This review focuses on energy conservation and emission reduction in the Central Sterile Supply Department (CSSD) of public hospitals. Based on policy frameworks including the Outline of the Healthy China 2030 Plan, the high-quality development initiative for public hospitals, and the "Three Transformations" strategy, and integrating the critical role of CSSD as the "master valve" for hospital infection control, this review systematically outlines the three-stage evolution of CSSD energy conservation and emission reduction: the passive energy-saving stage, the equipment and technology improvement stage, and the systematic management stage. Evidence was synthesized narratively from English- and Chinese-language literature published from inception to June 2025. By comprehensively analyzing existing literature, this review identifies the current bottlenecks faced by CSSDs, including challenges in technology adaptation, cross-departmental collaboration, intelligent system development, and cost-benefit balance. We propose three interrelated optimization pathways: precision technology, refined management, and integrated intelligence, and further discuss the challenges of transformation and future development directions toward a "safety-efficiency-low carbon" model. This review aims to provide theoretical support and practical guidance for energy conservation and emission reduction in CSSDs of public hospitals, assist hospitals in meeting the assessment target of "reducing energy consumption per 10,000 yuan of revenue", and promote the green and sustainable development of the medical industry.

PURPOSE:Evidence regarding the efficacy of trigeminal ganglion stimulation for refractory trigeminal zoster-associated pain (TZAP) is limited. This study investigated the use of percutaneous trigeminal ganglion stimulation in a series of TZAP patients and evaluated the efficacy of burst trigeminal ganglion stimulation (bTGS) and tonic trigeminal ganglion stimulation (tTGS) modalities on pain relief. PATIENTS AND METHODS:We retrospectively reviewed all eligible TZAP patients who received temporary trigeminal ganglion stimulation in our department between January 2022 and August 2024. Spontaneous pain and mechanical allodynia intensity were assessed using the numeric rating scale (NRS) before treatment and at 1 week, the day of electrode removal, 1 month, 2 months, and 3 months post-treatment. Other symptoms, pain interference with sleep, and scores on the self-rating depression scale and self-rating anxiety scale were also recorded. RESULTS:Among 31 patients, 16 received tTGS and 15 received bTGS. Compared with baseline, there was a statistically significant decrease in spontaneous pain NRS scores at 3 months (mean difference, 5.0; 95% CI, 4.2-5.8; p < 0.001). Similarly, the proportion of patients with mechanical allodynia NRS scores 3 or less increased significantly at 3 months (difference in proportions, 61.3%; 95% CI, 42.2%-80.4%; p < 0.001). In the tTGS group, the mean spontaneous pain NRS score decreased from 8.1 (95% CI, 7.5-8.8) at baseline to 3.2 (95% CI, 1.8-4.6) at 3 months (p < 0.001). In the bTGS group, the mean spontaneous pain NRS score decreased from 7.3 (95% CI, 6.6-8.1) at baseline to 2.3 (95% CI, 1.2-3.3, p < 0.001) at 3 months (p < 0.001). No serious adverse events occurred. CONCLUSION:This retrospective study suggests that trigeminal ganglion stimulation is a promising therapeutic option for patients with TZAP and that bTGS may serve as a feasible alternative.

