Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.

OBJECTIVE：To investigate the effects of lidocaine aerosol inhalation on perioperative pulmonary function ， inflammation factor and related complications of patients with one-lung ventilation. METHODS ：A total of 120 patients who were admitted to the Affiliated Hospital of Panzhihua University from January 2018 to May 2020 and planned to undergo partial pneumonectomy under general anesthesia and one-lung ventilation were selected. According to random number table method ，they were divided into lidocaine aerosol inhalation group （group L ）and sterile water aerosol inhalation group （group N ），with 60 cases in each group. Two groups were given Midazolam injection 0.1 mg/kg+Propofol injectable emulsion 2.0 mg/kg+Sufentanil citrate injection 0.4 μg/kg to induce anesthesia. After the insertion of the double-lumen tracheal tube ，group L was given aerosol inhalation of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 mL with sterile water ；group N was given aerosol inhalation of sterile water 20 mL at the flow rate of 2 L/min. Patients in both groups were continuously pumped with Propofol injectable emulsion 4-12 mg/（kg·h）+Remifentanil hydrochloride for injection 0.2-1 μg（/ kg·min）+Cisatracurium besilate for injection 0.05-0.1 mg/（kg·h）for anesthesia maintenance. Eight hours after operation ，group L inhaled of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 mL with sterile water again ，and group N inhaled of sterile water 20 mL again. Arterial blood gas analysis indexes [arterial partial pressure of oxygen （PaO2），partial pressure of carbon dioxide （PaCO2），lactic acid （Lac），oxygenation index （P/F）]，serum inflammatory factors [interleukin 6 （IL-6），tumor necrosis factor α（TNF-α）and nuclear factor κB（NF-κB）] were observed in 2 groups before anesthesia（T1），60 min of one-lung ventilation （T2），and 12 h after extubation （T3）. Respiratory and circulatory parameters [extravascular lung water（EVLW），pulmonary vascular permeability index （PVPI），heart rate （HR），stroke volume （SV）] were also observed 5 min after anesthesia （t1），T2 and 15 min after surgery （t3）. Extubation time ，visual analogue scale （VAS） score of 12 h after extubation，time of getting out of bed ，the incidence of throat pain of 12 h after extubation and the occurrence of ADR were recorded in 2 groups. RESULTS ：There was no significant difference in arterial blood gas analysis indexes ，serum inflammatory factor levels ，respiratory and circulatory parameters between the two groups at T 1 or t 1（P＞0.05）. The levels of PaO 2，PaCO2， Lac，IL-6，TNF-α and NF-κB in 2 groups at T 2 and T 3 were significantly higher than at T 1，P/F at T 2 and T 3 was significantly lower than at T 1；in group L ，the levels of PaCO 2，Lac，IL-6，TNF-α，NF-κB were significantly lower than group N，and PaO 2 and P/F were significantly higher than group N （P＜0.05）. EVLW and PVPI of 2 groups at T 2and t 3，SV of group L ，HR of group N were significantly higher than corresponding group at T 1，while EVLW ，PVPI and HR of group L were significantly lower than group N，SV was significantly higher than group N at corresponding period （P＜0.05）. The extubation time ，VAS score of 12 h after extubation，time to get out of bed after surgery ，the incidence of throat pain of 12 h after extubation in group L were significantly shorter or lower than group N （P＜0.05）. No obvious and serious ADR occurred during recovery. CONCLUSIONS：Lidocaine aerosol inhalation can effectively improve ventilation and oxygenation function of patients undergoing one-lung ventilation ，inhibit the release of inflammatory factors ，and reduce the incidence of postoperative complications with good safety.

Objective To investigate the current situation of labor analgesia in Shanghai, provide data supportion and decision-making basis for further popularization of labor analgesia.Methods Using the self-made questionnaire, Shanghai Medical Doctor Association of Anesthesiologist issued a notice on the purpose of the study and the way how to fill it up.The questionnaire was distributed and recycled through the website wjx.com.Results The 58 hospitals included in this survey accounted for 90.44％ of the total delivery in Shanghai in 2017, and the overall labor analgesia rate was37.22％.The number of deliveries in 13 maternal and child specialist hospitals accounted for 58.44％of 58 hospitals, and the labor analgesia rate was 56.75％.It accounted for 93.50％of the 58 hospitals analgesic deliveries.There are 44 (75.86％) hospitals carrying labor analgesia by intraspinal nerve block as the main method of labor analgesia.42 (95.45％) of these hospitals began to analgesia during the incubation period, 30 (68.18％) of these hospitals closed the analgesic pump during childbirth, and 40 (90.9％) hospitals had a maternal satisfaction of 85 or more, 36 (81.82％) of these hospitals charged labor analgesia in accordance with the anesthesia clause.However, among the 14 hospitals that did not practive labor analgesia, 13 (92.86％) were due to inadequate anesthesiologists and other relevant factors.Conclusion The overall labor analgesia rate in Shanghai was 37.22％.The service has been mainly provided in maternal and child specialist hospitals.The main factors restricting the labor analgesia are the shortage of anesthesiologists and the lack of specific charges.In order to promote the labor analgesia, policy support is an important aspect, and the labor analgesia process and innovative management mode should also be optimized.

