To illustrate the role of dehydrocorydaline (DHC) in chronic constriction injury (CCI)-induced neuropathic pain and the underlying mechanism. C57BL/6J mice were randomly divided into 3 groups by using a random number table, including sham group (sham operation), CCI group [intrathecal injection of 10

Preoperative stress has been recognized as an independent risk factor for chronic postsurgical pain (CPSP). However, the underlying mechanisms of CPSP influenced by preoperative stress remain elusive. Previous studies indicated that excessive stress could induce disruption of the blood-spinal cord barrier (BSCB). We wondered whether and how BSCB involves in CPSP by using a single prolonged stress (SPS) combining plantar incision model in male rats to mimic preoperative stress-related postsurgical pain. Here, we observed that preoperative SPS-exposed rats exhibited relentless incisional pain, which was accompanied by impairment of BSCB and persistent elevation of serum IL-6. Intraperitoneal injections of Tocilizumab (an IL-6 receptor monoclonal antibody) not only mitigated BSCB breakdown but also alleviated pain behaviors. In addition, intervening β3-adrenoceptor (ADRB3) signaling in brown adipocytes by SR59230a (a specific ADRB3 antagonist) treatment or removal of brown adipose tissues could effectively decrease serum IL-6 levels, ameliorate BSCB disruption, and alleviate incisional pain. Further results displayed that SI-exposed rats also showed markedly spinal microglia activation. And exogenous His-tagged IL-6 could pass through the disrupted BSCB, which might contribute to microglia activation. Injection of SR59230a or ablation of brown adipose tissues could effectively reduce the activation of spinal microglia. Thus, our findings suggest that serum IL-6 induced by brown adipocyte ADRB3 signaling contributed to BSCB disruption and spinal microglia activation, which might be involved in preoperative stress mediated CPSP. This work indicates a promising treatment strategy for preoperative stress induced CPSP by blocking ADRB3.

Total knee arthroplasty (TKA) is an important therapy for OA, but control of postoperative pain is a clinical challenge. We assumed that frailty could predict post-surgical pain after TKA, especially in older patients. Preoperative frailty in older patients is an important risk factor for both acute and chronic pain after TKA, suggesting that frailty assessment should become a necessary procedure before operation, especially in older patients. As a risk factor for post-surgical pain after TKA, timely intervention for preoperative frailty may be able to reduce the incidence of pain in older patients Frailty is reportedly associated with postoperative adverse outcomes and may increase the risk of post-surgical pain. Our study aimed to explore whether frailty was an independent risk factor for pain after total knee arthroplasty (TKA) in older patients. Included in this prospective observational study were patients aged 65 or older who underwent primary TKA. Frailty of the patients was assessed before surgery using the comprehensive geriatric assessment-frailty index and pain was evaluated before and after surgery using the Numerical Rating Scale. Of the 164 patients including 125 females with a mean age of 71.4 ± 4.6 years, 51 patients were identified as being frail. Patients with chronic post-surgical pain had a significantly higher frailty index than those without chronic post-surgical pain, which was the same in patients with acute post-surgical pain. After adjusting for other confounding factors, frailty was shown to be an independent risk factor for both acute (OR: 13.23, 95

OBJECTIVES:To evaluate the efficacy of a single preoperative dose of S-ketamine for chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgical lung lesion resection (VATS).DESIGN:A prospective randomized, double-blind controlled study.SETTING:Patients were enrolled from March 17, 2021, to November 18, 2021, at a single tertiary academic hospital.PARTICIPANTS:Patients were 18-to-65 years of age and undergoing VATS.INTERVENTIONS:The experiment was divided into an S-ketamine group (0.5 mg/kg intravenous injection before anesthesia induction) or a placebo group (the same volume of normal saline).MEASUREMENTS AND MAIN RESULTS:The primary endpoint was the incidence of CPSP and its neuropathic component. The secondary endpoints included acute postoperative pain, the use of postoperative analgesics, anxiety and sleep quality scores, and the occurrence of adverse effects. There were no significant differences between the 2 groups in the incidences of CPSP, neuropathic pain, acute postoperative pain, and postoperative use of analgesics. The sleep quality scores on the first postoperative day differed significantly between the groups (47.45 ± 27.58 v . 52.97 ± 27.57, p = 0.049), but not the anxiety scores. In addition, adverse effects were similar between the 2 groups.CONCLUSIONS:A single preoperative dose of S-ketamine in patients who underwent VATS had no significant effect on acute and chronic postoperative pain or the consumption of analgesics after surgery. A single preoperative dose of S-ketamine could improve sleep on the first day after surgery, whereas it had no significant effect on anxiety levels.

