Objective To observe the effect of flurbiprofen axetil on lung oxygenation function,re-spiratory mechanics and pulmonary complications in patients undergoing thoracoscopic right lung lobectomy with endobronchial blockers during one-lung ventilation(OLV).Methods Sixty patients scheduled for elective thoracoscopic right lung lobectomy with endobronchial blockers for OLV,25 males and 35 females,aged 35-64 years,BMI 18-28 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly allocated into two groups:the flurbiprofen axetil group(group F)and the control group(group C),30 patients in each group.In group F,flurbiprofen axeil 1.0 mg/kg was injected intravenously 15 minutes before anesthesia induction,while group C was not treated.Blood gas analysis was performed in 2 ml of radial artery 20 minutes before anesthesia induction(T0),30 minutes(T1)and 60 minutes(T2)after OLV,and 15 minutes(T3)after two lung ventilation,then oxygenation index(OI)was calculated respectively and SpO2 was recorded.Pa-rameters of lung mechanics were monitored at T1 and T2 including peak airway pressure(Ppeak),airway platform pressure(Pplat),dynamic lung compliance(Cdyn),and ratio of null lumen volume to tidal vol-ume(VD/VT).The incidence of hypoxemia and the number of remedial cases during OLV were recorded.The postoperative transfer to ICU and complications such as atelectasis,acute lung injury and pneumonia within 72 hours after surgery were recorded.Results Compared with group C,SpO2 at T1,PaO2 and OI at T1—T3,and Cdyn at T1 and T2 were significantly increased in group F(P＜0.05),Ppeak and VD/VT at T1 and T2,Pplat at T2 were significantly decreased in group F(P＜0.05).There were no hypoxemia and remedies occurred during OLV and no patients were transferred to ICU after surgery,no atelectasis,acute lung injury,and pneumonia occurred within 72 hours after surgery between the two groups.Conclusion For patients undergoing OLV with endobronchial blockers undergoing thoracoscopic right lung lobectomy,in-travenous flurbiprofen axetil before induction of anesthesia can help improve lung oxygenation and optimize respiratory parameters during one lung ventilation.

Objective To assess the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for anesthesia induction in painless gastrointestinal endoscopy.Methods Fifty-nine pa-tients underwent elective painless gastrointestinal endoscopy,26 males and 33 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups by random number table method:esketamine combined with ciprofol group(group EC,n = 29)and ciprofol group(group C,n = 30).Group EC received intravenous injection of esketamine 0.3 mg/kg and group C received the same amount of normal saline 2 minutes before administration of ciprofol.The initial anesthesia induction dose of ciprofol was 0.4 mg/kg.If a positive reaction occurs during the examination,the next patient will receive an increase dose of propofol 0.04 mg/kg,otherwise will decrease by propofol 0.04 mg/kg.The positive reaction was defined that the patient's BIS can not be decreased to 60 2 minutes after anesthesia induction,or the cough or body movement reaction occur at level 2 or above when entering the mirror.The dosage of ciprofol,recovery time,discharge time,the occurrence of intraoperative and postoperative adverse reactions were recorded.The ED50,95%effective dose(ED95)and 95%confidence interval(CI)of the two groups were calculated by Probit probability regression analysis.Results Compared with group C,the dosage of ciprofol,the incidence of hypotension and frequency of administration of vasoactive drugs during the exami-nation process in group EC were significantly reduced(P＜0.05).The ED50 of ciprofol for anesthesia in-duction in painless gastrointestinal endoscopy in group EC was 0.21 mg/kg(95%CI 0.12-0.25 mg/kg)and the ED95 was 0.32 mg/kg(95%CI 0.26-0.39 mg/kg).The ED50 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group C was 0.37 mg/kg(95%CI 0.32-0.40 mg/kg)and the ED95 was 0.48 mg/kg(95%CI 0.43-0.54 mg/kg).The ED50 and ED95 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group EC was significantly lower than that in group C(P＜0.05).There was no significant difference in other frequency of adverse events between the two groups.Conclusion Esketamine 0.3 mg/kg can reduce the ED50 of ciprofol in painless gastrointestinal endoscopy and reduce the dosage of ciprofol during the examination process,which is safe for painless gastrointestinal endoscopy with stable intraoperative circulation.

