BACKGROUND:Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. METHODS:This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. RESULTS:Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298. CONCLUSIONS:Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival. CLINICAL TRIAL REGISTRATIONS:ChiCTR-IPR-15006209; NCT02660411.

Currently, therapies for ischemic stroke are limited. Ginkgolides, unique Folium Ginkgo components, have potential benefits for ischemic stroke patients, but there is little evidence that ginkgolides improve neurological function in these patients. Clinical studies have confirmed the neurological improvement efficacy of diterpene ginkgolides meglumine injection (DGMI), an extract of Ginkgo biloba containing ginkgolides A (GA), B (GB), and K (GK), in ischemic stroke patients. In the present study, we performed transcriptome analyses using RNA-seq and explored the potential mechanism of ginkgolides in seven in vitro cell models that mimic pathological stroke processes. Transcriptome analyses revealed that the ginkgolides had potential antiplatelet properties and neuroprotective activities in the nervous system. Specifically, human umbilical vein endothelial cells (HUVEC-T1 cells) showed the strongest response to DGMI and U251 human glioma cells ranked next. The results of pathway enrichment analysis via gene set enrichment analysis (GSEA) showed that the neuroprotective activities of DGMI and its monomers in the U251 cell model were related to their regulation of the sphingolipid and neurotrophin signaling pathways. We next verified these in vitro findings in an in vivo cuprizone (CPZ, bis(cyclohexanone)oxaldihydrazone)-induced model. GB and GK protected against demyelination in the corpus callosum (CC) and promoted oligodendrocyte regeneration in CPZ-fed mice. Moreover, GB and GK antagonized platelet-activating factor (PAF) receptor (PAFR) expression in astrocytes, inhibited PAF-induced inflammatory responses, and promoted brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) secretion, supporting remyelination. These findings are critical for developing therapies that promote remyelination and prevent stroke progression.

目的 探讨应用手术器械遴选会在辅助外科医生进行手术器械采购论证并发掘现存的手术器械管理问题作用.方法 医院多部门协作应用计划-执行-检查-处理(PDCA)法筹划并组织手术器械遴选会,并评估该会议对手术器械遴选和采购论证的作用,根据临床反馈改进器械管理和会议组织.结果 遴选会中68名参会人员从展示的5 153件手术器械中遴选出了 1 654件.参会人员对手术器械功能、材质、结构等方面改进和前沿知识的知晓度有提高,对手术器械遴选目录中器械品牌和型号的满意度上升,对手术器械遴选会作为一种新型手术器械遴选方式的认可度有所增加,差异有显著统计学意义(P＜0.01).临床反馈的手术器械管理问题主要集中在器械包配置优化及器械外观功能改进.结论 遴选会让外科医生从多个维度对手术器械进行遴选评价,有助于提高手术器械采购论证的科学性和有效性,合理配置采购预算,选择临床需求高的手术器械.

BACKGROUND:Hypobaric hypoxia exposure leads to brain edema, followed by neuropsychological disorders. However, the related mechanism and effective treatments are still unclear. The study aimed to discuss the neuroprotective effects of Cordycepin on hypobaric hypoxia-induced cognitive impairment.METHODS:The study contained two parts. In the first part, rats underwent hypobaric hypoxia (HH) exposure for 7 days, with or without Cordycepin (10 mg/kg) or lipopolysaccharide (LPS,10 mg/kg) treatment once a day. In the second part, rats underwent HH exposure for 7 days, with or without TAK242 (3 mg/kg) and Cordycepin (10 mg/kg) once a day. Open field and Morris water maze test were performed one day after the 7days treatment. The BBB permeability was detected by the uptake of NaF. Western bloting was used to detect the levels of TLR4/MyD88/NF-κB pathway related proteins in the hippocampus. The hippocampal and serous levels of cytokines were detected by ELISA. The structure of tight junctions in the hippocampus was observed under the transmission electron microscopy.RESULTS:Both acute HH and LPS exposure could activate the TLR4 pathway and neuroinflammation, further induced BBB disruption and cognitive injury. Cordycepin could inhibit the activation of theTLR-4/NF-κB/MMP-9 pathway, which further attenuated cognitive dysfunction, and disruption of the blood-brain barrier (BBB) in HH and LPS exposed rats. Furthermore, TAK242, a TLR4 antagonist, also inhibited the activation of theTLR-4/NF-κB/MMP-9 pathway and BBB disruption, as well as attenuated HH induced cognitive impairment.CONCLUSIONS:Cordycepin could ameliorate HH-induced neuroinflammation, BBB disruption, and cognitive damage partly by inhibiting the TLR-4/NF-κB/MMP-9 pathway.

