Objective To evaluate the effect of electroacupuncture on postoperative cognitive func?tion in elderly patients undergoing carotid endarterectomy. Methods Fifty patients of both sexes, aged≥65 yr, of American Society of Anesthesiologists physical status Ⅱ orⅢ, with the educational level≥ the level of primary school, scheduled for elective unilateral carotid endarterectomy, were divided into 2 groups ( n=25 each) using a random number table: control group ( group C) and electroacupuncture group ( group EA). In group EA, electroacupuncture (frequency 2∕100 Hz, intensity 5-12 mA) of Baihui (GV20), Neiguan (PC6) and Zusanli (ST36) was performed throughout surgery starting from 30 min before opera?tion, and then general anesthesia was performed. General anesthesia was performed directly in group C. Before operation ( T0 ) , at the end of operation ( T1 ) and at 24 h after operation ( T2 ) , blood samples were collected from the internal jugular vein for determination of plasma S?100βprotein, tumor necrosis factor?αand brain?derived neurotrophic factor ( BDNF) concentrations by enzyme?linked immunosorbent assay. The cognitive function was assessed using Montreal Cognitive Assessment at T0,2 and at 3 and 7 days after opera?tion ( T3,4 ) . Results Compared with group C, the Montreal Cognitive Assessment scores were significantly increased at T2?4 , the plasma S?100β protein and tumor necrosis factor?α concentrations were significantly decreased at T1,2 , and the plasma BDNF concentrations were significantly increased at T2 in group EA ( P<0?05) . Conclusion Electroacupuncture can improve postoperative cognitive function in the elderly pa?tients undergoing carotid endarterectomy, which may be related to inhibition of inflammatory responses,
promotion of BDNF production and reduction of brain injury.

Objective To explore the application of direct observation of procedural skills (DOPS) in anesthesia-related effects skills teaching. Methods Anesthesia students in the Department of Anesthe-siology, Clinical Medical College, Yangzhou University between June 2013 and June 2015, received an anesthesia-related DOPS examination at the mid-internship and pre-delivery. Through the DOPS assessment results, the analysis of teachers' and students' satisfaction degree on the evaluation results, the teaching effect of DOPS was evaluated. At the same time, the students were surveyed to find out the satisfaction degree of DOPS. SPSS 18.0 was applied to processing the date. Measurement data were expressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results Interim assessment indicators for each individual average of more than four points , the individual departmental rotation examination scores were higher than the overall average score interim assessment results. Compared with interim assessment, satisfaction of teachers has made great progress in the end of assessment [(8.46 ± 0.32) vs. (8.14 ±0.60)], satisfaction of students was [(8.57 ±0.59) vs. (8.20 ±0.45)], satisfaction of the students was higher than the teachers [(8.57±0.59) vs. (8.46±0.32)], and the differences were statistically significant. Conclusion DOPS as an effective anesthesia-related skill of teaching and assessment method, can improve the level of anesthesia anesthesia-related skills of college students.

Objective To observe the effects of intranasal dexmedetomidine (DM)as premedi-cation on postoperative behavioral outcomes in children.Methods Sixty ASA physical status Ⅰ or Ⅱchildren of both genders,2-5 years,weighing 10-30 kg,undergoing hernia surgery,were equally as-signed into three groups (n =20 each)using a random number table:control group (group C),mid-azolam group(group M)and dexmedetomidine group(group D).Thirty minutes before anesthesia in-duction,the children were respectively received intranasal normal saline 0.02 ml/kg (group C),in-tranasal midazolam 0.2 mg/kg (group M)and intranasal DM 2 μg/kg (group D).The sedation score of children apart from parents,the receipt score of face mask for sevoflurane anesthesia induction,the postoperative recovery time,adverse effects,and the percentage of patients requiring rescue analgesic were recorded.To observe the postoperative behavioral outcomes on 1th、7th、30th day using the PH-BQ.Results Compared with group C,the sedation score and the receipt score of face mask of groups M and D were significantly increased (P <0.05).Compared with groups C and M,the adverse effects and the percentage of patients requiring rescue analgesic of group D were decreased (P <0.05).The incidence of the postoperative behavioral outcomes of group C was higher than groups M and D on 1th,7th day (P <0.05).And on 30th day after operation,there was no significant difference among three groups.Conclusion Intranasal dexmedetomidine as premedication can significantly decrease the incidence of the postoperative behavioral outcomes in children.