Objective To evaluate the efficacy of ultrasound-guided transversus abdominal plane (TAP) and posterior rectus sheath (PRS) block for postoperative analgesia in the patients undergoing radical resection for gastric cancer.Methods One hundred twenty patients of both sexes,aged 18-64 yr,with body mass index of 19-25 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical resection for gastric cancer,were divided into 2 groups (n =60 each) using a random number table:control group (group C) and ultrasound-guided TAP and PRS block group (group T+R).Bilateral TAP (0.375％ ropivacaine 0.5 ml/kg was injected) and PRS block (0.375％ ropivacaine 0.3 ml/kg was injected) were performed before induction of general anesthesia in group T+R.Patient-controlled intravenous analgesia was provided to all the patients after surgery in the two groups,and the visual analog scale score at rest and during activity was maintained less than 4 within 48 h after surgery.The requirement for rescue analgesia within 48 h after surgery and occurrence of adverse reactions during the analgesia period were recorded.Results Compared with group C,the requirement for rescue analgesia within 48 h after surgery and incidence of nausea and vomiting were significantly decreased in group T+R (P＜0.05).Conclusion Ultrasound-guided TAP and PRS block provides better efficacy for postoperative analgesia with less adverse reactions in the patients undergoing radical resection for gastric cancer.

Objective To investigate the effects of different doses of dexmedetomidine during com-bined intravenous-inhalational anesthesia on motor evoked potentials ( MEPs) monitoring and postoperative agitation in elderly patients undergoing cervical spine surgery. Methods Sixty patients of both sexes, aged 65-81 yr, weighing 51-78 kg, of American Society of Anesthesiologists physical statusⅠorⅡ, undergo-ing elective cervical spine surgery under general anesthesia, were divided into 3 groups ( n=20 each) using a random number table method: control group ( group C) , low-dose dexmedetomidine group ( group D1 ) and high-dose dexmedetomidine group ( group D2 ) . Anesthesia was induced by intravenous injection of mid-azolam 0. 04 mg∕kg, cisatracurium 0. 15 mg∕kg, propofol 2 mg∕kg and sufentanil 0. 3-0. 4 μg∕kg. MEPs was assessed with nerve electrophysiology monitor after induction of anesthesia. Anesthesia was maintained by inhalation of sevoflurane ( end-tidal concentration 1％) and target-controlled infusion of propofol ( target plasma concentration 2-3 μg∕ml). Narcotrend index was maintained at D2-E1. When T4∕T1>75％ (at T0 ) , dexmedetomidine was intravenously infused over 10 min in a loading dose of 0. 6μg∕kg, followed by an infusion of 0. 3μg·kg-1 ·h-1 until the end of surgery in group D1 . Dexmedetomidine was intravenously infused over 10 min in a loading dose of 1 μg∕kg, followed by an infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery in group D2 . The equal volume of normal saline was given intravenously in group C. At T0 , immediately after the end of administration of dexmedetomidine loading dose ( T1 ) and at 60 min of dexme-detomidine infusion ( T2 ) , the effective elicitation of MEPs and amplitude and latency of MEPs were recor-ded. The intraoperative cardiovascular events and occurrence of postoperative agitation in postanesthesia care unit were recorded. Results Compared with group C, no significant change was found in the latency, amplitude and effective elicitation rate of MEPs at each time point in group D1 ( P>0. 05) , the amplitude of MEPs was significanty decreased, the latency of MEPs was prolonged, and the elicitation rate of MEPs was decreased at T2 in group D2 , and the incidence of bradycardia during operation was significanty in-creased, and the incidence of postoperative agitation was decreased in D1 and D2 groups ( P<0. 05) . Com-pared with group D1 , the amplitude of MEPs was significantly decreased, the latency of MEPs was pro-longed, and the effective elicitation rate of MEPs was decreased at T2 ( P<0. 05), and no significant change was found in the incidence of intraoperative bradycardia and postoperative agitation in group D2 ( P>0. 05) . Conclusion Dexmedetomidine infused over 10 min in a loading dose of 0. 6 μg∕kg, followed by an intravenous infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery during combined intravenous-inhala-tional anesthesia exerts no effect on MEPs monitoring, and can decrease the incidence of postoperative agita-tion at the same time in elderly patients undergoing cervical spine surgery.

