Purpose:To observe the effect of ultrasound-guided single right stellate ganglion block (SGB) on postoperative first night sleep in patients undergoing maxillofacial surgery. Methods:This study included 120 participants who underwent maxillofacial surgery under general anesthesia from 11 April 2023 to 31 August 2024. These participants were divided into three groups, namely blank control group, 1% lidocaine group, and 2% lidocaine group, with 40 patients in each group. Their blood pressure, heart rate, blood oxygen saturation, and the visual analog scale (VAS) scores were recorded before the operation (baseline), immediately after awakening, immediately after arrival at the anesthesia intensive care unit (AICU), 1 h after arrival at the AICU, and 2 h after arrival at the AICU. The Richard-Campbell Sleep Questionnaire (RCSQ) was used to evaluate the sleep quality in the three patient groups on the first night after surgery. Complications associated with SGB and the number of sedative analgesic medication doses supplemented on the first postoperative night were recorded. Results:The RCSQ scores of the blank control group, 1% lidocaine group, and 2% lidocaine group were 44.5 (33.3, 62.0), 67.0 (54.0, 87.9), and 96.0 (65.8, 100.0), respectively, and the scores gradually increased (comparison among three groups: P < 0.0001). There was a statistical difference among the three groups in the gradual slowing down of heart rate after extubation and wakefulness, immediately after arrival at the AICU, 1 h after arrival at the AICU, and 2 h after arrival at the AICU. There were no significant complications of SGB in the three groups. The 1% and 2% lidocaine group reduced the number of postoperative sufentanil remedies. Conclusion:Ultrasound-guided single right SGB effectively improved the quality of postoperative first night sleep according to RCSQ and reduced stress reactions within 2 h in patients undergoing maxillofacial surgery. Notably, the efficacy of 4 mL of 2% lidocaine was superior to that of 4 mL of 1% lidocaine, making it a safe and effective method for improving postoperative sleep.

Severe COVID-19 cases often progress to life-threatening conditions such as acute respiratory distress syndrome (ARDS), sepsis, and multiple organ dysfunction syndrome (MODS). Gelsolin (GSN), an actin-binding protein with anti-inflammatory and immunomodulatory properties, is a promising therapeutic target for severe COVID-19. Plasma GSN levels are significantly decreased in critical illnesses, including COVID-19, correlating with dysregulated immune responses and poor outcomes. GSN supplementation may mitigate acute lung injury, ARDS, and sepsis, which share pathophysiological features with severe COVID-19, by scavenging actin, modulating cytokine production, enhancing macrophage phagocytosis, and stabilizing the alveolar-capillary barrier. Preliminary data indicate that recombinant human plasma GSN improves oxygenation and lung function in severe COVID-19 patients with ARDS. Although further research is needed to optimize GSN therapy, current evidence supports its potential to mitigate severe consequences of COVID-19 and improve patient outcomes. This review provides a comprehensive analysis of the biological characteristics, mechanisms, and therapeutic value of GSN in severe COVID-19.

Background According to the Chinese Society of Anesthesiology, it is recommended that patients with difficult airways be documented and notified, which will provide healthcare professionals with a direct reference when managing airways. However, compliance with this initiative remains unclear. This study was conducted to investigate the current status and need for difficult airway notification at Plastic Surgery Hospital and to explore the factors contributing to noncompliance. Methods Anesthesiologists, surgeons, and patients in Plastic Surgery Hospital were administered separate questionnaires regarding notification of difficult airway management. Participants were surveyed regarding their attitudes and current practices regarding difficult airway notification. In addition, questions were asked regarding the barriers that contribute to noncompliance. Results A total of 632 valid responses were obtained and analyzed, giving a response rate of 99.21%. 399 patients (89.46%) felt it was very important for anesthesiologists to inform them about their difficult airway, and 91.03% felt it was very important for them to receive a letter of their airway assessment. However, twenty-two anesthesiologists (64.7%) reported verbally informing less than 50% of patients about their difficult airway after surgery, and only four anesthesiologists informed all patients they encountered. Most surgeons (91.22%) and anesthesiologists (91.18%) believe that it is vital to inform patients verbally, while 114 surgeons (77.03%) and 31 anesthesiologists (91.18%) believe that it is essential to complete a difficult airway notification alert. Among the factors causing noncompliance, 17 (34.69%) believed that absence of mandatory rules, 9 (18.37%) believed that increased workload, and 8 (16.33%) believed that notification methods were lacking. Conclusions The compliance to difficult airway notification remains low in Plastic Surgery Hospital despite the high incidence of difficult airways. Although anesthesiologists, surgeons, and patients are strongly in favor of it. Among the barriers to compliance were the absence of a well-developed notification system and a means of notification such as an alert form for difficult airways. This may spur the anesthesiology society to publish the notification system.