Purpose:Chronic postsurgical pain (CPSP) is a common complication of video-assisted thoracoscopic surgery (VATS) and substantially impairs postoperative quality of life. We evaluated whether intercostal nerve block (ICNB) with liposomal bupivacaine provides superior chronic pain control compared with ropivacaine. Patients and Methods:We conducted a retrospective cohort study of 1325 adult patients who underwent elective VATS lung resection with ICNB administered using either liposomal bupivacaine or ropivacaine at the end of the surgery between September 2023 and August 2024. The primary outcome was the incidence of CPSP at 3 months postoperatively, defined as a numerical rating scale (NRS) pain score ≥1, a sensitive threshold to capture any postoperative pain. Secondary outcomes included NRS pain scores at rest at 24 and 48 hours postoperatively, cumulative opioid consumption within 48 hours, time to independent postoperative activities, length of hospital stay, and incidence of postoperative neuropathic pain at 3 months. Confounding was addressed using 1:1 propensity score matching with a 0.1 standard deviation caliper. Results:The median age was 61 years, and 59.9% were female. After propensity score matching, ICNB with liposomal bupivacaine was associated with a significantly lower incidence of CPSP at 3 months compared with ropivacaine (33.5% vs 42.3%; adjusted odds ratio, 0.68; 95% CI, 0.52 to 0.88; P=0.004). Patients receiving liposomal bupivacaine had reduced rest NRS pain scores at both 24 hours (3[2, 4] vs 4[3, 4]; P=0.002) and 48 hours (3[2, 3] vs 3[2, 4]; P=0.038). No significant differences were observed in other secondary outcomes. Conclusion:ICNB with liposomal bupivacaine was associated with reduced incidence of CPSP following VATS lung resection. These findings highlight the potential long-term analgesic benefit of liposomal bupivacaine and support the need for further randomised controlled trials evaluating long-term CPSP outcomes.

BackgroundPostoperative delirium (POD) is an acute disturbance of attention and awareness in older adults undergoing surgery. It is associated with prolonged hospital stay and increased morbidity and mortality. Recent studies suggested that neostigmine, an acetylcholinesterase inhibitor used to reverse neuromuscular blockade, may reduce POD risk. We aim to evaluate whether neuromuscular blockade reversal with neostigmine/glycopyrrolate reduces POD compared with sugammadex.MethodsThis single-center, triple-masked, randomized, controlled superiority trial will enroll 320 older adults scheduled for major non-cardiac and non-neurosurgical surgery. Patients will be randomized (1:1) to receive either neostigmine 40 μg/kg plus glycopyrrolate 8 μg/kg or sugammadex 2 mg/kg for neuromuscular blockade reversal at the end of surgery. The primary outcome is the incidence of POD within postoperative 7 days or until discharge, assessed twice daily with the validated Chinese version of 3-min Diagnostic Interview for Confusion Assessment Method. Secondary outcomes include days with POD and proportion of hospital days affected; POD severity assessed using the highest score and the sum scores of Confusion Assessment Method Severity; and 30-day cognitive function assessed using the 10-item Telephone Interview of Cognitive Status.DiscussionResults of this study will determine whether neostigmine/glycopyrrolate offers a simple, low-cost strategy to prevent POD and will inform evidence-based selection of neuromuscular reversal agents in older surgical patients.Trial registrationChinese Clinical Trial Registry (ChiCTR2400093158).

Substantial oxidative stress during myocardial ischemia/reperfusion (I/R) injury precipitates cell death and heart failure, for which translatable redox therapies remain scarce. Here, we show that nicotinamide riboside kinase 2 (NMRK2) is rapidly upregulated after reperfusion and exerts redox protection by a previously unrecognized mechanism. We established myocardial I/R injury in mice and hypoxia/reoxygenation (H/R) injury in cardiomyocytes. By elevating NADPH, restoring NAD+/NADH, increasing GSH/GSSG and activating Trx1, NMRK2 overexpression enhanced cellular antioxidant capacity and reduced oxidative damage during both myocardial I/R and cellular H/R injury. Knockdown of NAD kinase (NADK) abolished these protective effects. Mechanistically, nucleocytoplasmic fractionation and immunofluorescence confirmed robust Yes-associated protein (YAP) nuclear entry in NMRK2-overexpressing cells; Co-IP revealed NMRK2-induced disruption of the integrin β–YAP interaction; knockdown of integrin β reduced NADK expression and increased YAP phosphorylation at Ser127; and ChIP-qPCR and luciferase assays demonstrated that YAP directly binds the NADK promoter (−1500 to −1000 bp) for its transcriptional activation. In conclusion, NMRK2 sustains redox protection by disrupting the integrin β–YAP complex and driving YAP-dependent NADK transcription, providing a readily translatable therapy against myocardial I/R injury.