Delirium and cognition impairment are common complications in elderly patients after anesthesia and surgery. However, it remains unclear how to prevent these complications. Based on acupuncture theory, transcutaneous electrical stimulation (TES) improves brain function, which may be a preventive strategy. Therefore, we aimed to find whether TES could prevent surgery-induced delirium and cognitive dysfunction in elderly patients after surgery.

目的 探讨右美托咪定联合罗哌卡因双侧竖脊肌平面阻滞(ESPB)对老年患者腰椎间孔镜镇痛效果及术后恢复质量的影响.方法 选取2018年11月至2020年11月在北京世纪坛医院择期行腰椎间孔镜手术的老年患者(≥65岁)120例.随机分为对照组、右美托咪定组、ESPB组、联合组.对照组选择0.375％罗哌卡因20 ml局部浸润麻醉;右美托咪定组术前予右美托咪定0.5μg/(kg·h)泵注10 min,术中以0.3μg/(kg·h)维持;ESPB组术前俯卧位行超声引导下双侧ESPB,每侧注入0.375％罗哌卡因20 ml;联合组术前予右美托咪定0.5μg/(kg·h)泵注10 min,术中以0.3μg/(kg·h)维持.同时俯卧位行超声引导下双侧竖脊肌平面阻滞,每侧注入0.375％罗哌卡因20 ml.记录患者手术时间,入室后(T0)、切皮时(T1)、分离肌肉期间(T2)、椎间孔成形时(T3)、脊神经根减压(T4)、手术结束时(T5)时的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、视觉模拟评分法(VAS)评分、Ramsay评分,术中地佐辛用量,术中及术后24 h内各种不良事件及术后24 h患者恢复质量评分(QoR-15评分)和患者满意度.结果 T1、T2时点,ESPB组与对照组MAP、HR及SpO2无统计学差异(P>0.05);联合组、右美托咪定组MAP、HR明显低于ESPB组和对照组(P<0.05);T3、T4及T5时点,右美托咪定组、ESPB组及联合组MAP、HR明显低于对照组(P<0.05).T0、T1及T2时,4组VAS评分无统计学差异(P>0.05).T3、T4及T5时,联合组、ESPB组及右美托咪定组VAS评分明显低于对照组(P<0.05).T1～T5时,右美托咪定组及联合组Ramsay评分明显低于对照组和ESPB组(P<0.05).右美托咪定组、ESPB组及联合组术中地佐辛用量明显低于对照组(P<0.05).右美托咪定组、ESPB组及联合组术中出现疼痛、恶心呕吐、高血压的老龄患者明显少于对照组(P<0.05);右美托咪定组及联合组出现嗜睡的例数明显高于对照组和ESPB组(P<0.05).右美托咪定组、ESPB组及联合组术后24 h内出现疼痛、恶心呕吐的老龄患者及地佐辛用量明显少于对照组(P<0.05);而术后24 h内的恢复质量评分及满意度明显高于对照组(P<0.05).结论 右美托咪定联合罗哌卡因双侧竖脊肌平面阻滞能够提供充分的镇静镇痛效果,降低围术期应激反应,减少不良事件的发生,促进术后快速康复.

