Purpose:To explore the safety and efficacy of the novel G protein-biased μ-opioid receptor agonist oliceridine for painless gastroscopy. Methods:This study is a single-center randomized controlled clinical trial. One hundred and eighty-eight patients scheduled for painless gastroscopy were randomly assigned to four groups: Group L (oliceridine 10 μg/kg + propofol 2mg/kg), Group M (oliceridine 20 μg/kg + propofol 2mg/kg), Group H (oliceridine 30 μg/kg + propofol 2mg/kg) and Group C (sufentanil 0.1 μg/kg + propofol 2mg/kg). The primary outcome was the incidence of respiratory depression. Secondary outcomes included the incidence of respiratory arrest, bradypnea (respiratory rate<8 bpm) and hypoxemia (pulse oxygen saturation (SpO2) < 90%). Other outcomes included procedure and sedation-related outcomes, perioperative vital signs and adverse effects were recorded. Results:Among the 184 patients, 46, 46, 45 and 47 patients were randomly assigned to the L, M, H and C groups, respectively, and completed the trial. The incidence of respiratory depression in Group C (55.32%) and Group H (46.67%) was significantly higher than that in Group L (15.22%) and Group M (17.39%) (P<0.05). The incidence of respiratory arrest was higher in group H (42.22%) and group C (51.06%) compared to group L (13.04%) and group M (15.22%) (P < 0.05). The incidence of bradypnea and hypoxemia in group C (31.90% and 14.89%) was higher than that in group M (6.5% and 0) (P < 0.05). The sedation success rate was significantly lower in Group L than in Group M (71.74% vs 93.48%; P < 0.05). No significant differences were observed in the incidence of postoperative adverse effects. Conclusion:10 μg/kg and 20 μg/kg oliceridine is associated with a reduced risk of respiratory depression when co-administered with propofol for painless gastroscopy in adults, and the 20 μg/kg oliceridine exhibits superior sedative efficacy.

This study aimed to evaluate the effectiveness of whole-course high-quality nursing care combined with individualized nutritional intervention in patients undergoing spinal surgery during the perioperative period. In this single-center, single-blind randomized controlled trial, patients were assigned to receive either routine perioperative care or whole-course high-quality nursing care combined with individualized nutritional intervention. Outcomes included pain level (visual analog scale, VAS), functional recovery (Berg balance scale, BBS), 6-min walking distance (6MWD), nutritional status (albumin, total protein), activities of daily living (ADL), quality of life, incidence of complications, and nursing satisfaction. Compared with the control group, the intervention group had significantly lower VAS scores, higher BBS scores, longer 6MWD, and improved albumin and total protein levels (all P < 0.05). ADL and quality-of-life scores were higher in the intervention group, accompanied by greater nursing satisfaction and a lower incidence of postoperative complications (P < 0.05). Whole-course high-quality nursing management combined with nutritional intervention effectively improves pain control, functional recovery, nutritional status, daily living ability, and quality of life while reducing postoperative complications and improving nursing satisfaction in patients undergoing spinal surgery.

BACKGROUND:Endoscopic cyanoacrylate injection (ECI) is an established first-line treatment for gastric variceal bleeding (GVB). However, a rare but potentially fatal complication of this therapy is systemic embolization of the cyanoacrylate, most often to the lungs or spleen, while emboli to systemic circulation are exceedingly uncommon. CASE PRESENTATION:We report the case of a 71-year-old Asian male patient with cirrhosis who was found to have gastric variceal bleeding. He underwent endoscopic variceal obliteration using histoacryl (N-butyl cyanoacrylate) injection under intravenous anesthesia. Postprocedure, he exhibited delayed emergence from anesthesia and remained comatose. Laboratory and imaging examinations led to the diagnosis of multiple systemic embolization involving the brain, heart, spleen, and spinal cord, caused by cyanoacrylate. CONCLUSION:Although multiple systemic embolization is extremely rare, clinicians should be vigilant for this complication, especially in patients with abnormal shunts. Careful preprocedural screening for shunts, meticulous injection technique, and close monitoring may facilitate early detection and timely intervention, potentially improving patient outcomes.