Objective To investigate the effect of propofol on transforming growth factor (TGF)-β1/Smad2 signaling pathway in lung tissues in rats with lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Fifty-six male Wistar rats,aged 7-8 weeks,weighing 260-300 g,were randomly divided into 5 groups:control group (group A,n =8) ; LPS group (group B,n =12); 3 propofol groups (groups C,D,E,n =12).ALI was induced by intravenous LPS 8 mg/kg in groups B,C,D and E.In groups C,D,E,propofol 5 mg/kg was injectedintravenously before LPS administration and at 0 and 1 h after LPS administration,respectively,followed by infusion of propofol at 10 mg· kg-1 · h-1 until 5 h after LPS administration.Group A received the equal volume of normal saline.Arterial blood samples were collected immediately before LPS administration and 1,3 and 5 h after LPS administration for determination of pH value and PaO2.Then the animals were sacrificed and the lungs were immediately removed for calculation of the wet/dry lung weight ratio and for determination of the expression of TGF-β1-mRNA and Smad2 in lung tissues.Results Compared with group A,pH value and PaO2 were significantly decreased,wet/dry lung weight ratio was increased and the expression of TGF-β1 mRNA and Smad2 was up-regulated in groups B and E (P ＜ 0.05).Compared with group B,pH value and PaO2 were significantly increased,wet/dry lung weight ratio was decreased and the expression of TGF-β1 mRNA and Smad2 was down-regulated in groups Cand D,and PaO2 was significantly increased in group E (P ＜ 0.05).Conclusion The mechanism by which propofol alleviates ALI induced by LPS is related to inhibition of TGF-β1/Smad2 signaling pathway.

To meet the cultivation objectives of postgraduate of anesthesiology from TCM colleges, the anesthesiology department carried out reform and exploration on cultivation program.This method has trained professionals of anesthesiology with the features of integrated traditional and western medicine knowledge.

Objective To investigate the effects of dexmedetomidine on inflammatory responses in brain tissues of the patients undergoing carotid endarterectomy.Methods A total of 40 ASA physical status Ⅱ or Ⅲ patients,aged 65-80 yr,scheduled for elective unilateral carotid endarterectomy under general anesthesia,were randomly divided into 2 groups (n =20 each) using a random number table:dexmedetomidine group (group Dex) and control group (group C).In group Dex,dexmedetomidine 0.03 μg · kg-1 · min-1 was infused over 10 min before induction of anesthesia,and after tracheal intubation dexmedetomidine was then infused at a rate of 0.3 μg · kg-1 · min-1 until 30 min before the end of operation.The equal volume of normal saline was given in group C.At 20 min before induction of anesthesia (T0),10 min after induction of anesthesia (T1),15 min after carotid artery clamping (T2),15 min after carotid artery unclamping (T3),and at 6 and 24 h after operation (T4,5),blood samples were drawn from the ispilateral jugular bulb for determination of serum concentrations of malondialdehyde (MDA) (by TBA) and S100B,tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) (by ELISA).Results Compared with group C,the serum S100B concentrations were significantly decreased at T3-5,the serum TNF-α and IL-6 concentrations were decreased at T2.5,and the serum MDA concentration was decreased at T3 in group Dex.Conclusion Dexmedetomidine can reduce the brain damage through mitigating inflammatory responses in brain tissues of the patients undergoing carotid endarterectomy.

According to the characteristics of minor students majored in clinical anesthesia, an objective structured clinical examination (OSCE) program was established. This OSCE was applied to clinical anesthesia minor students for departmental rotation examination. Meanwhile, a questionnaire was set to collect students' attitude towards the OSCE assessment program. Results showed that OSCE assessment program could objectively and comprehensively reflect the students' clinical skills. Students participated in OSCE were quite satisfied with its design, organization, quality and effectiveness.