Background Hip or knee osteoarthritis (OA) is one of the main causes of disability worldwide and occurs mostly in the older adults. Total hip or knee arthroplasty is the most effective method to treat OA. However, severe postsurgical pain leading to a poor prognosis. So, investigating the population genetics and genes related to severe chronic pain in older adult patients after lower extremity arthroplasty is helpful to improve the quality of treatment. Methods We collected blood samples from elderly patients who underwent lower extremity arthroplasty from September 2020 to February 2021 at the Drum Tower Hospital Affiliated to Nanjing University Medical School. The enrolled patients provided measures of pain intensity using the numerical rating scale on the 90th day after surgery. Patients were divided into the case group (Group A) and the control group (Group B) including 10 patients respectively by the numerical rating scale. DNA was isolated from the blood samples of the two groups for whole-exome sequencing. Results In total, 661 variants were identified in the 507 gene regions that were significantly different between both groups ( P < 0.05), including CASP5, RASGEF1A, CYP4B1, etc. These genes are mainly involved in biological processes, including cell–cell adhesion, ECM–receptor interaction, metabolism, secretion of bioactive substances, ion binding and transport, regulation of DNA methylation, and chromatin assembly. Conclusions The current study shows some variants within genes are significantly associated with severe postsurgical chronic pain in older adult patients after lower extremity arthroplasty, indicating a genetic predisposition for chronic postsurgical pain. The study was registered according to ICMJE guidelines. The trial registration number is ChiCTR2000031655 and registration date is April 6th, 2020.

Background and Aims: Large number of nociceptive signals produced by intestinal inflammation are transmitted to the spinal dorsal horn, leading to microglia polarization, which is of great significance in mediating central sensitization. Emerging evidence indicate that m6A modification regulates a dynamic macrophage polarization. However, it remains unsolved to link polarization of microglia regulated by m6a modification to inflammatory bowel disease (IBD) associated hyperalgesia. Methods IBD-induced hyperalgesia was assessed by paw withdrawal mechanical threshold in a murine colitis model induced by dextran sulphate sodium (DSS). MeRIP sequence was performed on the LPS-treated primary microglia. The biological role and mechanism of m6A modified PIAS1 in microglia polarization and central sensitization were determined in vitro and in vivo . Results The level of m6A RNA was significantly increased in the spinal dorsal cord of colitis mice, accompanied by microglia polarization to M1-proinflammatory phenotype, and METTL3 was the main regulator involved in the abundant m6A RNA modification. Moreover, MeRIP sequence identified PIAS1 acts anti-inflammatory function though promoting PPARγ SUMOylation in regulating microglia polarization. Mechanistically, the m6A reader YTHDF2 directly recognized and bound to the m6A site on PIAS1 mRNA and reduced PIAS1 mRNA stability. Overexpression YTHDF2 decreased PIAS1 mRNA level and promoted the polarization to M1-phenotype in vitro . Finally, reduced m6A modification by specific downregulation METTL3 in microglia of the spinal dorsal horn contributes to alleviate IBD-associated hyperalgesia. Conclusions The mRNA stabilization of m6A-modified PIAS1-mediated PPARγ SUMOylation as the underlying mechanism through which METTL3 preserved M1-phenotype microglia contributes to IBD-associated hyperalgesia.

