Abstract Background The administration of anesthesia during gastrointestinal endoscopy potentially contributes to post-anesthesia cognitive dysfunction (PACD), with detrimental impacts for cognitive function. This study aimed to assess the knowledge, attitudes, and practices (KAP) towards PACD among patients undergoing gastrointestinal endoscopy in Wenzhou region. Methods This cross-sectional study was conducted between June and August 2023, and recruited individuals undergoing gastrointestinal endoscopy. Demographic data and KAP scores were collected through questionnaires. Pearson correlation analysis was applied to evaluate correlations between KAP scores, and logistic regression was utilized to identify influential factors. Results We collected 405 valid questionnaires, with 54.57% being male and 29.88% aged 31–40 years. Mean KAP scores were 13.99 ± 4.80, 16.19 ± 2.35, and 15.61 ± 2.86, respectively (possible range: 0–16, 0–25, and 0–25). Pearson correlation analysis demonstrated significant positive correlations between knowledge and practice (r = 0.209, P < 0.001), attitude and practice (r = 0.233, P < 0.001), and knowledge and attitude (r = 0.328, P < 0.001). Multivariate logistic regression revealed negative associations of opting for standard gastrointestinal endoscopy (without anesthesia) with knowledge (OR = 0.227, 95%CI: 0.088–0.582, P = 0.002) and practice scores (OR = 0.336, 95%CI: 0.154–0.731, P = 0.006). Additionally, the presence of cognitive-related diseases or symptoms before undergoing gastrointestinal endoscopy was negatively associated with knowledge scores (OR = 0.429, 95%CI: 0.225–0.818, P = 0.010). Conclusion Patients undergoing gastrointestinal endoscopy demonstrated good knowledge, neutral attitudes, and moderate practices regarding PACD. Educational interventions and behavior modification are recommended, particularly for individuals with lower monthly income, undergoing standard gastrointestinal endoscopy, or experiencing cognitive-related conditions.

Purpose Propofol is a widely used intravenous anesthetic in clinical practice. Lidocaine pretreatment is currently the most commonly used method to reduce the pain of propofol injection. However, propofol injection pain has not been eliminated and its incidence remains high. Transcutaneous electrical acupoint stimulation is a green therapy that combines transcutaneous electrical nerve stimulation therapy with the traditional acupuncture therapy of our motherland. This study investigated the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) combined with lidocaine in preventing propofol injection pain and determined whether it can reduce postoperative complications and promote rapid postoperative recovery of patients. Patients and Methods A total of 220 women scheduled to undergo hysteroscopic surgery were enrolled in the study. The included patients were randomly divided into four groups of 55 patients each: normal saline group (group K), lidocaine group (group L), TEAS group (group T), and lidocaine + TEAS group (group L + T). Patients in group K received 2 mL saline (0.9% NaCl) pre-injection before anesthesia induction. Group L received 40 mg lidocaine pre-injection (2 mL of 2% lidocaine) before anesthesia induction. Group T received 30 min of transcutaneous electrical stimulation at bilateral election Hegu, Neiguan, and 2 mL saline pre-injections before anesthesia induction. Group L + T received TEAS and lidocaine pre-injection. Results The VAS scores and the four-point verbal rating scale of propofol injection were significantly different among the four groups. The prevalence of nausea, vomiting, abdominal pain, and abdominal distension after surgery among the four groups were statistically different. The bleeding days after surgery were significantly different among the four groups. Conclusion TEAS combined with lidocaine pre-injection reduced the incidence of propofol injection pain and significantly reduced patients’ pain levels compared with single lidocaine pre-injection. TEAS can also reduce the incidence of postoperative nausea and vomiting, abdominal pain, and abdominal distension, shorten postoperative bleeding days, and accelerate the postoperative recovery of patients.

目的 探讨患者术前经皮穴位电刺激(TEAS)痛阈、耐痛阈与腹腔镜辅助下经阴道子宫切除术(LAVH)术后不同类型急性术后疼痛评分的相关性.方法 选取2018年1月至2019年12月温州医科大学附属第一医院择期行LAVH患者,术前1 d使用TEAS测定并记录患者的痛阈和耐痛阈,采用数字评分法(NRS)分别对患者的术后急性内脏痛、躯体痛进行评估,使用Pearson相关性方法分析TEAS的痛阈、耐痛阈与不同类型急性术后疼痛的相关性,并分别进行线性回归分析,求出回归方程.结果 本研究202例患者中,有99例患者术后出现中至重度内脏痛,86例患者术后出现中至重度躯体痛.经Pearson相关性分析,痛阈与内脏痛呈显著负相关(r=-0.319,P<0.05),耐痛阈与内脏痛之间呈显著负相关(r=-0.418,P<0.05),痛阈与躯体痛呈显著负相关(r=-0.246,P<0.05),耐痛阈与躯体痛之间呈显著负相关(r=-0.284,P<0.05).其回归方程分别为:Y(内脏痛评分)=-0.094 X(痛阈)+6.137,Y(内脏痛评分)=-0.089X(耐痛阈)+7.013;Y(躯体痛评分)=-0.074 X(痛阈)+4.829,Y(躯体痛评分)=-0.061X(耐痛阈)+5.221.结论 术前TEAS痛阈和耐痛阈可以在一定程度上预测LAVH患者术后急性内脏痛、躯体痛.临床上可以通过术前测定患者TEAS的痛阈和耐痛阈,并以此来客观地预测患者术后不同类型的急性术后疼痛.

