Objective To explore the rate and causes for cancellation of inpatients elective operations on the day of surgical operation in order to develop strategy for optimization of resource utilization. Methods This study retrospectively investigated inpatient elective operation cases in Peking Union Medical College Hospital from January 1 2019 to July 31 2020 from the hospital electronic information system and analyzed the rate and causes for cancellation of elective operations on the day of surgery. Results Totally 343 cases (0.52%) cancelled operation on the day of surgery among 66 090 inpatient elective operations. Reasons for cancellation involved medical(21.3%), surgical(39.7%), patients(29.2%)and anesthesia(9.9%)factors. Conclusions Most cancellation events can be prevented by improving specific measures like dedicated preoperative anesthesia assessment and the rate of operation cancellation is expected to be reduced significantly.

Objective Anti-N-methyl-D-Aspartate (NMDA) receptor encephalitis is a rare disease,recently described as autoimmune disorder of paraneoplastic limbic encephalitis,which is related to the NMDA receptor antibodies and frequently develops in young women with ovarian teratoma.The disease is usually accompanied by symptoms of psychosis and abnormal behaviors,autonomic nervous system dysfunction,central hypoventilation,and hyperthermia.During induction and maintenance of general anesthesia,we should be aware of adverse reactions such as cardiovascular events,hyperthermia and respiratory insufficiency.In order to maintain vital signs stable,pharmacological agents including vasopressors,β-blockers,antihypertensives,and anticholinergics should be prepared before the surgery.Invasive monitoring for blood pressure can be set if necessary.This study described the method for anesthetic management of 3 patients with anti-NMDA receptor encephalitis undergoing resection of ovarian teratoma under general anesthesia.Preoperative treatment included antipsychotic,anti-infective and immune therapy.General anesthesia was induced with propofol,rocuronium,fentanyl and midazolam to facilitate tracheal intubation and was maintained with inhalation of sevoflurane (mixed with oxygen and air) and intermittent iv boluses of fentanyl and rocuronium during the surgery.All the drugs mentioned above had no interaction or had slight indirect action on anti-NMDA receptors to avoid NMDA-related adverse reactions.In conclusion,the adequate preparation for the surgery should be done in this kind of patients,we should avoid using anesthetics having NMDA receptor antagonism (such as ketamine,N2O,methadone,dextromethorphan,phencyclidine) or other anesthetics acting indirectly (such as pentobarbital) on the NMDA receptors during anesthetic management in the patients with anti-NMDA receptor encephalitis.

OBJECTIVETo examine the analgesic effect of calpain inhibitor ALLN on the zymosan-induced paw inflammatory pain and its effect on the expression of cyclooxygenase-2 (COX-2) in the spinal dorsal horn.METHODSForty-eight Sprague-Dawley rats were equally divided into three groups: control group, sham-operated group, and zymosan group. According to Meller's method, zymosan (1.25 mg) was injected intraplantarly to induce paw inflammation in zymosan group; an equal volume of PBS was administered in the sham-operated group. Mechanical withdrawal threshold (MWT) and maximum thickness of paw were tested or measured before and 0.5, 1, 2, 4, 8, and 24 hours after injection. All rats were killed at different occasions following surgery to examine calpain activity in the spinal dorsal horn with Western blot analysis. Another sixty-four Sprague-Dawley rats were divided into three groups: sham-operated group, zymosan-induced paw inflammation with intraperitoneal dimethyl sulphoxide (DMSO) treatment group, and zymosan-induced paw inflammation with intraperitoneal calpain inhibitor ALLN treatment group. MWT and maximum thickness of paw were tested or measured before and 0.5, 1, 2, 4, 8, and 24 hours after injection. All rats were killed at different occasions following surgery to examine the COX-2 expression in the spinal dorsal horn with Western blot analysis.RESULTSMWT significantly decreased in the rats with zymosan-induced paw inflammation, while the maximum thickness of paw significantly increased, compared with control and sham-operated rats (P < 0.05). Calpain in the ipsilateral spinal dorsal horn was dramatically activated after zymosan injection (P < 0.01). Intraperitoneal ALLN injection significantly increased zymosan-induced MWT and decreased paw edema at the same time points after zymosan injection compared with DMSO treatment group (P < 0.05). Meanwhile, calpain inhibitor ALLN treatment significantly decreased the COX-2 expression in the spinal dorsal horn compared with DMSO treatment (P < 0.01).CONCLUSIONAdministration of calpain inhibitor ALLN is effective to attenuate zymosan-induced paw inflammatory pain. Calpain activation may be one aspect of the signaling cascade that increases the COX-2 expression in the spinal cord and contributes to mechanical hyperalgesia after peripheral inflammatory injury.

