Objective To observe the effect of propofol"bridging"30 minutes before the end of surgery to prevent postoperative nausea and vomiting(PONV)in patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia.Methods A total of 70 patients undergoing general anesthesia for elective gynecological laparoscopic surgery at the First Affiliated Hospital of Anhui Medical University from June 2022 to September 2023 were enrolled prospectively,who were randomly assigned to either sevoflurane anesthesia group(group S,n=35)or propofol"bridging"group(group P,n=35).Standardized induction protocols were applied in both groups.After induction,anesthesia was maintained with sevoflurane and remifentanil throughout surgery in group S,while the same anesthesia was maintained in group P,but sevoflurane was withdrawn 30 minutes before the end of surgery,followed by intravenous pump infusion of propofol as a bridge until surgery concluded.The patients in both groups were monitored by bispectral index(BIS)to maintain the appropriate anesthesia depth and keep the anesthesia depth stable during the bridging period.The incidence of PONV within 24 h after surgery,the incidence of moderate-to-severe PONV and the use of rescue antiemetics during 0-8 h,＞8-16 h,and＞16-24 h postoperatively were recorded in the two groups.Results Compared with the group S,in the group P,the incidence of PONV was significantly reduced within 24 h after surgery(17.1％vs 42.9％,x2=5.51,P=0.019),the incidence of moderate-to-severe PONV and the use of rescue antiemetics were significantly decreased 0-8 h postoperatively(P＜0.05),and the inhalation time and dosage of sevoflurane were significantly reduced(P＜0.05).Conclusion Propofol"bridging"can effectively reduce the incidence of PONV within 24 h after gynecologic laparoscopic surgery under sevoflurane anesthesia,and decrease the incidence of moderate-to-severe PONV and the use of rescue antiemetics in the early postoperative period.

STUDY OBJECTIVE:Postoperative pain following thoracic surgery is often severe, and serratus anterior plane block (SAPB) is widely used for perioperative analgesia in such patients. Local anesthetics injected on the surface of the serratus anterior muscle are called superficial SAPB (SSAPB), while those injected on the deep surface are called deep SAPB (DSAPB). We observed the differences in analgesic effects of two variants of SAPB (superficial and deep) on patients receiving single-port video-assisted thoracoscopic surgery (VATS). DESIGN:A randomized prospective trial. SETTING:Single university teaching hospital. PATIENTS:Eighty patients who underwent single-port VATS under general anesthesia. INTERVENTIONS:Eighty patients who received single-port VATS were randomly assigned to Group S (patients who received SSAPB) and Group D (patients who received DSAPB). MEASUREMENTS:The primary outcome was opioid consumption within 24 h after surgery. Secondary outcomes were pain scores at rest and on coughing before surgery, immediately after surgery, 6, 12, and 24 h after surgery. MAIN RESULTS:Within 24 h after surgery, the total opioid consumption of patients in Group S was lower than that of patients in Group D (P = 0.001). The pain scores of patients in Group S were lower than those in Group D at rest or coughing 6 h after surgery (P = 0.000, P = 0.000). The pain score on coughing in Group S was lower than that in Group D at 12 h after surgery (P = 0.000), and there was no difference in postoperative pain scores between the two groups at other time points. CONCLUSION:For patients undergoing single-port VATS lobectomy, SSAPB was associated with reduced opioid consumption and lower pain scores compared to DSAPB.

BACKGROUND:Research has revealed non-pharmacological methods mitigate the occurrence of emergence delirium with a lower incidence of negative side effects, but the mechanism remains unclear. This study aimed to investigate whether postoperative cartoon viewing after awakening from sevoflurane anesthesia in the postanesthesia care unit reduces the incidence of emergence delirium in young children, and to examine relevant electroencephalography findings. METHODS:This was a single-center, randomized controlled trial. One hundred thirty-eight children aged 2-7 years who underwent elective tonsillectomy and/or adenoidectomy under sevoflurane anesthesia and who were classified as American Society of Anesthesiologists physical status I or II were included. Patients were randomized to receive a standard recovery protocol (control group) or to view a cartoon video (cartoon group) after awakening from anesthesia in the postanesthesia care unit. The primary outcome was the incidence of emergence delirium. The secondary outcomes included the Pediatric Anesthesia Emergence Delirium Scale, Watcha Scale, and the Faces, Legs, Activity, Cry, and Consolability Scale scores; side effects; length of stay; differences in frontal electroencephalographic asymmetry measured in the postanesthesia care unit; and post hospitalization behavior questionnaire for ambulatory surgery scores. RESULTS:The incidence of emergence delirium in the postanesthesia care unit was lower in the cartoon group (n = 69) than in the control group (n = 69) (8.7 % vs. 26.1 %, p = 0.012). In addition, the Pediatric Anesthesia Emergence Delirium Scale scores at 5 (median difference = 2, 95 % confidence interval 1 to 3, p < 0.001), 15 (median difference = 1, 95 % confidence interval 0 to 2, p < 0.001) and 25 min (median difference = 1, 95 % confidence interval 0 to 1, p < 0.001), as well as the maximal score (median difference = 2, 95 % confidence interval 1 to 3, p < 0.001), were greater in the control group than in the cartoon group. Eighty stable electroencephalography datasets revealed frontal asymmetry differences before and after awakening, which were lower (median difference = -1.208, 95 % confidence interval -1.450 to -0.965, p < 0.001) in the control group (n = 41) than in the cartoon group (n = 39) and moderately negatively correlated with emergence delirium (r = -0.30, p = 0.014). CONCLUSIONS:Young children who viewed a cartoon video after awakening from sevoflurane anesthesia in the postanesthesia care unit demonstrated a lower incidence of emergence delirium. A considerable difference in frontal electroencephalographic asymmetry may help to explain this effect. REGISTRATION:This trial was registered at Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR2300073195. Registered 04/07/2023, first recruitment 05/07/2023).

