BackgroundSurgery is the primary treatment for non-small cell lung cancer (NSCLC), but microscopic residual disease may be unavoidable. Preclinical studies have shown that volatile anesthetics might suppress host immunity and promote a pro-malignant environment that supports cancer cell proliferation, migration, and angiogenesis, whereas propofol may preserve cell-mediated immunity and inhibit tumor angiogenesis. However, clinical evidence that propofol-based total intravenous anesthesia (TIVA) can reduce tumor recurrence after curative resection remains inconsistent due to the retrospective observational nature of previous studies. Therefore, we will test the hypothesis that the recurrence-free survival (RFS) after curative resection of NSCLC is higher in patients who received TIVA than volatile anesthetics (GAS) in this multicenter randomized trial.MethodsThis double-blind, randomized trial will enroll patients at 22 international sites, subject to study registration, institutional review board approval, and patient written informed consent. Eligible patients are adult patients undergoing lung resection surgery with curative intent for NSCLC. Exclusion criteria will be contraindications to study drugs, American Society of Anesthesiologists physical status IV or higher, or preexisting distant metastasis or malignant tumor in other organs. At each study site, enrolled subjects will be randomly allocated into the TIVA and GAS groups with a 1:1 ratio. This pragmatic trial does not standardize any aspect of patient care. However, potential confounders will be balanced between the study arms. The primary outcome will be RFS. Secondary outcomes will be overall survival and complications within postoperative 7 days. Enrollment of 5384 patients will provide 80% power to detect a 3% treatment effect (hazard ratio of 0.83) at alpha 0.05 for RFS at 3 years.DiscussionConfirmation of the study hypothesis would demonstrate that a relatively minor and low-cost alteration in anesthetic management has the potential to reduce cancer recurrence risk in NSCLC, an ultimately fatal complication. Rejection of the hypothesis would end the ongoing debate about the relationship between cancer recurrence and anesthetic management.Trial registrationThe study protocol was prospectively registered at the Clinical trials (https://clinicaltrials.gov, NCT06330038, principal investigator: Hyun Joo Ahn; date of first public release: March 25, 2024) before the recruitment of the first participant.

In electro-surgery, surgical smoke was hazard to surgeons and patient in theatre. In order to institute effective countermeasures, quantifying of the effect of tip temperature of electro-surgical unit to surgical smoke distribution in theatre was studied. The relation of tip temperature to power of electro-surgical unit through in vitro cutting experiment. Based on experiment data, the mathematical model was established to simulate the electro-surgery in laminar operation room. As the power of electro-surgical knife increased, the knife tip temperature increased. Total content of (CO, CO2, CH4, NH3) in waste gas and net flow rate of waste gas at outlet increased with the rising temperature of knife tip and formation rate of condensed tar droplets and non-viable particles also increased. Based on simulation, it was found that The maximum height of surgical smoke rising right above the incision of electro-surgical unit was increased with rising temperature of electro-surgical knife tip. There was a spread route of dispersed surgical smoke near the walls of theatre through natural convection. The polynomial fitting relationship was derived. As the tip temperature of knife increased from 200 to 500°C, maximum ascending height of surgical smoke right above the incision position of electro-surgical unit increased from 1.1 m to 1.45 m. When the tip temperature of electro-knife was more 400°C, the CO content in the surgeon’s operating zone was more than 200 ppm, which would cause the surgeon’s HbCO level increased. As the patient’s tissue in the wound during operation was open, when the electro-knife of more than 400°C, the content of condensed tar droplets and in-viable particle was higher than 20 g/m3 and 12 g/m3 in the zone around patient’s wound of open tissue, which should be hazard to health of patient.