BACKGROUND:Ubiquitin-mediated degradation of the Mas-related G protein-coupled receptor C (MrgC) reduces the number of receptors. However, the specific deubiquitinating enzyme antagonize this process has not been reported. In this study, we investigated the effect of ubiquitin-specific protease-48 (USP48) on bone cancer pain (BCP) and its effect on MrgC.METHODS:A mouse model of BCP was established. BCP behaviours of mice were assessed after intrathecal injection of adeno-associated virus (AAV)-USP48. USP48 and MrgC interactions were studied by immunoprecipitation. Overexpression and knockdown of USP48 were conducted in N2a cells to investigate the effect of USP48 on MrgC receptor number and ubiquitination.RESULTS:Spinal cord level USP48 expression was reduced in mice with BCP. Intrathecal injection of AAV-USP48 increased paw withdrawal mechanical threshold and reduced spontaneous flinching in mice. In N2a cells, there were increased number of MrgC receptors after overexpression of USP48 and decreased number of MrgC receptors after knockdown of USP48. USP48 interacted with MrgC and overexpression of USP48 altered the level of ubiquitination of MrgC.CONCLUSION:USP48 antagonizes ubiquitin-mediated autophagic degradation of MrgC and alleviates BCP in a murine animal model. Our findings may provide a new perspective for the treatment of BCP.SIGNIFICANCE:Our finding may provide an important theoretical basis as well as an intervention target for clinical development of drugs for BCP.

Abstract Background Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP. Results 2348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1033 of 2348). Within those suffering CPSP, 14.71% (n = 152 of 1033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. Age < 65 years (OR 1.278, 95% CI 1.057–1.546, P = 0.011), female (OR 1.597, 95% CI 1.344–1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090–1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696–3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047–1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159–3.574, P = 0.013), and history of postoperative wound infection (OR 5.949, 95% CI 3.153–11.223, P < 0.001) were independent risk factors for CPSP development. Conclusions CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

目的 探索以案例为导向的教学法(case based learning,CBL)联合以问题为导向的教学法(problem based learning,PBL)在麻醉学专业型硕士研究生教学中的应用体会及价值.方法 2016年8月—2020年7月纳入麻醉学专业型硕士研究生48名,随机分为对照组和观察组,对照组进行传统教学,观察组实施CBL联合PBL教学法,观察两组学生的理论及技能考核成绩、状态焦虑评分、文献检索能力、论文书写能力.结果 CBL联合PBL教学法组学生理论及技能考核成绩、文献检索能力、论文书写能力明显高于对照组,且状态焦虑评分显著低于对照组,差异有统计学意义(P<0.05).结论 采用CBL联合PBL的教学法有助于麻醉学专业型硕士研究生全方位能力的提升.

Tracheal diverticulum is a benign lesion involving the trachea and the main bronchus. It is characterized by a paratracheal air cyst caused by limited expansion of the tracheal wall. Because of the abnormal anatomical structure, the patients with tracheal diverticulum may have emergency airway events, which makes the perioperative anesthesia management special. This paper introduces the epidemiology and anatomical basis of tracheal diverticulum, perioperative anesthesia management (preoperative evaluation, selection of anesthesia methods, respiratory management, anesthesia resuscitation) and prevention and treatment of common complications, in order to provide reference for perioperative management of patients with tracheal diverticulum.

Objective: To explore potential risk factors of postoperative nausea and vomiting (PONV) following ambulatory surgery. Method: Clinical data of 1670 cases receiving ambulatory surgery in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from September 2017 to December 2019 were retrospectively analyzed. They were categorized to PONV group and non-PONV group, and perioperative data in both groups were analyzed for assessing risk factors of PONV following ambulatory laparoscopy. Results: There were 156/1,670 (9.3%) PONV cases, and the female and male incidence in recruited cases was 12.0% and 6.0%, respectively. Analyses on perioperative data of them identified that female gender [adjusted odds ratio (aOR) = 2.060, P < 0.001], operation time >1 h (aOR = 1.554, P = 0.011), postoperative pain at rest (aOR = 1.909, P = 0.013) and postoperative pain during activities (aOR = 3.512, P < 0.001) were independent risk factors of PONV following ambulatory surgery. Furthermore, postoperative pain at rest and during activities were linearly, positively correlated to the incidence of PONV. Conclusion: Female gender, operation time >1 h and postoperative pain are closely related with the incidence of PONV following ambulatory surgery. Alleviating postoperative pain properly is one of the methods to reduce risk factors of PONV following ambulatory surgery.