BACKGROUND:Dexmedetomidine (Dex) as a local anesthesia adjuvant for nerve block procedures can improve the quality of patient recovery. However, the impact of using Dex as a local anesthetic adjuvant for serratus anterior plane block (SAPB) procedures on recovery quality for children undergoing ear reconstruction remains unclear. METHODS:Eighty-four patients who underwent ear reconstruction with autogenous costal cartilage (ACC) were randomized into two groups (n = 42/group) in which SAPB was performed with ropivacaine alone (R group) and with Dex and ropivacaine (DR group). Primary outcomes were patient 15-item quality of recovery (QoR-15) scale scores on days 1 and 2 post-surgery. Secondary outcomes included postoperative rest and coughing numerical rating scale (NRS) chest pain scores, duration of analgesia, oral rescue analgesic usage, and opioid-related side effects. RESULTS:Forty patients per group completed the study. QoR-15 scores on days 1 and 2 post-surgery in the DR group were significantly increased relative to the R group (126.35 ± 9.81 vs. 115.53 ± 8.58 and 131.78 ± 8.67 vs. 122.80 ± 8.59, all P < 0.001). Rest and coughing NRS chest pain scores at 2, 4, 8, 12, and 24 h postoperatively in the DR group were all significantly lower relative to the R group (all P < 0.05). The DR group also exhibited significantly longer analgesic duration (P < 0.001) and significantly reduced incidences of oral rescue analgesic usage and opioid-related side effect (all P < 0.05). CONCLUSION:Combining Dex and ropivacaine for SAPB in children undergoing ear reconstruction with ACC can significantly improve the quality of recovery, quality of analgesia, and analgesic duration.