目的 探讨通心络胶囊对急性低压缺氧暴露大鼠认知功能损伤的神经保护作用及其相关机制.方法 64只雄性Sprague-Dawley大鼠随机均分为四组,包括正常组(C),通心络组(TXL),低压低氧组(HH),和低压低氧+通心络组(TXL+HH).在低压低氧暴露前,所有大鼠进行5 d水迷宫训练.然后在低压低氧环境下暴露7 d.7 d后,采用旷场实验,水迷宫实验测定认知功能,然后处死取海马组织,Western blot检测海马组织TLR-4、MyD88、IκB-α,NF-κB p65,AQP4,MMP-9的表达,ELISA检测血清和海马组织中IL-1β、TNF-α、IL-6的水平,HE染色观察海马组织病理学变化,并测定大鼠的脑水含量.结果(1)行为学实验:四组大鼠旷场实验结果无统计学差异(P>0.05);但在水迷宫空间探索实验中发现,与C组比较,HH组大鼠原平台所在象限停留时间及穿越平台次数明显降低(P<0.05);TXL干预后,大鼠原平台所在象限停留时间及穿越平台次数较低压低氧组明显升高,(P<0.05);(2)炎症指标比较:与C组比较,HH组大鼠血清及海马组织IL-1β、TNF-α、IL-6水平,海马TLR-4、MyD88、NF-κB p65蛋白水平明显升高(P<0.05),TXL干预后,炎症指标相关蛋白水平均下降(P<0.05);(3)海马组织损伤比较:HH组大鼠海马AQP4及MMP-9表达及脑水含量明显高于C组(P<0.05),海马区细胞排列紊乱,肿胀明显,边界模糊;而TXL干预后,AQP4,MMP-9表达及脑水含量均明显下降(P<0.05).结论 急性低压缺氧暴露可导致认知功能障碍和脑组织水肿,通心络干预可通过抑制TLR4/MyD88/NF-κB信号通路活化,减轻海马炎症,改善认知损伤和脑组织水肿.

Background: Experimental and observational research suggests that combined epidural–general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural–general anesthesia improves long-term survival in elderly patients. Methods: This article presents a long-term follow-up of patients enrolled in a previous trial conducted at five hospitals. Patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries were randomly assigned to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival. Results: Among 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). Among patients assigned to combined epidural–general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P = 0.408. Cancer-specific survival was similar with combined epidural–general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290. Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural–general anesthesia versus 389 of 859 [45%] with general anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P = 0.692. Event-free survival was 466 of 853 [55%] in patients who had combined epidural–general anesthesia versus 450 of 859 [52%] for general anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P = 0.815. Conclusions: In elderly patients having major thoracic and abdominal surgery, combined epidural–general anesthesia with epidural analgesia did not improve overall or cancer-specific long-term mortality. Nor did epidural analgesia improve recurrence-free survival. Either approach can therefore reasonably be selected based on patient and clinician preference. In patients aged 60 to 90 yr having major noncardiac thoracic and abdominal surgery, combined epidural–general anesthesia compared to general anesthesia alone did not improve overall or cancer-specific long-term survival. Combined epidural–general anesthesia also did not improve recurrence-free survival. Supplemental Digital Content is available in the text.

Background Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural–general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery. Methods Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days. Results Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural–general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural–general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001). Conclusions Older patients randomized to combined epidural-general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

目的 探讨含不同浓度罗哌卡因肿胀液在淋巴水肿吸脂减容术中的有效性及安全性.方法 选择2017年1月至2018年6月首都医科大学附属北京世纪坛医院择期行吸脂减容术患者60例,随机分4组,每组15例,分别用0.75％罗哌卡因20 ml(G1组)、30 ml(G2组)、40 ml(G3组)、50 ml(G4组)加入碳酸氢钠1.5 g、肾上腺素3 mg和生理盐水配成3 000 ml膨胀液.记录麻醉诱导前5 min(T0)、注射膨胀液后5 min(T1)、术毕即刻(T2)和拔除气管导管(T3)时的MAP、HR和SpO2.记录拔除气管导管后(T4)、术后1 h(T5)、术后6 h(T6)、术后24 h(T7)疼痛视觉模拟评分(visual analogue scale,VAS)和追加镇痛药例数.结果 G2、G3、G4组T4～T6的VAS评分均低于G1组,差异均有统计学意义(P＜0.05),而G2、G3、G43组间各时点比较,差异均无统计学意义(P＞0.05);G1、G2、G3组均无心血管及神经毒性等不良反应.但术后随访发现,G4组术后出现局部皮肤麻木、感知觉障碍等表现,提示浓度增加对局部皮肤仍存在麻醉遗留效果.结论 肿胀液中含0.75％罗哌卡因30 ml及40 ml能够为淋巴水肿吸脂提供了足够的镇痛,且比较安全.