Cardiac Troponin I (cTnI) is a preferred biomarker to diagnose acute myocardial infarction which is one of the leading risks to health globally due to its short term. However, clinical analyzers are difficult to achieve its on-site quantitative detection. A novel label-free aptasensor was constructed to realize ultrasensitive and rapid recognition of cTnI. A nanocubic AuNPs/In2O3 composite was designed to provide synergistic effects of abundant active sites and signal magnification for aptamers grafting. Relying on a conductance-dependence strategy, this aptasensor can achieve the quantitative detection within 10 min, which is much faster than state-of-the-art analyzers, as well as exhibiting an ultrawide linear range of 0.1-1000 ng/mL and a low detection limit of 0.06 ng/mL with an excellent selectivity in the analysis of human serum.

Nerve injury-induced maladaptive changes of gene expression in dorsal root ganglion (DRG) neurons contribute to neuropathic pain. Long non-coding RNAs (lncRNAs) are emerging as key regulators of gene expression. Here, a conserved lncRNA is reported, named DRG-specifically enriched lncRNA (DS-lncRNA) for its high expression in DRG neurons. Peripheral nerve injury downregulates DS-lncRNA in injured DRG due, in part, to silencing of POU domain, class 4, transcription factor 3, a transcription factor that interacts with the DS-lncRNA gene promoter. Rescuing DS-lncRNA downregulation blocks nerve injury-induced increases in the transcriptional cofactor RALY-triggered DRG Ehmt2 mRNA and its encoding G9a protein, reverses the G9a-controlled downregulation of opioid receptors and Kcna2 in injured DRG, and attenuates nerve injury-induced pain hypersensitivities in male mice. Conversely, DS-lncRNA downregulation increases RALY-triggered Ehmt2/G9a expression and correspondingly decreases opioid receptor and Kcna2 expression in DRG, leading to neuropathic pain symptoms in male mice in the absence of nerve injury. Mechanistically, downregulated DS-lncRNA promotes more binding of increased RALY to RNA polymerase II and the Ehmt2 gene promoter and enhances Ehmt2 transcription in injured DRG. Thus, downregulation of DS-lncRNA likely contributes to neuropathic pain by negatively regulating the expression of RALY-triggered Ehmt2/G9a, a key neuropathic pain player, in DRG neurons.

Approximately 2% to 4% of adolescents suffer from scoliosis worldwide. Among them, some patients with severe progression need to receive posterior orthopedic surgery. Concerning this kind of surgery is time-consuming and traumatic, which may lead to massive blood and fluid loss, thus optimization of the fluid management strategy to avoid damage caused by intraoperative excessive or insufficient fluid volume to important organs of adolescents is one of the keys to the success of the surgery. At present, there is no consensus on the strategies of fluid management in such surgeries. This paper reviewed the latest research advances in the strategy of intraoperative fluid infusion and blood transfusion, including volume monitoring indicators, fluid infusion methods, liquid types, blood conservation, and transfusion indications, to provide new ideas for further optimization of fluid management in such surgeries and theoretical support for further studies.

Due to the short course and high mortality of acute myocardial infarction (AMI) which will cause irreversible myocardial necrosis to induce cardiac arrest, its early diagnosis within minutes is always a challenge in clinical emergency. In this work, an ultrafast and ultrasensitive aptasensor is designed to achieve quantitatively detection of cardiac troponin I (cTnI) which is proved as a highly specific and sensitive biomarker to AMI, and within only 4 min, the cTnI concentration can be accurately reported. This aptasensor is constructed via an in situ growth of the oriented Pt‐polyaniline (PANI) needle‐like nanoarrays providing both high electrocatalysis and abundant active sites as the signal magnifier and DNA carrier. A target‐induced strand release strategy is proposed to remarkably accelerate the recognition process of cTnI through the specific design of DNA stand for binding. The as‐prepared aptasensor can exhibit an ultrawide linear detection range of cTnI from 1 pg mL−1 to 100 ng mL−1 satisfying the clinical demand for AMI diagnosis, together with excellent selectivity among various biomarkers. Based on its fast recognition ability, this aptasensor presents a high accuracy in the practical detection of human serum to prove its promising ability in the early and on‐site diagnosis of AMI.