Intraoperative neurophysiological monitoring (IONM) has evolved from a novel technique into an evidence-based standard treatment method for high-risk neurosurgical and spinal surgeries. Its effectiveness is based on two interrelated pillars: optimized multimodal monitoring, mainly including motor and somatosensory evoked potentials (MEPs/SSEPs) as well as electromyography (EMG), and total intravenous anesthesia (TIVA) combined with a precise neuromuscular blockade-based anesthesia protocol. IONM significantly reduces neurological function damage during surgeries for spinal deformities, intramedullary tumors, acoustic neuromas, and gliomas in the brain functional area, redefining the standards of safe surgical practice. However, there are still certain challenges, including the difficulty in converting signal changes into clinical actions, controlling high false alarm rates, and overcoming technical/logistical obstacles in complex and lengthy surgeries. These objectively existing problems further highlight the importance of clinical judgment. Looking to the future, a key developmental direction involves transforming intraoperative neurophysiological monitoring (IONM) from a passive monitoring tool into a system capable of predictive guidance and comprehensive neuroprotection. Emerging models include artificial intelligence (AI) technologies for real-time analysis and technologies for fusing multimodal data into surgical “dashboards”, but they still face significant obstacles in data quality, clinical validation, and human-centered design. Closed-loop systems and the application of neurobiomarker recognition to achieve neuroprotection remain enduring research topics. In summary, the development of IONM technology towards a more mature direction requires a coordinated planning scheme: establishing evidence-based standards, promoting data-driven discoveries through large-scale collaborative research, and achieving deep multidisciplinary integration within the surgical team. The ultimate goal is to make IONM an intelligent guiding tool that not only monitors but also actively optimizes surgical strategies to ensure the preservation of neural function.

Myocardial injury after non-cardiac surgery (MINS) is a common and clinically important postoperative complication associated with increased short- and long-term mortality. As most cases lack typical ischemic symptoms, diagnosis relies primarily on systematic postoperative biomarker surveillance. Current guidelines recommend serial postoperative measurement of cardiac troponin (cTn) or high-sensitivity cTn, the reference-standard biomarker for myocardial necrosis, in patients at elevated perioperative risk. However, cTn demonstrates limited sensitivity during the early h following myocardial ischemia, underscoring the need for complementary biomarkers capable of detecting ischemic injury before the onset of irreversible myocardial necrosis or troponin elevation. This review summarizes recent advances in emerging circulating biomarkers for early MINS detection, including heart-type fatty acid-binding protein, ischemia-modified albumin, cardiac myosin-binding protein C, copeptin, and other markers reflecting ischemia, necrosis, inflammation, and fibrosis. We critically examine their underlying pathophysiological mechanisms, diagnostic performance, and release kinetics, highlighting their potential to shorten the diagnostic "blind window" associated with conventional biomarkers. The integration of multi-marker panels represents a promising strategy to enhance early diagnostic sensitivity and improve prognostic stratification. Nonetheless, large-scale prospective studies are required to validate their clinical utility and define their role in perioperative decision-making and guideline development.