目的 观察右美托咪定复合地佐辛术后镇痛对胸腔镜肺叶切除术患者睡眠质量及炎性反应的影响.方法 选择120例择期全麻下胸腔镜肺叶切除术患者,随机分为实验组和对照组,每组60例.两组患者手术结束前行肋间神经阻滞,术后接PCIA止痛泵,实验组配方为右美托咪定3μg/kg+地佐辛1 mg/kg+恩丹司琼8 mg+生理盐水至100 mL.对照组为地佐辛1 mg/kg+恩丹司琼8 mg+生理盐水至100 mL.两组背景输注流速为2 mL/h,单次追加1 mL/次,锁定时间15 min.采用阿森失眠量表评估患者术前晚和术后第1、2、3天睡眠情况;记录术后4、12、24和48 h VAS评分,PCIA按压次数及地佐辛消耗量、芬太尼补救剂量;记录不良反应发生情况.于麻醉前、术后4、24和48 h采集外周血,以ELISA法测定CRP、IL-6浓度.结果 术后第1、2、3天实验组AIS评分均较对照组明显降低(P<0.05).各时点实验组血清CRP、IL-6水平均低于对照组水平(P<0.05).实验组术后各时点VAS评分,术后PCIA按压次数,地佐辛消耗量及芬太尼补救剂量,不良反应发生率均明显低于对照组(P<0.05).结论 右美托咪定复合地佐辛用于胸腔镜肺叶切除术患者术后镇痛,能达到良好镇痛的同时,改善患者的睡眠质量,并在一定程度上减轻炎性反应和术后不良反应.

目的 探讨含罗哌卡因的膨胀液在吸脂术中的有效性.方法 选择2015年1月～2017年1月因下肢淋巴水肿择期行吸脂术60例,随机分为2组各30例,分别用2％利多卡因25 ml(L组)或0.75％罗哌卡因30 ml(R组),加入碳酸氢钠1.5 g、肾上腺素3 mg和生理盐水配制成3000 ml膨胀液.记录2组诱导前(T0)、注射膨胀液前(T1)、术毕(T2)和拔除气管导管时(T3)的平均动脉压(MAP)和心率(HR);记录拔除气管导管时(T3)、术后1 h(T4)、2 h(T5)、6 h(T6)、12 h(T7)和24 h(T8)各时间点疼痛视觉模拟评分(VAS)和追加镇痛药物例数.结果 2组术中MAP、HR无统计学差异(P>0.05).在T4、T5、T6和T7时间点,R组VAS评分低于L组[T4:(2.2±0.8)分vs.(4.1±0.6)分,t=-10.226,P=0.000;T5:(2.3±0.8)分vs.(4.2±0.6)分,t=-9.517,P=0.000;T6:(2.7±0.8)分vs.(4.4±0.7)分,t=-8.932,P=0.000;T7:(2.8±0.9)分vs.(3.6±0.6)分,t=-3.981,P=0.000].在T4、T5和T6时间点,R组追加镇痛药物例数少于L组[T4:2例vs.9例,χ2=5.455,P=0.020;T5:2例vs.12例,χ2=9.317,P=0.002;T6:3例vs.11例,χ2=5.963,P=0.015].结论 在吸脂手术中含罗哌卡因的膨胀液具有较高的安全性,并可提供良好的术后镇痛.

目的 回顾分析气管肿瘤切除麻醉管理.方法 对首都医科大学附属北京世纪坛医院2009至2016年共7例气管肿瘤切除术麻醉回顾性分析,结合文献探讨气管肿瘤切除术围术期的麻醉管理方法.结果 围术期麻醉处理合理、安全,保证手术顺利进行,无麻醉并发症.结论 气管肿瘤手术麻醉管理涉及围术期各方面,重点是对气道的管理及保护,避免肺泡通气不足、弥散障碍,手术期间应加强监测,保证患者安全.