The goal of this study was to investigate the value of the long-term average spectrum in the acoustic analysis of snore sounds arising from different sources in the upper airway. Long-term average spectrum was used to analyze sequences of 10 consecutive snore sounds that had been divided into 2 groups, soft-palate type and lateral-wall type, according to the vibration site generating the snore sounds and the patterns of soft tissue collapse in the upper airway as identified by drug-induced sleep endoscopy. We calculated the first spectral peak, mean spectral energy, high-frequency energy, 0–1 kHz spectral energy, 1–5 kHz spectral energy, and 0–1 kHz/1–5 kHz difference from each group and compared the differences between them. All parameters except mean spectral energy showed significant differences between the 2 groups. The first spectral peak of less than 265.53 Hz, and the 0–1k/1–5 kHz difference of less than –11.6 dB strongly suggests soft-palate-type snore sounds. Long-term average spectrum has potential application for snore sound source identification. We recommend using first spectral peak and a 0–1 kHz/1–5 Hz difference to identify soft-palate-type snore sounds.

目的 比较肺保护性通气策略与传统通气策略在全身麻醉患者经后腹膜腹腔镜手术中的通气效果.方法 选取2017年1月至2019年6月于北京医院/国家老年医学中心/中国医学科学院老年医学研究院全身麻醉下侧卧折刀位行经后腹膜腹腔镜肾癌手术的患者60例,按照随机数字表法分为两组:传统通气策略组(A组)和肺保护性通气策略组(B组),A组和B组各30例.记录T1(全身麻醉插管后)、T2(侧卧折刀位5min)、T3(气腹30min)、T4(手术结束时)时刻的气道平均压、肺顺应性和呼气末二氧化碳(end-tidal carbon dioxide,EtCO2);记录T0(入手术室)、T2、T3、T4、T5(术后24h)时刻的动脉血pH、动脉血氧分压(arterial partial pressure of oxygen,PaO2)和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2);记录有无术后呼吸衰竭.结果 B组在T1、T2、T3、T4时刻的气道平均压均明显低于A组,B组在T1、T2、T3、T4时刻的肺顺应性和EtCO2均明显高于A组,差异有显著性(P<0.05).B组在T2、T3时刻的PaCO2均明显高于A组,差异有显著性(P<0.05),而T4、T5时两组的PaCO2差异无显著性(P>0.05),其余血气指标差异无显著性(P>0.05).两组患者术后均未发生呼吸衰竭.结论 肺保护性通气策略降低术中气道压,具有更好的肺顺应性,术中PaCO2会有一过性升高但无相关并发症,可安全用于全身麻醉下经后腹膜腹腔镜手术.

Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

目的 评价不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜胆囊切除术患者的镇痛效果.方法 选取2019年8月至2020年8月于北京医院/国家老年医学中心/中国医学科学院老年医学研究院择期做腹腔镜胆囊切除术患者90例为研究对象,采用随机数字表法分为A组、B组、C组,每组各30例.A组给予0.2％罗哌卡因腹横肌平面阻滞,B组给予0.5μg/kg右美托咪定复合0.2％罗哌卡因腹横肌平面阻滞,C组给予1.0μg/kg右美托咪定复合0.2％罗哌卡因腹横肌平面阻滞.比较分析三组患者麻醉苏醒时间、自主呼吸恢复时间、拔出喉罩时间、拔出喉罩后5min的Steward苏醒评分,术后6h、12h、24h的视觉模拟评分(visual analogue score,VAS),术后氟比洛芬酯和芬太尼的使用情况,术后不良反应发生情况.结果 与A组比较,B组患者自主呼吸恢复时间缩短,差异有显著性(P<0.05);A组和B组患者苏醒时间和拔出喉罩时间比较差异均无显著性(P>0.05);与A组和B组比较,C组患者苏醒时间、自主呼吸恢复时间和拔出喉罩时间均明显延长,差异有显著性(P<0.05).三组患者Steward苏醒评分比较差异无显著性(P>0.05).与A组比较,B组和C组患者术后6h、12h、24h的VAS评分明显降低,差异有显著性(P<0.05);B组和C组患者术后6h、12h、24h的VAS评分比较差异均无显著性(P>0.05).与A组比较,B组和C组患者氟比洛芬酯使用率明显降低,差异有显著性(P<0.05).A组、B组和C组患者术后分别有4例(13.3％)、2例(6.7％)、2例(6.7％)发生恶心和呕吐不良反应,三组患者不良反应发生率比较差异无显著性(χ2=1.098,P=0.578).三组患者均未出现神经阻滞和全身麻醉相关并发症,均未发生术后嗜睡及呼吸抑制等不良反应.结论 腹腔镜胆囊切除术患者给予0.5μg/kg右美托咪定复合罗哌卡因行腹横肌平面阻滞,患者麻醉恢复快,镇痛效果佳,且安全性较好,值得临床应用.

