Objective To compare the effects of desflurane inhalation anesthesia versus propofol total intravenous anesthesia on postoperative recovery quality in patients undergoing endoscopic transnasal pituitary adenoma resection,and to provide evidence-based recommendations for optimizing anesthetic management in this surgical population.Methods This single-center,prospective,randomized controlled trial enrolled 112 patients scheduled for endoscopic transnasal pituitary adenoma resection,who were randomly assigned to either the desflurane group(n=56)or the propofol group(n=56).The desflurane group received desflurane[0.7-1.0 minimum alveolar concentration(MAC)]combined with remifentanil for anesthesia maintenance,whereas the propofol group received propofol(4-6 mg·kg-1·h-1)with remifentanil.The primary outcome was defined as the time from discontinuation of anesthetics to achieving an Aldrete score of 9.Secondary outcomes included emergence time,extubation time,and incidences of postoperative agitation and vomiting.Results Patients receiving desflurane achieved an Aldrete score of 9 significantly faster than those in the propofol group(13.0 min vs 16.5 min,P=0.003).Similarly,both emergence time(14.0 min vs 16.5 min,P=0.009)and extubation time(13.0 min vs 16.5 min,P=0.003)were significantly shorter in the desflurane group.However,the desflurane group had higher incidences of postoperative agitation(17.9%vs 3.6%,P=0.015)and vomiting(19.6%vs 5.4%,P=0.022).No significant difference was observed in severe agitation rates or 24 h postoperative recovery quality[Quality of Recovery-15(QoR-15)scores]between groups.Conclusion Desflurane anesthesia significantly accelerates postoperative recovery in patients undergoing endoscopic transnasal pituitary adenoma resection,however,it may increase risks of mild agitation and vomiting.In clinical applications,it is necessary to balance recovery benefits against potential adverse effects,and take targeted prophylactic measures.

Postoperative cognitive dysfunction(POCD)is a common complication of anesthesia and surgery.With advances in neurocognitive science,POCD has been classified under the category of perioperative neurocognitive disorders(PND).However its diagnostic criteria have not been standardized.Patients undergoing neurosurgery often have pre-existing mild cognitive impairment.Moreover cognitive impairment can be directly exacerbated by structural and functional brain damage resulting from surgical procedures,which is significantly different from other surgical procedures.Dexamethasone,a commonly used neurosurgical agent,exerts neuroprotective effects through anti-inflammation,reduction of cerebral edema,and lowering of intracranial pressure.While some studies have indicated dexamethasone's potential to mitigate POCD in non-neurosurgical settings,its performance and underlying mechanisms in neurosurgical procedures remain unclear.After a systematic search,only one randomized controlled trial for microvascular decompression was identified that directly addressed this issue.This article aims to address the research gap concerning the relationship between dexamethasone and POCD in neurosurgery procedures to provide insights and implication for future investigations.

Objective To compare the effects of desflurane inhalation anesthesia versus propofol total intravenous anesthesia on postoperative recovery quality in patients undergoing endoscopic transnasal pituitary adenoma resection,and to provide evidence-based recommendations for optimizing anesthetic management in this surgical population.Methods This single-center,prospective,randomized controlled trial enrolled 112 patients scheduled for endoscopic transnasal pituitary adenoma resection,who were randomly assigned to either the desflurane group(n=56)or the propofol group(n=56).The desflurane group received desflurane[0.7-1.0 minimum alveolar concentration(MAC)]combined with remifentanil for anesthesia maintenance,whereas the propofol group received propofol(4-6 mg·kg-1·h-1)with remifentanil.The primary outcome was defined as the time from discontinuation of anesthetics to achieving an Aldrete score of 9.Secondary outcomes included emergence time,extubation time,and incidences of postoperative agitation and vomiting.Results Patients receiving desflurane achieved an Aldrete score of 9 significantly faster than those in the propofol group(13.0 min vs 16.5 min,P=0.003).Similarly,both emergence time(14.0 min vs 16.5 min,P=0.009)and extubation time(13.0 min vs 16.5 min,P=0.003)were significantly shorter in the desflurane group.However,the desflurane group had higher incidences of postoperative agitation(17.9%vs 3.6%,P=0.015)and vomiting(19.6%vs 5.4%,P=0.022).No significant difference was observed in severe agitation rates or 24 h postoperative recovery quality[Quality of Recovery-15(QoR-15)scores]between groups.Conclusion Desflurane anesthesia significantly accelerates postoperative recovery in patients undergoing endoscopic transnasal pituitary adenoma resection,however,it may increase risks of mild agitation and vomiting.In clinical applications,it is necessary to balance recovery benefits against potential adverse effects,and take targeted prophylactic measures.