Objective To compare the effect of glycopyrrolate or atropine in combination with neostigmine on adverse cardiovascular events(ACEs)after operation in elderly patients undergoing laparo-scopic surgery.Methods A total of 142 patients scheduled for elective laparoscopic surgery were enrolled,69 males and 73 females,aged 65-80 years,BMI 18-28 kg/m2,ASA physical status Ⅰ or Ⅱ.The pa-tients were randomly divided into two groups:the glycopyrrolate group(group G)and the atropine group(group A),71 patients in each group.After the last administration of muscle relaxants for more than 30 mi-nutes,antagonizing residual neuromuscular blockade was performed.Glycopyrrolate 4 μg/kg and neostigmine 20 μg/kg were given intravenously in group G,atropine 10 μg/kg and neostigmine 20 μg/kg were given intravenously in group A.The incidence of ACEs and severe ACEs during operation and 72 hours after operation were recorded.Recovery situation in PACU such as NRS scores at rest and coughing,Rich-mond agitation-sedation scale(RASS)score,and modified Aldrete score 15 and 30 minutes after extubation were recorded.Emergence agitation,dry mouth,nausea,vomiting,and delirium 24 hours after operation were recorded.Results Compared with group A,the total incidence of ACEs,tachycardia,and myocardial ischemia after operation were significantly decreased in group G(P＜0.05),the incidence of dry mouth 24 hours postoperatively was significantly increased in group G(P＜0.05).There was no severe ACEs oc-curred in the two groups 72 hours after operation.Conclusion Compared with atropine,glycopyrrolate combined with neostigmine in elderly patients undergoing laparoscopic surgery can reduce the incidence of cardiac tachycardia,myocardial ischemia,and total ACEs after operation,and there was no severe ACEs occurred.However,it can increase the incidence of dry mouth 24 hours after operation.

Objective To evaluate the effect of endoscopic laryngeal mask on perioperative airway management and postoperative recovery in patients undergoing gastric endoscopic submucosal dissection(ESD).Methods Ninety patients,aged 18-64 years,BMI 18-25 kg/m2,ASA physical statusⅠorⅡ,who underwent elective gastric ESD were randomly divided into two groups:the endoscopic laryngeal mask group(group E)and the endotracheal tube group(group C),45 patients in each group.After induction of general anesthesia,group E received endoscopic laryngeal mask airway ventilation,and the endoscope was inserted through the endoscopic channel of the laryngeal mask,group C received tracheal intubation,and the endoscopy was inserted through the mouth.The successful time and one-time success rate of intubation,and the insertion time and withdrawal rate of endoscopy were recorded.The operative time,extubation time and PACU residence time were recorded.HR,MAP were recorded when the patient entered the room(T0),at the time of intubating(T1),inserting gastroscopy(T2),exiting gastroscopy(T3),extubation(T4),and leaving PACU(T5).The average airway pressure and peak airway pressure at T1-T3 were recorded.The airway sealing pressure and endoscopic view grading system(EVGS)grading of group E were recorded before and after changing the position,and at the end of surgery.The adverse reactions and the satisfaction of anesthesiologists and gastroenterologists were recorded.Results Compared with T0,HR and MAP were significantly increased at T1 and T4 between the two groups(P＜0.05).Compared with group C,the suc-cessful time of intubation,the extubation time,and PACU residence time were significantly shortened,HR and MAP were significantly decreased at T1 and T4,the incidence of choking cough during extubation,post-operative pharyngeal pain,and hoarseness were significantly decreased(P＜0.05).There were no signifi-cant differences in the one-time success rate of intubation,the insertion time and withdrawal rate of endosco-py between the two groups.Endoscopic laryngeal mask showed good sealing and alignment in group E.Conclusion Endoscopic laryngeal mask could shorten the success time of establishment of artificial airway in patients with gastric ESD,without interfering with digestive endoscopy operations,shorten extubation time and PACU retention time,maintain intraoperative hemodynamic stability,and reduce adverse reactions.