Objective:To investigate the effects of lung protective ventilation on postoperative intrapulmonary oxygenation in elderly patients undergoing abdominal surgery under general anesthesia.Methods:A total of 104 elderly patients(operation time≥2 hours)planned for elective abdominal surgery were randomly divided into two groups by random lottery numbers: the lung protective ventilation group(Group P, n=52, with 2 cases withdrawing consent after surgery)and the traditional ventilation group(Group T, n=52). Patients received endotracheal intubation and mechanical ventilation after general anesthesia.For Group P, respiratory parameters used for assessment included the fraction of inspiration O 2(FiO 2)50%, tidal volume 6 ml/kg, respiratory rate 14-16 times/min, and positive end expiratory pressure(PEEP)5 cmH 2O(1 cmH 2O=0.098 kPa). Sustained lung inflation was performed once every 30 min with lung inflation pressure set at 30 cmH 2O for 30 s. For Group T, parameters for assessment were FiO 2 50%, tidal volume 10 ml/kg and respiratory rate 10-12 times/min.General condition, liquid intake and output, baseline and third day post-surgery values for alveolar-arterial oxygen partial pressure difference, oxygenation index, forced vital capacity(FVC), forced expiratory volume in 1s(FEV l)and FEV 1/FVC ratio on the third day after surgery were recorded for both groups.The modified clinical pulmonary infection score on the first day after surgery was also recorded. Results:The oxygenation index was higher and the alveolar-arterial oxygen partial pressure difference was lower on the third day after surgery in Group P than in Group T(351.1±57.3, vs.(324.5±55.0), (25.7±10.9)mmHg(1 mmHg=0.133 kPa) vs.(31.4±11.9)mmHg, F=0.364 and 0.026, P<0.05). There was a significant difference in the proportion of patients with modified clinical pulmonary infection score > 3 on the first day after surgery between Group P and Group T(13.6% or 6/44 vs.32.7% or 17/35, F=6.249, P<0.05). Compared with the baseline values, the FEV 1/FVC, FEV 1 and FVC on the third day after surgery had no significant difference between the two groups( P>0.05). Conclusions:Lung protective ventilation can improve pulmonary gas exchange after major abdominal surgery under general anesthesia in elderly patients, improve intrapulmonary oxygenation and reduce postoperative pulmonary complications.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

中心静脉导管置管相关并发症不仅会威胁患者健康,而且相关治疗会增加患者费用,因此如何提高其安全性一直是临床关注的问题.近年来,随着超声设备的应用、并发症管理策略的改善以及技术培训的规范,使得中心静脉导管置管的安全性得到了提高.

目的 分析药物诱导睡眠内镜下不同严重程度的睡眠呼吸障碍患者鼾声来源的特点及分类.方法 选择74例(19～55岁,平均37.9±8.70岁)AHI<50的单纯打鼾(simple snoring,SS)和不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者为研究对象,分为SS及轻度OS-AHS组(39例)和中、重度OSAHS组(35例);各组分别用右美托咪定复合异丙酚进行诱导睡眠后,通过纤维鼻咽喉镜观察两组对象仰卧位打鼾时咽部组织振动及塌陷的情况,并进行分类比较.结果 74例患者中,鼾声来源及振动形式不同,分为软腭振动为主型(I型,前后型),咽侧壁振动为主型(II型,左右型),软腭+咽侧壁共同振动型(III型,向心型)三种类型;软腭振动为主型在SS及轻度OSAHS组和中、重度OSAHS组中的例数分别为24例(61.54％)和10例(28.57％);咽侧壁振动为主型在两组中的例数分别为9例(23.08％)和16例(45.71％);软腭+咽侧壁共同振动型在两组中的例数分别为6例(15.38％)和9例(25.71％),两组间鼾声来源类型及分布差异有统计学意义(P=0.016).结论 不同程度睡眠呼吸障碍的患者睡眠中鼾声来源部位及咽部组织振动形式不同;咽侧壁振动为鼾声的主要来源(Ⅱ型及Ⅲ型),且随打鼾者阻塞程度加重而占比增加;以鼾声主要来源为依据的分类法可为该类患者治疗方案的制定提供依据.

