Sleep disruption (SD) is increasingly recognized as a systemic stressor that worsens inflammatory disease, yet how it reshapes lung immunity remains poorly defined. To address this, we combined an ovalbumin (OVA)-induced allergic airway inflammation model with sleep disruption paradigms, together with transcriptomic profiling, in vivo pharmacological interventions, and in vitro RAW264.7 macrophage-like cells. In an OVA-induced allergic airway inflammation model, SD markedly increased methacholine responsiveness, aggravated peribronchial inflammation and mucus metaplasia, and promoted a more severe inflammatory airway phenotype. These changes were accompanied by enhanced pulmonary catecholaminergic signaling, reflected by increased tyrosine hydroxylase immunoreactivity and elevated norepinephrine levels. Mechanistically, SD induced mitochondrial dysfunction in the lung, characterized by ultrastructural injury, increased mitochondrial reactive oxygen species, and accumulation of cytosolic mtDNA, together with activation of the cGAS-STING pathway. Cell-type localization analysis showed that activated STING signaling was predominantly associated with F4/80-positive pulmonary macrophages, whereas overlap with Ly6G-positive neutrophils was limited. In vivo, chemical sympathectomy with 6-hydroxydopamine attenuated airway hyperresponsiveness and reduced pulmonary STING pathway activation. In RAW 264.7 cells, norepinephrine (NE) amplified lipopolysaccharide (LPS)-induced inflammatory responses, promoted mitochondrial oxidative stress, increased cytosolic mtDNA accumulation, and enhanced IRF3 activation, effects that were attenuated by adrenergic blockade and STING inhibition. Together, these findings support a model in which sleep disruption increases catecholaminergic exposure in allergic lungs, thereby driving macrophage mitochondrial stress and mtDNA-cGAS-STING dependent inflammatory amplification. This work identifies a brain-to-lung neuroimmune mechanism linking sleep loss to worsened airway disease and highlights sympathetic-macrophage signaling as a potential mechanism-informed therapeutic target. Sleep disruption enhances sympathetic nervous system activity, leading to increased norepinephrine (NE) release to the lung. NE acts on pulmonary macrophages, likely through adrenergic signaling pathways, inducing mitochondrial oxidative stress and structural disruption. This is characterized by elevated mitochondrial ROS, which promotes the release and cytosolic accumulation of mitochondrial DNA (mtDNA). The released mtDNA activates the cGAS-STING signaling pathway, leading to TBK1-IRF3 activation and downstream inflammatory gene expression, ultimately contributing to enhanced airway inflammation, mucus hypersecretion, and airway hyperresponsiveness under allergen challenge. Created in BioRender. Haotian, C. (2026) https://BioRender.com/xywyr61.

Airway epithelial dysfunction is a hallmark of asthma, contributing to chronic inflammation and structural remodeling. Recent research suggests the role of post-translational modifications in regulating epithelial immune responses. However, the role of specific deubiquitinating enzymes (DUBs) remains unclear. In this study, we identified OTU deubiquitinase 7a (OTUD7a) as a gene that is significantly downregulated in a murine model of allergic asthma. Transcriptomic analysis of two independent datasets (GSE71822 and GSE9383) consistently revealed the suppression of OTUD7a in asthmatic lungs. Furthermore, immunofluorescence analysis suggested that OTUD7a was detected in CC10-positive bronchiolar epithelial cells, non-ciliated epithelial cells known for their anti-inflammatory functions. To explore the molecular associations of OTUD7a, we established a club cell line overexpressing Flag-tagged OTUD7a and performed co-immunoprecipitation-mass spectrometry (Co-IP/MS). We identified 1135 candidate interacting proteins. In parallel, LC-MS/MS-based ubiquitinome profiling in ovalbumin (OVA)-induced asthmatic lungs revealed widespread changes in protein ubiquitination, with more than 3000 differentially modified ubiquitination sites. These changes were enriched in pathways associated with immune signaling, cytoskeletal dynamics, and epithelial barrier function. Collectively, our findings suggest that OTUD7a, as a DUB detected in CC10-positive bronchiolar epithelial cells, is markedly decreased in asthma and they present a comprehensive landscape of ubiquitination changes in allergic airway inflammation. Therefore, our study offers new insight into post-translational regulation in the pathogenesis of asthma.