Objective:To investigate the effects of ultrasound-guided serratus anterior plane block (SAPB) on hemodynamics in children with microtia undergoing auricular reconstruction.Methods:This research was a prospective randomized control study. Patients were prospectively recruited from March 2022 to July 2022 at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Children with microtia undergoing auricular reconstruction with costal cartilage were randomly included in either a SAPB-pre group(SAPB pre-rib harvest group) or a SAPB-post group(SAPB post-rib harvest group). Both groups of children were anesthetized with combined intravenous and inhalation anesthesia. Anesthesia maintenance was provided with i. v. propofol 4-6 mg·kg -1·h -1 and remifentanil 0.1-0.3 μg·kg -1·min -1, sevoflurane at 1% concentration, and a flow rate of 2.5 L/min. During the operation, bispectral index(BIS) was maintained between 40-60, and alterations in mean arterial pressure (MAP) and heart rate (HR) were <20%, compared to the basic values. During the operation, 1% sevoflurane was inhaled to maintain anesthesia. The fluctuation of BIS, MAP, and HR was adjusted by the intraoperative infusion of remifentanil and propofol. Ultrasound-guided SAPB in the SAPB-pre group was performed by an anesthesiologist after tracheal intubation of general anesthesia. In the SAPB-post group, ultrasound-guided SAPB was performed by the same anesthesiologist before the tracheal catheter was removed at the end of the operation, and the concentration of ropivacaine was 0.25% (3 mg/kg). MAP, HR, and BIS were recorded at each time point of admission, pre-rib harvest, during-rib harvest, post-rib harvest, anesthesia extubation, leaving the room. The consumptions of propofol and remifentanil during the operation were also recorded. Continuous data were presented as Mean±SD. Non-repeated measurement parametric variables were compared using the independent samples t-test. Repeated measurement parametric variables were assessed using repeated measures analysis of variance. The same data at varying time points were compared using Dunnett- t test of multiple comparison procedures. Categorical data were compared using the Chi-square test. Results:Sixty children were randomized to SAPB-pre group and SAPB-post group and 30 in each group. The data of gender (boy 22/ girl 8 vs. boy 23/ girl 7), age[(8.03±1.07)years vs. (8.33±1.16)years], body mass index [(17.46±2.79)kg/m 2 vs. (17.23±2.11)kg/m 2], operation time[(185.33±16.29)min vs. (190.00±16.50)min] and length of costocartilage[(23.13±1.46)cm vs. (23.63±1.27)cm] between the two groups showed no significant differences ( P>0.05). There was no significant difference in MAP, HR and BIS values at the time of pre-rib harvest, during-rib harvest, and post-rib harvest in the SAPB-pre group ( P>0.05). In the SAPB-post group, the fluctuations of MAP, HR and BIS values at the time of pre-rib harvest, during-rib harvest and post-rib harvest were obvious ( P<0.01). The consumptions of propofol and remifentanil during the operation in the SAPB-pre group were significantly less than that in the SAPB-post group[(555.67±150.90)mg vs. (788.50±191.02)mg, P<0.01; (745.33±183.56)μg vs. (1 080.00±247.26)μg, P<0.01]. Conclusion:Ultrasound-guided serratus anterior plane block can stabilize the hemodynamics during auricular reconstruction using costal cartilage and reduce the consumption of general anesthetic.

Abstract Backgrounds To preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children. Methods One hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation. Results The first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04–1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03–1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia. Conclusion The SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management. Trial registration This study was approved by the University’s Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn . Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Background: Video-stylet-guided nasotracheal intubation (NTI) is an effective technique for airway management. However, the impact of the bend angle on the success rate of intubation remains unclear. Purpose: Does increasing the bend angle of a stylet to 90 degrees increase NTI success rate?. Study Design, Setting, Sample: This prospective randomized controlled trial was conducted in the operating room of a population-based hospital. Adult patients requiring NTI were recruited. Predictor/Exposure/Independent Variable: The primary predictor variable is the choice of stylet bend angle (90 degrees vs 70 degrees bend) in NTI. Main Outcome Variable(s): The primary outcome variables were success rates of NTI, defined as the proportion of successful intubation cases to total cases. Covariates: Demographics, intubation time, the distance from the thyroid prominence to the nostril, additional maneuvers applied during intubation, and cases of epistaxis were recorded. Analyses: The student's t-test was used to compare continuous variables between groups. Ordinal data (intubation attempts, head extension, and epistaxis) were analyzed using the Wilcoxon rank-sum test. As appropriate, frequency (external pharyngeal pressure) was analyzed using the c2 test or Fisher's exact test. A P value of <.05 was considered statistically significant. Results: Of the 103 subjects assessed for eligibility, 98 were enrolled in the study. The mean age (27.0 +/- 6.9 years vs 27.0 +/- 4.1 years, P = .972) and sex differences (male/female: 9/40 vs 7/42, P = .136) were comparable between groups. The overall success rate in the 70 degrees group was significantly lower than that in the 90 degrees group (91.8 vs 100%, P < .001). The intubation time in the 70 degrees group was significantly longer than that in the 90 degrees group (43.2 +/- 15.8 s vs 33.7 +/- 7.3 s, P < .001). Conclusions and Relevance: A 90 degrees bend angle of the stylet significantly improves the likelihood of successful NTI. (c) 2023 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 82:152-158, 2024