Preoperative oral carbohydrate intake can improve the postoperative recovery of fasting patients in many kinds of surgeries; however, the effect of carbohydrates on patients undergoing daytime oral surgery is still unclear. This study was designed to evaluate the effect of preoperative oral carbohydrate intake on the quality of recovery of patients undergoing daytime oral surgery using the quality of recovery-15 (QoR-15) questionnaire. Ninety-two patients scheduled for daytime oral surgery were randomly allocated to the midnight fasting group (F group, n = 45) or the carbohydrate-Outfast loading group (O group, n = 47). Participants in the F group fasted from midnight the day before surgery. Patients in the O group also fasted but received the Outfast drink (4 ml/kg) 2–3 h before the induction of anesthesia. QoR-15 questionnaire, patient well-being, and satisfaction were assessed before anesthesia induction and 24 h after surgery. Perioperative blood glucose, postoperative exhaust time, and adverse events were also recorded. The QoR-15 scores were significantly higher in the O group than in the F group preoperatively and postoperatively. Seven parameters representing patient well-being evaluated on a numeric rating scale (NRS, 0–10) were lower in the O group than in the F group postoperatively, except for the hunger and sleep quality scores. Patient satisfaction scores on a 5-point scale were higher in the O group than in the F group preoperatively and postoperatively. Meanwhile, the postoperative exhaust time was significantly shorter in the O group compared to the F group, while there were no significant differences in blood glucose concentrations between two groups. Preoperative oral carbohydrate intake could improve postoperative recovery quality, well-being, and satisfaction of patients undergoing daytime oral surgery 24 h after surgery, and may serve as a treatment option for patients undergoing daytime oral surgery. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100053753) on 28/11/2021.

Objective. To assess whether the different fiberoptic bronchoscopy (FOB) grades of laryngeal mask airway (LMA) SupremeTM TM affects pharyngolaryngeal morbidity (PLM, including sore throat, dysphonia, pharyngoxerosis, and dysphagia) after general anesthesia. Methods. A total of 235 adult patients scheduled for elective laser lithotripsy undergoing general anesthesia with the placement of LMA SupremeTM TM were enrolled. The position of LMA SupremeTM TM was assessed by FOB and categorized into five grades. Meanwhile, patients were divided into four groups (grades A-D); none was assessed as grade E. We collected blinded data on PLM at 2 (H+2), 6 (H+6), and 24 hours (H+24) postoperatively. The incidence and severity of PLM as the primary outcome and incidence of PLM at three time points as a secondary outcome were compared. Results. The incidence of PLM was higher at 2 and 6 hours than at 24 hours; however, no significant difference was found between the incidence of PLM in the FOB groups. Furthermore, the severity of sore throat and dysphonia between groups were obviously differed at H+6 and H+24, but similar at H+2. The severity of postoperative pharyngoxerosis and dysphagia were similar between groups at three time points. Conclusions. A positive association was found between the severity of postoperative sore throat and dysphonia and FOB grade after LMA SupremeTM TM placement. PLM secondary to placement of the LMA SupremeTM TM was short lasting.