Objective To investigate the effect of esketamine combined with erector spinae plane block(ESPB)on the quality of early postoperative recovery in patients undergoing thoracoscopic pulmonary surgery.Methods Ninety patients who underwent thoracoscopic lung surgery(thoracoscopic radical resec-tion of lung cancer,thoracoscopic lobectomy or segmentectomy)from May 2022 to July 2023 were selected,47 males and 43 females,aged 18-64 years,BMI 18-25 kg/m2,ASA physical statusⅠorⅡ.According to random number table method,the patients were divided into two groups:the ESPB group(group C)and the esketamine combined with ESPB group(group D),45 patients in each group.Patients in the two groups completed ultrasound-guided ESPB,followed by sufentanil anesthesia induction and patient-controlled intra-venous analgesia(PCIA)in group C,while esketamineanesthesia induction,maintenance,and PCIA in group D.The intraoperative dosage of anesthetics,numerical rating scale(NRS)score during activity 1 hour,6,12,24,and 48 hours after operation,the number of PCIA compressions within 24 hours after op-eration,the number of rescue analgesia after operation,the recovery time of anesthesia,the incidence of postoperative nausea and vomiting within 2 days after operation and the adverse reactions related to esket-amine were recorded.The 40-item recovery quality scale(QoR-40)score was used to evaluate the quality of recovery of patients 1 day before operation and 2 days after operation.The hospital anxiety and depression scale(HADS)was used to assess patients anxiety and depression 1 day before surgery and at discharge.Results Compared with group C,the dosage of propofol and remifentanil intraoperatively,the incidence of postoperative nausea and vomiting were decreased(P＜0.05),the QoR-40 score was increased 2 days after operation,HADS score at discharge was decreased in group D(P＜0.05).Conclusion Esketamine combined with ESPB is safe and effective for patients undergoing thoracoscopic lung surgery.The periopera-tive analgesia is perfect,the adverse reactions are few,and the quality of early recovery is high,which pro-vides a new anesthesia choice for such surgery.

Objective To investigate the accuracy of cone-beam CT(CBCT)by measuring tongue thickness(TT)in predicting difficult glottis exposure in patients undergoing maxillofacial surgery.Methods Ninety-seven patients undergoing elective maxillofacial surgery under general anesthesia were selected,45 males and 52 females,aged 18-67 years,ASA physical status Ⅰ or Ⅱ.The TT was measured by CBCT before operation.The inter-incisor distance(IID),BMI,thyromental distance(TMD),and modified Mal-lampati test(MMT)were also recorded.According to the Cormack-Lehane(CL)grade at the time of gener-al anesthesia induction,the patients were divided into two groups:the easy laryngoscope exposure group(group E,CL gradeⅠorⅡ,n = 86)and the difficult laryngoscope exposure group(group D,CL gradeⅢ or Ⅳ,n = 11).The relationship between IID,BMI,TMD,MMT,TT,and laryngoscopy exposure was analyzed,and the receiver operating characteristic(ROC)curve was used to analyze the relationship be-tween each index and difficult laryngoscopy exposure.Results Compared with group E,the BMI,MMT,and TT of group D were significantly increased(P＜0.05),while the TMD was significantly decreased(P＜0.05).The area under the ROC curve(AUC)of BMI,TMD,MMT,and TT to predict difficult glot-tis exposure was 0.690,0.714,0.726,and 0.797,the sensitivity was 36.4%,63.6%,63.6%,and 81.8%,and the specificity was 95.3%,69.8%,76.7%,and 68.6%,respectively.Using BMI,MMT,TMD,and TT as a model to predict difficult glottis exposure,the AUC was 0.913,the sensitivity was 90.9%and the specificity was 83.7%.Conclusion TT measured by CBCT is an independent impact factor for predicting difficult laryngoscope exposure.The comprehensive model incorporating BMI,TMD,MMT,and TT has a better predictive effect.