Objective To evaluate the efficacy of dexmedetomidine combined with remifentanil for drug-induced sleep endoscopy (DISE) in the patients with snoring. Methods Sixty patients of both sexes with snoring, aged 18-61 yr, with body mass index of 21. 0-33. 1 kg∕m2 , of American Society of Anesthe-siologists physical statusⅠ or Ⅱ, scheduled for elective DISE, were randomly divided into either dexme-detomidine combined with propofol group (group P) or dexmedetomidine combined with remifentanil group (group R), with 30 patients in each group. Dexmedetomidine was infused within 10 min in a loading dose of 0. 6 μg∕kg, followed by an infusion of 0. 6 μg·kg-1 ·h-1 for 10 min in both groups. Then propofol was given by target-controlled infusion with the initial target effect-site concentration (Ce) of 1. 0 μg∕ml in group P, and remifentanil was given by target-controlled infusion with the initial target Ce of 1. 5 ng∕ml in group R. At 2 min after the target effect-site and plasma concentrations were balanced, the Ces of propofol and remifentanil were adjusted by increments of 0. 2 μg∕ml and 0. 2 ng∕ml, respectively, until satisfactory snoring occurred and then the Ce was maintained at this level in P and R groups. Bispectral index value was re-corded at 5 min after admission to the operating room (T1 ), at 20 min of dexmedetomidine infusion (T2 ), at 2 min after the target effect-site and plasma concentrations were balanced (T3 ), at the beginning of DISE (T4 ), when the nasopharyngolarygnoscope reached the site of oropharynx (T5 ) and at the end of DISE (T6 ). Observer's Assessment of Alertness∕Sedation scale scores were recorded at T1-4 . The time for prepar-ing sedation, recovery time, the lowest value of SpO2 and development of adverse events were recorded. Re-sults Sixty patients completed DISE successfully. Compared with group P, the bispectral index value at T3-6 was significantly increased, the time for preparing sedation was prolonged, the recovery time was short-ened, the lowest value of SpO2 was increased, and the incidence of respiratory depression was decreased in group R (P< 0. 05). There was no significant difference in Observer's Assessment of Alertness∕Sedation scale scores at T1-4 between two groups ( P> 0. 05). Conclusion Combination of dexmedetomidine and remifentanil produces better efficacy for DISE than combination of dexmedetomidine and propofol in the pa-tients with snoring.

Primary mass lesions of the interatrial septum are usually due to septal lipomatosis. We present images of an interatrial septal mass due to a cavernous hemangioma. An asymptomatic 73-year-old female underwent a routine echocardiogram and was found to have a 3.6 × 3.7-cm interatrial mass along the septum and extending to the roof of the right atrium (RA) which was also visualized on a magnetic resonance imaging scan (Figures 1 and 2). A coronary angiogram showed no significant coronary artery disease and no collateral “tumor” vessels. At the time of surgery, cardiopulmonary bypass (CPB) was initiated with ascending aortic and bicaval cannulation. Following antegrade, hypothermic cardioplegic arrest, a longitudinal atriotomy revealed an encapsulated mass abutting the atrial septum extending from the fossa ovalis to the roof of the RA (Figures 3 and 4). The tumor was completely excised without entering the septum which remained intact (Figure 5). The RA was closed with a continuous running suture. The CPB and crossclamp times were 88 and 63min, respectively. The patient tolerated the procedure well and had an uncomplicated postoperative course. The histopathology revealed benign endothelial cells and large communicating vascular channels consistent with a cavernous hemangioma (Figure 6).

