Objective To investigate the indications to use a temporary pacemaker for bifascicular block in perioperative period.Methods The treatment for 40 patients with heart bifascicular block and a special case were retrospectively studied.All cases,according to their disease history,clinical symptoms,physical ability and atrio-ventricular conduction ability,were divided into two groups:P group(prophylactic insertion of a temporary pacemaker) and N group(without inserting a pacemaker).During operation,we observed whether atrio-ventricular block occurs,the performance of pacemaker and atropine's therapeutic efficacy to bradycardia.Results Anesthesia was postponed in one case because of acute left bundle branch block(LBBB) and the patient died with severe myocardium damage soon after failed resuscitation.All other cases went through anesthesia and operation smoothly.Bradycardia and hypotension could be relieved somewhat by medication in operation,and no complete atrio-ventricular block developed.Conclusion There is no need inserting a temporary pacemaker for chronic bifascicular block if asymptomatic and no atrio-ventricular block.Transesophageal atrial pacing is an easy way to evaluate in quantification atrio-ventricular conduction ability.

Objective Compare the three kind of criteria in evaluating the incidences of postop-erative cognitive dysfunction in non-cardiac surgery.Methods Four hundred and sixty one non-cardiac surgery patients were randomly enrolled in this study group and two hundred forty four non-surgery patients as control group.Patients??cognitive state was measured on preoperative and postoperative 1 and 3 d by mini-mental state examination(MMSE).POCD was assessed by patients??education level, one standard deviation and Z-score scale,respectively.Results On the first and third day after sur-gery,Z-score scale assess POCD result showed the highest relevance ratio and 95%CI as well as the lowest education level.The education scale showed the lowest incidence of POCD.Education level criteria was positive on postoperative 1 and 3 day,while one case on postoperative 1 day and four cases on postoperative 3 day were negative by Z-score scale.Conclusion The incidence of POCD in same pa-tients by three kind of criteria are different.The Z-score scale is recommended to evaluate the POCD in order to avoid misdiagnosis.

Objective To compare the effects of different methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery.Methods One thousand ASA Ⅰ or Ⅱ patients,aged 18-60 years and undergoing non-cardiac surgery,were randomly divided into five groups (n=200 each):isoflurane + propofol + fentanyl group (group IPF),isoflurane + remifentanil group (group IR),sevoflurane + propofol + fentanyl group (group SPF),sevoflurane + remifentanil group (group SR),and propofol + remifentanil group (group PR).Two hundred patients receiving non-operative treatment served as control group (group C).In groups IPF and SPF,anesthesia was maintained with inhalation of 1.68％ isoflurane or 1.71％ sevoflurane,target controlled infusion (TCI) of propofol with the target plasma concentration of 2-5 μg/ml,and intermittent intravenous boluses of fentanyl.In groups IR,SR and PR,anesthesia was maintained with inhalation of 1.68％ isoflurane or 1.71 ％ sevoflurane,or TCI of propofol with the target plasma concentration of 2-5 μg/ml,and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml.The patients' cognitive function was assessed with minimental state examination (MMSE) 1 day before operation,when leaving the post-anesthetic care unit (PACU),and 1 and 3 days after operation,respectively.Z score was used to identify the cognitive dysfunction as recommended by Moiler when leaving the PACU,and 1 and 3 days after operation.Results Compared with group C,the MMSE score was significantly decreased when leaving the PACU,and the incidence of cognitive dysfunction increased when leaving the PACU and 1 day after operation in the other groups (P ＜ 0.05).Compared with groups IPF,IR,SPF and PR,the incidence of cognitive dysfunction was significantly increased in group SR (P＜0.05).Conclusion General anesthesia with sevoflurane combined remifentanil exerts fewer effects on the postoperative cognitive function in patients undergoing non-cardiac surgery.