Postoperative cognitive dysfunction(POCD)is a common complication of anesthesia and surgery.With advances in neurocognitive science,POCD has been classified under the category of perioperative neurocognitive disorders(PND).However its diagnostic criteria have not been standardized.Patients undergoing neurosurgery often have pre-existing mild cognitive impairment.Moreover cognitive impairment can be directly exacerbated by structural and functional brain damage resulting from surgical procedures,which is significantly different from other surgical procedures.Dexamethasone,a commonly used neurosurgical agent,exerts neuroprotective effects through anti-inflammation,reduction of cerebral edema,and lowering of intracranial pressure.While some studies have indicated dexamethasone's potential to mitigate POCD in non-neurosurgical settings,its performance and underlying mechanisms in neurosurgical procedures remain unclear.After a systematic search,only one randomized controlled trial for microvascular decompression was identified that directly addressed this issue.This article aims to address the research gap concerning the relationship between dexamethasone and POCD in neurosurgery procedures to provide insights and implication for future investigations.

Objective:To identify the risk factors for postoperative sleep disturbance (PSD) in patients undergoing spine surgery.Methods:In this case-control study, patients who underwent spine surgery from December 2023 to June 2024 at Beijing Tiantan Hospital of Capital Medical University, were selected as the subjects of the study. The quality of postoperative sleep was assessed using the Athens Insomnia Scale (AIS). The baseline characteristics and various perioperative indicators of the patients were collected. The patients were divided into PSD group and non-PSD group according to whether they had PSD. The variables with statistically significant differences from the univariate analysis were included in a multivariate logistic regression to identify the risk factors for PSD.Results:The results of the multivariate logistic regression analysis showed that preoperative sleep disturbance (odds ratio [ OR]=2.23, 95% confidence interval [ CI] 1.06-4.72, P=0.036), course of disease > 12 months ( OR=2.20, 95% CI 1.14-4.24, P=0.019) and AIS score > 2 on the night before surgery ( OR=2.06, 95% CI 1.02-4.16, P=0.045) were the independent risk factors for PSD in patients undergoing spine surgery. Conclusions:Preoperative sleep disturbance, course of disease > 12 months and AIS score > 2 on the night before surgery are independent risk factors for PSD in patients undergoing spine surgery.

Objective:To summarize the key points of perioperative anesthesia management of infants undergoing endoscopic endonasal resection of craniopharyngioma.Methods:The medical records of infants, aged 1-3 yr, undergoing endoscopic endonasal resection of craniopharyngioma at Beijing Tiantan Hospital affiliated to Capital Medical University from January 1, 2023 to December 31, 2023, were retrospectively analyzed. The demographic and perioperative information was collected.Results:Six pediatric patients were included, with 5 males and 1 female, with height of (103±6) cm and weight of (16±3) kg. Five cases had abnormal anterior pituitary hormones before surgery. All the children with abnormal hormone levels were given hormone supplementation during surgery, except for those with elevated free thyroxine. None of the 6 children showed significant electrolyte abnormalities or diabetes insipidus. Five children received blood transfusion treatment, with an allogeneic red blood cell volume of (114±79) ml. Among them, 4 children received allogeneic plasma transfusion, with a volume of (75±69) ml. All the 6 pediatric patients were conscious with tracheal tubes removed after surgery. Three pediatric patients had hyponatremia, and 2 pediatric patients still had hypothyroidism. All the pediatric patients did not experience postoperative diabetes insipidus, cerebrospinal fluid rhinorrhea or epileptic seizures.Conclusions:Adequate preoperative assessments should be conducted, and detection of anterior pituitary hormone levels should be improved, with hormone replacement therapy administered when necessary in the perioperative anesthesia management for endoscopic endonasal resection of craniopharyngioma in infants. Vital signs should be closely monitored, and prompt treatment should be administered when diabetes insipidus and electrolyte disorders are found during surgery. Attention should be given to airway management to avoid airway spasms after surgery.