The advancement of anesthesiology has demanded our subspecialty to transition to perioperative medicine.It is essential for anesthesiologists to master the skill of transesophageal echocardiography (TEE) for perioperative monitoring and diagnosis.Multiple subspecialties have established or started to implement the formal echocardiogaphy training programs.To be fully competent in the perioperative TEE technique and provide reliable information for perioperative management, the anesthesiologist must obtain the basic knowledge and operational skills of TEE.It is necessary for our subspecialty to establish a strategic, systematic and standardized training program.It is imperative to ensure high quality and effectiveness of TEE training within our specialty.All trainees must meet the credentials of the perioperative TEE examination, which will improve the quality of anesthesia care and patient safety.

Objective:To compare the effectiveness of oxycodone with that of L-bupivacaine (group LRA) for the control of moderate/severe pain of patients with advanced-stage peripheral arterial obstructive disease (PAOD).Methods:Forty hospitalized PAOD patients treated for pain management for at least 7 days after surgery or discharged from the hospital without surgery were randomLy divided into oral slow-release oxycodone group (group OX) and epidural L-bupivacaine group (group LRA).The outcome measures were pain intensity using the visual analogue scale under static,(VASs) and dynamic (VASd) conditions,vital signs,treatment side effects and patient satisfaction.Results:In both groups,pain control was satisfactory and VAS scores median were VASs ＜ 3 and VASd＜ 4;under dynamic conditions,pain control was better in the LRA group (P＜0.01).Against few and transient side effects,most patients (n=38) found both pain treatments good or excellent.Conclusion:In the perioperative settings,epidural infusion of local anaesthetics,such as L-bupivacaine,is an effective technique for pain control in PAOD patients;for patients with contraindications for this technique or for nonsurgical or outpatients,slow-release oxycodone is suggested as a possible alternative for the control of severe pain.

Objective: To compare the influence between desflurane and propofol anesthesia on postoperative cognitive recovery in middle-aged patients with breast cancer. Methods: 60 ASA I~II women undergoing breast surgery were randomly divided into desflurane group and propofol group. Cognitive recovery was evaluated by using the Cognitive Failure Questionnaire and a modifie-dversion of the Post-operative Quality of Recovery Scale. Results: According to Cognitive Failure Questionnaire, post-operative cognitive recovery was 65% and 66% at 72 h, and 71% and 72% at 1 week for the desflurane and the propofol groups, respectively. Recovery evaluated by Post-operative Quality of Recovery Scale was 52% and 50% at 2 h, increased to 71% and 87% at 48 h for the desflurane and the propofol groups, respectively. Conclusion: Cognitive was not completely recovery at the first week after surgery neither in desflurane nor propofol groups. There was no difference in overall cognitive recovery between the two groups.

Objective To evaluate the usefulness of ETView TVT for anesthetic airway management by analyzing the clinical characteristics of 56 cases.Method We collected 56 cases of ETView TVT for anesthetic airway management in our hospital.The patients' airway characteristics,the clinical manifestations and outcomes were recorded and analyzed.Result 32 cases of ETView TVT were used according to plan,while 24 cases were unplanned.Among 56 cases,30 cases of ETView TVT were in cardiac anesthesia,including 8 cases for one lung ventilation with the endobronchial blocker tube,14 cases for postoperative long-term mechanical ventilation and bronchial aspiration,8 cases for unpredicted difficult intubation.10 cases were for altemative one lung ventilation with the endobronchial blocker tube after double-lumen tube ventilation failed in thoracic surgery.10 cases were for tracheotomy in otolaryngological surgery.6 cases were for unpredicted difficult airway management in other types of surgeries.All 56 patients had Cormack and Lehane glottis view level I by ETView TVT,while 1 patient had level Ⅰ,16patients had level Ⅱ,25 patients had level Ⅲ,14 patients had level Ⅳ by Macintosh.Patients had a better Cormack and Lehane glottis view by ETView than by Macintosh (P＜0.01).All the patients maintained SpO2≥95％ during intubation and the airway management was resolved with ETView TVT without advert complications associated with intubation.Conclusion Useness of ETView TVT simplies the airway management protocol,improves the Cormack and Lehane glottis view,facilitates unpredicted difficult airway management and postoperative bronchial aspiration,avoids hypoxemia during replacing airway equipments and decreases airway risk.

