Valvular heart disease(VHD)is a common type of heart disease in adults,with approximately 80 000 VHD surgeries performed annually in China.As the population ages,the number of VHD patients is expected to further increase.To standardize perioperative management of VHD surgeries and improve patient survival and quality of life,the Cardiovascular Anesthesia Committee of the Chinese Society of Cardiothoracic and Vascular Anesthesiology,in collaboration with the Professional Committee of Anesthesiology,National Expert Committee for Cardiovascular Diseases and Anesthesiology Branch of Beijing Medical Association organized a multidisciplinary expert panel develop current consensus.Following the principles and standards for developing clinical practice guidelines,the panel formulated the expert consensus on perioperative management of adult valvular heart disease surgery(2025).This consensus addresses 6 key clinical aspects of adult VHD surgery:preoperative evaluation,perioperative monitoring,intraoperative management,blood conservation,perioperative analgesia,and perioperative management of transcatheter valve intervention.Based on the best available evidence and expert consensus,21 recommendations are formulated to guide perioperative management in VHD surgeries in China.

Valvular heart disease(VHD)is a common type of heart disease in adults,with approximately 80 000 VHD surgeries performed annually in China.As the population ages,the number of VHD patients is expected to further increase.To standardize perioperative management of VHD surgeries and improve patient survival and quality of life,the Cardiovascular Anesthesia Committee of the Chinese Society of Cardiothoracic and Vascular Anesthesiology,in collaboration with the Professional Committee of Anesthesiology,National Expert Committee for Cardiovascular Diseases and Anesthesiology Branch of Beijing Medical Association organized a multidisciplinary expert panel develop current consensus.Following the principles and standards for developing clinical practice guidelines,the panel formulated the expert consensus on perioperative management of adult valvular heart disease surgery(2025).This consensus addresses 6 key clinical aspects of adult VHD surgery:preoperative evaluation,perioperative monitoring,intraoperative management,blood conservation,perioperative analgesia,and perioperative management of transcatheter valve intervention.Based on the best available evidence and expert consensus,21 recommendations are formulated to guide perioperative management in VHD surgeries in China.

The gut microbiota is generally thought in regulating the body's metabolism and immune function.The imbalance of gut microbiota is related to the occurrence and development mechanisms of acute and chronic lung dis-eases,resulting from lung injury.The"gut-lung axis"pays a main role in various ways in the occurrence of lung injury,including intestinal barrier dysfunction,reduced diversity of gut microbiota,decreased secretion of beneficial metabolites,translocation of gut microbiota and metabolites to the lungs,immune damage to the body and lungs,increased inflammatory response in the lungs.

In the field of standardized residency training for anesthesiologists in China, there is currently a lack of a formative evaluation system targeting the clinical competencies of residents. By searching the domestic and international literature on the application of the Milestones Evaluation System in standardized residency training of anesthesiologists, this article comprehensively reviews the background of competency-based medical education, the construction and development of the ACGME Milestones System in the United States, the design and establishment of Milestones Evaluation System in China, the application of Milestones Evaluation System in anesthesiology, and the issues that need to be noted in the implementation process. This review provides a useful reference for the application and promotion of Milestones Evaluation System in standardized residency training of anesthesiologists in China.

Objective:To develop college students' proactive aggression questionnaire (CPAQ) and test its reliability and validity.Methods:From March 2023 to April 2024, a questionnaire survey was conducted among 1 552 college students(618 individuals in Sample 1, 783 individuals in Sample 2, 151 individuals in Sample 3 (retested after a 6-month interval), and 49 individuals in Sample 4 (randomly selected from Sample 3)).The reliability and validity of CPAQ were assessed using SPSS 24.0 and Mplus 8.3 software through item analysis, exploratory factor analysis, confirmatory factor analysis, internal consistency reliability, test-retest reliability, compatibility validity, discriminant validity, and empirical validity.Results:The results of the project analysis showed that the 33 items in the CPAQ were significantly correlated with the total score( r=0.25-0.78, P<0.05), and item scores between the high and low group were significantly different (all P<0.001). Exploratory factor analysis retained 28 items, which belonged to three dimensions of proactive aggression (instrumental motivation, moral inhibition, and moral disengagement). The results of confirmatory factor analysis showed that the three-dimensional model of the questionnaire was well fitted ( χ2/ df=3.25, CFI=0.96, TLI=0.95, RMSEA=0.05, SRMR=0.06). The Cronbach's α coefficients for the total score of CPAQ and its sub dimensions were 0.93, 0.95, 0.89 and 0.75, respectively(all P<0.05). The test-retest reliability was 0.64, 0.63, 0.67 and 0.60, respectively(all P<0.01). In the compatibility validity test, the instrumental motivation dimension score was positively correlated with the proactive aggression dimension score of reactive-proactive aggression questionnaire(RPQ)( r=0.50, P<0.05), while moral inhibition dimension was negatively correlated with empathy and guilt scores( r=-0.30, -0.39, P<0.05). The dimension of moral disengagement was positively correlated with the score of the moral disengagement scale( r=0.58, P<0.05). In the discriminant validity test, the correlation of CAPQ and RPQ reactive aggression dimension score was not significant( r=0.08, P=0.16). In the criterion related validity test, the correlation coefficients between the score of CAPQ and each calibration questionnaire and scale were 0.70-0.83. In the empirical validity test, there was a significant difference in the different CPAQ score groups for proactive aggressive behavior(high group: (1.16±0.18), low group: (1.04±0.08), t=2.60, P<0.05). Conclusion:CPAQ has good discrimination, reliability, and validity, which could be used as a tool to measure proactive aggressive behavior among college students.