With the development of aging society,postoperative cognitive dysfunction(POCD)has become one of the main complications in elderly patients after surgery,influencing the rehabilitation of patients greatly.In recent years,there are a lot of domestic and foreign research on the exploration of postoperative cognitive dysfunction.The occurrence of cogni-tive dysfunction may be related to inflammatory reaction,oxidative stress and so on.It is caused by multiple factors.But, there is no clear conclusion on its pathogenesis and diagnostic criteria at present.There are many ways to evaluate cognitive function.Chinese medicine,as a traditional medicine in China,has long studied the recovery of nerve function.POCD can be reduced by Chinese medicine Shenmai injection,ligustrazine,ginkgo leaf injection,electroacupuncture stimulation and per-cutaneous acupoint electrical stimulation.But the influence of compound electroacupuncture on POCD needs to be further explored in the future.

目的:观察地佐辛与氟比洛芬酯在腹腔镜胆囊切除术术后镇痛效果及安全性.方法:择期行腹腔镜胆囊切除术患者60例,随机分4组,每组15例.A组缝皮时给予地佐辛0.1 mg/kg和氟比洛芬酯1 mg/kg;B组缝皮时给予地佐辛0.1 mg/kg;C组缝皮时给予氟比洛芬酯1 mg/kg;D组缝皮时给予芬太尼1μg/kg.分别记录术毕给药后1、2、6、24h视觉模拟评分(VAS评分),不良反应及患者生命体征.结果:术后1 h时间点D组与其他三组VAS评分比较有统计学意义,术后24小时时间点D组与A组VAS评分比较有统计学意义(P<0.05);各组术后生命体征、不良反应发生率均无明显差异(P>0.05).结论:地佐辛与氟比洛芬酯联合应用于腹腔镜胆囊切除术术后镇痛,可以明显降低患者术后疼痛,提供较长时间镇痛,可安全应用于临床.

Purpose: To compare the outcomes of spinal anesthesia in obese and non-obese patients. Methods: In this study, 199 patients who underwent total knee replacement arthroplasty (TKRA) were categorized into obesity group (n = 61) and non-obesity group (n = 138). Anesthesia was considered successful if a bilateral T12 sensory blockage occurred within the first 15 mm of injection of intrathecal drug. Parameters that influence spinal anesthesia were analyzed using logistic regression by means of multiple variables that independently influence the outcome of spinal anesthesia. Results: It was observed that the independent predictors for successful anesthesia in the patients were dose of bupivacaine (odds ratio at 95 % confidence interval = 2.08; range: 1.61 - 2.67) and obesity status (odds ratio at 95 % confidence interval = 2.83; range: 1.21 - 6.49). The outcome of the multivariate analysis also indicated that the dose of bupivacaine, body mass index (BMI) and obesity were predictors of spinal anesthesia. It was also found that the period of the sensory blockage due to bupivacaine was longer in the obesity group than in the non-obesity group. Conclusion: Sensory blockage in bupivacaine anesthesia during TKRA is influenced by dose of bupivacaine, obesity and BMI.

Objective To compare shikani optical stylet and Mc coy laryngoscope on elder patients with intratracheal intubation anesthesia.Methods 112 cases of elder patients with intratracheal intubation anesthesia were enrolled as study objects, all patients were divided into shikani optical stylet group (52 cases), Mc coy laryngoscope group (60 cases) according to different intubation way. Then detect the hemodynamic parameters, stress-related indicators, EEG relevant indicators of the two groups.Results One time success rate and total success rate in Shikani visual laryngoscope group was higher than Mc Coy visual laryngoscope group, while many times intubation rate was lower (P < 0.05); T1, T2 MAP, HR levels were lower in Shikani optical stylet group than Mc Coy laryngoscope group patients (P < 0.05); Plasma levels of epinephrine, norepinephrine, and glucose on T1, T2 in Shikani optical stylet group was lower than that in Mc Coy laryngoscope group (P < 0.05); T1, T2 BIS, ECoG grading, αβ% values in Shikani optical stylet group was lower than that in Mc coy laryngoscope group (P < 0.05).Conclusions Elderly patients with intratracheal intubation anesthesia received shikani optical stylet can enhance the success rate of intubation and effectively stabilize patients circulatory system, reduce excessive physical stress caused by various system dysfunction, which shows positive significance.