Objective To compare the effects of methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery. Methods One thousand ASA Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing non-cardiac surgery were randomly divided into 5 groups ( n = 200 each) : isoflurane + propofol + fentanyl group (group IPF); isoflurane + remifentanil group (group IR) ; sevoflurane + propofol + fentanyl group (group SPF) ; sevoflurane + remifentanil group (group SR) ; propofol + remifentanil group (group PR) . Two hundred non-operative patients served as control group (group C) . In groups IPF and SPF, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71 % sevoflurane, TCI of propofol with the target plasma concentration of 2-5 μg/ml, and intermittent iv boluses of fentanyl. In groups IR, SR and PR, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71% sevoflurane, or TCI of propofol with the target plasma concentration of 2- 5 μg/ml, and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml. The patients' cognitive function was assessed using mini-mental state examination (MMSE) at 1 d before operation, while leaving postanesthesia care unit (PACU) , and at 1 and 3 d after operation. The Z score was used to identify the cognitive dysfunction as recommended by Moller while leaving PACU, and at 1 and 3 d after operation. Results Compared with group C, the MMSE score was significantly decreased while leaving PACU , and the incidence of cognitive dysfunction increased while leaving PACU and at 1 d after operation in the other groups ( P ＜ 0.05). Compared with groups IPF,IR,SPF and PR, the incidence of cognitive dysfunction was significantly increased in group SR ( P ＜ 0.05) . Conclusion General anesthesia with sevoflurane combined remifentanil exerts less effect on the postoperative cognitive function in patients undergoing non-cardiac surgery.

Objective To evaluate the accuracy of modified thyromental height (MTMH) in predicting difficult laryngoscopy.Methods Two hundred and sixty-three patients of both sexes requiring endotracheal intubation,aged over 17 yr,with body mass index less than 33 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were selected.The modified Mallampati test (MMT) score,thyromental height (TMH) and MTMH ("sniffing" thyromental height) were assessed after admission to the operating room.MMT grade Ⅲ or Ⅳ was set as positive predicting index.Direct laryngoscope was placed after induction of anesthesia to expose the glottis,and difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ after external laryngeal manipulation.The area under the receiver operating characteristics curve (AUC) was used to evaluate the accuracy of MMT,TMH and MTMH in predicting difficult laryngoscopy.Results Difficult laryngoscopy was found in 24 patients and non-difficult laryngoscopy in 239 patients,the incidence of difficult laryngoscopy was 10.0％,and there were no failed intubations.The AUC (95％ confidence interval) of MTMH in predicting difficult laryngoscopy was 0.966 (0.396-0.984),the best cut-off value was 46.83 mm,and Youden index was 0.8456.The sensitivity and specificity of MTMH in predicting difficult laryngoscopy was 91.67％ and 92.89％,respectively,and the odds ratio was 143.647.The AUC of MTMH in predicting difficult laryngoscopy was significantly enlarged when compared with that of MMT and TMH (P＜0.05).Conclusion MTMH can accurately predict difficult laryngoscopy with the best cut-off value of 46.83 mm in patients.

Objective:To assess the value of preoperative salivary cortisol morning/night secretion ratio (AM/PM ratio) in predicting acute postoperative pain in patients.Methods:This was a prospective cohort study. A total of 120 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with body mass index of 18-28 kg/m 2, undergoing elective single-port laparoscopic hysterectomy from January to October 2023 in Subei People′s Hospital of Jiangsu Province, were selected, and their anxiety and depression status was evaluated by using the Hospital Anxiety and Depression Mood Measurement Scale (HADS) before surgery. Saliva samples were collected in the morning and evening 1 day before operation, and the cortisol concentration was determined by enzyme-linked immunosorbent assay. The ratio of morning cortisol concentration to night cortisol concentration before operation was calculated (cortisol AM/PM ratio). The patients were divided into two groups according to the highest numerical rating scale (NRS) score within 48 h after surgery: no or mild pain group with the highest NRS score ≤3 and moderate to severe pain group with the highest NRS score ≥ 4. Multivariate logistic regression was used to identify the risk factors of moderate to severe acute pain after surgery, and the receiver operating characteristic curve was plotted to evaluate the predictive value. Results:Multivariate logistic regression analysis showed that age, preoperative HADS anxiety score, preoperative HADS depression score and preoperative cortisol AM/PM ratio were independent risk factors for moderate to severe acute pain after surgery ( P<0.05). The results of the receiver operating characteristic curve showed that the area under the curve of preoperative cortisol AM/PM ratio in predicting moderate to severe acute postoperative pain was 0.803 (95% confidence interval 0.708-0.898, P<0.001), the optimal cut-off value was 3.46, the sensitivity was 71.1%, and the specificity was 87.7%. Conclusions:Preoperative salivary cortisol morning/night secretion ratio can predict the occurrence of acute postoperative pain in patients.