Migraine is a chronic neurological disorder characterized by severe headache, nausea, and sensitivity to light and sound, affecting approximately 1 billion people globally. Despite advances in understanding migraine pathophysiology, particularly with the emergence of CGRP-targeted therapies, the mechanisms underlying neuroinflammation and glial contributions remain poorly understood. Current treatments are effective for a subset of patients, yet they don’t tackle the fundamental neurogenic and neuroinflammatory processes that fuel chronic migraine, especially the pathophysiological aspects contributed by glial cells. This review integrates recent preclinical and clinical evidence to elucidate how diverse glial cells, including central glia (astrocytes, microglia and oligodendrocytes) and peripheral glia (Schwann cells, satellite glial cells), coordinate the neuroinflammation associated with migraine. Evidence shows that astrocytes and microglia are essential to both cortical spreading depolarization (CSD) and mediating the inflammatory cascades that maintain chronic pain. Oligodendrocytes, though less studied, are predicted to affect neuronal excitability and energy metabolism, while Schwann cells and satellite glial cells mediate peripheral nociceptive signaling through their interactions with neural and immune elements. New therapeutic strategies have been put forward. These include targeting glial-specific signaling pathways and employing advanced drug delivery systems such as viral vectors and nanoparticles to improve treatment effectiveness. Glial cells are pivotal regulators of migraine-associated neuroinflammation. This review underscores their critical role in migraine pathophysiology and highlights glial-targeted therapies as a promising direction for future research and treatment development.

Background:Whether opioid-free anesthesia (OFA) improves postoperative quality of recovery remains uncertain. This study aims to compare the effects of an intraoperative OFA protocol with traditional intraoperative opioid-based anesthesia (OBA) on recovery quality in patients undergoing gynecological laparoscopic surgery. Methods:This multicenter, randomized, double-blind, controlled trial will include 300 adult women scheduled for elective gynecological laparoscopic surgery at five tertiary hospitals in China. Patients will be randomized in a 1:1 ratio to either the OFA group (dexmedetomidine, esketamine, and lidocaine) or OBA group (sufentanil), stratified by study center. Following anesthesia induction, all patients will receive bilateral transversus abdominis plane blocks and propofol-based total intravenous anesthesia. The primary outcome is postoperative quality of recovery at 24 h, assessed using the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes include incidence of postoperative nausea and vomiting, QoR-15 scores at 48 and 72 h, numeric rating scale pain scores at rest and on coughing, cumulative opioid consumption, health-related quality of life and incidence of chronic pain at 3 months. Adverse events include hypotension, bradycardia, hypertension, tachycardia, oversedation, desaturation, dizziness, headache, ileus, hyperalgesia, psychiatric related side effects (hallucinations, agitation, nightmares, or delirium) occurring intraoperatively or during hospitalization. The primary analysis will be conducted according to the modified intention-to-treat principle. Discussion:We hypothesize that an intraoperative intravenous OFA regimen will enhance recovery quality compared with a traditional intraoperative OBA regimen in women undergoing gynecological laparoscopic surgery. The findings are expected to inform evidence-based optimization of anesthetic strategies in this surgical population. Trial registration number:https://www.chictr.org.cn, identifier (ChiCTR2500106392).

Introduction Emergence agitation (EA) is a clinically significant complication during early recovery from general anesthesia. This protocol describes a randomized controlled trial designed to determine whether intraoperative low-dose remimazolam maintenance reduces the incidence of EA without prolonging emergence time in patients undergoing oral surgery.Patients and Methods This multicenter, randomized, controlled clinical trial will enroll 388 patients scheduled for oral surgery under general anesthesia. Patients will be randomly allocated in a 1:1 ratio to either the remimazolam group, receiving a low-dose intraoperative infusion of remimazolam, or the control group, receiving an equivalent volume of normal saline. The primary outcome is the incidence of emergence agitation; the key secondary outcome is emergence time. Emergence time will be evaluated within a non-inferiority framework, whereas the incidence of emergence agitation will be tested for superiority. Additional endpoints comprise pain scores, analgesic use, the rate of postoperative nausea and vomiting (PONV), recourse to rescue antiemetics, the occurrence of postoperative sleep disturbance (PSD), time spent in the post-anesthesia care unit (PACU), postoperative hospital length of stay, overall recovery quality, the frequency of perioperative adverse events, and patient satisfaction.Discussion This trial will investigate the efficacy and safety of intraoperative low-dose remimazolam maintenance in patients undergoing oral surgery. The findings may provide evidence supporting a practical pharmacological intervention to reduce EA and enhance postoperative recovery.Trial registration Chinese Clinical Trial Registry (ChiCTR2600116544).

