haematoma. In the subgroup analysis, 29% of patients with haematoma experienced difficult intubation, and retropharyngeal haematoma (OR 10.435; 95% CI 1.249 to 87.144; p =0.030) was identified as an independent risk factor for difficult intubation. Patients with haematoma had longer hospitalisation duration (p <0.001) and greater costs associated with their stay (p <0.001).Conclusion ACCF and elevated maximum MAP during the recovery period were independent risk factors for postoperative haematoma following ACSS. Patients with post-ACSS haematoma are at high risk of a difficult airway, with retropharyngeal haematoma being strongly associated with challenging airway management. Postoperative haematoma was associated with longer hospitalisation duration and greater costs.Trial registration number China Clinical Trial Registry: ChiCTR2400086263.

BACKGROUND:Accurate assessment of difficult airway (DA) is critical, as failure to identify DA may lead to life-threatening complications. This study aimed to develop a multiparameter predictive model for DA using a novel ultrasound reference line (XU-line). METHODS:In this prospective, observational, single-blinded study, patients scheduled for elective cervical spondylosis surgery at Peking University Third Hospital underwent preoperative airway evaluation via physical indices and ultrasonography. Distances from the XU-line to six anatomical landmarks (hyoid bone, cricoid cartilage, epiglottis, vocal cords, thyroid isthmus, and suprasternal notch) were measured both in supine and sniffing positions. Participants were stratified into "easy laryngoscopy" and "difficult laryngoscopy" groups based on Cormack-Lehane (C-L) grades. Multivariate logistic regression identified independent predictors of difficult laryngoscopy. RESULTS:There were significant differences in the thirteen clinical factors between the two groups. Sex, modified Mallampati test, skin-to-epiglottis distance (neutral position), XU-line-to-vocal-cords distance (sniffing position), and spatial distances from XU-line to cricoid cartilage were found to be independent risk factors for difficult laryngoscopy. A combined model incorporating these five factors demonstrated superior predictive performance (sensitivity: 82.0 %; specificity: 61 %) compared to individual clinical predictors or traditional clinical models. CONCLUSION:The spatial relationship between cervical airway structures and the XU-line may serve as a novel predictive index in a comprehensive DA assessment model.

Postoperative retropharyngeal hematoma (RH) is a potentially life-threatening complication of anterior cervical spine surgery (ACSS). Difficult intubation frequently arises during airway management in patients with RH, presenting substantial challenges in clinical practice. This retrospective cohort study aimed to (1) identify risk factors linked to RH development after ACSS, and (2) highlight risk factors for difficult intubation within the RH patient group. This retrospective analysis utilized a single-center longitudinal ACSS cohort from March 2013 to March 2024. The RH cohort was defined as patients who developed postoperative RH, while a non-RH control group (4:1 ratio) was established through matching for the same operator, gender, and operative year, with age matched within ± 5 years. Patients with RH were categorized into two groups based on whether they experienced difficulty in tracheal intubation during airway management prior to hematoma evacuation: the difficult intubation group and the non-difficult intubation group. Multivariable analysis identified independent risk factors for RH and difficult intubation. The incidence of postoperative RH following ACSS was 0.25

The burgeoning field of Narrative Medicine (NM) in China has drawn the attention of scholars and medical practitioners nationwide, yet discrepancies in understanding its principles and methods remain.The absence of overarching guidance and detailed practice strategies has impeded the development of NM's potential.To address this gap and to foster a unified approach to the history, practice, and research of NM, the Narrative Medicine Association of the Chinese Preventive Medicine Association and the Narrative Medicine Association of the Beijing Integrative Medicine Association convened a panel of experts to draft the Expert Consensus on Narrative Medicine in China (ECNMC 2023) [1].Medicine is fundamentally concerned with preventing and treating diseases as well as preserving or reinstating the physical, psychological, and social well-being of individuals.Humane care should be at the core of medicine.Nonetheless, the emphasis on medical technologism and the paucity