目的:比较可视软性喉镜与光棒用于颈椎损伤手术患者全身麻醉气管插管的有效性与安全性.方法:选择2017年1月至2019年2月本院60例高位颈椎骨折需行气管插管全身麻醉的患者,随机分为可视软性喉镜组(U组)和光棒组(G组)各30例.术前所有患者颈托固定,U组使用UE可视软性喉镜行气管插管,G组使用光棒行气管插管,确认气管插管成功后接呼吸机机械通气.比较两组气管插管时间、一次性插管成功率、拔管后口咽部并发症、插管前后的皮层体感诱发电位(CSEP)及运动诱发电位(MMEP)的变化.记录两组患者麻醉前、麻醉诱导后、气管插管后即刻、气管插管后1 min、气管插管后3 min的平均动脉压(MAP)和心率(HR).结果:U组气管插管时间较G组插管时间长(P＜0.05);U组和G组气管插管一次性成功率分别为95％和100％;插管后即刻G组患者MAP升高较U明显(P＜0.05);与U组比较,G组插管后即刻及插管后1 min、3 min的HR升高较明显(P＜0.05);U组患者口咽部并发症较G组少;两组患者插管后SSEP及MMEP与插管前相比无阳性改变.结论:可视软性喉镜较光棒需要更长的气管插管时间,两者的气管插管一次性成功率均较高,但可视软性喉镜插管期间循环波动较小、术后口咽部并发症较轻,值得临床推广应用.

Mas-related G-protein-coupled receptor subtype C (MrgC) has been shown to play an important role in the development of bone cancer pain. Ubiquitination is reported to participate in pain. However, whether MrgC ubiquitination plays a role in bone cancer pain remains unclear. To answer this question, we designed and performed this study. Osteosarcoma cells were implanted into the intramedullary space of the right femurs of C3H/HeJ mice to induce progressive bone cancer pain. MrgC agonist bovine adrenal medulla 8–22 (BAM 8–22) or MrgC antagonist anti-MrgC antibody were injected intrathecally on day 14 after bone cancer pain was successfully induced. The pain behaviors, the MrgC ubiquitination levels and intracellular calcium concentration in spinal neurons were measured before and after injection, respectively. With comparison to normal and sham group, mice in tumor group exhibited serious bone cancer pain on day 14, and the level of MrgC ubiquitination and intracellular calcium concentration in spinal neurons was significantly higher. Intrathecal injection of BAM 8–22 significantly alleviated bone cancer pain, increased the MrgC ubiquitination level and decreased intracellular calcium concentration in spinal neurons; however, these effects were reversed by administration of anti-MrgC antibody. Our study reveals that MrgC ubiquitination participates in the production and maintenance of bone cancer pain in mice, possibly through the regulation of intracellular calcium concentration in mice spinal neurons.

Preoperative stress could delay the recovery of postoperative pain and has been reported to be a risk factor for chronic postsurgical pain. As stress could facilitate the proinflammatory activation of microglia, we hypothesized that these cells may play a vital role in the development of preoperative stress-induced pain chronification after surgery. Our experiments were conducted in a rat model that consists of a single prolonged stress (SPS) procedure and plantar incision. A previous SPS exposure induced anxiety-like behaviors, prolonged incision-induced mechanical allodynia, and potentiated the activation of spinal microglia. Based on the results from ex vivo experiments, spinal microglia isolated from SPS-exposed rats secreted more proinflammatory cytokines upon challenge with LPS. Our results also demonstrated that microglia played a more important role than astrocytes in the initiation of SPS-induced prolongation of postsurgical pain. We further explored the therapeutic potential of agonism of α7 nAChR, an emerging anti-inflammatory target, for SPS-induced prolongation of postsurgical pain. Multiple intrathecal (i.t.) injections of PHA-543613 (an α7 nAChR agonist) or PNU-120596 (a type II positive allosteric modulator) during the perioperative period shortened the duration of postsurgical pain after SPS and suppressed SPS-potentiated microglia activation, but their effects were abolished by pretreatment with methyllycaconitine (an α7 nAChR antagonist; i.t.). Based on the results from ex vivo experiments, the anti-inflammatory effects of PHA-543613 and PNU-120596 may have been achieved by the direct modulation of microglia. In conclusion, stress-induced priming of spinal microglia played a key role in the initiation of preoperative stress-induced prolongation of postsurgical pain, and PHA-543613 and PNU-120596 may be potential candidates for preventing pain chronification after surgery.

