Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Opioid-free anesthesia(OFA)is a multimodal analgesic strategy that combines multiple non-opioid drugs and/or techniques to obtain high-quality anesthesia.With the popularization of the concept of enhanced recovery after surgery(ERAS),OFA has become a common concern hot spot for perioperative phy-sicians.OFA is in line with the ERAS concept,and under multimodal anesthesia and pain management,it can reduce surgical stress,inflammation reaction and postoperative complications,significantly improve the prog-nosis of patients,promote postoperative rapid recovery and reduce the burden of medical and health resources.This article reviews the adverse reactions of opioids,OFA concept and indications,the clinical application of OFA in recent years,the existing controversies and problems to be solved.

Ketamine is a racemic mixture composed of an equal amount of L-ketamine and D-ketamine. It has a long history of use as an anesthetic, with various effects such as relieving anxiety, reducing suicidal ideation, and treating chronic pain. However, the widespread use of ketamine is limited by adverse reactions such as dizziness, nausea, elevated blood pressure, and potential abuse. Esketamine has been a hot drug on the domestic market in recent years. As a right-handed isomer of ketamine, Esketamine has the aforementioned effects while reducing the incidence of adverse reactions and improving patient tolerance. It has broad application prospects in multiple clinical environments in the fields of psychotherapy and anesthesia. Therefore, this article provides a review of the application and pharmacological characteristics of ketamine during the perioperative period, briefly describing the pharmacological effects and possible mechanisms of ketamine, and introduces the clinical application progress of ketamine in sedation, analgesia, and anti anxiety and depression during the perioperative period. This article also explores the application prospects of ketamine in the perioperative period, in order to provide reference and guidance for the promotion and application of ketamine, and to provide new research directions.

Objective To observe the skin temperature changes on blocked area of ultrasoundguided thoracic paravertebral block and to explore the accuracy of the temperature changes in predic ting the effect of nerve block in breast cancer patients.Methods One hundred and twenty breast cancer patients undergoing modified radical mastectomy,aged 29-67 years,ASA physical status Ⅰ-Ⅲ,were selected for the study.Before general anesthesia induction,ultrasound-guided thoracic paravertebral block was performed.After the block site T34 was determined,25 ml 0.25％ ropivacaine was injected around the thoracic paravertebral space.The skins of palm and axillary regions both in blocked and unblocked sites were randomly selected.The skin temperature before nerve block and 15 min after were recorded,and the skin temperature changes were calculated.The sensitivity and specificity of the temperature changes in determining the effect of thoracic paravertebral block was assessed by using the receiver operating characteristic curve (ROC).Pearson correlation was used to analyze the correlation.Results The value of area under curve (AUC) of the ROC of the skin temperature changes in palm regions responding to the effects of block was 0.892 (95％CI 0.803-0.947).The cut-off value was 0.9C which sensitivity and specificity was 87.3％ and 75.9％,respectively.The AUC in axillary regions was 0.813 (95％CI 0.756 0.884),the cut-off value was 0.4 C which sensitivity and specificity was 80.7％ and 71.6％,respectively.The value of AUC in palm regions was larger than in axillary regions (P＜0.05).Conclusion The present study demonstrated that the changes of the skin temperature in palm and axillary regions have a high accuracy in predicting the effect of T3-4 thoracic paravertebral block,which can be used in determining the success of T3-4 thoracic paravertebral block.The assessment of temperature changes in palm regions is more accuracy than in axillary.

Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery (male 43 cases,female 37 cases,aged 24-79 years,ASA gradeⅠorⅡ)were included for the trial.After endotracheal extubation and on arri-val in the post-anaesthesia care unit (PACU),the levels of pain on numerical rating scale (NRS)were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50 μg fentanyl was administrated after 5 min if NRS rated in 4-10.The pupillary diameter (PD),systolic blood pressure (SBP)and heart rate (HR)were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5 minutes with NRS 0-3 to 4-10,after 5 minutes with NRS 4-10 to 0-3,in 10 minutes with NRS 4-10 which were marked respectively with ΔPD,ΔSBP and ΔHR.With the variation of NRS as a criterion,the reactivity of ΔHR,ΔSBP and ΔPD responding to NRS varia-tion were assessed by analysing the receiver operating characteristic curve (ROC),the area under the receiver operating characteristic curve (AUC)was calculated.Results The patients' ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD 0.904 (95% CI 0.822-0.987 ), AUCΔSBP 0.65 1(95%CI 0.5 10-0.781)and AUCΔHR 0.588(95%CI 0.444-0.733)respectively.Value of AUCΔPD was larger than that of AUCΔSBP and AUCΔHR respectively (P < 0.05 ).Importantly, operating characteristic curve (ROC)analysis showed that the diagnostic cutoff value of ΔPD was 41.3% with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value of ΔSBP was 10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demon-strated that the accuracy of ΔPD was higher than ΔSBP and ΔHR responding to pain/analgesia evalu-ation.ΔPD was a valuable index for assessment of postoperative pain.

Objective To investigate the accuracy of analgesia/nociception index (ANI) in assessing the severity of postoperative pain in patients.Methods Eighty patients,aged 21-77 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective operation,were admitted to the postanesthesia care unit after the patients were extubated at the end of operation,and ANI was monitored.Immediately after admission to the postanesthesia care unit (T0),numerical rating scale (NRS) score was recorded.If NRS score was 0-3,the patients received no treatment,and NRS score was recorded again 10 min later (T1).If NRS score was 4-10,fentanyl 50 μg was injected intravenously,and NRS score was recorded again 5 min later (T2).ANI value was recorded at T0,T1 and T2.NRS score was considered as the criterion for assessment of the severity of pain.The receiver operating characteristic curve was used to analyze the sensitivity and specificity of ANI in determining NRS scores,the cut-off value was determined,and the area under the curve and 95％ confidence interval were calculated.Pearson correlation was used to analyze the correlation between ANI and NRS score.Results The area under the curve (95％ confidence interval) of ANI in determining NRS scores was 0.873 (0.816-0.929),and the cut-off value was 45 with a sensitivity of 74.8％ and a specificity of 87.5％.ANI was negatively correlated with NRS score,and the correlation coefficient was-0.705 (P＜0.05).Conclusion ANI provides high accuracy in assessing the severity of postoperative pain with a cut-off value of 45 in the patients.

Objective To investigate whether rosuvastatin has the effects of anti-oxidative stress and attenuates vascular endothelial adhesiveness on the vessel wall in apolipoprotein E(apoE)knockedout mice. Methods Eighty 8-week-old apolipoprotein E-deficient mice and twenty 8-week-old C57BL/6 mice,were fed a normal chow diet for 12 weeks,and were divided into 2 weeks treatment group and 6 weeks treatment group.apoE knocked-out mice were subcutaneously injected with rosuvastatin at a dose of 1, 5, or 20 mg/kg daily for 2 or 6 weeks prior to sacrifice.Blood sample was taken by cardiopuncture and the aorta was obtained at the end of the 2th or 6th weeks. Results Total cholesterol level was significantly decreased after 2 or 6 weeks of 5,or 20 mg/kg rosuvastatin treatment[2 weeks:(480.7±35.3)mmol/L,(371.5±27.1)mmol/L;6 weeks:(400.1±37.6)mmol/L,(305.0±19.3)mmol/L],compared with 0 mg/kg group(20 weeks:(675.0±42.0)mmol/L;6weeks:(660.0±44.3)mmol/L](P＜0.05 or 0.01).But the changes of triglyceride and high-density lipoprotein were not like the above.The endothelial adhesiveness for monocytes was significantly attenuated after 2 weeks in 20 mg/kg group versus 0 mg/kg group[(2.24±0.72)%vs.(3.76 ±2.53)%](P＜0.05),and even more significantly after 6 weeks in 5,20 mg/kg groups[(1.94±0.40)%,(3.95±2.61)%](P＜0.01).In addition,rosuvastatin inhibited vascular expression of p22phox and superoxide production[0 mg/kg for 6 weeks group:(3.22±1.53)%,(4.75±2.62)μg/L;20 mg/kg for 6 weeks group:(1.41±0.72)%,(2.72±0.88)μg/L](all P＜0.05). Conclusions Rosuvastatin has a role of anti-oxidative stress and attenuates vascular endothelial adhesiveness on the vessel wall.