BACKGROUND:Machine learning (ML) has emerged as a promising tool for predicting diabetic kidney disease (DKD), yet the performance and clinical utility of these models remain unclear. We conducted a systematic review and meta-analysis to evaluate ML models for DKD prediction. METHODS:We systematically searched seven databases from inception to May 16, 2026. Studies developing or validating ML models for DKD diagnosis were included. Quality was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST) and its AI extension (PROBAST+AI), and reporting completeness was evaluated using the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement and its AI extension (TRIPOD+AI). Pooled sensitivity, specificity, and area under the curve (AUC) were estimated using bivariate random-effects models. RESULTS:Sixty-six models were included. The pooled AUC was 0.926 (95% CI: 0.898-0.947), with sensitivity of 0.83 (95% CI: 0.79-0.86) and specificity of 0.90 (95% CI: 0.87-0.93). Neural networks achieved the highest AUC (0.973), followed by random forest (0.910). However, heterogeneity was substantial (I2 > 85%). Meta-regression identified model type (P = 0.019) and study design (P = 0.037) as significant effect modifiers. CONCLUSIONS:ML models show promising discriminative performance for DKD prediction, but the evidence is severely limited by high heterogeneity, lack of external validation and reporting of calibration metrics, and poor methodological transparency. Future research must prioritize external validation, calibration assessment, standardized reporting, and prospective impact studies.

Bleeding is a common issue in pediatric living donor liver transplantation (LDLT). Coagulopathy related bleeding can lead to increased morbidity and mortality. There has been limited research on the use of coagulation factor complexes, specifically fibrinogen concentrate (FibC) and prothrombin complex concentrate (PCC), in pediatric LDLT. Pediatric patients who underwent LDLT between March 2019 and December 2024 were identified. Patients who received FibC and PCC were assigned to the F group(n = 103), while those who did not receive these treatments were designated as the C group (n = 272). After 1:1 propensity score matching, 57 patients were included in each group for analysis. The primary endpoint was the need for red blood cell (RBC) transfusion in pediatric patients undergoing LDLT. There was no significant difference in the volume of RBC infusion between groups F and C (median [interquartile range]: 550.00 (400.00, 600.00) ml vs. 700.00 (400.00, 750.00) ml [p = 0.281]). In terms of plasma and intraoperative bleeding, group F demonstrated a trend toward lower levels compared to group C; however, there was no significant difference between the two groups. The two groups had no significant difference in intraperitoneal drainage volume or RBC infusion volume 24 h after surgery. Both groups also showed no difference in postoperative outcomes such as mechanical ventilation time, ICU stay, and hospital length of stay. Fibrinogen, PT, and INR levels post-surgery were significantly better in Group F than in Group C. Additionally, the groups had no notable differences in postoperative complications, including thromboses or embolism. This study indicates that using FibC and PCC was linked to a trend of reducing intraoperative RBC administration and bleeding in pediatric patients undergoing LDLT, although no significant difference was observed. Coagulopathy management strategies emphasizing targeted factor replacement should be a focus for future research.

BACKGROUND:Cancer-related neuropathic pain significantly affects patients' quality of life. Despite existing treatments, pain control remains inadequate for many of these patients. There is a lack of strong evidence for the efficacy of the combination of pregabalin, which is often used to treat neuropathic pain, and opioids for treating cancer-related neuropathic pain. OBJECTIVE:This study aimed to evaluate the analgesic effects and safety of pregabalin combined with opioids for managing cancer-related neuropathic pain through high-quality evidence analysis. STUDY DESIGN:A systematic review and meta-analysis of pregabalin combined with opioids for cancer-related neuropathic pain. METHODS:We systematically searched the PubMed, Web of Science, Embase, Cochrane Library and Cochrane Central Register of Controlled Trials databases from their inception through October 5, 2023. Two reviewers independently selected studies and extracted articles that met the inclusion and exclusion criteria. Quality assessments of the included studies were performed using the modified Cochrane Collaboration tool; data analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration). RESULTS:A total of 8 studies were included in our qualitative synthesis, and 6 studies were included in the meta-analysis (6 studies with 757 patients, including 342 in the experimental group and 415 in the control group). The results showed a significant difference between the pregabalin combined with opioids group and the opioids alone group in terms of Numeric Rating Scale (NRS-11) pain scores (weighted mean difference [WMD] = -1.00; 95% CI, -1.29 to -0.70; P < 0.001). However, no significant difference in the NRS-11 score was observed between the pregabalin combined with opioids group and active comparator combined with opioids group (WMD = -0.47; 95% CI, -1.05 to 0.11; P = 0.11). There was a significant difference between the pregabalin combined with opioids group and the active comparator combined with opioids group in terms of extra morphine milligram equivalents (relative risk [RR] = 0.37; 95% CI, 0.20 to 0.70; P = 0.002). No significant difference was observed in quality of life (WMD = -2.01; 95% CI, -5.29 to 1.27; P = 0.23). In general, the frequency of adverse events in the pregabalin combined with opioids group was greater than that in the opioids alone group, but the frequency of adverse events between the pregabalin combined with opioids group and the active comparator combined with opioids group was unclear. LIMITATIONS:The limited number of articles and sample size are the limitations of this meta-analysis. CONCLUSIONS:Pregabalin combined with opioids reduces cancer-related neuropathic pain but increases dizziness, somnolence, and peripheral edema, thus supporting its use in the clinic for treating cancer-related neuropathic pain. However, further high-quality randomized controlled trials are needed to confirm these findings.