Introduction Elderly patients who have solid organ cancer often receive surgery. Some of them may develop delirium after surgery and delirium development is associated with worse outcomes. Furthermore, despite all of the advances in medical care, the long-term survival in cancer patients is far from optimal. Evidences suggest that choice of anaesthetics during surgery, that is, either inhalational or intravenous anaesthetics, may influence outcomes. However, the impact of general anaesthesia type on the occurrence of postoperative delirium is inconclusive. Although retrospective studies suggest that propofol-based intravenous anaesthesia was associated with longer survival after cancer surgery when compared with inhalational anaesthesia, prospective studies as such are still lacking. The purposes of this randomised controlled trial are to test the hypotheses that when compared with sevoflurane-based inhalational anaesthesia, propofol-based intravenous anaesthesia may reduce the incidence of early delirium and prolong long-term survival in elderly patients after major cancer surgery. Methods and analysis This is a multicentre, open-label, randomised controlled trial with two parallel arms. 1200 elderly patients (≥65 years but <90 years) who are scheduled to undergo major cancer surgery (with predicted duration ≥2 hours) are randomised to receive either sevoflurane-based inhalational anaesthesia or propofol-based intravenous anaesthesia. Other anaesthetics and supplemental drugs including sedatives, opioids and muscle relaxants are administered in both arms according to routine practice. The primary early outcome is the incidence of 7-day delirium after surgery and the primary long-term outcome is the duration of 3-year survival after surgery. Ethics and dissemination The study protocol has been approved by the Clinical Research Ethics Committees of Peking University First Hospital (2015[869]) and all participating centres. The results of early and long-term outcomes will be analysed and reported separately. Trial registration number ChiCTR-IPR-15006209; NCT02662257; NCT02660411.

Objective To investigate the protective effect of cholinergic anti-inflammatory pathway (CAP) via the M1 receptor agonist,the M2 receptor antagonist and the nAChR7 agonist.during cerebral ischemia-reperfusion injury in rats.Methods Twenty-five male healthy Sprague-Dawley rats were randomly divided into five equal groups:sham operation (Sham) group,ischemia reperfusion (I/R) group,methoctramine (MET) group,McN-A-343 (MA343) group and choline (CHO) group.Rats were subjected to four-vessel occlusion (4-VO) global cerebral ischemia.by electrocauterization of the bilateral vertebral arteries,except Sham group.15 min before ischemia-reperfusion,we administered intracerebroventricularly (i.c.v.) Methoctramine (500 ng/kg,10 μL),McN-A-343 (500 ng/kg,10 μL) and Choline(500 ng/kg,10 μL) to MET group,MA343 group and CHO group,other groups receiving saline (0.9％).Then forebrain ischemia was induced by tightening of the clasps that around the common carotid arteries for 20 minutes,except Sham group.Blood and tissue samples were collected after reperfusion for 6 h in all groups.Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels of hippocampus,heart,liver,lung,kidney and plasma were measured by radio-immunoassay(RIA).Apoptosis was detected by terminal deoxynucleotidyl-trallsferase meiated dUTP nick end labeling (TUNEL).Results Methoctramine and McN-A-343 could markedly inhibit the increase of TNF-α and IL-1 βcontent in hippocampus,heart,liver,kidney and plasma after ischemia.Choline could also attenuated TNF-α and IL-1βexpression in hippocampus but could not inhibit them in heart,liver,kidney and serum.TNF-α and IL-1β levels in lung could not be suppressed by methoctramine,McN-A-343 or choline.Compared with I/R,the apoptotic cells in MET group,MA343 group and CHO group were significantly decreased.Conclusion It is indicated that CAP plays a potential role in alleviating local and systemic inflammatory response during cerebral ischemia-reperfusion injury.The mechanisms of antiinflammatory were likely to suppress the expression of TNF-α and IL-1 β.