Purpose: Dexmedetomidine exerts a sedative effect by promoting the sleep pathway endogenously and producing a state similar to N2 sleep. This study aimed to study the efficacy and safety of dexmedetomidine nasal spray in the treatment of postoperative sleep disturbance.Methods: This study enrolled 120 participants [men and women; age, 18–40 years; American Society of Anesthesiologists grade, I or II] who underwent maxillofacial surgery under general anesthesia through nasotracheal intubation. The participants were randomly divided into three groups: blank control group (BC group), 1.0 μg/kg dexmedetomidine group (1.0 Dex group), and 1.5 μg/kg dexmedetomidine group (1.5 Dex group), with 40 patients allocated to each group. At 21:30 on the night after the operation, the intervention groups were administered their corresponding doses of dexmedetomidine nasal spray. The Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate the baseline sleep status of participants 1 month preoperatively and on the night after the operation. Polysomnography (PSG) was used to record the sleep status on the night after the operation. We recorded the rescue times of sedative and analgesic drugs on the first night after surgery, adverse reactions, total hospital stay duration, and total costs.Results: Compared with patients in the BC group, those in 1.0 Dex and 1.5 Dex groups had longer N2 sleep duration, were awake for a shorter time after dose administration, woke up less often, and had significantly improved sleep efficiency (p < 0.05). Compared with the BC group, the PSQI scores of 1.0 Dex and 1.5 Dex groups were significantly lower on the night after operation, and the proportion of PSQI > 5 was significantly lower (p < 0.05). Compared with patients in the BC group and the 1.0 Dex group, those in the 1.5 Dex group had significantly prolonged N3 sleep, reduced frequency of requiring sufentanil rescue, lower incidence of sore throat after surgery, and shorter average length of hospital stay (all, p < 0.05).Conclusion: The sleep quality of participants on the night after having undergone maxillofacial surgery was safely and effectively improved by 1.0–1.5 μg/kg dexmedetomidine atomized nasal sprays. Notably, only the latter could prolong N3 sleep. Level of Evidence II: Evidence was obtained from at least one properly designed randomized controlled trial.

BACKGROUND:Goldenhar syndrome is a congenital disease that involves an absence or underdevelopment of structures that arise from the first and second pharyngeal arches and more or less severe extracranial anomalies. A variety of supraglottic malformations may be observed, including mandibular hypoplasia, mandibular asymmetry and micrognathia. Subglottic airway stenosis (SGS), which can cause difficulties in airway management during the perioperative period, is seldom emphasized in literature descriptions of Goldenhar syndrome, but can be clinically significant.CASE PRESENTATION:An 18-year-old female with a history of Goldenhar syndrome presented for placement of a right mandibular distractor, right retroauricular dilator, and stage I transfer of a prefabricated expanded flap under general anesthesia. During tracheal intubation, the endotracheal tube (ETT) met resistance unexpectantly when attempting to pass through the glottis. Subsequently, we attempted the procedure with a smaller size ETT but again met resistance. With fiberoptic bronchoscope, we found that the whole segment of the trachea and bilateral bronchi were obvious narrow. Given the finding of unexpected severe airway stenosis and the associated risks with proceeding with the surgery, the operation was cancelled. We removed the ETT once the patient was fully awake.CONCLUSIONS:Anesthesiologists should be aware of this clinical finding when evaluating the airway of a patient with Goldenhar syndrome. Coronal and sagittal measurements on computerized tomography (CT) and three-dimensional image reconstruction can be used to evaluate the degree of subglottic airway stenosis and measure the diameter of the trachea.