The intravitreal dexamethasone implant (Dex) is widely used for various ocular conditions, including diabetic macular edema (DME), retinal vein occlusion (RVO), and non-infectious uveitis. Despite its efficacy, concerns remain regarding its safety profile. This study aims to analyze the adverse events (AEs) associated with Dex reported in the FDA Adverse Event Reporting System (FAERS) database from 2010 to 2024. Data were extracted from FAERS, focusing on cases where Dex was the primary suspect drug. The dataset was processed to eliminate duplicates and incomplete entries. Disproportionality analysis, including Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR), was used to detect safety signals. AEs were categorized by system organ class (SOC) and preferred term (PT). A total of 1,588 adverse event reports (AERs) were analyzed, revealing a significant upward trend. The Eye disorders was the most commonly reported SOC, with strong disproportionality signals (ROR: 45.11; PRR: 23.71). Key AEs identified at the PT level included Corneal decompensation, Choroidal hematoma, and Posterior capsule rupture, which were not listed on the drug label. Considering the reported numbers, the Endophthalmitis was the most common AE. Additionally, a significant proportion of AEs were observed within the first seven days post-administration, emphasizing the need for monitoring. While Dex remains an effective treatment option for ocular conditions, its use is associated with significant risks, particularly regarding unexpected and severe complications such as corneal decompensation. Continuous pharmacovigilance and detailed patient monitoring are essential to mitigate these risks. Future studies should focus on prospective designs and comprehensive clinical data to better understand the safety profile of Dex.

Background:Zoster-associated pain (ZAP) significantly impacts quality of life (QoL) and poses therapeutic challenges. However, there is limited comparative evidence on interventional strategies, particularly regarding short-term spinal cord stimulation (st-SCS) vs. pulsed radiofrequency (PRF), stratified by disease duration and dermatomal involvement. Objectives:This retrospective study aimed to compare the efficacy and safety of st-SCS and PRF in patients with ZAP, with the primary outcome defined as ≥50% pain reduction at 1 month post-treatment. Secondary outcomes included neuropathic pain characteristics, quality of life (QoL), medication use, and adverse events. Methods:Clinical data were retrospectively extracted from the institutional pain management database at West China Hospital, covering the period between July 2022 and February 2024. Eligible patients had a clinical diagnosis of ZAP and received either st-SCS or PRF following standard clinical practice. Outcomes assessed included pain severity, neuropathic pain characteristics, QoL indicators, medication usage, and adverse events. Follow-up assessments occurred immediately post-treatment and at 1, 3, 6, and 12 months. Stratified analyses were performed according to disease duration and affected dermatomes. Results:A total of 186 patients met the inclusion criteria (st-SCS, n = 96; PRF, n = 90). st-SCS showed superior pain relief compared to PRF, with significantly higher rates of ≥50% pain relief immediately post-treatment (72.92 vs. 14.44%, P < 0.001), at 1 month (46.88 vs. 31.11%, P = 0.035), and at 3 months (64.58 vs. 43.33%, P = 0.005). Stratified analysis indicated greater efficacy of st-SCS in patients with disease durations of 1-2 months and thoracic dermatomal involvement, showing significantly lower NRS scores across multiple follow-ups. Additionally, st-SCS significantly reduced neuropathic pain characteristics, with lower Douleur Neuropathique 4 (DN4) scores at 1 month (1.77 ± 0.80 vs. 2.11 ± 0.99, P = 0.046), 3 months (1.42 ± 0.98 vs. 2.29 ± 1.16, P < 0.001), and 6 months (1.38 ± 0.93 vs. 1.81 ± 1.02, P = 0.008). QoL improvements were consistently greater with st-SCS, particularly regarding sleep quality, mood, and life enjoyment from 1 to 6 months post-treatment. Conclusions:st-SCS provides superior short-term and sustained pain relief and QoL enhancements compared to PRF in managing ZAP, especially in patients with shorter disease duration and thoracic and abdominal involvement. Both treatments demonstrated comparable safety profiles, confirming the viability and effectiveness of st-SCS as an advantageous interventional option for managing zoster-associated pain.