Objective To investigate the role of calpain in the spinal dorsal horn in development of paw inflammatory pain in rats.Methods Forty-eight male SD rats,aged 6 weeks,weighing 160-200 g,were randomly divided into three groups:normal control group(group C,n =8),PBS group( n =16),zymosan-induced paw inflammatory pain group (group Z,n =24).Inflammatory pain was induced by injection of zymosan 1.25 mg into the plantar surface of left hindpaw.Group PBS received the equal volume of PBS 100 μl.The mechanical paw withdrawal threshold (MWT),paw withdrawal thermal latency (PWTL) and maximum thickness of the plantar surface of left hindpaw were measured before (T0 ) and at 30 min,1,2,4,8,24 and 48 h(T1-7 ) after zymosan or PBS injection.Eight rats were sacrificed at T4 in group PBS and at T4.6,7 in group Z respectively.The left lumbar segment (L4-6) was removed to determination of spectrin α Ⅱ breakdown products,IκBα,cyclooxygenase-2 (COX-2)expression and NF-κB activity in the spinal dorsal horn by Western blot.Results Compared with group C,MWT and PWTL were significantly decreased,maximum thickness of paw and NF-κB activity in the spinal dorsal horn were significantly increased,spectrin α Ⅱ breakdown products and COX-2 expression in the spinal dorsal horn were upregulated,while IκBα expression was down-regulated in group Z( P ＜ 0.05 or 0.01 ),but no significant change was found in group PBS( P ＞ 0.05).Conclusion The activation of calpain in the spinal dorsal horn is involved in the development of paw inflammatory pain in rats through activating NF-κB and up-regulating the expression of COX-2.

目的 评价该模型大鼠的疼痛行为学特点和炎性水肿程度,并对该模型大鼠脊髓背角COX-2表达水平进行分析.方法 SD大鼠48只,随机分为3组,即对照组(n=8)、假手术组(n=16)及zymosan组(n=24).按Meller方法制作zymosan足底炎性疼痛模型,假手术组在左侧后足皮下注射同等容积的PBS.采用电子Von Frey压力测痛仪、热板和电子数显卡尺分别于制模后0.5h、h、2h、4h、8h、24h和48h测定各组大鼠左侧后足机械刺激缩足阈值、热敏缩足反射阈值和左足最大厚度.各组大鼠在指定时间点处死后取制模侧腰段脊髓背角,采用Western blot方法测定脊髓背角中COX-2表达水平.结果 与对照组和假手术组比较,zymosan组大鼠制模侧后足机械刺激缩足阈值和热敏缩足反射阈值显著降低(P＜0.05,P＜0.01),最大厚度显著增加(P＜0.01),提示zymosan组大鼠出现机械痛敏、热痛敏和炎性水肿.Zymosan组大鼠制模侧脊髓背角COX-2表达水平显著增加,与对照组和假手术组比较有显著性差异(P＜0.05).结论 Zymosan足底炎性疼痛大鼠模型可以产生持续的、可信的痛觉过敏,与人体损伤后情况基本一致,并诱导脊髓背角COX-2表达水平增加,是研究组织损伤诱发炎性疼痛机制的较佳选择.