Background: Acute kidney injury is the most common complication after liver transplantation. Sodium bicarbonate Ringer's solution is a new type of crystalloid solution that has been recently used in the clinical setting. Whether sodium bicarbonate Ringer's solution reduces the occurrence of postoperative AKI and improves the clinical outcomes of liver transplantation patients is not clear. Objective: To compare the effects of sodium bicarbonate Ringer's solution versus normal saline on acute kidney injury and clinical outcomes following classic orthotopic liver transplantation. Methods: Sixty-four participants were randomly assigned to the sodium bicarbonate Ringers (BRS) group or the normal saline (NS) group. The primary outcomes were the incidence and severity of acute kidney injury after liver transplantation. The secondary outcomes included the rate of renal replacement therapy, length of mechanical ventilation, stay in the ICU, stay in the hospital after surgery and 30-day mortality. Other outcomes included the concentration of sodium, chloride, bicarbonate, anion gap, lactate concentration and changes in chloride preoperatively and postoperatively. Result: Sixty-two patients completed the trial and were analyzed, with 31 patients in each group. There was a significantly lower rate of postoperative acute kidney injury in the BRS group (14/31, 45.2%) than in the NS group (24/31, 77.4%), with a relative risk of 0.58 (95% CI, 0.38-0.90; p = 0.009). The severity of AKI in the BRS group was lower than that in the NS group (Z = -2.932, p = 0.003). There was no significant difference observed in the secondary outcomes. For other outcomes, the concentration of preoperative sodium was lower than postoperative sodium in the NS group (137.2 vs. 140.4, p = 0.009). The concentration of preoperative chloride was lower than that of postoperative chloride in the NS group (102.9 vs. 106.2, p < 0.001). The change in the concentration of chloride in the BRS group was lower than that in the NS group (1.6 vs. 4.7, p = 0.006). Conclusion: Sodium bicarbonate Ringer's solution reduced the incidence and severity of acute kidney injury after classic orthotopic liver transplantation.

[目的]比较超重患者无痛胃镜检查中依托咪酯联合丙泊酚与单独使用丙泊酚的效果.[方法]将60例患者随机分为丙泊酚组(P组)和依托咪酯联合丙？白酚组(EP组).P组在胃镜检查前首次给予1％丙泊酚(1 mg/kg),EP组给予1％丙泊酚(0.5 mg/kg)加依托咪酯(0.1 mg/kg).后重复给予P组10～20 mg丙泊酚或EP组5～10 mg丙泊酚加1～2 mg依托咪酯,以维持足够的镇静水平.[结果]与T0比较,T1及T2时刻2组患者的收缩压、舒张压、平均动脉压、心率均明显降低,且与EP组相比,P组下降更为显著,差异有统计学意义(P＜0.05),EP组麻醉后循环波动较小.与P组相比,EP组患者从静脉注入麻醉药物到患者意识消失的时间更长(P＜0.05).EP组低血压、呼吸抑制以及注射痛的发生例数低于P组,差异有统计学意义(均P＜0.05).[结论]依托咪酯联合丙泊酚对超重患者无痛胃镜检查中的呼吸和循环影响不大,患者苏醒质量高,不良反应少,比单用丙泊酚更安全有效.

Objective:To investigate the effects of sevoflurane at different concentrations on epileptic discharge during general anesthesia induction in children.Methods:Sixty-six pediatric patients of both sexes, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective tonsillectomy or (and) adenoidectomy under general anesthesia, were divided into 3 groups ( n=22 each) using a random number table method: 4% sevoflurane group (L group), 6% sevoflurane group (M group) and 8% sevoflurane group (H group). Combined intravenous-inhalational anesthesia was used during operation.The occurrence of epileptiform discharge during induction period and delirium during emergence was recorded.The correlation between epileptiform discharge and delirium during emergence was analyzed using χ2 test. Results:Compared with group L, the incidence of excitatory epileptiform discharge was significantly decreased in group H, and the incidence of epileptiform discharge was significantly reduced in group M and group H ( P<0.05). There was no significant difference in the incidence of excitatory epileptiform discharge and epileptiform discharge between group M and group H ( P>0.05). There was no significant difference in the incidence of inhibitory epileptiform discharge and delirium during emergence among the three groups ( P>0.05). The occurrence of epileptiform discharges and excitatory epileptiform discharges was correlated with the occurrence of delirium during emergence ( P<0.05), and the occurrence of inhibitory epileptiform discharges was not correlated with the occurrence of delirium during emergence ( P>0.05). Conclusion:Low concentration (4%) of sevoflurane can lead to an increase in excitatory epileptiform discharges during emergence from general anesthesia in children.

目的 分析术中回收式自体输血(IBS)用于老年患者不停跳冠脉搭桥术(OPCABG)手术的应用效果.方法 对择期全麻下行OPCABG手术的老年患者167例进行回顾性统计分析,其中男84例,女83例,年龄65～ 82岁(69.51±3.75岁),体质量46 ～ 94 kg,ASAⅢ-Ⅳ级.根据术中是否应用IBS技术分为自体血组(IBS组,n=76)和异体血组(AB组,n=91).观察并记录术前及术后1、2、7d的血红蛋白(HGB)、白细胞(WBC)、血小板(PLT)、红细胞(RBC)的数值,以及术前和术后1、7d的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)的数值,异体红细胞及血浆量,术后24 h引流量及围术期相关并发症等.结果 与AB组比较,IBS组的异体红细胞、血浆的总输注量及术后24 h引流量显著降低(P＜0.05),同时并未增加患者的ICU停留时间及住院时间,但IBS组术后2d的白细胞数量高于AB组(P＜0.05).与AB组比较,IBS组患者围术期输血相关不良反应明显降低(P＜0.05).结论 回收式自体输血可显著减少老年患者行OPCABG手术的异体红细胞及血浆的输入量,降低输血相关不良反应的发生率,同时对凝血功能无明显影响,可安全有效地应用于老年心脏手术患者.