Bone cancer pain (BCP) is a severe complication of advanced bone cancer. Although cannabinoid receptor 2 (CB2) agonists may have an analgesic effect, the underlying mechanism remains unclear. CB2 serves a protective role in various pathological states through the activation of autophagy. Therefore, the present study aimed to determine whether the analgesic effects of the selective CB2 agonist JWH015 was mediated by the activation of autophagy in BCP. BCP was induced by the intra-femur implantation of NCTC2472 fibrosarcoma cells in C3H/HeN mice. The pain behaviors were assessed on the following postoperative days. The selective CB2 agonist JWH015 (1 and 2 mu g) was intrathecally administered on day 14 following implantation. AM630 (1 mu g), a CB2 antagonist, was injected 30 min before JWH015 administration. Lipopolysaccharide (LPS; 100 nM)-stimulated primary neurons were treated with JWH015 (1 mu M) and AM630 (1 mu M) to further verify the mechanism by which CB2 affects autophagy. The results demonstrated that autophagy flux was impaired in spinal neurons during BCP, as indicated by the increased ratio of microtubule-associated protein 1 light chain 3 beta (LC3B)-II/LC3B-I and increased expression of p62. Intrathecal administration of JWH015 attenuated BCP, which was accompanied by the amelioration of impaired autophagy flux (decreased LC3B-II/LC3B-I ratio and decreased p62expression). In addition, the activation of glia cells and upregulation of the glia-derived inflammatory mediators, interleukin (IL)-1 beta and IL-6 were suppressed by JWH015. In LPS-stimulated primary neurons, IL-1 beta and IL-6 were increased, and autophagy flux was impaired; whereas treatment with JWH015 decreased the expression of IL-1 beta and IL-6, LC3B-II/LC3B-I ratio and expression of p62. These effects were by pretreatment with the CB2-selective antagonist AM630. The results of the present study suggested that the impairment of autophagy flux was induced by glia-derived inflammatory mediators in spinal neurons. Intrathecal administration of the selective CB2 agonist JWH015 ameliorated autophagy flux through the downregulation of IL-1 beta and IL-6 and attenuated BCP.

Objective To explore the risk factors of postoperative nausea and vomiting (PONV) in elderly patients after gastrointestinal surgery.Methods Clinical data were collected from 1 021 elderly patients (age ≥65 y) who underwent gastrointestinal surgery in Nanjing Drum Tower Hospital from January 2016 to December 2017 and retrospectively analyzed.According to the occurrence of PONV,the patients were divided into two groups.The two groups were compared for the differences in perioperative factors.Furthermore,the Logistic regression analysis was performed to investigate the independent risk factors correlated with PONV.Results The incidence of PONV was 7.3％.The most important risk factors for PONV were aging 75 y or older [odds ratio (OR)=1.74,P=0.027],female (OR=1.69,P=0.039),intraoperative administration of sevoflurane (OR=2.32,P=0.01 3),duration of intraoperative hypotension ＞20 min (OR=l.64,P=0.048),the use of postoperative opioid analgesics (OR =2.14,P=0.002) and postoperative infection (OR =2.03,P=0.009).Further analyses suggested that the association remained to be statistically significant only in patients experiencing duration of intraoperative hypotension＞20 min (OR=6.28,P=0.006).Conclusions The occurrence of PONV in elderly patients after gastrointestinal surgery is related to multiple perioperative factors.Maintenance of hemodynamic stability,avoiding the use of inhalational anesthetics,preventing postoperative infection and weakening postoperative pain reasonably may reduce the risk of PONV in elderly patients.