Background Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest. Methods Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. Results Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower ( P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished ( P < 0.05), and the patient satisfaction was markedly higher ( P < 0.001) in the SAPB+PSB group. Conclusion USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert consensus focused on the assessment of the difficult airway before, so this expert consensus is developed to provide guidance for airway assessment, making this process more standardized and accurate to reduce airway-related complications and improve safety. Methods: Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology (CSA) met to discuss the first draft and then this was sent to 15 international experts for review, comment, and approval. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is used to determine the level of evidence and grade the strength of recommendations. The recommendations were revised through a three-round Delphi survey from experts. Results: This expert consensus provides a comprehensive approach to airway assessment based on the medical history, physical examination, comprehensive scores, imaging, and new developments including transnasal endoscopy, virtual laryngoscopy, and 3D printing. In addition, this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway. Conclusions: This consensus applies to anesthesiologists, critical care, and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.

目的 观察3种喉镜辅助经鼻气管插管的临床效果.方法 选取2019年5月至2021年1月中国医学科学院北京协和医学院整形外科医院择期全身麻醉下行颌面外科手术的患者132例,随机分为Macintosh直接喉镜组(MA组)、Tosight视频喉镜组(TO组)和MDH电子软镜组(MD组),每组44例.记录导管到达口咽部时间、声门暴露时间、置入导管时间及插管总时间;记录插管次数、首次插管成功率、有无按压气管环、是否旋转导管置入和有无口鼻腔黏膜出血;记录患者血流动力学改变情况;记录术后2 h咽喉部并发症发生情况.结果 TO组和MD组能较好地暴露声门,均为44例,全部为C-L分级I级,高于MA组(36例),差异有统计学意义(P＜0.05);TO组和MD组首次插管成功率均为100.0％,高于MA组的90.9％,差异有统计学意义(P＜0.05);3组Mallampatti分级和插管总成功率差异无统计学意义(P＞0.05).与MA组和TO组比较,MD组鼻导管置入或软镜到达口咽部时间[(9.7±5.5)s]、声门暴露时间[(14.5±8.9)s]、置入导管时间[(27.9±13.9)s]、插管总时间[(52.0±14.9)s]均最长,但黏膜出血发生率(4.5％)及术后咽痛发生率(2.3％)最低,差异均有统计学意义(P＜0.05).3组插管过程血流动力学稳定,术后咽部不适、声音嘶哑发生率比较,差异均无统计学意义(P＞0.05).结论 3种喉镜均能很好地完成鼻插管,Tosight视频喉镜和MDH电子软镜能更好地暴露声门,首次插管成功率高;MDH电子软镜辅助经鼻插管时间长,但黏膜出血及术后咽痛发生率低.

目的 观察评价右美托咪定联合瑞芬太尼程序化镇静镇痛麻醉用于长时间吸脂手术的有效性和安全性.方法 共160例ASA分级Ⅰ和Ⅱ级,年龄18～57岁,择期在程序化镇静镇痛麻醉下行脂肪抽吸术的女性患者,按照手术时间的长短分为长时组(GL组)和短时组(GS组),每组80例.两组患者麻醉方法相同,麻醉开始时静脉予咪达唑仑0.04 mg/kg,以0.1 μg/(kg·min)恒速泵注瑞芬太尼,同时静脉输注右美托咪定负荷量1μg/kg(15min输注完),后以0.4～0.7 μg/(kg·h)静脉持续泵注.分别记录患者在给药前即刻(T0)、右美托咪定负荷剂量输注完成后即刻(T1)、局麻开始(T2)、手术开始(T3)、停止输注右美托咪定即刻(T4)、手术结束(T5)各时间点的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO2)、脑电双频谱指数(BIS)、Ramsay镇静评分(RSS);记录患者术中出现呼吸抑制、面罩吸氧、托下颌的情况和最低呼吸频率;记录患者术中体动发生的次数、术后苏醒时间、对手术有无记忆、视觉模拟疼痛评分(VAS)及患者和术者的满意度评分.结果:两组患者术中均获得较为满意的镇静镇痛效果,术中维持RSS评分2～4分,BIS值62～75,在T4、T5时间点,GL组的HR和MAP显著高于GS组(P＜0.05);在T1、T2时间点,GL组的RR和RSS评分均显著低于GS组(P＜0.05);在T2、T5时间点,GL组的BIS显著低于GS组(P＜0.05).两组患者术中最低呼吸频率、呼吸抑制、面罩吸氧、托下颌发生率及体动次数、术后苏醒时间、对手术记忆的发生率、术后VAS评分、患者和术者的满意度评分的差异均无统计学意义(P＞0.05).结论 右美托咪定联合瑞芬太尼程序化镇静镇痛麻醉可以安全、有效应用于长时间脂肪抽吸手术,其麻醉不良反应发生率与短时间手术无明显差异.