Objective This study aims to investigate the current status of burnout among anesthesi-ology residents,and to explore its influencing factors and potential interventions.Methods A total of 2 651 practicing anesthesiology residents from 218 hospitals nationwide were included in this study.Demographic characteristics,occupational features,and psychological resilience scores(Connor-Davidson resilience scale)were collected using a questionnaire distributed electronically.The Maslach burnout inventory-human service survey(MBI-HSS)was used to assess burnout.A comparison between groups with and without occu-pational burnout was conducted.Multiple logistic regression analysis was used to identify risk factors for burnout among anesthesiology residents.Results Out of the expected 2 651 questionnaires,1 990 valid responses were received(response rate 77.7%).The prevalence of burnout among the residents was 53.4%(1 063/1 990).Compared with residents without occupational burnout,those with burnout had a signifi-cantly higher proportion of females,working in tertiary hospitals,unmarried individuals,frequency of en-countering challenging patients,participating in on-call duty,and research tasks,and had a significantly lon-ger weekly working hours(P＜0.05).Multivariate logistic regression analysis indicated that female(OR = 1.58,95%CI 1.28-1.97,P＜0.01),longer working hours(OR = 1.62,95%CI 1.45-1.81,P＜0.01),and higher frequency of encountering challenging patients(OR = 1.11,95%CI 1.11-1.40,P＜0.01)were risk factors for occupational burnout.High levels of psychological resilience was protective factor against burnout(OR = 0.86,95%CI 0.84-0.88,P＜0.01).Conclusion The occurrence of burnout among anesthesiology residents is high.It is crucial to focus on and design practical preventive measures to en-hance psychological resilience,ensuring healthy physical and mental development of the resident community.

Postoperative nausea and vomiting(PONV)is a common complication of general anes-thesia.PONV makes negative influence on recovery and prolongs hospital stays.In addition toantiemetic prophylaxis,electrical acupoint stimulation(EAS)has been widely applied in clinical scenario and signifi-cantly reduces PONV incidence,but its mechanism,stimulation parameters,and combined efficacy with pharmacological strategy remain unclear.This article reviews the stimulation parameters,efficacy,safety,and mechanism of EAS for PONV prevention.This review aims to provide insights for future studies.

Objective To explore the practice and significance of the new course of"Enhanced Recovery after Sur-gery(ERAS)and Perioperative Management"for graduate students under multidisciplinary cooperation.Methods The Department of Anesthesiology collaborated with the Department of Clinical Nutrition,Department of Geriatrics and six related surgical departments to develop a course of 30 credit hours on"ERAS and Perioperative Manage-ment"in Peking Union Medical College Hospital.Researchers analyzed the teaching effectiveness of the course by collecting survey questionnaires and evaluating scheme report of ERAS case.Results Researchers found that ten graduates joined this course and they believed that learning improved their understanding of ERAS related knowl-edge,such as preoperative nutrition and functional state optimization,intraoperative volume and temperature man-agement,prevention of postoperative nausea and vomiting,and perioperative pain management.Students had high satisfaction with the course and believed that it would help improve their clinical literacy.Conclusions The new course of"ERAS and Perioperative Management"for graduates may support capacity building in terms of clinical logic and thinking about ERAS and promotion of skills for perioperative management.Our experience of graduates′training with"Enhanced Recovery after Surgery and Perioperative Management"course can be shared by other trainers of health institution of China.

  Objective  This study aimed to investigate Chinese anesthesiologists' comprehension of palliative care and their experiences with palliative sedation for patients in the end-stage of life.  Methods  From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The survey questionnaire encompassed general information, professional experience, familiarity with palliative care, emotional responses to end-stage cases, experience with sedation for critically ill or end-stage patients, and preferences for sedation medication.  Results  A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. Among them, 572 anesthesiologists(22.6%, 572/2536) reported familiarity with palliative medicine. Male anesthesiologists, as well as those with prior experience in caring for critically ill or end-stage patients, involved in pain management and practicing in hospitals with established institutional palliative care teams, demonstrated greater familiarity with palliative care concepts(all P<0.05). Over 40% of respondents felt powerless, helpless, and indecisive when confronted with end-stage patients. Anesthesiologists knowledgeable about palliative care exhibited greater confidence in managing critically ill or end-stage patients(9.8% vs. 4.4%, P=0.001). Among the anesthesiologists surveyed, 734 had administered sedation to end-stage patients, with 151 of them(20.6%, 151/734) inappropriately relying solely on opioids for sedation.  Conclusions  The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China is still very limited. The establishment of palliative care teams, provision of education and training in palliative care, and enhancement of familiarity with palliative principles may bolster anesthesiologists' confidence when encountering critically ill or end-stage patients and subsequently enhance the quality of care for patients in the terminal stages of life.

Postoperative pain seriously affects the recovery process of patients, resulting in prolonged hospital stay and increased care costs. Appropriate application of patient-controlled analgesia devices can effectively relieve perioperative acute pain. In 1994 patient-controlled analgesia began to be used in Peking Union Medical College Hospital, and the Acute Pain Service Working Group was established in 2004. With the cooperation of anesthesiologists and specialist nurses, the group jointly has implemented the whole process and standardized management based on patient-controlled analgesia, and constantly improved and innovated working methods, laying a solid foundation for the development of postoperative pain management. This paper systematically reviews and summarizes the work from the aspects of clinical focus, nursing management experience, promotion and dissemination of pain treatment concepts, and development of acute pain service model under the new situation, with the hope of providing valuable reference for comprehensively strengthening pain management in the process of diagnosis and treatment, and enhancing patients' satisfaction with perioperative analgesia services.