BACKGROUND:Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium (POD). The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of POD.METHODS:A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of POD was the primary endpoint and was determined with the confusion assessment method, and incidence of postoperative cognitive dysfunction (POCD) was assessed with the mini-mental state examination. The time of ambulation, discharge time, and complications over a 30-day postsurgery period were also recorded.RESULTS:A total of 296 patients were randomly assigned to 2 groups. The patients sedated with dexmedetomidine had lower incidences of POD and POCD and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the 2 groups.CONCLUSIONS:As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early POCD and offering a better short-term recovery for elderly patients receiving hip arthroplasty.

We sought to evaluate the safety, efficacy, and cost-effectiveness of intraoperative blood salvage (IBS) in off-pump coronary artery bypass grafting (OPCABG) surgery with different amount of bleeding.

Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy (GDFT) in elective hepatectomy.Methods Seventy patients undergoing hepatectomy, 42 males and 28 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ, were included and randomly divided into three groups base on fluid treatment: conventional fluid therapy (group C, n=24), goal-directed fluid therapy filled with colloids (group G1, n=23) and goal-directed fluid therapy filled with crystalloids (group G2, n=23).Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP, stroke volume variation (SVV) and cardiac index (CI), and the Flotrac/Vigileo system was used to obtain SVV and CI in group G1 and group G2.250 ml colloids were administered if SVV>13% in group G1 while 250 ml crystalloids were administered in group G2.If CI<2.5 L·min-1·m-2, dobutamine 2.0-10.0 μg·kg-1·min-1 was given until CI≥2.5 L·min-1·m-2.The ScvO2, Lac and Glu were tested at 5 min before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and the end of operation (T4).The duration of operation, fluid requirement, urinary output, bleeding volume, and the use of vasoactive agent were recorded.The exhaust time, ambulation time and postoperative hospital stay were recorded.Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with group C, the total volume was lower, flatus time, ambulation time and postoperative hospital stay were shorter, ScvO2 at T3 and T4 were higher, Lac at T2-T4 were lower, Glu at T3 and T4 were lower, ALT and AST on the third day and the fifth day after surgery were lower in group G1 (P<0.05).Compared with group G1, the amount of crystalloids was increased, the incidences of postoperative nausea and vomiting were significantly higher in group G2 (P<0.05).There was no significant difference in flatus time, ambulation time and postoperative hospital stay between group G1 and group G2.Conclusion GDFT in hepatectomy propably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay.GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting.There is no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids.

Objective To observe the effect of goal-directed fluid management using pleth variability index(PVI) during craniotomy.Methods 76 patients scheduled for craniotomy were assigned randomly divided into PVI group(n=38) and control group(n=38).Two groups were received lactated Ringer′s solution 6~8 ml/kg during the anesthesia induction.After induction, PVI group infused lactated Ringer′s solution at a rate of 2 ml/(kg·h).If PVI>14% more than 5 minutes, 3 ml/kg hydroxyethyl starch(6% HES) infused rapidly.Control group infused lactated Ringer′s solution at a rate of 4~6 ml/(kg·h).When MAP less than 8.67 kPa, intermittent infused 100~250 ml hydroxyethyl starch(6% HES) rapidly.The liquid infusion, urine volume, bleeding volume, time of operation, anesthsic time and blood gas analysis were recorded before induction(T0), before surgery(T1), strippingtumor(T2), end of the surgery(T3), respectively.Follow-up the complications and recovery on the first, second, third, seventh and thirtieth postoperative day.Results There were no significance on general monitoring indicators between the two groups.Compared with control group, the crystalloid infusion and the whole transfusion were significantly lower in PVI group, colloidal liquid infusion was significantly higher in PVI group(P<0.05).There were no significantly differences in blood gas analysis(Lac, pH, Glu, BE) at four times between the two groups.Compared with control group, postoperative follow-up facial edema, postoperative defecation time and postoperative hospital stay were significantly lower in PVI group (P<0.05).Conclusion Goal-directed fluid therapy based on PVI can optimize fluid infusion, reduce the incidence of postoperative complications and improve postoperative recovery in patients undergoing craniotomy.