目的 观察经皮穴位电刺激﹙TEAS﹚辅助全麻下对乳腺癌根治术中镇痛效应和血流动力学的影响.方法 选取来自温州医科大学附属第一医院2019年7月～2020年2月全麻下行乳腺癌根治术患者80例,按随机数字表法随机分成两组:TEAS组和对照组,每组各40例.TEAS组在麻醉诱导前30 min行TEAS﹙取穴为双侧合谷、内关、足三里、三阴交﹚,直至手术结束.对照组予相同位置贴电极片,不予电刺激处理.两组患者均采用常规诱导后置入喉罩全麻.记录两组术中各时间点的MAP、HR和脑电双频谱值﹙BIS﹚、拔管时间、术中麻醉用药情况.结果 两组患者的一般情况和手术情况无差异.TEAS组的拔管时间较对照组缩短,术中瑞芬太尼用量减少﹙P<0.05﹚;TEAS组在插管后即刻﹙T1﹚、插管后5 min﹙T2﹚、拔管后即刻﹙T6﹚、拔管后3 min﹙T7﹚的MAP水平显著低于对照组﹙P<0.05﹚,TEAS组在插管后即刻﹙T1﹚、插管后5 min﹙T2﹚、拔管后即刻﹙T6﹚的HR水平显著低于对照组﹙P<0.05﹚;TEAS组的T1时刻BIS值显著低于对照组﹙P<0.05﹚.结论 经皮穴位电刺激辅助全麻可以增强乳腺癌根治术中镇痛效应,减轻术中应激反应.

OBJECTIVE:To investigate the effect of electroacupuncture (EA) on pain behaviors and expression of spinal transcription factor GATA-binding Protein 4 (GATA4) and adenosine A1 receptor in neuropathic pain rats, so as to explore its mechanism underlying pain relief. METHODS:The present study includes 2 parts. In the first part, 18 SD rats were randomly divided into control, adenovirus short-hairpin interference RNA for GATA4 (AV-shGATA4 RNA) and adenovirus empty vector (AV-control short-hairpin RNA, AV-shCTRL) groups, with 6 rats in each group. The expression of GATA4 protein in the lumbar spinal cord (L4-L6) was detected to evaluate the transfection efficiency of AV-shGATA4 RNA (silencing GATA4 expression). In the second part, thirty SD rats were randomly divided into 5 groups, namely sham operation, CCI model, EA, EA+AV-shGATA4 RNA, and EA+AV-shCTRL groups, with 6 rats in each group. The neuropathic pain model was established by chronic constriction injury (CCI) of the right sciatic nerve. On the 7th day following modeling, EA was applied to the right "Zusanli"(ST36) and "Taichong"(LR3) (1 mA，2 Hz /100 Hz) for 30 min. Rats of the EA+AV-shGATA4 RNA and EA+AV-shCTRL groups received intrathecal injection of AV-shGATA4 RNA and AV-shCTRL(1×1011 PFU/mL，10 μL)at the spinal L4-L6 segments, separately, 48 h before EA intervention. The mechanical pain threshold and thermal pain threshold of the affected limb were detected before molding, 7 days following molding and 60 min after EA. The expressions of adenosine A1 receptor and GATA4 protein in the spinal cord (L4-L6) were detected by Western blot. RESULTS:Outcomes of the first part showed that compared with the control group, no significant changes were found in the mechanical and thermal pain thresholds in both AV-shCTRL and AV-shGATA4 RNA groups and in the expression of spinal GATA4 protein of the AV-shCTRL group (P＞0.05). The expression of spinal GATA4 protein of the AV-shGATA4 RNA group was significantly lower than that of the AV-shCTRL group (P<0.05). In the second part of the study, before CCI modeling, there were no significant differences among the five groups in the mechanical and thermal pain thre-sholds (P> 0.05). On the 7th day following modeling, the mechanical and thermal pain thresholds were significantly lowered in compa-rison with their own pre-modeling of each group and with the sham operation group (P<0.05). At 60 min after EA and compared with the model group, the mechanical and thermal pain thresholds were significantly increased in both the EA and EA+AV-shCTRL groups (P<0.05) but not in the EA+AV-shGATA4 RNA group (P>0.05), suggesting a critical involvement of GATA4 in EA analgesia. The expression levels of adenosine A1 receptor and GATA4 protein were significantly increased in the model group than in the sham operation group (P<0.05), and considerably further up-regulated in both EA and EA+AV-shCTRL groups (P< 0.05), rather than in the EA+AV-shGATA4 RNA group (P>0.05), suggesting that the effects of EA in up-regulating the expression of A1 receptor and GATA4 were eliminated after silencing GATA4 protein. CONCLUSION:EA of ST36 and LR3 can relieve pain by increasing the expression of adenosine A1 receptor of the lumbar spinal cord in neuropathic pain rats, which is probably mediated by GATA4 protein.