目的 探讨通过透明的气管导管应用可视软镜观察SaCoVLM(safe comfortable video laryngeal mask)可视喉罩插入所造成咽喉部黏膜的即刻损伤情况,以评估此方法的可行性.方法 选取2021年2-8月中国医学科学院整形外科医院拟行外耳再造手术的小耳畸形患儿60例,经SaCoVLM可视喉罩进行气管插管后,将喉罩退出后,经透明的气管导管应用可视软镜观察喉罩置入过程对咽喉壁的即刻损伤情况.主要观察指标是喉罩位置分级、喉罩退出后喉罩带血情况及咽喉部黏膜损伤评分,次要指标包括喉罩的密封压、喉罩置入难易程度、喉罩放置时间、气管导管置入时间、喉罩退出时间以及气道并发症和咽喉部疼痛情况等,同时采用单因素logistic风险比例模型筛选与损伤可能相关的危险因素.结果 60例患儿全部完成SaCoVLM可视喉罩置入、气管插管和喉罩退出.喉罩退出后共有22例(36.7％)喉罩背面带有血迹,通过可视软镜观察咽喉部黏膜损伤0级24例(40.0％),1级19例(31.7％),2级3例(5.0％),3级14例(23.3％).术后随访共有20例患儿出现咽痛.采用单因素logistic风险比例模型分析结果显示,喉罩置入难易程度(P=0.048)、喉罩置入时间(P=0.045)及喉罩位置分级(P=0.050)是喉罩损伤相关的危险因素.结论 应用可视软镜通过透明的气管导管观察SaCoVLM可视喉罩置入过程引起咽喉部黏膜的即时损伤是可行的.

Costal cartilages harvest for ear reconstruction is accompanied by severe pain in chest. However, there is no perfect solution for reducing this chest pain. Evaluate the efficacy and safety of analgesia using ultrasound-guided bilateral serratus anterior plane block (SAPB) in children receiving costal cartilage harvest for ear reconstruction. Sixty children undergoing ear reconstruction using costal cartilage were randomized to an SAPB group (SAPB with 3 mg/kg 0.25% ropivacaine) or an incision infiltration (II) group (II with 3 mg/kg 0.75% ropivacaine), and 29 in each group completed the study. All children received patient-controlled intravenous analgesia (PCIA). The primary outcomes were numerical rating scale (NRS) scores of pain while rest and coughing at 1, 6, 12, 24, and 48 h after surgery. The secondary outcomes were sufentanil use within 24 h, duration of analgesia, use of oral rescue analgesics, first time out of bed, and incidence of treatment-related adverse effects. The SAPB group had lower rest and coughing NRS scores at 6 and 12 h after surgery (all P < 0.001), but the scores were similar at other times. The SAPB group used less sufentanil within 24 h, but had a longer duration of analgesia (both P < 0.001). The II group used more oral rescue analgesics within 48 h, had a longer time until first time out of bed, and had more opioid-related side effects (all P < 0.01). There were no SAPB-related complications. Ultrasound-guided SAPB can provide safe and effective regional pain relief after costal cartilage harvest for ear reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Objective To explore the advantage and feasibility of the program of training anesthesiologists that is based on the clinical postdoctoral program of Peking Union Medical College Hospital (PUMCH) with collaboration between general hospitals and specialized hospitals. Methods We analyzed the operational volume of the operation platform in PUMCH and the clinical characteristics of the specialized hospitals in Beijing, and built a collaborative standardized training base that combines general hospitals with specialized hospitals. Before and after the implementation of the collaborative training program, the number of training cases of each sub-specialty and the trainees' scores of the assessment of clinical abilities were compared. Results After implementation of the collaborative standardized training program, the number of training cases of pediatric anesthesia, obstetrics anesthesia, and cardiovascular surgery anesthesia were significantly increased (all P < 0.01) with the total number of clinical anesthetic cases unchanged. Meanwhile, the scores of medical knowledge and skills, communication and collaboration, and patient care of the trainees were significantly improved (all P < 0.05). Conclusion The collaborative standardized training program can optimize the disease resources and improve the core competency of trainees, and is feasible for standardized postdoctoral training of clinical anesthesiology.