Objective To explore the neurophysiological signatures of auditory event-related potentials(AERP)during propofol-induced graded sedation depths,and their correlations with sedation levels and behavioral responsiveness,and further to evaluate the feasibility of AERP components as potential biomarkers for quantifying consciousness states.Methods An auditory Oddball paradigm was used to evoke AERP responses in healthy volunteers under propofol-induced graded sedation.Linear mixed model was applied to explore the relationships between the mean amplitudes of AERP components[mismatch negativity(MMN);P300]and both sedation-induced conscious states[Modified Observer's Assessment of Alertness/sedation Scale(MOAA/S)scores]and behavioral performance(response accuracy).Results Twenty-two healthy volunteers were included.Data analysis revealed significant negative correlations between the mean amplitudes of MMN components[MMN-Dev:β=-0.62(-2.70--0.07),P=0.04;MMN-Nov:β=-0.15(-0.27--0.03),P=0.02]and MOAA/S scores during propofol sedation.Novel stimulus-evoked MMN amplitudes also correlated with response accuracy[MMN-Nov:β=-5.08(-7.78--2.37),P<0.01].There was a weak positive correlation between novel stimulus-evoked P300 amplitudes and MOAA/S scores[β=0.16(0.04-0.39),P=0.04],however,the correlation was no significant difference after adjusting for confounding factors including age,education level,and cognitive level.Conclusion The mean amplitude of MMN component elicited during auditory tasks was correlated with conscious states and behavioral accuracy under propofol-induced graded sedation.MMN holds promise as a potential neurophysiological indicator for quantifying conscious states or behavioral responsiveness during sedation.

Objective To analyze the application effects of laryngeal mask airway(LMA)general anesthesia versus endotracheal intubation(ETI)general anesthesia in Parkinson's disease(PD)patients undergoing deep brain stimulation(DBS)implantable pulse generator(IPG)surgery.Methods A retrospective analysis was conducted on 164 PD patients who underwent IPG surgery at our hospital from August 2020 to February 2021.Patients were divided into two groups based on airway management:LMA group(n=61)and ETI group(n=103).Perioperative hemodynamic parameters,including mean arterial pressure(MAP)and heart rate(HR),were observed at five time points:pre-induction(T0),post-induction(T1),skin incision(T2),extubation(T3),and post-anesthesia care unit(PACU)admission(T4).Key outcomes,such as extubation time,intraoperative hypoxia events,LMA-to-ETI conversion rate,and postoperative complications(respiratory depression,pneumonia),were compared between the two groups.Results The LMA group had a significantly lower body mass index than the ETI group[(22.75±3.11)kg/m2 vs(23.85±3.49)kg/m2,P=0.039],while the other baseline characteristics were comparable.After induction,the LMA group exhibited a less decrease in MAP[(85.46±11.63)mmHg vs(74.13±11.78)mmHg in the ETI group,P<0.001].At extubation,the ETI group showed higher MAP[(98.27±13.78)mmHg vs(89.66±10.50)mmHg in the LMA group,P<0.001].The intraoperative use of vasoactive drugs was significantly lower in the LMA group(3.3%)than that in the ETI group(13.6%,P=0.032).The mean extubation time was shorter in the LMA group[(8.43±5.25)min vs(14.28±7.66)min in the ETI group,P<0.001].No intraoperative hypoxia or LMA-to-ETI conversion events occurred in either group.Postoperative respiratory depression and pneumonia rates showed no statistically significant differences between the groups.Conclusion LMA general anesthesia can be safely applied in PD patients undergoing DBS IPG implantation.It shortens extubation time,reduces the use of vasoactive drugs,and does not increase the risk of intubation-related complications.