The effects of general anesthetic agents (GAAs) on microglia and their potential neurotoxicity have attracted the attention of neuroscientists. Microglia play important roles in the inflammatory process and in neuromodulation of the central nervous system. Microglia-mediated neuroinflammation is a key mechanism of neurocognitive dysfunction during the perioperative period. Microglial activation by GAAs induces antiinflammatory and pro-inflammatory effects in microglia, suggesting that GAAs play a dual role in the mechanism of postoperative cognitive dysfunction. Understanding of the mechanisms by which GAAs regulate microglia may help to reduce the incidence of postoperative adverse effects. Here, we review the actions of GAAs on microglia and the consequent changes in microglial function. We summarize clinical and animal studies associating microglia with general anesthesia and describe how GAAs interact with neurons via microglia to further explore the mechanisms of action of GAAs in the nervous system.

AbstractSepsis-induced acute lung injury (SALI) poses a significant threat with high incidence and mortality rates. Ginsenoside Rg1 (GRg1), derived from Ginseng in traditional Chinese medicine, has been found to reduce inflammation and protect lung epithelial cells against tissue damage. However, the specific roles and mechanisms by which GRg1 mitigates SALI have yet to be fully elucidated. In this context, we employed a relevant SALI mouse model, alongside network pharmacology, molecular docking, and molecular dynamics simulation to pinpoint GRg1's action targets, complemented by in vitro assays to explore the underlying mechanisms. Our research shows that GRg1 alleviates CLP-induced SALI, decreasing lung tissue damage and levels of serum proinflammatory factor IL-6, TNF-α, and IL-1β, also enhancing the survival rate of CLP mice. A total of 116 common targets between GRg1 and ALI, with specific core targets including AKT1, VEGFA, SRC, IGF1, ESR1, STAT3, and ALB. Further in vitro experiments assessed GRg1's intervention effects on MLE-12 cells exposed to LPS, with qRT-PCR analysis and molecular dynamics simulations confirming AKT1 as the key target with the favorable binding activity for GRg1. Western blot results indicated that GRg1 increased the Bcl-2/Bax protein expression ratio to reduce apoptosis and decreased the high expression of cleaved caspase-3 in LPS-induced MLE-12 cells. More results showed significant increases in the phosphorylation of PI3K and AKT1. Flow cytometric analysis using PI and Annexin-V assays further verified that GRg1 decreased the apoptosis rate in LPS-stimulated MLE-12 cells (from 14.85 to 6.54%, p < 0.05). The employment of the AKT1 inhibitor LY294002 confirmed these trends, indicating that AKT1’s inhibition negates GRg1’s protective effects on LPS-stimulated MLE-12 cells. In conclusion, our research highlights GRg1's potential as an effective adjunct therapy for SALI, primarily by inhibiting apoptosis in alveolar epithelial cells and reducing pro-inflammatory cytokine secretion, thus significantly enhancing the survival rates of CLP mice. These beneficial effects are mediated through targeting AKT1 and activating the PI3K-AKT pathway.