Airway hyperresponsiveness (AHR) is often associated with mood disorders such as anxiety and depression which makes the airway symptoms more complicated and refractory. However, the underlying mechanisms remain unclear. This study investigated whether this was related to the activation of microglia in the hippocampus. Female Balb/c mice were randomly assigned into an AHR model induced by ovalbumin (OVA) and an anxiety model induced by chronic restraint stress (CRS). Anxiety-like behavior was assessed by open field test, elevated plus maze and tail suspension test. Airway resistance following methacholine inhalation was measured by using the FlexiVent apparatus. Hematoxylin and eosin, periodic acid-Schiff as well as Masson trichrome were performed to evaluate inflammatory cell infiltration in the lung tissue. In addition, the status of microglia in the hippocampus was evaluated by immunofluorescence, while the activation of inflammation signaling pathway was assessed by Western blots. Compared with the Control group, mice in OVA and CRS groups exhibited higher airway resistance, spent less time in the center area of the open field and the open arms of the elevated plus maze, and showed increased immobility time in the tail suspension test. Microglia in hippocampus exhibited pronounced morphological alterations, increased expression of activation markers Iba1 and CD86, and upregulation of the NLRP3 inflammasome pathway. Minocycline treatment significantly reduced the airway resistance and anxiety-like behavior in OVA mice, while also inhibiting activation of the NLRP3 inflammasome pathway. This study provides evidence for the comorbidity between AHR and anxiety, potentially mediated by hippocampal microglial activation and the NLRP3/Caspase-1/IL-1β pathway. These findings enhance our understanding of the underlying mechanisms, and offer potential targets for treating AHR-related anxiety.

Abstract Background There have been no reports on the successful implementation of stellate ganglion block (SGB) in mice. Objectives This study aims to investigate a new method for implementing SGB in mice by placing them in a supine position with abducted upper limbs and touching the trachea and sternoclavicular joint with the hand. Methods Fifty BABL/C mice, 8–10 weeks, were selected and randomly divided into four groups: control group (n = 5); SGB-R group (n = 15); SGB-L group (n = 15); and SGB-L + R (group n = 15). SGB was administered with 0.15% ropivacaine solution in a volume of 0.1 mL. The control group received equal volumes of saline. Horner's syndrome, heart rate, and complications such as brachial plexus block, vascular injury, pneumothorax, local anesthetic toxicity, and death were observed. Results Horner's syndrome developed in 100% of SGB surviving mice; no difference was seen in the time to onset (100.4 ± 13.4 vs 96.7 ± 12.4, mean ± SD, seconds) and duration (264.1 ± 40.5 vs 296.3 ± 48.0, mean ± SD, min) of Horner's syndrome in the left and right SGB (P > 0.05). Compared with the control group (722 [708–726], median [IQR], bpm), the heart rate was significantly slowed down in the right SGB (475 [451.5–491], median [IQR], bpm) (P < 0.05). While the heart rate was slowed down after performing the left SGB, the difference was not statistically significant (P > 0.05). The overall complication rate was 18.4%, with a brachial plexus block rate of 12.3%, a vascular injury rate of 4.6%, and a mortality rate of 1.5%, as well as no local anesthetic toxicity (includes bilateral implementation of SGB) or pneumothorax manifestations were found. Conclusions This method allows for the successful implementation of SGB in a mouse model.

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.

Purpose:Esketamine have anesthetic and analgesic properties. This study aimed to observe the enhancing effect of subanesthetic doses of esketamine (0.15-0.3 mg/kg/h) with dexmedetomidine and remifentanil during anesthesia for liposuction surgery. Patients and Methods:A total of 155 subjects were randomized with a 1:1 ratio to Group E (esketamine-dexmedetomidine/remifentanil, n=78) or Group C (saline-dexmedetomidine/remifentanil group, n=77). The primary outcome was satisfaction of patient and surgical team with the procedure. The secondary outcomes were the postoperative Athens Insomnia Scale (AIS) and Hospital Anxiety and Depression Scale (HADS) scores, hemodynamic and respiratory changes, drug consumption, adverse event rates, and predictors associated with patient satisfaction. Results:Patient and surgical team satisfaction with the procedure was significantly higher in Group E than in Group C (4.7 ± 0.6 vs 4.2 ± 0.7, P < 0.001; 4.7 ± 0.5 vs 4.4 ± 0.7, P = 0.005). The postoperative AIS (4 [1, 6] vs 5 [2, 9], P = 0.012) and HADS-A (1 [0, 3] vs 2 [0, 6], P = 0.012) scores were significantly lower in Group E than in Group C. Hemodynamic and respiratory parameters were more stable in Group E than in Group C, with the lower opioids consumption of sufentanil (0 [0, 4] vs 5 [2.5, 7.7], P < 0.001) and remifentanil (700 [480, 900] vs 800 [500, 1200], P = 0.023) in Group E compared to Group C. On ordinal logistics regression, postoperative sleep quality (OR, 0.70; 95% CI, 0.62-0.79), anxiety level (OR, 0.77; 95% CI, 0.62-0.95) and recovery time in post-anesthesia care unit (PACU) (OR, 0.69; 95% CI, 0.56-0.98) were identified as significant predictors associated with patient satisfaction. Conclusion:A subanesthetic dose of esketamine (0.15-0.3 mg/kg/h) as an adjuvant can improves the sedative and analgesic effects of dexmedetomidine and remifentanil during anesthesia for liposuction surgery. Clinical Trial Registration:ChiCTR2400080363.