The Ambu Aura-i laryngeal mask is considered to be a device for blind intubation as well as for fiberoptic guided intubation. The novel video laryngeal airway mask SaCoVLM is a supraglottic airway device that allows intubation under direct vision. We hypothesized that success rates for device placement and tracheal intubation with the SaCoVLM would be comparable with the Ambu Aura-i mask. A prospective, randomized clinical trial was conducted from March 2021 to December 2021. One hundred and twenty patients were enrolled and randomized in the study. Direct intubation was performed with the SaCoVLM, and fiberoptic guided intubation was performed with the Ambu Aura-i mask. The primary outcome measure was the first success rate of LMA placement. Secondary outcome measures were the time from device placement and time from endotracheal intubation (as well as the time for LMA removal after successful intubation), differences in airway leak pressure, fiberoptic grade of the laryngeal view, and incidence of blood staining. The first success rate of LMA placement was similar for the two devices. There was no difference in the time for successful endotracheal intubation between the Ambu Aura-i and SaCoVLM groups (24.1 s ± 6.3 versus 25.7 s ± 2.1; p > 0.05). The time for removal was slower in the SaCoVLM group than in the Ambu Aura-i group (20.8 s ± 0.8 versus 14.7 s ± 6.1; p < 0.01). The airway leak pressure was higher in the SaCoVLM group than in the Ambu Aura-i group (27.0 s ± 1.0 versus 22.3 s ± 3.6; p < 0.01), and the incidence of blood staining was higher in the SaCoVLM group (16.7%). The SaCoVLM has an overall comparable performance to the Ambu Aura-i mask. However, the SaCoVLM is better relative to direct intubation without the assistance of a flexible intubation scope, which reduces the device’s demand.

To assess the effects of the number and duration of general anesthesia exposure on the sleep quality of 6–15-year-old school children who underwent plastic surgery. The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children (SDSC). The children were divided into two groups according to their exposure to general anesthesia: No General Anesthesia (NGA) and General Anesthesia (GA) groups. The GA group was further divided into three subgroups according to the number of exposures: Single-exposure, Double-exposure, and Multiple-exposure groups. The GA group was also subdivided into two groups according to the cumulative total time of anesthesia exposure: < 3 h and ≥ 3 h groups. Multivariate logistic regression analysis was used to confirm the potential factors that affect children with sleep disturbance (SDSC scores > 39) after general anesthesia exposure. Linear regression was used to analyze the correlation of the factors with the SDSC scores. The SDSC scores were higher in the GA group [35.4 ± 4.3 vs. 34.0 ± 3.6, P < 0.0001] as compared to the NGA group. The number of children with SDSC scores > 39 was also higher in the GA group [80 (17.5%) vs. 17 (7.4%), P < 0.0001]. More anesthesia exposure was correlated with higher total SDSC scores [34.5 ± 4.3 for single exposure vs 35.1 ± 3.9 for double exposure vs 37.5 ± 4.5 for multiple exposures, P < 0.0001] and a higher proportion of SDSC scores > 39 [24 (12.0%) for single exposure vs 24 (15.5%) for double exposure vs 32 (31.1%) for multiple exposures, P < 0.0001]. Longer anesthesia exposure was also correlated with higher total SDSC scores [34.4 ± 4.5 for < 3 h vs. 35.8 ± 4.2 for ≥ 3 h, P = 0.002]. The number of exposures to general anesthesia was a potential factor in sleep disturbance among children, determined based on logistic regression. Children who underwent plastic surgery between the ages of 6 and 15 years with general anesthesia exposure might have worse sleep quality and a higher incidence of sleep disorders. More frequent anesthesia exposure leads to worsened sleep quality and a higher incidence of sleep disorders. This study also confirmed that a longer duration of cumulative anesthesia exposure also leads to worse sleep quality.