目的 探讨乳腺癌根治术行经皮穴位电刺激(TEAS)对术后恢复和远期生活质量的影响.方法 选取拟择期在喉罩全麻下行乳腺癌根治术患者72例,随机分为TEAS组和对照组,每组各36例.术前均行焦虑抑郁量表(HAD)评分,TEAS组患者在麻醉诱导前30 min于双侧合谷穴(LI4)、内关穴(PC6)、足三里穴(ST36)、三阴交穴(SP6)行TEAS,频率为2/100 Hz疏密波,强度为6～12 mA,至手术结束.对照组采用相同装置贴电极片,不予任何处理.术毕两组患者均使用患者自控静脉镇痛泵(PCIA).统计手术时间、麻醉苏醒时间、喉罩拔除时间;统计术中瑞芬太尼、丙泊酚用量;记录患者在入恢复室即刻(T0)、入恢复室30 min(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)的疼痛数字评分(NRS)和24 h PCIA累计按压次数;记录患者术后肛门首次排气时间、首次进水时间、下床活动时间及术后恶心、呕吐不良反应的发生率;采用40项恢复质量评分量表(QoR-40)评估患者术后24 h康复质量.采用简明疼痛量表(BPI)和健康调查12条简表(SF-12)评估术后1、3个月远期恢复质量以及统计术后3个月乳腺癌术后疼痛综合征(PMPS)发生率.结果 与对照组比较,TEAS组患者麻醉结束拔除喉罩时间缩短(P＜O.05),术中瑞芬太尼消耗总量减少(P＜0.05);TEAS组患者术后入恢复室30 min(T1)、术后6 h(T2)的NRS评分降低(P＜0.05);TEAS组患者术后肛门首次排气时间、下床活动时间缩短(P＜0.05),术后24h的QoR-40评分升高(P＜0.05);TEAS组术后1个月患者BPI量表疼痛影响评分降低,SF-12量表生理健康评分升高(P＜0.05).结论 TEAS可以改善乳腺癌根治术患者围术期疼痛,减少术中瑞芬太尼用量,缩短术后喉罩拔除时间,缩短肛门首次排气时间,提早患者下床活动时间,提高患者术后恢复质量,改善短期内生理健康和疼痛对生活的影响.

OBJECTIVE:To observe the effect of acupoint stimulation on the quality of recovery in patients with radical thyroidectomy under the concept of enhanced recovery after surgery (ERAS). METHODS:A total of 62 patients with radical thyroidectomy were randomized into an observation group and a control group, 31 cases in each one. In both of the two groups, general anesthesia with tracheal intubation was applied, the same anesthesia induction and maintenance medication were given. In the observation group, auricular point pressing with magnetic beads was adopted at bilateral shenmen (TF4) and transcutaneous electrical acupoint stimulation (dilatational wave, 2 Hz/100 Hz in frequency, 6 to 12 mA) was performed at bilateral Hegu (LI 4) and Neiguan (PC 6) from 30 min before anesthesia induction to the end of the anesthesia. In the control group, medical adhesive plaster was pasted at bilateral shenmen (TF4) and the electrodes were plastered at bilateral Hegu (LI 4) and Neiguan (PC 6) with no corresponding stimulation. In both of the two groups, visual analogue scale for anxiety (VAS-A) score was observed to evaluate the anxiety severity before anesthesia induction; the total intraoperative dosages of sufentanil, remifentanil and propofol were recorded; the numerical rating scale (NRS) score was used to assess the pain severity of instant time (T0) and 30 min (T1) of entering post-anesthesia recovery room (PACU), motor and static mode at 2 h (T2), 6 h (T3), 12 h (T4), 24 h (T5) after surgery; time of first anal exhaust, time of getting out of bed after surgery, total hospitalization time and the incidences of postoperative nausea and vomiting were observed; the quality of recovery was assessed by the 40-item quality of recovery score (QoR-40). RESULTS:The VAS-A score and the total intraoperative dosage of remifentanil in the observation group were reduced compared with the control group (P<0.05). The NRS scores at T0-T4 in the observation group were lower than those in the control group (P<0.01, P<0.05), while the difference between the two groups in NRS score at T5 was not significant (P>0.05). The time of first anal exhaust and getting out of bed after surgery in the observation group were advanced than those in the control group (P<0.05), there was no significant difference between the two groups in total hospitalization time and incidences of postoperative nausea and vomiting (P>0.05). Compared with the control group, the QoR-40 score was increased in the observation group (P<0.05). CONCLUSION:Acupoint stimulation can improve the preoperative anxiety in patients with radical thyroidectomy, reduce the intraoperative anesthetic dosage and postoperative pain, advance the time of anal exhaust and getting out of bed, improve the quality of postoperative recovery and enhance the recovery process.