Objective To evaluate the efficacy and safety of bilateral transversus abdominis plane block (TAPB)combined with bilateral rectus sheath block (RSB)in abdominal surgery. Methods Ninety ASA Ⅰ or Ⅱ patients,35 males,55 females,aged 19-79 years,with body mass index 18-30 kg/m2 ,scheduled for elective laparoscopic cholecystectomy were randomly divided into three groups(n=30):ultrasound-guided bilateral TAPB combined with bilateral RSB group (group TR),ultrasound-guided bilateral TAPB group (group T),patient-controlled intravenous analgesia (PCIA)group (group P).In group TR,ultrasound-guided bilateral TAPB were performed with 20 ml of 0.22% ropivacaine mesylate injection in each side and ultrasound-guided bilateral RSB were per-formed with 10 ml of 0.22% ropivacaine mesylate injection in each side before surgery.In group T, ultrasound-guided bilateral TAPB were performed with 20 ml of 0.22% ropivacaine mesylate injection in each side and ultrasound-guided bilateral RSB were performed with 10 ml of NS in each side before surgery.In group P,ultrasound-guided bilateral TAPB were performed with 20 ml of NS in each side and ultrasound-guided bilateral RSB were performed with 10 ml of NS in each side before surgery, and PCIA was applied in group P.BP,HR,SpO2 were observed when patients were sent into the op-erating room, 2 minutes before trocar puncture, and 2 minutes after trocar puncture, the consumption of propofol and remifentanil used during the surgery were recorded.The score of visual analogue scale (VAS)during rest and movement were recorded at 2,6,12,24 h after surgery.The patient analgesia satisfaction and the adverse reactions were recorded.Results Compared with group T and group P,group TR had less change of BP before and after trocar puncture(P <0.05).The VAS score was significantly lower in group TR after operation(P <0.05).There were no statistical significant differences of VAS score at 24 h after operation among the three groups.The patient anal-gesia satisfaction was significantly better in group TR than other two groups (P < 0.05 ). Conclusion Ultrasound-guided bilateral transversus abdominis plane block combined with bilateral rectus sheath block is of safety and much efficacy of postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

Objective To compare the postoperative cognitive function in elderly patients undergoing sevoflurane-based anesthesia versus propofol-based anesthesia.Methods Sixty-two patients of both sexes,aged 65-80 yr,weighing 48-90 kg,of ASA physical status Ⅰ or Ⅱ,were randomly allocated to either sevoflurane-based anesthesia group (group S,n=31) or propofol-based anesthesia group (group P,n =31).At 1 day before operation and 7 days after operation,cognitive function was assessed by MiniMental State Examination,Digit Span Test (forward test and backward test),Digit-Symbol Substitution Test,Trail Making Test A and Word Recognition Test,and the scores were recorded.Results There were no significant differences between the two groups in the scores of each test used for assessment of cognitive function.Compared to group P,Mini-Mental State Examination scores,forward test scores and backward test scores obtained from Digit Span Test,Digit-Symbol Substitution Test scores,and Word Recognition Test scores were significantly decreased at 7 days after operation,and no significant change was found in Trail Making Test A scores in group S.Conclusion Postoperative cognitive function is decreased under sevoflurane-based anesthesia when compared with that under propofol-based anesthesia in the elderly patients.

Dexmedetomidine( DEX) is a pure potent, highly se-lective and highly specific agonist ofα2-adrenergic receptors with sedative, analgesic and sympatholytic properties. The sedative effect mimics natural sleep of“arousable” and“cooperative” se-dation without respiratory depression. Due to the above properties and advantages, DEX has received adequate attention in clinical practice and its spectrum of application is also expanding. In re-cent years, it is proved that DEX is neuroprotective not only in animal researches but also in clinical studies. The neuroprotec-tion of DEX and its related mechanism will be briefly reviewed in this paper.

Objective To evaluate the effects of sevoflurane on learning and memory of neonatal mice .Methods 122 neonatalmice (7 days postnatal) were included in this study .72 of them were exposed to sevoflurane (1 .0 or 0 .5MAC ,minimum alveolar concentration) or 40% O2 for 2 h(hours) .Morris water maze was performed 4 and 12 weeks after anesthesia .Latency and swimming speed during training ,time on island and times across island during the research were recorded .The rest 50 mice was used in artery blood analysis during sevoflurane (1 .0 or 0 .5 MAC ,0 ,1 ,2 h) .Results pH ,PaO2 ,PaCO2 ,SaO2 were stable during anesthesia .Latency in control group were significantly shorter than the two anesthesia groups 4 weeks after anes-thesia and 3 days after the training .During the last 2 training days ,the latency in 1 .0 MAC sevoflurane-exposed mice were sig-nificantly longer than that of the 0 .5 MAC group .12 weeks after anesthesia ,the latency was still significantly longer in 1 .0 MAC sevoflurane-exposed mice on the last training day .The time on island and/or times across island were significantly decreased in anesthesia groupsduring theresearch performed 4 weeks and 12 weeks after anesthesia .Conclusion Early exposure to sevoflurane leads to a concentration and time-depended persistent learning and memory deficits to neonatal mice .