Importance: The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic. Objective: We performed a systematic review and meta-analysis comparing puncture cricothyrotomy with scalpel cricothyrotomy using overall success rate, first-time success rate, and time taken to perform the procedure as the primary outcome together with complications as a secondary outcome.Evidence review: Pubmed databases, EMBASE databases, MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, from 1980 to October 2022.Findings: A total of 32 studies were included in the systematic review and meta-analysis. It also showed that PCT was close to SCT in terms of overall success rate (82.2% vs. 82.6%, Odd Ratios OR = 0.91, [95%CI: 0.52-1.58], p = 0.74) as well as first-performance success rate (62.9% vs. 65.3%, OR = 0.52, [0.22-1.25], p = 0.15). PCT does not compare favorably with SCT in terms of required time for the procedure (the mean time required for PCT versus SCT incision in the intervention groups was 0.34 standard deviations higher (Mean Difference MD = 17.12, [3.37-30.87], p = 0.01) as well as complications (21.4% vs. 15.1%, Relative Risk RR = 1.49, [0.80-2.77], p = 0.21).Conclusions and relevance: The results show that SCT has an advantage over PCT in terms of time required for the procedure, while there is no difference in overall success rate, first-time success rate after training, and complications. The superiority of SCT may be the result of fewer and more reliable procedural steps. However, the level of evidence is low (GRADE).(c) 2023 The Author(s). Published by Elsevier Masson SAS on behalf of Societefranc,aise d'anesthesie et de reanimation (Sfar). This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Background Hemifacial microsomia (HFM) is a congenital craniofacial malformation, and its features include hypoplasia and asymmetry in skeletal tissue and soft tissue. These features are usually associated with a difficult airway. Mandibular distraction osteogenesis can achieve mandibular advancement, but its effect on the subsequent laryngoscopic views has not been adequately documented. Aim The aim of this study was to determine the change in laryngoscopic views after mandibular distraction osteogenesis (MDO) in children with HFM and to examine the radiological changes after MDO by using computed tomography (CT)-based three-dimensional (3-D) airway reconstruction. Methods An observational prospective study was carried out in children with HFM undergoing MDO. All children underwent 3-D airway reconstruction preoperatively before the placement and removal of the distractor. The temporomandibular joint lesions in children were classified by the Pruzansky-Kaban classification. The Cormack-Lehane grade was assessed after induction under direct laryngoscopy. The relationship between difficult laryngoscopy and the Pruzansky-Kaban classification was assessed. Changes in the upper pharyngeal airway parameters and laryngoscopic views were analyzed. Results Forty children (ages ranging from 5 to 16 years, males = 26, females = 14) with HFM underwent 80 anesthesia for MDO. The incidence of difficult laryngoscopy before mandibular distraction was 5/12 (41.7%) in type IIa, 19/24 (79.2%) in type IIb and 1/4 (25%) in type III HFM. The mean difference in the incidence of difficult laryngoscopy before and after MDO was 33.3% (95% CI: -6.7% to 73.3%), 50.0% (95% CI: 8.4% to 91.6%), and 0% for type IIa, type IIb, and type III, respectively. In type IIb, 12/19 cases of difficult laryngoscopy became easy after mandibular distraction: this was associated with an increase in the palatopharyngeal and glossopharyngeal CT parameters (p < .05). In type IIa, 5/5 cases of difficult laryngoscopy became easy after mandibular distraction, and 1/7 cases of easy laryngoscopy became difficult laryngoscopy. However, there were no significant changes in the palatopharyngeal, glossopharyngeal, and hypopharyngeal CT parameters in type IIa and type III HFM (p > .05). Conclusions MDO can improve the laryngoscopic views in children with HFM. According to the Pruzansky-Kaban classification, children with type IIb showed the highest incidence of difficult laryngoscopy before MDO. After MDO, the improvement in laryngoscopic views under direct laryngoscopy in type IIb was related to the increase in the palatopharyngeal and glossopharyngeal volume.