ObjectiveTo investigate the risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients after colorectal cancer surgery.Methods One hunderd and twenty ASA Ⅱ or Ⅲ patients aged ≥ 65 yr undergoing colorectal cancer surgery were divided into POCD group and non-POCD group according to the results of the Mini-Mental State examination (MMSE) at 7th day after operation.Age,weight,sex,the educational level,anatomical location of the tumor,TNM stages,complications,preoperative TCM syndrome type,duration of anesthesia,emergence time,the blood loss during opertion and the number of intraoperative hypotension were recorded.The cognitive function was assessed at 1 d before operation and at 1,3,7 d after operation using MMSE.The risk factors for POCD were analyzed by multivariate logistic regression analysis.ResultsThe incidence of POCD was 29.2 ％.Logistic regression analysis results indicated that age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension were the risk factors for POCD( P ＜ 0.05).Conclusion Age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension are risk factors for POCD in elderly patients after colorectal cancer surgery.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in frail elderly patients.Methods:Sixty frail elderly patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Fried frailty phenotype scale≥3, were divided into 2 groups ( n=30 each) using a random number table method: control group (group C) and TEAS group.In group TEAS, patients received TEAS of Shenmen, Neiguan and Zusanli acupoints starting from 30 min before anesthesia induction until the end of surgery.The frequency was 2/100 Hz, wave length was 0.25 ms and the intensity was maintained at about 1-30 mA according to the current that could be tolerated.The same acupoints were continuously stimulated for 30 min at 24, 48 and 72 h after operation.Electroacupuncture was performed for 30 min at the points 4 cm lateral to the same acupoints in group C. The occurrence of POD was evaluated by Confusion Assessment Method at 1-7 days after surgery.The intraoperative consumption of propofol, remifentanil and sufentanil, the effective pressing times of patient-controlled intravenous analgesia (PCIA) pump, the requirement for rescue analgesia at 0-8 h (T 1), 8-24 h (T 2) and 24-48 h (T 3) after operation and the development of rescue analgesia, POD, postoperative nausea and vomiting (PONV) and somnolence after operation were recorded. Results:Compared with group C, requirement for rescue analgesia and the incidence of POD, PONV and somnolence after operation were significantly decreased, and intraoperative consumption of propofol and remifentanil and the postoperative effective pressing times of PCIA at T 1-3 were decreased in group TEAS ( P<0.05). Conclusion:TEAS can reduce the occurrence of POD in frail elderly patients.

Objective:To investigate the implementation status of appropriate technique of Traditional Chinese Medicine (TCM) in the perioperative period in China using questionnaires.Methods:From May to June 2022, the questionnaire designed by ourselves was sent to anesthesiologists participating in the survey through the WeChat platform nationwide, and the system automatically recorded the survey.Results:A total of 6 230 anesthesiologists participated in the questionnaire survey, there were 6 160 valid questionnaires, with an effective rate of 98.88%.The anesthesiologists participating in the questionnaire survey were distributed in 16 provincial administrative regions in China, of which the rate from tertiary hospitals was 32.59%, the rate from secondary hospitals was 67.41%, and the application rate of TCM appropriate techniques in the perioperative period was 9.8%.The application rate of TCM appropriate techniques in the perioperative period was higher in tertiary hospitals than in secondary hospitals (9.51% vs. 6.31%, P<0.05), and the application rate was significantly higher in TCM hospitals than in integrated Chinese and Western Medicine hospitals and Western medicine general hospitals (26.15% vs.7.26% vs. 2.49%, P<0.05). Among the provinces participating in the survey, Guangdong Province had the highest application rate of TCM appropriate techniques in the perioperative period (13.60%). In the anesthesiologists carried out TCM appropriate techniques in the perioperative period, the highest application rate of TCM appropriate techniques in non-drug therapy was 59.0%, and the highest application rate in abdominal surgery was 47.4%, and most anesthesiologists (68.1%) selected TCM appropriate techniques according to the type of surgery in patients.Anesthesiologists who applied TCM appropriate techniques in the perioperative period believed that TCM appropriate technique cloud reduce the development of nausea and vomiting in the perioperative period (66.8%), alleviate perioperative pain (54.8%), promote the recovery of perioperative gastrointestinal function (49.8%), and reduce the development of perioperative neurocognitive disorders (47.0%). The main reasons for the lack of TCM appropriate techniques in the perioperative period were the lack of standardized technical training and relevant guidelines (87.11%), the lack of relevant charging items (58.30%), the technical level of operators (46.20%), the lack of support by surgeons (43.40%), and the non-cooperation of patients (27.10%). Conclusions:At present, the application rate of TCM appropriate techniques in the perioperative period is generally low, and the application rate varies greatly among different provinces and hospitals of different levels.Publicity should be expanded through multiple channels, various forms of technical training should be carried out, the implementation plan and guidelines of TCM appropriate technologies should be continuously optimized, and the promotion and application of TCM appropriate techniques in the perioperative period should be strengthened.