Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

In recent years, with the gradual and extensive application of digital medical treatment in the field of medica anesthesia, its role in the postoperative pain management of children has attracted increasing attention. It provides new ideas for the preoperative prediction, postoperative monitoring and evaluation, and treatment management of postoperative pain in children, as well as a new scheme for anesthesiologists to formulate the best postoperative pain management strategy for children. This article reviews digital medical treatment and its application in clinical anesthesia, and reviews the application prospects of this therapy in postoperative pain in children, in order to deepen clinicians' knowledge.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.

Objective:To investigate the current status of standardized training of pediatric anesthesiologists in different regions of China and the feedback from trainees on the training process and results.Methods:In this retrospective cross-sectional study based on the data of the national survey in 2022, a questionnaire survey was conducted among the anesthesiologists who had received specialized training in 39 training bases for pediatric anesthesia in China, and based on the report of National Bureau of Statistics, China was divided into four regions for analytical purposes. IBM SPSS Statistics 25 was used to perform statistical analyses, and the Kruskal-Wallis H test was used for comparison of continuous data and ranked data between multiple groups. Results:A total of 174 questionnaires were collected, among which there were 155 valid questionnaires (89.08%). Most individuals participating in the specialized training were married women aged 31-35 years, and they mainly held a master's degree and worked at a comprehensive grade A tertiary hospital before training, with a registered specialty of surgery. As for the supporting measures for specialized training, the working hours in the eastern region were significantly shorter than those in the central region ( P=0.033), while the hourly wage in both the central and eastern regions was significantly higher than that in the northeast region ( P=0.005). As for the degree of satisfaction with the assessment and management systems of the specialized training, compared with the northeastern region, the western region showed a significantly higher degree of satisfaction with the assessment of comprehensive clinical ability at the time of recruitment and the system operation of final theoretical assessment ( P=0.017 and 0.031). As for the degree of satisfaction with the completion of teaching activities of the specialized training, the northeast region showed a significantly higher degree of completion of 360-degree evaluation than the eastern region ( P=0.015), while compared with the northeast region, the western region showed significantly better performance in guaranteeing the teaching activities once a week ( P=0.003). In addition, the northeast region showed significantly better performance than the central region in terms of independent outpatient services ( P=0.034), while the western region showed significantly better results than the northeast region in the difficulty of final theoretical assessment and its consistency with the goals of specialized training ( P=0.046). As for the self-evaluation of physicians receiving specialized training, the western region showed a significantly higher self-evaluation of clinical thinking than the eastern region ( P=0.011). Conclusions:There are certain differences in the supporting measures, management systems, and teaching contents of specialized training and self-evaluation by physicians receiving specialized training. This feedback can enhance the exchange and learning across different regions of China, promote the quality of specialized training, and improve the degree of satisfaction among physicians receiving specialized training.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.

Objective:To investigate the current status of standardized training of pediatric anesthesiologists in different regions of China and the feedback from trainees on the training process and results.Methods:In this retrospective cross-sectional study based on the data of the national survey in 2022, a questionnaire survey was conducted among the anesthesiologists who had received specialized training in 39 training bases for pediatric anesthesia in China, and based on the report of National Bureau of Statistics, China was divided into four regions for analytical purposes. IBM SPSS Statistics 25 was used to perform statistical analyses, and the Kruskal-Wallis H test was used for comparison of continuous data and ranked data between multiple groups. Results:A total of 174 questionnaires were collected, among which there were 155 valid questionnaires (89.08%). Most individuals participating in the specialized training were married women aged 31-35 years, and they mainly held a master's degree and worked at a comprehensive grade A tertiary hospital before training, with a registered specialty of surgery. As for the supporting measures for specialized training, the working hours in the eastern region were significantly shorter than those in the central region ( P=0.033), while the hourly wage in both the central and eastern regions was significantly higher than that in the northeast region ( P=0.005). As for the degree of satisfaction with the assessment and management systems of the specialized training, compared with the northeastern region, the western region showed a significantly higher degree of satisfaction with the assessment of comprehensive clinical ability at the time of recruitment and the system operation of final theoretical assessment ( P=0.017 and 0.031). As for the degree of satisfaction with the completion of teaching activities of the specialized training, the northeast region showed a significantly higher degree of completion of 360-degree evaluation than the eastern region ( P=0.015), while compared with the northeast region, the western region showed significantly better performance in guaranteeing the teaching activities once a week ( P=0.003). In addition, the northeast region showed significantly better performance than the central region in terms of independent outpatient services ( P=0.034), while the western region showed significantly better results than the northeast region in the difficulty of final theoretical assessment and its consistency with the goals of specialized training ( P=0.046). As for the self-evaluation of physicians receiving specialized training, the western region showed a significantly higher self-evaluation of clinical thinking than the eastern region ( P=0.011). Conclusions:There are certain differences in the supporting measures, management systems, and teaching contents of specialized training and self-evaluation by physicians receiving specialized training. This feedback can enhance the exchange and learning across different regions of China, promote the quality of specialized training, and improve the degree of satisfaction among physicians receiving specialized training.