SaCo(safe comfortable)可视喉罩是一种新型的国产可视喉罩,喉罩内置的摄像头可以持续观察喉罩的置入、留置、拔除的全部过程,为喉罩的安全使用提供方便.小耳畸形患儿有不同程度的半侧颜面短小或者小颌畸形,此类患儿咽腔容积小,困难气管插管的发生率较高[1-2].大量的临床观察已经证实,经喉罩和插管型喉罩可以快速完成气管插管,是目前解决困难插管最有效方法之一[3-4].由于普通喉罩没有可视功能,气管插管时需要联合使用可视插管软镜,增加了操作的步骤和设备需求,在一定程度上限制该方法的广泛使用.本研究观察小耳畸形患儿经SaCo可视喉罩实施气管插管的安全性,为患儿的气管插管和困难插管提供一种新的选择.

整形外科手术患者术后睡眠障碍不仅会影响机体的恢复,还会造成负面的心理问题,严重影响患者的预后,因此应引起足够的重视.术后睡眠障碍是多种因素共同作用的结果,包括手术方式、麻醉方式、患者的心理因素以及术后患者包扎、术后恢复环境等,尤其对于整形外科术后患者睡眠障碍更普遍.传统的临床干预治疗方式主要包括物理干预和药物干预,但疗效不佳、不良反应多、患者接受度低.因此,迫切需要寻找一种简单、有效、无创且可以改善整形外科术后患者睡眠障碍的治疗方案,不仅能给患者提供舒适化的医疗体验,而且能够加速整形外科术后患者的康复.但目前整形外科术后患者睡眠障碍的常规治疗方案还有待进一步优化.

To evaluate changes in the sleep patterns of patients undergoing general anesthesia for maxillofacial plastic surgery. A total of 200 consecutive craniofacial plastic surgery patients were enrolled in this study. Sixteen patients who did not stay in the craniofacial ward on the night before surgery were excluded, providing a final total of 184 patients. PSQI was used to evaluate sleep quality 1 month before surgery (baseline) and on the night before surgery. According to the baseline sleep quality score, patients were assigned to the sleep disorder group (SD group, n = 51, 27.7%; PSQI score > 5) or non-sleep disorder group (NSD group, n = 133, 72.3%; PSQI score ≤ 5). The PSQI score on the night before the operation was compared with the baseline score. Amongst the total sample size, the incidence of disturbed sleep on the night before surgery was significantly higher than baseline (PSQI score > 5: 89,48.4% vs.51,27.7%, respectively, P = 0.037). In the NSD group, the PSQI score the night before surgery was significantly increased compared with the baseline score (5.6 ± 3.2 vs. 2.4 ± 1.4, respectively, P < 0.0001). The PSQI score on the night before surgery was significantly lower in the NSD group than in the SD group (5.6 ± 3.2 vs. 7.4 ± 4.1, respectively, P = 0.009). On the night before surgery, the time to fall asleep was significantly prolonged. The sleep duration, the total time in bed, and the sleep efficiency were significantly reduced compared with the baseline in the NSD group. On the night before surgery, the sleep duration and the total time in bed were also reduced in the SD group, however, with no significant change in PSQI score. Patients without sleep disorders were more likely to have sleep disorders before surgery. So, this study concluded that a goal of perioperative management should be to actively address the sleep problems before surgery.