IntroductionTrigeminal neuralgia (TN) is a debilitating neuropathic pain disorder traditionally attributed to neurovascular compression; however, this mechanism does not fully explain the marked clinical heterogeneity or persistent pain observed in a subset of patients. Increasing evidence suggests that central neuroinflammatory processes contribute to neuropathic pain, but immune profiles in the cerebrospinal fluid (CSF) and serum of patients with TN remain poorly characterized.MethodsWe conducted a single-center cross-sectional study including 14 patients with TN and 19 non-pain controls. CSF samples were obtained from 14 TN patients and 10 controls, while serum samples were available from 10 TN patients and 9 controls. Concentrations of a broad panel of cytokines, chemokines, and growth factors were measured using multiplex immunoassays. Group comparisons were performed using non-parametric statistical tests, with false discovery rate correction for multiple comparisons.ResultsPatients with TN reported severe pain (median numerical rating scale score: 8), whereas controls reported no pain. Demographic characteristics, including age, sex, and body mass index, were comparable between groups. Compared with controls, CSF from TN patients showed significantly elevated levels of multiple pro-inflammatory cytokines and chemokines, including TNF-α TNF-β, IL-1β, IL-9, IL-16, IL-17, IL-18, IFN-γ, CCL5, CXCL12, and macrophage migration inhibitory factor (MIF) (all false discovery rate-adjusted p < 0.05). In contrast, vascular endothelial growth factor (VEGF) concentrations were significantly reduced in the CSF of TN patients. No corresponding inflammatory alterations were observed in serum samples.DiscussionTN is associated with a distinct CSF immune signature characterized by elevated pro-inflammatory mediators and altered growth factor profiles. These findings support the involvement of central neuroimmune mechanisms in the pathophysiology of TN and highlight the potential value of CSF biomarkers for improving mechanistic understanding and identifying novel therapeutic targets.

Background:Large language models are increasingly used to obtain health information, but their quality in pediatric anesthesia remains insufficiently evaluated. This study aimed to assess the reliability and readability of four widely used AI chatbots in this context. Methods:This cross-sectional observational study developed 18 pediatric anesthesia-related questions using Medical Subject Headings terms, online search trend analysis, and commonly queried topics reflecting parental information needs. Each question was submitted under standardized conditions to four generative AI-driven chatbots: OpenAI's GPT-5.1 Thinking, Google's Gemini 3 Pro, Anthropic's Claude Opus 4.5 Extended Thinking, and DeepSeek-V3.2-Speciale. Models were accessed in their vendor-deployed configurations without task-specific fine-tuning. The generated responses were evaluated for information reliability using the Ensuring Quality Information for Patients (EQIP) instrument, DISCERN tool, Global Quality Score (GQS), and Journal of the American Medical Association (JAMA) benchmark criteria. Readability was assessed using seven validated indices including Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Gunning Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. Results:A total of 72 chatbot-generated responses were included for analysis. Significant between-model differences were observed in DISCERN, EQIP, and GQS, while JAMA benchmark scores were consistently low across all models. DeepSeek and Gemini showed higher median reliability scores across several instruments, although significant pairwise differences mainly involved ChatGPT. None of the evaluated models achieved the recommended sixth-grade readability level across any index. Correlations between reliability and readability were non-significant, suggesting that these represent independent dimensions of information quality. Conclusions:Current LLM-based chatbots provided pediatric anesthesia information with variable reliability and consistently suboptimal readability. Although certain models demonstrated relatively higher information quality, limited transparency and excessive reading complexity may restrict their suitability for public-facing educational use. These findings highlight the need for improved quality control, enhanced transparency, and readability-focused optimization in pediatric perioperative education.