Objective To explore the neurophysiological signatures of auditory event-related potentials(AERP)during propofol-induced graded sedation depths,and their correlations with sedation levels and behavioral responsiveness,and further to evaluate the feasibility of AERP components as potential biomarkers for quantifying consciousness states.Methods An auditory Oddball paradigm was used to evoke AERP responses in healthy volunteers under propofol-induced graded sedation.Linear mixed model was applied to explore the relationships between the mean amplitudes of AERP components[mismatch negativity(MMN);P300]and both sedation-induced conscious states[Modified Observer's Assessment of Alertness/sedation Scale(MOAA/S)scores]and behavioral performance(response accuracy).Results Twenty-two healthy volunteers were included.Data analysis revealed significant negative correlations between the mean amplitudes of MMN components[MMN-Dev:β=-0.62(-2.70--0.07),P=0.04;MMN-Nov:β=-0.15(-0.27--0.03),P=0.02]and MOAA/S scores during propofol sedation.Novel stimulus-evoked MMN amplitudes also correlated with response accuracy[MMN-Nov:β=-5.08(-7.78--2.37),P<0.01].There was a weak positive correlation between novel stimulus-evoked P300 amplitudes and MOAA/S scores[β=0.16(0.04-0.39),P=0.04],however,the correlation was no significant difference after adjusting for confounding factors including age,education level,and cognitive level.Conclusion The mean amplitude of MMN component elicited during auditory tasks was correlated with conscious states and behavioral accuracy under propofol-induced graded sedation.MMN holds promise as a potential neurophysiological indicator for quantifying conscious states or behavioral responsiveness during sedation.

Objective To analyze the application effects of laryngeal mask airway(LMA)general anesthesia versus endotracheal intubation(ETI)general anesthesia in Parkinson's disease(PD)patients undergoing deep brain stimulation(DBS)implantable pulse generator(IPG)surgery.Methods A retrospective analysis was conducted on 164 PD patients who underwent IPG surgery at our hospital from August 2020 to February 2021.Patients were divided into two groups based on airway management:LMA group(n=61)and ETI group(n=103).Perioperative hemodynamic parameters,including mean arterial pressure(MAP)and heart rate(HR),were observed at five time points:pre-induction(T0),post-induction(T1),skin incision(T2),extubation(T3),and post-anesthesia care unit(PACU)admission(T4).Key outcomes,such as extubation time,intraoperative hypoxia events,LMA-to-ETI conversion rate,and postoperative complications(respiratory depression,pneumonia),were compared between the two groups.Results The LMA group had a significantly lower body mass index than the ETI group[(22.75±3.11)kg/m2 vs(23.85±3.49)kg/m2,P=0.039],while the other baseline characteristics were comparable.After induction,the LMA group exhibited a less decrease in MAP[(85.46±11.63)mmHg vs(74.13±11.78)mmHg in the ETI group,P<0.001].At extubation,the ETI group showed higher MAP[(98.27±13.78)mmHg vs(89.66±10.50)mmHg in the LMA group,P<0.001].The intraoperative use of vasoactive drugs was significantly lower in the LMA group(3.3%)than that in the ETI group(13.6%,P=0.032).The mean extubation time was shorter in the LMA group[(8.43±5.25)min vs(14.28±7.66)min in the ETI group,P<0.001].No intraoperative hypoxia or LMA-to-ETI conversion events occurred in either group.Postoperative respiratory depression and pneumonia rates showed no statistically significant differences between the groups.Conclusion LMA general anesthesia can be safely applied in PD patients undergoing DBS IPG implantation.It shortens extubation time,reduces the use of vasoactive drugs,and does not increase the risk of intubation-related complications.