目的 比较不同气道评估指标预测小耳畸形患儿喉镜显露困难(DLV)的有效性.方法 择期全麻下行自体肋软骨耳廓重建术小耳畸形患儿200例,男159例,女41例,年龄6～14岁,ASAⅠ或Ⅱ级,麻醉诱导前评估改良Mallampati分级(MMT)、张口度(IIG)、甲颏间距(TMD)、下颌前伸能力(FPM)和身高/甲颏间距比值(RHTMD).全麻吸入诱导下置入直接喉镜显露声门,评估Cormack-Lehane(C-L)分级,Ⅲ级和IV级视为DLV.采用受试者工作特征(ROC)曲线评估各项指标预测喉镜显露困难的效能.结果 200例患儿中存在DLV有46例(23％).MMT、IIG、TMD、FPM、RHTMD预测DLV的AUC(95％CI)分别为0.71(0.64～0.77)、0.74(0.67～0.80)、0.87(0.81～0.91)、0.61(0.54～0.68)和0.85(0.79～0.89),TMD和RHTMD预测效能优于MMT、IIG和FPM.结论 TMD是小耳畸形患儿最佳气道评估指标.

BACKGROUND:Children with microtia may experience difficult laryngoscopy because the ear and the mandible develop from the first and second bronchial arches and clefts.METHODS:In this prospective observational study, we enrolled 166 patients (6-14 years old) with microtia scheduled for auricular reconstruction with autologous costal cartilage framework. Airway of the subjects was assessed preoperatively with the Modified Mallampati classification, Thyromental distance, Interincisor gap, Forward protrusion of the mandible and Horizontal length of the mandible. Anesthesiologist performed the direct laryngoscopy. Difficult laryngoscopy was classified as grade III or IV based on the Cormack-Lehane classification.RESULTS:A total of 166 patients completed the study, including 158 (95%) isolated microtia patients and 8 (5%) hemifacial microsomia patients. The incidence of difficult laryngoscopy was 34/166 (20.5%) in all patients, 3/8 (37.5%) in hemifacial microsomia patients, 31/158 (19.6%) in isolated microtia patients (P=0.35). Multivariate logistic regression shows that Thyromental distance, Interincisor gap, Forward protrusion of the mandible are all independent predictors of difficult laryngoscopy. The sensitivity and specificity of each predictor were: Thyromental distance (82.35%, 89.39%), Interincisor gap (58.82%, 86.36%), and Forward protrusion (17.65%, 97.73%), respectively. The cutoff values of Thyromental distance and Interincisor gap for prediction of difficult laryngoscopy were 4.0 cm and 3.3 cm. The best combination of predictors was Thyromental distance/Interincisor gap/Forward protrusion of the mandible with a sensitivity of 94.12% and specificity of 86.36%.CONCLUSIONS:The combination of Thyromental distance, Interincisor gap, and Forward protrusion of the mandible is the optimal assessment to predict difficult laryngoscopy in school-aged patients with microtia.

Background Hemifacial microsomia (HFM) is a congenital craniofacial malformation which is associated with difficult airway. Anesthesiologists may experience difficult intubation in children with HFM. Mandibular distraction could increase the length of the mandible. Theoretically, it should be advantageous to laryngeal view during tracheal intubation. This study reviewed airway management in children with HFM, assessed the efficiency of direct laryngoscopy versus airway-visualizing equipment during the tracheal intubation and determined whether mandibular distraction could improve the laryngoscopic view in children with HFM. Methods A retrospective review of cases involving children with HFM aged 5 to 17 years old underwent anesthesia from December 2016 to April 2019 at a single center was performed. The demographic data, preoperative airway assessments, procedure type, anesthetic technique, method of airway management, anesthetists’ comments on mask ventilation, laryngoscopy and intubation parameters were collected. Results At last, 136 HFM children entered this study, a total of 311 anesthesia procedures were completed during the study period. Face mask ventilation was possible for most of children except 1 child (bilateral involvement) required two practitioners. The success rates of intubation for the primary video laryngoscopy and fibroscopy were both 100%, but 79.5% for direct laryngoscopy ( P < 0.001). 95 (38.9%) children who had difficult laryngoscopic view (DLV) were significantly correlated with failed direct laryngoscopy ( P < 0.001). Airway-visualizing equipment (video laryngoscope and Fiberscope) was the primary airway technique in 3 (75%) bilaterally involved children. 60 children underwent both mandibular distraction osteogenesis and the removal of distractor. The laryngoscopic views improved in 26 (43%) children after treatment with mandibular distraction ( P < 0.001). Conclusions Airway-visualizing equipment can be effectively utilized for intubation in HFM children with DLV. Mandibular distraction could improve the laryngeal view effectively.