Background:Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and devastating postoperative complication, particularly among older adults. Accurate risk stratification and early prediction of CSA-AKI are essential for guiding preventive strategies and optimizing clinical decision-making. Methods:In this retrospective study, data from two centers (n=623) were utilized for model training and internal validation, whereas data from a third, distinct center (n=110) were reserved for external validation. CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) Serum creatinine criteria. Key predictors were identified using a consensus of four methods: Least Absolute Shrinkage and Selection Operator (LASSO), Recursive Feature Elimination (RFE), Boruta, and Random Forest-based filtering. Six machine learning (ML) models, including Logistic Regression (LR), K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM), were developed utilizing five-fold cross-validation. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) approach was applied to interpret the best-performing model. Results:Development of CSA-AKI was noted in 177 patients (24.1%) during the first postoperative week. In terms of comparative performance, LightGBM exhibited the greatest AUC (0.784, 95% confidence interval [CI]: 0.702-0.859). The most influential features were lactate, surgical duration, activated partial thromboplastin time (APTT), transfusion volume, and Prothrombin Time (PT). SHAP-based summary and force plots interpreted the model at global and local levels. Furthermore, SHAP dependence plots elucidated non-linear effects of single features on CSA-AKI risk. Conclusion:Machine learning models demonstrate high efficacy in predicting CSA-AKI risk in older adults. The LightGBM model outperformed other algorithms; coupled with interpretability tools, it can assist clinicians to identify high-risk patients earlier and optimize perioperative management.

Introduction Esophagectomy provokes an intense systemic inflammatory response that is significantly associated with postoperative morbidities. Whether a single preoperative high-dose dexamethasone can attenuate this response and improve recovery remains unknown.Patients and Methods This single-center, randomized, double-blind, parallel-group trial will enroll 82 adults undergoing elective transthoracic esophagectomy at the First Affiliated Hospital of Soochow University, Suzhou, China. Patients will be randomly assigned (1:1) to receive intravenous dexamethasone 15 mg (high-dose) or 5 mg (low-dose) during anesthesia induction. Both groups will receive standardized general anesthesia and perioperative care. The primary outcome is the peak plasma C-reactive protein (CRP) level within 72 h after surgery. Secondary outcomes include CRP values at 24, 48 and 72 h; 72-h recovery quality, assessed using the 15-item quality of recovery scale; cumulative 72-h opioid consumption; in-hospital major complications (anastomotic leakage, mechanical ventilation > 48 h, pulmonary infection, renal failure, reoperation, death); 7-d hyperglycemic events (> 10 mmol/L); and length of postoperative hospital stay.Discussion By comparing two clinically relevant dexamethasone doses, this trial will provide high-quality evidence on the efficacy and safety of using 15 mg dexamethasone to mitigate excessive systemic inflammation and improve recovery after esophagectomy.Trial registration Chinese Clinical Trial Registry (ChiCTR2500109536; registered on September 19, 2025)

BackgroundPostoperative sleep disturbance (PSD) is a common complication after surgery and is associated with impaired recovery. This protocol describes a randomized controlled trial designed to determine whether intraoperative 40 Hz gamma frequency auditory stimulation reduces the incidence of PSD after laparoscopic gynecological surgery.MethodsThis randomized, double-blind, controlled trial will enroll 342 patients scheduled for laparoscopic gynecological surgery under general anesthesia. Patients will be randomly allocated in a 1:1:1 ratio to three parallel groups: control (no headphones), sham stimulation (headphones without auditory output), or active stimulation (headphones delivering 40 Hz auditory stimulation). The primary outcome is the incidence of PSD on the first postoperative night. Secondary outcomes include the incidence of PSD on postoperative nights 2 and 3, daily Athens Insomnia Scale (AIS) scores, anxiety and depression scores (HADS-A/-D), sedative-hypnotic use, pain scores, analgesic consumption, the incidence of postoperative nausea and vomiting (PONV), rescue antiemetic use, duration of post-anesthesia care unit (PACU) stay, length of postoperative hospital stay, quality of postoperative recovery (QoR-15), perioperative adverse events, and patient satisfaction.DiscussionThis trial will evaluate whether intraoperative 40 Hz gamma frequency auditory stimulation reduces PSD in patients undergoing laparoscopic gynecological surgery. The findings may provide evidence for a non-invasive perioperative strategy to mitigate sleep disruption and improve postoperative recovery.Clinical trial registrationhttp://www.chictr.org.cn, identifier [ChiCTR2500110341].