目的 通过与Air-Q气管插管型喉罩的比较,评估SaCoVLM可视喉罩直视下指导儿童气管插管的临床效果.方法 选取2021年2-8月中国医学科学院北京协和医学院整形外科医院择期行全身麻醉下外耳再造手术患儿120例,采用随机数字表法分为Air-Q插管型喉罩组(A组)和SaCoVLM喉罩组(S组),每组60例.喉罩置入到位后,A组联合可视插管软镜完成插管,S组则在视频直视下实施气管插管.记录喉罩置入时间、喉罩退出时间及经喉罩气管插管时间和次数、调节手法;测量喉罩密封压;记录可视软镜在喉罩开口处的声门暴露分级、SaCoVLM可视喉罩声门暴露分级以及术后并发症的发生情况.结果 A组喉罩置入时间和喉罩退出时间短于S组[(14.1±7.2)s比(19.5±12.2)s、(18.4±5.1)s比(30.7±8.6)s],差异均有统计学意义(P＜0.05);A组气管插管时间长于S组[(39.8±9.5)s比(32.4±17.1)s],差异有统计学意义(P＜0.05);S 组密封压高于 A 组[(260±52)mmH2O比(204±48)mmH2O,1 mmH2O=0.009 8 kPa],差异有统计学意义(P＜0.05).拔除喉罩后,A组有4例喉罩尖端带血,S组有8例喉罩尖端带血、10例喉罩背面带血,两组比较差异有统计学意义(P＜0.05).结论 SaCoVLM可视喉罩可在喉罩内视频的指导下直接完成气管插管,插管时间明显缩短且较Air-Q插管型喉罩,且能获得更高的密封压.而Air-Q插管型喉罩的置入和退出更为容易,损伤相对较小.

目的 观察右美托咪定经鼻喷雾治疗术后睡眠障碍的临床效果.方法 选择全麻气管插管下行颌面外科手术患者78例,男12例,女66例,年龄18～40岁,ASAⅠ或Ⅱ级.将患者随机分为两组:对照组(C组)和右美托咪定组(D组),每组39例.术后当天21:30 C组和D组分别给予生理盐水0.01 ml/kg和右美托咪定1μg/kg经鼻喷雾.采用多导睡眠监测仪(PSG)记录术后当天N1期、N2期、N3期、REM期睡眠时间、清醒时间、觉醒次数和睡眠效率.采用匹兹堡睡眠质量指数(PSQI)量表评估术前1个月及术后当天的睡眠情况.记录术后当天补救镇静镇痛情况.结果 与C组比较,术后当天D组N2期睡眠明显延长(P<0.05),清醒时间明显缩短(P<0.05),觉醒次数明显减少(P<0.05),睡眠效率明显提高(P<0.05).与术前1个月比较,术后当天两组PSQI总分明显升高(P<0.05),与C组比较,术后当天D组PSQI总分明显降低(P<0.05).术后当天两组补救镇静镇痛率差异无统计学意义.结论 通过右美托咪定经鼻喷雾,可有效延长颌面外科手术患者术后当天的N2期睡眠,缩短清醒时间,减少觉醒次数,明显提高睡眠效率.