目的 比较不同气道评估方法预测半侧颜面短小畸形(hemifacial microsomia,HFM)患儿喉镜显露困难的有效性.方法 选取2017年1月至2018年12月中国医学科学院整形外科医院择期全麻下行下颌骨延长器置入术及自体肋软骨耳廓重建的HFM患儿131例,年龄6～14岁,美国麻醉医师协会(American Association of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,麻醉诱导前评估患儿改良Mallampati分级(modified Mallampati classification,MMT)、张口度(interincisor gap,ⅡG)、甲颏间距(thyromental distance,TMD)和身高甲颏间距比(ratio of height to TMD,RHTMD).全麻吸入诱导后置入直接喉镜显露声门,采用Cormack-Lehane(C-L)分级评估,Ⅲ级和Ⅳ级视为喉镜显露困难(difficult laryngoscopic view,DLV).计算各评估方法ROC的AUC,DLV的敏感性、特异性.绘制各评估指标的ROC曲线并确定DLV的临界值.结果 131例患儿中DLV者75例(57％).RHTMD法评估DLV的AUC为0.81,预测DLV的临界值为28.3,敏感性、特异性分别为88.00％、69.64％,优于MMT、ⅡG.TMD预测DLV的AUC、临界值、敏感性、特异性分别为0.79、4.6 cm、78.67％、73.21％.TMD诊断有效性与RHTMD接近,特异性高于RHTMD,敏感性低于RHTMD.结论 RHTMD与TMD是HFM学龄期患儿预测DLV的有效指标,预测准确性高于MMT、ⅡG.RHTMD预测DLV准确性最高,与TMD有相近的敏感性、特异性,可用于HFM患儿DLV的评估.

目的 对比观察颌面手术咽后壁纱布填塞及手术部位对术后咽喉痛的影响.方法 选取2017年9月至2018年5月中国医学科学院整形外科医院70例美国麻醉医师协会(American Society of Anesthesiologist,ASA)分级Ⅰ级的颌面手术患者,随机分为A组(无咽后壁纱布组,35例)和B组(咽后壁纱布组,35例),处理方式为全身麻醉后有或无咽后壁纱布填塞,观察术后1h、4h、12h、24 h患者咽喉痛情况及术区在口裂上、下时的咽喉痛情况.结果 术后1h、4h、12h、24 h,A组咽喉痛的发生率分别为80.0％、91.4％、91.4％、82.8％,B组发生率分别为68.6％、88.6％、88.6％、80.0％,组间比较差异无统计学意义(P＞0.05).术区仅涉及口裂以上者,术后咽喉痛的总体发生率为61.1％;术区涉及口裂下者,术后咽喉痛的发生率为100％,差异有统计学意义(P＜ 0.001).结论 颌面手术是否应用咽后壁纱布,对术后咽喉痛发生率可能无影响,手术损伤可能是颌面手术咽喉痛的主要原因之一.

Objective To investigate the effect of intravenous dexmedetomidine injection(1 μg/kg)on the intubating conditions after inhalation induction with sevoflurane 8% and nitrous oxide(N2O)50% in children. Methods Totally 122 patients aged 4-10 years with an American Society of Anesthesiologists physical statusⅠ undergoing elective plastic surgery under general anesthesia were randomly divided to dexmedetomidine group(intraveneously injected with dexmedetomidine 1μg/kg)and control group(injected with normal saline)by using the random sampling table.On arrival of the operating room,anesthesia was induced with sevoflurane 8% and N2O 50% in oxygen 50%.When the patient became unconscious,the intravenous cannula 24# was inserted on the dorsum of hand.One minute later,laryngoscopy and tracheal intubation were performed.The intubating conditions were assessed by the scoring system in the previous study. Results The rates of acceptable conditions were 97% and 90% in dexmedetomidine group and in control group(P=0.143),and the rates of excellent conditions were 82% and 67%(P=0.04),respectively.In dexmedetomidine group,there were no signifi-cant differences of mean arterial presser and heart rate between the time-point of before intubation and the time-point of immediately after intubation.Conclusion Intravenous bolus of dexmedetomidine(1 μg/kg)can effectively improve the intubating conditions after inhalation induction of sevoflurane 8% and N2O 50% in children and make the hemodynamics more stable during tracheal intubation.