The study investigates the therapeutic effects and mechanisms of ginsenoside Rg_1(GRg_1) on sepsis-induced acute lung injury(SALI). A murine model of SALI was created using cecal ligation and puncture(CLP) surgery, and mice were randomly assigned to groups for GRg_1 intervention. Survival and body weight changes were recorded, lung function was assessed with a non-invasive lung function test system, and lung tissue damage was evaluated through HE staining. The content and expression of inflammatory factors were measured by ELISA and qRT-PCR. Apoptosis was examined using flow cytometry and TUNEL staining. The activation and expression of apoptosis-related molecules cysteinyl aspartate specific proteinase 3(caspase-3), B-cell lymphoma-2(Bcl-2), Bcl-2 associated X protein(Bax), and endoplasmic reticulum stress-related molecules protein kinase R-like endoplasmic reticulum kinase(PERK), eukaryotic initiation factor 2α(eIF2α), activating transcription factor 4(ATF4), and C/EBP homologous protein(CHOP) were studied using Western blot and qRT-PCR. In addition, an in vitro model of lipopolysaccharide(LPS)-induced lung alveolar epithelial cell injury was used, with the application of the endoplasmic reticulum stress inducer tunicamycin to validate the action mechanism of GRg_1. RESULTS:: indicated that, when compared to the model group, GRg_1 intervention significantly enhanced the survival time of CLP mice, mitigated body weight loss, and improved impaired lung function indices. The GRg_1-treated mice also displayed reduced lung tissue pathological scores, a reduced lung tissue wet-to-dry weight ratio, and lower protein content in the bronchoalveolar lavage fluid. Serum levels of interleukin-6(IL-6), interleukin-1β(IL-1β), and tumor necrosis factor-α(TNF-α), as well as the mRNA expressions of these cytokines in lung tissues, were decreased. There was a notable decrease in the proportion of apopto-tic alveolar epithelial cells, and down-regulated expressions of caspase-3, Bax, PERK, eIF2α, ATF4, and CHOP and up-regulated expression of Bcl-2 were observed. In vitro findings showed that the apoptosis-lowering and apoptosis-related protein down-regulating effects of GRg_1 were significantly inhibited with the co-application of tunicamycin. Altogether, GRg_1 reduces apoptosis of alveolar epithelial cells, inhibits inflammation in the lungs, alleviates lung injury, and enhances lung function, possibly through the PERK/eIF2α/ATF4/CHOP pathway.

BACKGROUND Patients experience severe pain in early postoperative rehabilitation after total knee arthroplasty (TKA). This study aimed to compare the effect of femoral nerve block with different concentrations of chloroprocaine on postoperative rehabilitation in patients with TKA. MATERIAL AND METHODS Ninety patients who only received unilateral TKA were randomly and equally divided into C1 (1% chloroprocaine 0.2 ml/kg), C2 (2% chloroprocaine 0.2 ml/kg), or NS (0.9% sodium chloride solution 0.2 ml/kg) groups. The patients received rehabilitation 3 times a day on days 3-6 after surgery, and femoral nerve block was performed with corresponding solution 10 min before each training session. We recorded the maximum knee flexion angles (MKFA) and maximum knee extension angles (MKEA) during active exercise on day 7 after surgery, as well as the incidence of MKFA ³100°, American knee society (AKS) scores, and postoperative rehabilitation satisfaction. Adverse effects after administration in each group were also recorded. RESULTS Compared with group NS, patients in group C1 and C2 had larger MKFA during active exercise on day 7 after TKA, and had better rehabilitation satisfaction (P<0.05). MKEA, the incidence of MKFA ≥100°, and AKS scores showed no significant differences in the 3 groups. There were more patients with decline of muscle strength in group C2 (P<0.05), and no other adverse reactions were recorded. CONCLUSIONS Chloroprocaine for femoral nerve block can be safely used in rehabilitation after TKA and to improve the knee flexion angle in the early postoperative period. Because they may have fewer adverse effects, 1% chloroprocaine 0.2 ml/kg may be preferred.

Background Ciprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor. Aim To determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety. Method A total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs). Results The success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol. Conclusion The efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg. Trial registration Clinicaltrials.gov, NCT03698617, retrospectively registered.