Sugammadex (SUG) is a novel antagonist of neuromuscular blocking agents (NMBAs). The NMBA rocuronium is usually employed to obtain better surgical conditions in kidney transplant. Nevertheless, rocuronium has several disadvantages, such as an increased risk of pulmonary complications. Thus, SUG is vital to kidney-transplant surgery. However, because SUG is excreted by the kidneys in prototypes, the pharmacokinetics (PK) may be affected in patients with renal impairment. We developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to monitor SUG in plasma samples to investigate the PK of SUG in kidney-transplant patients. Due to the complexity and limitation of other methods of sample preparation, magnetic solid-phase extraction (MSPE) was adopted to purify samples. Chromatographic separation was obtained using a reversed-phase Polaris® C18 column and gradient elution with 0.1% formic acid (FA) in water as phase A and in methanol (MeOH) as phase B as mobile phases. The transitions 999.7 → 963.9 (m/z) and 1055.7 → 1012.2 (m/z) were used to quantify SUG and ORG26265, respectively, under negative electrospray ionization. A linear calibration curve was achieved in concentrations varying from 100 to 10 000 ng mL-1. The acceptable accuracy varied from 95.7% to 106.4%, and intra- and inter-precision did not exceed 15% (20% at the lower limit of quantitation (LLOQ)). The matrix effect, stability, dilution integrity, and carry-over were validated. This method was applied successfully for the PK study of 13 recipients and 12 donors of kidney transplant after intravenous injection of SUG (2 mL per kg bodyweight).

Continuing medical education plays a pivotal role in fostering and upholding the standard of excellence in medicine. Both SPOC (small private online course) and BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) methodologies are rooted in the same educational and learning theories, emphasizing active student engagement, interaction, and feedback. Using ultrasound-guided spinal anesthesia as an exemplar, we aimed to investigate the feasibility of blended teaching (combination of BOPPPS and SPOC) for anesthesiology clinicians and explore trainees' and trainers' perspectives towards the innovative method. Twenty-seven attending anesthesiologists were randomly divided into experimental group (n = 14, blended teaching method) and control group (n = 13, traditional teaching method). The questionnaire was administered before and a week post-training. Their operative skills (measured by operation time) were assessed. The students' cognitive evaluation of the blended teaching mode was conducted in the experimental group. The experimental group demonstrated notably higher theoretical scores compared to the control group [(46.42 +/- 5.345) vs (41.92 +/- 5.219), t = 2.213, P < .05]. The operation time in the experimental group was significantly shorter than that in the control group [(84.79 +/- 28.450) seconds vs (114.23 +/- 35.607) seconds, t = -2.383, P < .05]. Most participants preferred blended learning as it was more effective than traditional learning. Suggestions for enhancement included enhanced online interactivity with trainers and the inclusion of case analysis. Integration of blended teaching incorporating BOPPPS and SPOC methodologies holds promise for enhancing the efficiency of skill training among anesthesiologists. Blended learning may become a viable and well-received option among anesthesia clinicians in China.

Anticipating difficult laryngoscopy is crucial for preoperative assessment, especially for patients with cervical spondylosis. Radiological assessment has become essential for improving airway management safety. This research introduces novel radiological indicators from lateral cervical X-ray in the extended head position proposed to enhance the accuracy of predicting difficult laryngoscopy. A prospective cohort study included 422 patients scheduled for elective cervical spine surgery. The Cormack-Lehane grades I and II were categorized as “easy laryngoscopy group”, while grades III and IV were labeled “difficult laryngoscopy group”. Demographic data, conventional bedside indicators including inter-incisor gap (IIG), neck circumference (NC), thyromental distance, the upper lip bite test (ULBT), and 4 radiological indicators including Mandibular Length, Laryngeal Height, the Larynx-Mandibular Angle Test (LMAT) and Larynx-Mandibular Height Test (LMHT) were analyzed comparatively. A binary logistic regression model was developed to identify independent predictive factors. The predictive value of the indicators was evaluated with the area under the curve (AUC). A total of 402 patients were analyzed in the present study. A binary logistic regression model identified IIG, NC, ULBT, and LMAT as the independent indicators associated with difficult laryngoscopy. A novel combined predictive model equation was derived: Ɩ=−0.969 − 1.33×IIG + 0.408×ULBT + 0.201×NC − 0.042×LMAT. The AUC for this composite model was 0.776, exceeding the individual AUC of 0.677 for LMHT. LMHT and the novel combined predictive model incorporating LMAT are potentially valuable predictors for difficult laryngoscopy in patients with cervical spondylosis. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200058361) on April 7, 2022.

