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.

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.

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.

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 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.

腹横肌平面阻滞(TAPB)是一种用于腹部镇痛的筋膜间平面阻滞技术.与硬膜外镇痛相比,超声引导下的TAPB操作简单,创伤性小.在联合入路和新型局部麻醉药物的使用下,TAPB的镇痛效果更佳.目前TAPB在腹部镇痛中广泛应用,既可以单独或联合其他麻醉方式用于术中麻醉,也可以作为多模式镇痛的一部分缓解术后疼痛.此外,TAPB还可以作为一种治疗手段用于缓解手术室外的肾绞痛和慢性难治性腹痛.但有关TAPB在缓解内脏痛和替代硬膜外镇痛方面的有效性仍需进一步研究.

目的 观察不同折弯角度可视管芯引导经鼻气管插管的效果.方法 选择择期行颌面手术经鼻气管插管的全麻患者120例,男19例,女101例,年龄18～60岁,ASAⅠ或Ⅱ级.根据插管时可视管芯前端折弯角度的不同,将患者随机分为三组:70°组、90°组和110°组.记录鼻孔-喉结的垂直距离(简称TND)、插管时间、插管次数、声门显露情况、插管辅助手法以及鼻出血情况.结果 三组TND差异无统计学意义.90°组、110°组插管时间明显短于70°组,插管成功率明显高于70°组(P<0.05).90°组、110°组插管时间、插管成功率差异无统计学意义.90°组声门显露级别明显优于70°组和110°组(P<0.05),70°组、110°组声门显露级别差异无统计学意义.三组插管时均采用头后仰的辅助手法,但70°组后仰程度大,而90°组、110°组多为轻度后仰.110°组有1例(2.5％)需辅助提颏,1例(2.5％)需助手辅助托下颌,而70°组则有6例(15.0％)需调整喉部位置.三组鼻出血发生率差异无统计学意义.结论 可视管芯引导经鼻气管插管时,与70°折弯角度比较,90°折弯角度插管时间更短、成功率更高、插管所需辅助调整更少.110°折弯角度插管时间和成功率和90°折弯角度接近,但需要更多的辅助调整.

低氧血症是胸腔镜心脏手术单肺通气时的主要并发症,能影响患者的正常生理功能,也是麻醉医生面临的一大挑战.为避免低氧血症的发生,我们需了解其发生的原因、预防和处理措施,现就以上三方面内容进行分析并作一综述.