Objective To compare the intubating conditions between dexmedetomidine and remifentanil when combined with sevoflurane-nitrous oxide (N2O) for anesthesia induction in the pediatric patients.Methods A total of 122 pediatric patients,aged 4-10 yr,of American Society of Anesthesiologists physical status Ⅰ,undergoing elective plastic surgery,were randomly divided into dexmedetomidine group (group D,n =61) and remifentanil group (group R,n=61).Eight percent sevoflurane and 60％ N2O were inhaled for induction of anesthesia,and the fresh gas flow was set at 6 L/min.After disappearance of eyelash reflex,dexmedetomidine 1 μg/kg and remifentanil 1 μg/kg were intravenously injected over 50-60 s in D and R groups,respectively,and 1 min later tracheal intubation was performed.The intubating conditions were graded,and the satisfactory intubating conditions and successful intubation were recorded.The development of adverse cardiovascular reactions and complications such as hyoxemia and laryngospasm before and after intubation and postoperative pharyngodynia was recorded.Results Compared with group D,no significant change was found in the success rate of intubation,rate of satisfactory intubation,intubating condition grade or incidence of postoperative pharyngodynia (P＞ 0.05),and the incidence of hypertension and sinus tachycardia after intubation was significantly increased in group R (P＜0.05).No pediatric patients developed hyoxemia,laryngospasn or sinus tachycardia in two groups.Conclusion When 8％ sevoflurane and 60％ N2O are inhaled for anesthesia induction,combing with dexmedetomidine 1 μg/kg produces better clinical efficacy than combing with remifentanil 1 μg/kg in improving the intubating conditions for pediatric patients.

Objective To observe the effects of two different intranasal dexmedetomidine doses as premedication on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. Methods Children aged 3-6 years, of American Society of Anesthesiologists physical status 1, and scheduled for plastic surgery were enrolled in this study. Children were assigned to receive either spray administration of intranasal dexmedetomidine 1 μg/kg (group D1, n=21) or 2 μg/kg (group D2, n=20) approximately 30 minutes before anesthesia. Anesthesia was induced with sevoflurane up to 8% in 100% O2, with fresh gas flow set to 6 L/min. After the pupil fixed to the middle position, sevoflurane dial setting was reduced to 5% and fresh gas flow reduced to 3 L/min. The endtidal sevofluran (ETsevo) concentration for laryngeal mask airway insertion sustained for 10 minutes after vein intubation, which was determined according to the Dixon's up and down method. The initial endtidal sevoflurane concentration in each group was set at 2%. ETsevo was increased/decreased (1:1.2) in the next patient according to the response to laryngeal mask airway insertion. Bispectral index, mask acceptance, all response to laryngeal mask airway insertion, and ETsevo of laryngeal mask airway insertion of children were recorded. Results The bispectral index value was 77.4±3.6 in group D2, which was significantly lower than that (87.4±1.9) in group D1 when children entered operation room (P<0.05). Mask acceptance was 76.2% in group D1 and 90.0% in group D2. The EC50 of sevoflurane for laryngeal mask airway insertion was 1.09% (95% CI=0.89%-1.28%) in group D2, which was lower than 1.59% (95% CI=1.41%-1.78%) in group D1 (P<0.05). Conclusion Compared with the dose of 1 μg/kg, spray administration of intranasal dexmedetomidine 2 μg/kg as premedication can reduce the sevoflurane EC50 for successful laryngeal mask airway placement in children.

Objective To compare two spray administration of intranasal dexmedetomidine (DEX) doses for premedication in children. Methods In this prospective,randomized,double-blind study,41 children aged 3-6 years were enrolled. Children were assigned to receive either spray administration of intranasal DEX 1 μg/kg (Group D1) or 2 μg/kg (Group D2). The Ramsay Sedation Scale scores were evaluated at 5 min intervals. Sedation status at separation from patient was also evaluated. Heart rate (HR) and saturation of peripheral oxygen (SpO2) were recorded before and every 15 min after drug administration. Results The median sedation onset time was 30 min and 20 min in group D1 and group D2,respectively. Compared with the children in group D1,those in group D2 were significantly more sedated when they were separated from their parents (61.9% vs. 95.0%,respectively)(χ2=5.549,P=0.010). In Group D2,the HR decreased by 15.8% (t=2.415,P=0.021) 30 min after the spray administration of intranasal DEX. Compared with the baseline values,there was no significant difference in both groups in terms of SpO2(t=-1.426,P=0.162;t=-1.096,P=0.280)and HR in group D1 (t=-0.299,P=0.767) 30 min after the spray administration of intranasal DEX. Conclusion Spray administration of intranasal DEX 2 μg/kg provides superior sedation in children.