Abstract Background Postoperative retropharyngeal hematoma (RH) following anterior cervical spine surgery (ACSS) can cause acute airway obstruction (AAO). In severe cases, difficult intubation (DI) may occur, posing serious challenges to airway management. The purpose of this retrospective study was to investigate the incidence and risk factors for DI and to explore airway management in RH evacuation following ACSS. Methods A series of 40 consecutive patients who underwent RH evacuation following ACSS were retrospectively identified at Peking University Third Hospital from March 2010 to March 2023. Patients were categorized into the DI group or no-DI group. Demographic, clinical symptom, and airway assessment data were recorded to identify risk factors for DI. Results The incidence of postoperative RH out of all ACSS surgery was 0.2% (40/16,127). General anesthesia was applied for RH evacuation in all 40 patients. The incidence of DI during RH evacuation was 35% (14/40). Thirty-nine patients were successfully treated and discharged, and one patient died of hypoxic-ischemic encephalopathy 24 days after RH evacuation. Class III & IV acute airway obstruction (AAO) (odds ratio [OR], 5.384; 95% confidence interval [CI], 1.098–26.398; P = 0.038) and time interval between symptom onset and airway intervention (TI) (OR, 2.073; CI [1.072–4.010]; P = 0.030) were found to be independent risk factors for DI. Patients with DI had longer tracheal catheter retention times and longer durations of stay in the intensive care unit (ICU) (P < 0.001). Conclusions Class III & IV AAO and TI are independent risk factors for DI during RH evacuation following ACSS. DI is associated with longer retention of the tracheal catheter and longer duration of stay in the ICU. Appropriate airway intervention should be performed for high-risk patients. Trial registration: ChiCTR2200061982

OBJECTIVE:To investigate the incidence and potential risk factors associated with postoperative spinal epidural hematoma (SEH) following anterior cervical spine surgery (ACSS). METHODS:A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022. Patients who developed postoperative SEH were categorized as the SEH group, while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator, same gender, same surgery year, and similar age (±5 years) at a ratio of 4 ∶ 1. The general condition, preoperative comorbidities, anticoagulant or antiplatelet therapy, preoperative coagulation and platelet counts, American society of Anesthesiologists physical status classification, cervical spondylosis classification, preoperative modified Japanese Orthopaedic Society score and cervical disability index score, surgical modality, surgical segment levels, ossification of the posterior longitudinal ligament among the surgical level, surgery duration, estimated blood loss, postoperative drainage volume, preoperative mean arterial pressure, mean arterial pressure during postoperative awakening periods, hospital stay and hospitalization cost were compared between the two groups. A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of the indicators. RESULTS:A total of 85 patients were enrolled in the study, including 17 patients in the SEH group and 68 patients in the non-SEH group. Seventeen patients with SEH underwent hematoma evacuation, and all of them were successfully treated and discharged from the hospital. Corpectomy (OR=7.247; 95%CI: 1.962-26.766; P=0.003) and the highest mean arterial pressure during awakening (OR=1.056; 95%CI: 1.002-1.113; P=0.043) were independent risk factors for SEH. The AUC values were 0.713 (95%CI: 0.578-0.848) and 0.665 (95%CI: 0.51-0.82) respectively. The patients with SEH had longer hospital stays (P < 0.001) and greater hospitalization costs (P=0.035). CONCLUSION:Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS. High-risk patients should be closely monitored during the perioperative period.