Objective To investigate the effect of age,gender,weight and UGT1A4142T>G gene poly-morphism on the efficacy of LTG in epileptic children treated with valproic acid ,and to determine the effective se-rum concentration of LTG in children with epilepsy in south China. Methods A total of 72 pediatric patients with epilepsy received LTG and VPA treatments were enrolled in this study. Patients were treated from January 2010 to September 2016 in Guangzhou women and childrens′medical center. Serum concentration of LTG was measured by using the liquid chromatography-tandem mass spectrometry. UGT1A4142T > G was genotyped by the polymerase chain reaction-restriction fragment length polymorphism method. The correlations between the efficacy of LTG and age,gender,weight were analyzed by chi-square test,non-parametric test and logistic regression analysis,respec-tively. Results The curative effect of patients who were younger and with lighter weight were relatively poor ,and men were better than women in the curative effect. UGT1A4142T > G was not related with LTG efficacy. When combined with VPA,the effective serum concentration of LTG in children with epilepsy was more than 2 g/mL. Conclusion There is a good correlation between age and LTG curative effect. The effective serum concentration of LTG in children with epilepsy,who were co-treated with VPA,was more than 2 g/mL. This study provides a refer-ence for the individual administration of children with epilepsy in south China.

OBJECTIVE:To investigate the effects of UGT1A4142T>G polymorphism and blood concentration of valproic ac-id(VPA)on blood concentration of lamotrigine(LTG)in southern Chinese Han children with epilepsy,and to establish the predic-tion equation for quantitatively estimating blood concentration of LTG. METHODS:A total of 72 southern Chinese Han children with epilepsy selected from Guangzhou Women and Children's Medical Center during Jan. 2010-Sept. 2016 were given LTG+VPA. LC-MS/MS and enzyme amplified immunoassay were adopted to determine the blood concentration of LTG and VPA. RFLP-PCR was adopted to determine UGT1A4142T>G polymorphism. The relationships of age, gender, blood concentration of VPA, UGT1A4142T>G polymorphism and LTG concentration-to-dose-ratio (CDR) were also investigate. The prediction equation for blood concentration of LTG was established by multiple linear regression analysis. RESULTS:Age and blood concentration of VPA were positively related to CDR of LTG(r=0.225,0.300,P<0.05);there was no statistical significance in the influence of gender on CDR of LTG(P>0.05). UGT1A4 TT,TG and GG genotypes were detected in 39,29,and 4 cases respectively;the frequencies of each genotype were in line with the Har-dy-Weinberg balance(P>0.05). CDR of LTG of TT genotype was significantly lower than those of TG and GG genotype,with sta-tistical significance(P<0.05). Results of multiple linear regression analysis showed that the dose of LTG(x1),body weight(x2), blood concentration of VPA(x3)and UGT1A4142T>G polymorphism(x4)were all related to blood concentration of LTG(P<0.05). Using blood concentration of LTG(c)as dependent variable,above factors as independent variable,the regression equation was c=0.794+0.032x1-0.057x2+0.010x3+0.532x4(R2=0.616,P<0.05;UGT1A4 TT genotype was equal to 0,TG and GG genotype was equal to 1). There was a strong positive correlation between predicted blood concentration and measured ones(r=0.785,P=0.001). CONCLUSIONS:The dose of LTG,body weight,blood concentration of VPA and UGT1A4142T>G polymorphism may associated with blood concentration of LTG. Established prediction equation can provide reference for precise medication in south-ern Chinese Han children with epilepsy.

Objective To compare the experience of perioperative management and anesthesia in VHL syndrome and non-VHL patients undergoing pheochromocytoma resection .Methods 50 patients scheduled for surgical removal of pheochromocytoma in PUMC Hospital from 2009-01-01 to 2014-12-31 were included in this retrospective analysis . Among them,12 patients were diagnosed with VHL syndrome ,others were non-VLH patients.We focused on the clini-cal records , especially clinical manifestation , preoperative preparation , intraoperative anesthetic management , opera-tion duration and postoperative hospital stay .Results Comparing with non-VHL patients , VHL syndrome patients undergoing pheochromocytoma resection surgery were much younger , with multiple pheochromocytoma and a signifi-cantly increased norepinephrine release .The drug preparation period was much longer , as well as the operative time and hospital stay (P<0.05).But no statistical difference existed in the intraoperative hemodynamic fluctuation and the outcomes of the patients .Conclusions VHL syndrome patients mainly present with multiple pheochromocytoma which has more aggressive function .Since the long operation duration and high risk , the optimization of perioperative management and adequate drug preparation are the key factors to ensure the operation safety .