右心房肿物患者本身即有猝死的危险，进行右心房肿物切除术时麻醉和手术操作能加剧这种风险。因为术中要避免放置肺动脉导管进行血流动力学监测，近年来食管超声心动图（transesophageal echocardiography， TEE）监测越来越多地应用于此类手术。本文将分析右心房肿物切除术的麻醉安全隐患，总结麻醉要点，并详细介绍TEE在麻醉安全中的作用。

Abstract Objective: To discuss the possibility of fundamental frequency (F0) and formant frequency (FF) to generally differentiate the sources of snoring sounds determined by drug-induced sleep endoscopy (DISE). Methods: A total of 74 snoring subjects underwent DISE and snoring sounds were recorded simultaneously. The noise-suppressed snoring sounds were analyzed and classified into different groups based on the sources of vibration identified by DISE. F0 and FFs were calculated. Results: Totally, 516 snoring sounds from three vibrating sources (the palate, combined the palate and the lateral wall, the lateral wall) of 47 patients were divided into three groups then analyzed. The levels of F0 and FFs for each group follow the order: Group 1 < Group 2 < Group 3. There was statistical difference between Group 1 and other groups in F0 and F2 (p < .05). The area under the receiver–operator curves (AUC) was F0, at 0.727, and the cut-off value was 134.2 Hz; and F2, at 0.654, and the cut-off value was 2028.0 Hz. Conclusions: F0 and the second formant frequency (F2) are found to be significantly lower in palatal snoring sound. F0 might be a significant in distinguishing palatal snoring sound from non-palatal snoring sound. F2 is more significant than F1 and F3 in identifying the sources of the snoring sounds but is less sensitive than F0.

Objective To investigate the consistency of the sources of snoring sound induced by simulated snoring and drug-induced sleep endoscopy in simple snores (SS) and mild obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods A total of 40 cases diagnosed as either SS or mild OSAHS by polysomnography (PSG) underwent simulated snoring and drug-induced sleep endoscopy successively.The vibration of soft tissue of upper airway was observed with fiberoptic laryngoscope.Results Under simulated snoring condition and drug-induced sleep endoscopy,there were different vibrations in the pharynx.The McNemar statistical results showed that there was no significant difference between simulated snoring and drug-induced sleep endoscopy in determining the vibration of soft palate and epiglottis/tongue base (P =0.774,0.077),while there was very significant difference between the two methods in determining the vibration of the lateral phaynged wall (P =0.002).Under these two conditions,there was no significant difference in the incidence rates of vibration of both soft palate and epiglottis/tongue base (P =0.770,0.110),while the incidence rate of vibration of lateral pharyngeal wall was much higer under drug-induced sleep endoscopy than that under simulated snoring (P =0.005).Conclusion Compared with drug-induced sleep endoscopy,simulated snoring is relatively reliable in determination of soft palate vibration,slightly inferior for epiglottis/tongue base,but is unreliable in the determination of lateral pharyngeal wall vibration.

The management of unanticipated difficult airway is a clinical challenge to anesthesiologists. The ETView Tracheoscopic Ventilation Tube (ETView), which is capable of real-time video imaging of the airway without needing additional equipment, may provide a promising settlement for the cases. Here, we reported a successful management of unanticipated difficult bag-mask ventilation airway with the ETView. More importantly, we successfully maintained oxygenation by modifying its injection and suction port.