Background: Myoclonus is an undesirable phenomenon that occurs after induction of general anesthesia using etomidate. Opioids such as sufentanil are considered effective pretreatment drugs for myoclonus inhibition, although high doses are required. Transcutaneous acupoint electrical stimulation (TAES), a noninvasive technique involving electrical stimulation of the skin at the acupuncture points, exhibits analgesic effects, promotes anesthetic effects, decreases the dose of anesthetic drugs, and increases endogenous opioid peptide levels. In the present study, we investigated the effects of TAES combined with low-dose sufentanil pretreatment on the incidence and severity of etomidate-induced myoclonus in patients undergoing elective hysteroscopy. Methods: In a double-blind manner, 172 patients (American Society of Anesthesiologists class I-II; age, 20-55 years) scheduled to undergo elective hysteroscopy were randomized into the following groups (n=43 each): control (false TAES followed by saline injection after 30min), TAES (TAES followed by saline injection after 30minutes), sufentanil [false TAES followed by low-dose sufentanil (0.1 mu g/kg) injection after 30 minutes], and sufentanil plus TAES (TAES followed by low-dose sufentanil injection after 30 minutes). In all groups, general anesthesia was induced by etomidate 0.3mg/kg after sufentanil or saline injection. The incidence and severity of myoclonus were assessed for 2minutes after etomidate administration. The visual analogue scale (VAS) scores for pain at 1hour after surgery were recorded. The heart rate (HR), mean arterial pressure (MAP), and peripheral capillary oxygen saturation (SPO2) were recorded before premedication, after etomidate injection, after uterus expansion, and after recovery from anesthesia. Results: The incidence of myoclonus was highest in the control group (88.3%), followed by TAES (74.4%), sufentanil (60.4%), and TAES plus sufentanil (48.8%) groups. Thus, the incidence was significantly higher in the control and TAES groups than in the sufentanil and TAES plus sufentanil groups. Grade 3 myoclonus occurred in 30.2%, 9.3%, 11.6%, and 9.3% patients in the control, TAES, sufentanil, and TAES plus sufentanil groups, respectively, with significant differences between the control group and the other 3 groups. Furthermore, the postoperative VAS scores for pain were significantly lower in the TAES, sufentanil, and TAES plus sufentanil groups compared with those in the control group. There were no significant differences in any other parameters among groups. Conclusion: Our results suggest that TAES combined with low-dose opioids such as sufentanil can decrease the incidence and severity of etomidate-induced myoclonus.

Sepsis is a systemic inflammatory reaction caused by infection. Multiple organ failure ultimately leads to high morbidity and mortality. Unfortunately, therapies against these responses have been unsuccessful due to the insufficient underlying pathophysiological evidence. Protein interacting with C-kinase 1 (PICK1) has received considerable attention because of its important physiological functions in many tissues. However, its role in sepsis-induced acute lung injury (ALI) is unclear. In this study, we used cecal ligation and puncture (CLP) to establish a septic model and found that decreased microtubule-associated protein-1light chain 3 (LC3)-II/LC3-I in PICK1−/− septic mice was caused by autophagy dysfunction. Consistently, the transmission electron microscopy (TEM) of bone marrow-derived macrophages (BMDMs) from PICK1−/− mice showed the accumulation of autophagosomes as well. However, more serious damage was caused by PICK1 deficiency indicating that the disrupted autophagic flux was harmful to sepsis-induced ALI. We also observed that it was the impaired lysosomal function that mediated autophagic flux blockade, and the autophagy progress was relevant to PI3K-Akt-mTOR pathway. These findings will aid in the potential development of PICK1 with novel evidence of autophagy in sepsis treatment and prevention.