Objective To investigate the effects of intraoperative fraction of inspiration oxygen(FiO2)30%and 80%on pulmonary function after laparoscopic radical prostatectomy for prostate cancer in elderly patients.Methods Sixty elderly patients,aged≥65 years,BMI 18-30 kg/m2,ASA physical sta-tus Ⅱ or Ⅲ,underwent elective laparoscopic radical prostatectomy for prostate cancer were selected.The patients were divided into two groups:the FiO2 30%group(group L)and the FiO2 80%group(group H),30 patients in each group.After tracheal intubation,the patients were manoeuvred,and inhaled oxygen con-centration was adjusted by 30%until the removal of the tracheal tube in group L.In group H,inhaled oxy-gen concentration was adjusted by 80%until the removal of the tracheal tube.HR and MAP were recorded 5 minutes after admission(T0),1 hour after the start of surgery(T1),2 hours after the start of surgery(T2),and 30 minutes after extubation(T3),arterial blood gas analysis was performed to record PaO2 and PaCO2,and the oxygenation index(OI)was calculated.Electrical impedance tomography(EIT)monitoring was performed at T0 and T3 to assess the pulmonary ventilation function,and the percentage of the area of the central ventilation zone(CoV),dependent static zone(DSS),and non-dependent static zone(NSS)were recorded.Exertional expiratory volume in the first second(forecd expirtory volume in the first second,FEV1),exertional lung capacity(forecdvital cipitory,FVC),and 1-second rate(FEV1/FVC)were meas-ured on preoperative day 1,postoperative day 1,postoperative day 3 and postoperative day 5.The occur-rence of pulmonary complications such as atelectasis,respiratory infection,and pleural effusion within 5 days postoperatively were recorded.Results Compared with group H,the percentage of DSS area at T3 was significantly decreased(P＜0.05),PaO2 and OI were significantly increased(P＜0.05),FVC,FEV1,and FEV1/FVC on postoperative day 1 were significantly increased(P＜0.05),FEV1/FVC on postopera-tive day 3 was significantly increased(P＜0.05),the incidence of cumulative pulmonary atelectasis was significantly decreased in group L within 5 days postoperatively(P＜0.05).Conclusion Compared with FiO2 80%,FiO2 30%intraoperatively significantly improves pulmonary ventilation and oxygenation 30 mi-nutes after laparoscopic radical prostatectomy with early postoperative lung function in elderly patients,and reduces postoperative pulmonary atelectasis.

Objective To investigate the impact of intravenous inject esketamine before operation on postoperative fatigue syndrome(POFS)in patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Sixty-two patients,41 males and 21 females,aged 34-64 years,BMI 18-25 kg/m2,ASA physical statusⅠ orⅡ,scheduled for laparoscopic radical surgery for colorectal cancer under general anesthesia,were randomly assigned into two groups:the esketamine group(group E)and the control group(group C),31 patients in each group.Group E received a single intravenous injection of esketamine 0.25 mg/kg 5 minutes before surgery,while group C received sodium chloride 5 ml.The intravenous analgesia program was identical between the two groups.The jugular venous blood samples were taken for determination of serum concentrations of tumor necrosis factor-α(TNF-α)and superoxide dismutase(SOD)10 minutes before anesthesia,at the end of operation,and 12 and 24 hours after operation.Identity-consequence fatigue scale(ICFS-10)score were performed 1 day before surgery,3,5,and 7 days after op-eration,respectively,and the occurrence of POFS(ICFS-10 score＞24 points)were recorded.The time of extubation and the occurrence of adverse reactions such as coughing,delirium and restlessness during awak-ening,the complications of systems postoperatively,and the postoperative hospitalization time were recorded.Results Compared with group C,the concentration of serum TNF-α were significantly decreased while the concentration of serum SOD were significantly increased at the end of operation,12 and 24 hours after operation(P＜0.05),ICFS-10 score 3,5,and 7 days after operation,and the incidence of POFS 7 days after operation were significantly decreased(P＜0.05).There were no significant differences in extu-bation time,coughing,delirium and restlessnes,the complications postoperatively,and postoperative hospi-talization time between the two groups.Conclusion A single intravenous injection of esketamine can reduce the incidence of POFS in patients undergoing laparoscopic radical surgery for colorectal cancer,and no postoperative adverse reactions increased.