Introduction Adequate sedation is essential for paediatric patients undergoing invasive haematologic-oncologic procedures. The combination of propofol and remifentanil is commonly used yet is associated with respiratory depression. Esketamine has anaesthetic, analgesic and sympathomimetic properties and is known to cause less respiratory depression than other sedatives. This study aims to assess esketamine versus remifentanil in combination with propofol for invasive haematological-oncological procedures for paediatric patients.Methods and analysis This prospective, randomised, double-blind, two-period crossover trial will include 80 paediatric patients aged 6–12 years, with American Society of Anesthesiologists Physical Status II to III, who are scheduled to undergo repeated invasive procedures including bone marrow aspirates and lumbar punctures under sedation. Participants will be randomised to two sequences: AB or BA. In sequence AB, children will receive propofol (3 mg/kg) and esketamine (0.5 mg/kg) in period 1 and propofol (3 mg/kg) and remifentanil (1 µg/kg) in period 2. In sequence BA, the order is reversed. The primary endpoint of this trial is the incidence of desaturation events, defined as SpO2<90% during the sedation and recovery. The secondary endpoints include: (1) the interruption rate of the procedure; (2) total dose of propofol; (3) the number of times esketamine or remifentanil is added; (4) recovery time; (5) distress behaviour; (6) a composite of sedation-related adverse events, including psychotomimetic effects (hallucinations, nightmares, fatigue, dizziness and headache), nausea, vomiting, bradycardia and hypotension; (7) operator satisfaction; (8) patient satisfaction and (9) anaesthetist satisfaction.Ethics and dissemination The trial was approved by the Ethics Committee of the Children’s Hospital of Soochow University (Approval No. 2025008). The results of this trial will be submitted for peer review and publication in a scientific journal.Trial registration number ChiCTR2500098533.

BACKGROUND Beta-1 receptor blockade is well characterized for its protective effects against septic symptoms, and esmolol (ES) is a selective beta 1-adrenoceptor antagonist. AIM To assess the effects of ES on lipopolysaccharide (LPS)-induced septic intestinal damage and explore the associated mechanism by focusing on the AMPK/mTOR/ULK1 pathway. METHODS Sepsis was induced via an intraperitoneal injection of LPS in male SD rats or LPS treatment in rat intestine epithelial cells. To assess their anti-sepsis effects, rats and cells were pretreated with ES, 3-methyladenine, rapamycin (RAPA), and/or compound C, 30 minutes before LPS exposure. Then, intestinal damage, intestinal fatty acid-binding protein (I-FABP) and diamine oxidase (DAO) levels in intestinal tissue, interleukin (IL)-6, IL-1, tumor necrosis factor-alpha (TNF-alpha), IL-17, and IL-10 levels, cell viability, autophagic processes, and AMPK/mTOR/ULK1-related signaling transduction were detected via a series of in vivo and in vitro assays. RESULTS LPS induced intestinal damage in a time-dependent manner and suppressed autophagy at 12 and 24 hours. Pretreatment with ES or RAPA reduced I-FABP and DAO release; improved the damage score; and increased the expression of Beclin-1, LC3-II, p-AMPK, p-ULK1 and numbers of autophagosomes, and decreased the expression of p-mTOR at 12 and 24 hours, indicating amelioration of intestinal injury and augmentation of autophagy in rats. The results of in vivo assays were consistent with those in the IEC-6 intestinal epithelial cell line. Pre-treatment with ES reduced IL-1, TNF-alpha, IL-17, and IL-6 release and increased IL-10 release in cells. CONCLUSION The current findings demonstrate that ES ameliorates LPS-induced septic intestinal damage by activating autophagy through modulation of the AMPK/mTOR/ULK1 pathway.