Background Prolonged length of stay in post-anesthesia care unit (PLOS in PACU) is a combination of risk factors and complications that can compromise quality of care and operating room efficiency. Our study aimed to develop a nomogram to predict PLOS in PACU of patients undergoing elective surgery. Methods Data from 24017 patients were collected. Least absolute shrinkage and selection operator (LASSO) was used to screen variables. A logistic regression model was built on variables determined by a combined method of forward selection and backward elimination. Nomogram was designed with the model. The nomogram performance was evaluated with the area under the receiver operating characteristic curve (AUC) for discrimination, calibration plot for consistency between predictions and actuality, and decision curve analysis (DCA) for clinical application value. Results A nomogram was established based on the selected ten variables, including age, BMI < 21 kg/m 2 , American society of Anesthesiologists Physical Status (ASA), surgery type, chill, delirium, pain, naloxone, operation duration and blood transfusion. The C-index value was 0.773 [95% confidence interval (CI) = 0.765 - 0.781] in the development set and 0.757 (95% CI = 0.744-0.770) in the validation set. The AUC was > 0.75 for the prediction of PLOS in PACU. The calibration curves revealed high consistencies between the predicted and actual probability. The DCA showed that if the threshold probability is over 10% , using the models to predict PLOS in PACU and implement intervention adds more benefit. Conclusions This study presented a nomogram to facilitate individualized prediction of PLOS in PACU for patients undergoing elective surgery.

BackgroundChoosing the appropriate concentration and volume of anesthetics is critical for a successful nerve block. The current study aimed to determine the minimum effective volume (MEV) of 0.5% ropivacaine for US-guided CEB in 90% of patients (MEV90) undergoing anorectal surgery. The aims were to reduce the occurrence of complications associated with a sacral blockade in anorectal surgery, broaden the indications for surgical procedures and treatment, and improve patient satisfaction. This study presents the groundwork for the development of individualized anesthetic programs. We believe that the study would serve as a reference for the use of caudal epidural block (CEB) in lower abdominal surgery for intraoperative and postoperative analgesia.MethodsThis study used a biased coin design (BCD) up-and-down method (UDM). We divided the participants into two groups based on gender, and each group independently performed the biased coin design up-and-down method. We used 0.5% ropivacaine for the first patient in each group; however, the volume was 10 ml for men and 8 ml for women. Therefore, the dose of anesthetics given to each patient was determined by the response of the previous patient. If the block of the previous patient failed, the volume was increased by 2 ml in the following patient. Otherwise, the next subject had an 11% chance of receiving a volume of 2 ml less or an 89% chance of receiving no volume change. We defined a successful block as painless surgery with anal sphincter relaxation 15 min after the drug injection. Enrollment was completed after 45 successful caudal blocks for each group.ResultsCaudal epidural block was successfully performed on 50 men and 49 women. The MEV90 of ropivacaine for CEB was calculated to be 12.88 ml (95% CI: 10.8–14 ml) for men and 10.73 ml (95% CI: 9.67–12 ml) for women. Men had a MEV99 of 13.88 ml (95% CI: 12.97–14 ml), and women had a MEV99 of 11.87 ml (95% CI: 11.72–12 ml).ConclusionWith operability and general applicability, it is possible to increase the success rate of CEB for anorectal surgery to 99% as well as decrease the incidence of anesthesia-related complications. CEB can meet the needs of patients for rapid postoperative rehabilitation, improve patient satisfaction, and lay a solid foundation for postoperative analgesia.

Neuroscientists have recognized the importance of astrocytes in regulating neurological function and their influence on the release of glial transmitters. Few studies, however, have focused on the effects of general anesthetic agents on neuroglia or astrocytes. Astrocytes can also be an important target of general anesthetic agents as they exert not only sedative, analgesic, and amnesic effects but also mediate general anesthetic-induced neurotoxicity and postoperative cognitive dysfunction. Here, we analyzed recent advances in understanding the mechanism of general anesthetic agents on astrocytes, and found that exposure to general anesthetic agents will destroy the morphology and proliferation of astrocytes, in addition to acting on the receptors on their surface, which not only affect Ca2+ signaling, inhibit the release of brain-derived neurotrophic factor and lactate from astrocytes, but are even involved in the regulation of the pro- and anti-inflammatory processes of astrocytes. These would obviously affect the communication between astrocytes as well as between astrocytes and neighboring neurons, other neuroglia, and vascular cells. In this review, we summarize how general anesthetic agents act on neurons via astrocytes, and explore potential mechanisms of action of general anesthetic agents on the nervous system. We hope that this review will provide a new direction for mitigating the neurotoxicity of general anesthetic agents.