Background:The utilization of Propofol, a widely used intravenous sedative or anesthetic, is characterized by its quick onset, predictable control, and fleeting half-life during both general anesthesia and intensive care unit sedation. Recent evidence, however, has highlighted propofol's propensity to induce euphoria, particularly in patients undergoing painless procedures such as gastrointestinal or gastric endoscopy. Given its widespread use in patients undergoing such procedures, this study aims to investigate the clinical evidence and factors that may influence propofol-induced euphoria in these settings. Methods:The Addiction Research Center Inventory-Chinese Version (ARCI-CV) scale was administered to 360 patients undergoing gastric or gastrointestinal endoscopy using propofol as a sedative. Patient characteristics including past medical history, depression, anxiety, alcohol abuse, and sleep disturbance were recorded through history taking and assessment using various questionnaires prior to the examination. The euphoric and sedative statuses were assessed at 30 min and 1 week post-examination. Results:The experimental results of a survey of 360 patients who underwent gastric or gastrointestinal endoscopy using propofol showed that the mean Morphine-Benzedrine Group (MBG) score before the procedure and after 30 min of the procedure was 4.23 and 8.67, respectively. The mean Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score before the procedure and after 30 min of the procedure was 3.24 and 6.22, respectively. These results showed that both MBG and PCAG scores increased significantly after the procedure. Certain factors, such as dreaming, propofol dose, duration of anesthesia, and etomidate dose, were all correlated with MBG both at 30 min and 1 week after the examination. In addition, etomidate had an effect of decreasing MBG scores and increasing PCAG scores both at 30 min and 1 week after the examination. Conclusion:Taken together, propofol may elicit euphoria and potentially contribute to propofol addiction. There are several risk factors for the development of propofol addiction, including dreaming, propofol dose, duration of anesthesia, and etomidate dose. These findings suggest that propofol may have a euphoric effect and may have the potential for drug addiction and abuse.

Objective:To explore the application of interactive portrait method to improve the teaching of anesthesia trainees.Methods:A total of 32 students from the eight-year clinical medicine program of Peking University Health Science Center in 2018 whose internship rotations happened in the Department of Anesthesia of Peking University Third Hospital were enrolled as the research participants, and divided into the experimental group and the control group by random number table method. Eighteen students in the experimental group are trained by interactive portrait method, and 14 students in the control group are trained by traditional method. After the internship, the learning effect is evaluated by knowledge assessment, in-class skill test and questionnaire survey results. Independent sample t-test and χ2 The test were used to compare between the two groups. Results:The knowledge test scores of the two groups were (19.43±2.84) and (18.71±1.81), respectively, with no significant difference ( t=0.88, P=0.094); The success rate of tracheal intubation and intraspinal anesthesia in the experimental group was 18/18 and 18/18 respectively; while the students in the control group were 12/14 and 14/14 respectively, with no significant difference (both P>0.05). The results of the questionnaire survey showed that the students in the experimental group had higher self-scores than the students in the control group in terms of independently drawing laryngoscopic anatomy [(9.72±0.56) vs. (6.79±2.81)] and completing intraspinal puncture operation [(8.67±1.29) vs. (5.93±2.60)], and the differences were statistically significant (both P<0.05). Conclusions:The use of interactive portrait method in anesthesia probation teaching can help students master the basic theory and clinical skills of anesthesia, and is generally recognized by students.

目前麻醉专业的住院医师培训工作存在实训教学不足、理论与实践脱节等问题.纤维支气管镜引导下清醒插管是处理非紧急困难气道的金标准,但该技术学习曲线长,学习效率低,技能提升缓慢,是临床教学中的难点和痛点.本研究借助ORSIM模拟器开展项目式教学,以解决真实情境问题为任务,使住培医师在课堂即能体验到知识和技能的运用,学会探究并实践知识的建构和迁移,为临床住培医师的实训教学提供新思路和新方法.