Oliceridine is a novel G-protein selective µ-agonist that has been reported to provide better analgesia and safety than conventional opioids. The purpose of this study is to explore the efficacy and safety of oliceridine combined with propofol-etomidate(PE) sedation in geriatric outpatients undergoing painless gastroscopy. This prospective, single-center, double-blinded, randomized controlled trial will be conducted at a tertiary A hospital and will enroll one hundred twelve geriatric outpatients undergoing painless gastroscopy. Eligible participants will be randomly assigned to either the experimental group or the control group.The experimental group will receive oliceridine combined with PE sedation, while the control group will receive dezocine combined with PE sedation.The primary efficacy and safety outcomes will be the use of PE sedation and the occurrence of adverse events during painless gastroscopy. Secondary outcomes will include hemodynamic parameters during painless gastroscopy and adverse events during the post-anaesthesia care unit (PACU) stay. Exploratory outcomes will encompass gastroscopy time; time to awakening in the PACU; length of stay in the PACU; pain score, sedation score, and modified Aldrete score at PACU discharge; endoscopist satisfaction; patient satisfaction; and the readmission rate. We hypothesize that oliceridine combined with PE sedation will provide more effective analgesia with improved safety. The findings of this trial will furnish helpful clinical evidence and guidance for the novel selection of analgesics for geriatric outpatients undergoing painless gastroscopy. ChiCTR2500098774.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used in multimodal pain management under the concept of enhanced recovery after surgery (ERAS), adverse reactions and safety events caused by their unreasonable use have become increasingly prominent. Drawing on the latest literature and evidence-based medicine domestically and abroad, and based on the research and practice frontiers of domestic perioperative analgesia, this working group has reached a consensus on several key domain—including the application regimens of NSAIDs for perioperative analgesia, drug interactions, and precautions as well as prevention strategies in special populations—yielding 12 definitive recommendations. This consensus aims to provide guidance for the standardized selection and application of NSAIDs for perioperative analgesia, and to further promote the rational, safe, and effective use of NSAIDs.

INTRODUCTION:Post-procedural fatigue is common after sedated gastrointestinal endoscopy and prolongs recovery. We describe a protocol for a prospective, single-center, randomized, controlled, 3 × 3 factorial trial to evaluate the effects of different sedative-analgesic combinations on patient-reported fatigue after gastrointestinal endoscopy. PATIENTS AND METHODS:Three hundred and fifteen patients (aged ≥ 45 years, ASA physical status I or II) presenting for gastrointestinal endoscopy with planned intravenous sedation will be randomly allocated (1:1:1:1:1:1:1:1:1; block sizes 9 and 18) to one of nine equip-sized groups generated by the factorial combination of three sedatives (propofol, ciprofol, remimazolam) with three adjuvant analgesics (sufentanil, esketamine, lidocaine). Sedation will be titrated to Modified Observer's Assessment of Alertness/Sedation scores of 1-2. The primary outcome is the Christensen Fatigue Scale score (range 1-10; higher = worse) 30 min after the procedure. The secondary outcome is the composite incidence of intra-procedural hypotension (mean arterial pressure < 65 mmHg) and hypoxemia (SpO2 < 90% for ≥ 10 s). Primary analysis will employ two-way factorial ANOVA to test the main effects of sedatives and analgesics on the 30-min fatigue score, with an exploratory interaction analysis. DISCUSSION:The results of this trial will provide high-resolution evidence on which sedative or analgesic agent most effectively mitigates early post-endoscopy fatigue, thereby informing patient-centered sedation choices and enhancing recovery. TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2500112657; registered on November 18, 2025).