Objective To observe the efficacy of different dosage of midazolam oral solution in re-lieving anxiety in children undergoing laparoscopic high ligation of the hernia sac with oblique inguinal her-nia.Methods A total of 120 children,93 males and 27 females,aged 2-6 years,78-120 cm in height and 11-25 kg in weight,ASA physical statusⅠ orⅡ,were selected to perform laparoscopic high ligation of inguinal oblique hernia sac under general anesthesia.According to random number table method,the chil-dren were divided into three groups:the oral midazolam 0.25 mg/kg group(group M1),0.5 mg/kg group(group M2),and 0.75 mg/kg group(group M3)30 minutes before anesthesia,40 children in each group.Modified Yale preoperative anxiety scale-short form(mYPAS-SF)was recorded at premedication,parental separation,and immediate induction of anesthesia.Induction compliance checklist(ICC)score,recovery time,extubation time,PACU residence time,pediatric anesthesia emergence delirium scale(PAED)and the modified face,legs,activity,cry and consolability scale(FLACC)30 minutes after operation were also recorded.Results Compared with before taking medication,mYPAS-SF scores in groups M2 and M3 at parental separation and immediate induction of anesthesia were significantly decreased(P＜0.05).Com-pared with group M1,mYPAS-SF scores at parental separation and immediate induction of anesthesia and ICC scores at immediate induction of anesthesia were significantly lower in groups M2 and M3(P＜0.05),the recovery time,extubation time and PACU resident time in groups M2 and M3 were significantly pro-longed,PAED score was decreased significantly within 30 minutes after operation(P＜0.05).Compared with group M2,the awakening time and extubation time in group M3 were significantly prolonged.(P＜0.05).Conclusion Oral midazolam 0.5 mg/kg or 0.75 mg/kg 30 minutes before anesthesia can effectively alleviate the preoperative anxiety of children,improve the degree of cooperation in anesthesia in-duction,and reduce the occurrence of postoperative agitation,the recovery time and extubation time pro-longed in children with oral midazolam 0.75 mg/kg.Therefore,an oral solution of midazolam 0.5 mg/kg was a more appropriate dose for preoperative antianxiety regimen in children.

Objective To investigate the effect of continuous intraoperative insulin infusion on my-ocardial blood perfusion after cardiac surgery under cardiopulmonary bypass(CPB).Methods Forty-eight patients,21 males and 27 females,aged 55-80 years,BMI 18-28 kg/m2,ASA physical status Ⅱ-Ⅳ,who underwent elective cardiac surgery with CPB were selected and randomly divided into two groups:the insulin group(group I,n = 25)and the control group(group C,n = 23).The same anesthesia protocol was implemented in both groups.After induction of anesthesia,group Ⅰ received intravenously infusion of in-sulin 30 mU·kg-1·h-1,glucose 0.12 g·kg-1·h-1,and potassium chloride 0.06 mmol·kg-1·h-1,and group C received saline 10 ml/h,all of which were infused until the end of surgery.The targeted blood glucose range for both groups was set at 6.1-11.1 mmol/L.Transesophageal echocardiography(TEE)was performed 10 minutes after induction of general anesthesia(T2)and before the end of surgery(T6)to ex-amine the coronary sinus(CS)flow spectrum and diameter,pulmonary venous flow spectrum,and calculate CS net antegrade flow velocity time integral(VTI).Femoral mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),cardiac index(CI)and peripheral vascular resistance index(SVRI)were recorded at T2,2 minutes before CPB(T3),the end of CPB(T5),and T6.The concentra-tions of blood glucose and lactate 5 minutes before anesthesia induction(T1),T3,30 minutes after CPB(T4),T5,T6,6 hours after surgery(T7),12 hours after surgery(T8),and 24 hours after surgery(T9)were recorded.The levels of high-sensitivity C-reactive protein(hs-CRP),high-sensitivity troponin I(hs-TnI),and creatine kinase isoenzyme(CK-MB)were recorded 1 day preoperatively,1 and 2 days post-operatively.Results Compared with group C,in group I,CS net antegrade flow VTI and blood flow per minute were significantly increased(P<0.05),and pulmonary venous peak atrial reversal wave velocity(ARp)was significantly reduced at T6(P<0.05),SV and CI were significantly increased and SVRI was significantly decreased at T5 and T6(P<0.05),lactate concentration was significantly decreased at T7 and T8(P<0.05),hs-CRP and CKMB were significantly decreased 1 and 2 days postoperatively(P<0.05),hs-TnI was significantly reduced 2 days postoperatively(P<0.05).Conclusion Continuous insulin admin-istration during cardiac surgery with CPB while maintaining blood glucose at 6.1-11.1 mmol/L can enhance myocardial blood perfusion,mitigate postoperative inflammatory response,and reduce myocardial injury.