Objective To explore the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for sedation in elderly patients undergoing ultrasound-guided transperineal prostate biopsy.Methods Forty-nine elderly male patients,aged 65-75 years,BMI 18.5-30.0 kg/m2,ASA physical stutas Ⅰ-Ⅲ,who underwent ultrasound-guided transperineal prostate biopsy,were randomly as-signed into the esketamine-ciprofol group(group E,n=23)and the ciprofol group(group C,n=26).After intravenous administration of sufentanil 0.1 μg/kg,patients in group E received esketamine 0.2 mg/kg,while patients in group C received the same volume of normal saline.The up-and-down sequential allocation method was used to calculate the effective dose of ciprofol.The initial dose of ciprofol was 0.2 mg/kg in group E and 0.3 mg/kg in group C,and the dose gradient was 0.05 mg/kg for both groups.If there was no body movement during the first puncture of prostate after the loss of eyelash reflex,the ciprofol dose in the next patient was reduced by 0.05 mg/kg.Otherwise,the ciprofol dose in the next patient was in-creased by 0.05 mg/kg.The study was completed until 7 inflection points alternating between non-body movement and body movement achieved.The total amount of ciprofol,surgical time,recovery time,stay in recovery room,hypotension,bradycardia,respiratory depression,injection pain,nausea and vomiting,and adverse reaction of the mental system were recorded.The Probit method was used to calculate the ED50 and 95%effective dose(ED95)with 95%confidence interval(CI)of ciprofol for inhibition of body movement.Results Compared with group C,the total amount of ciprofol in group E was significantly reduced(P＜0.05).There were no significant differences between the two groups in surgical time,recovery time,stay in recovery room,and adverse events.The ED50 of ciprofol in group E was 0.22 mg/kg(95%CI 0.19-0.26 mg/kg),and the ED50 in group C was 0.38 mg/kg(95%CI 0.31-0.46 mg/kg).Compared with group C,the ED50 in group E was significantly reduced(P＜0.05).The ED95 of ciprofol in group E was 0.28 mg/kg(95%CI 0.25-0.49 mg/kg),and the ED95 in group C was 0.51 mg/kg(95%CI 0.44-1.25 mg/kg).Compared with group C,the ED95 in group E was significantly reduced(P＜0.05).Conclusion The ED50 of ciprofol for inhibition of body movement in elderly patients undergoing ultrasound-guided transperi-neal prostate biopsy was 0.38 mg/kg,which was reduced to 0.22 mg/kg by using lose-dose esketamine 0.2 mg/kg as an adjuvant.

Objective:To investigate the effect of bupivacaine liposome for erector spinae plane block on the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.Methods:From July 2023 to January 2024, 128 American Society of Anesthesiologists Physical Status classification ⅠorⅡ patients of either sex, aged 18-75 yr, with body mass index of 18-32 kg/m 2, scheduled for elective thoracoscopic lung resection at the First Affiliated Hospital of Soochow University, were assigned to either bupivacaine liposome group (BL group) or bupivacaine hydrochloride group (BH group) using a random number table method, with 64 patients in each group. Patients received an ultrasound-guided erector spinae plane block following anesthesia induction. BL group received an injection of bupivacaine liposome 20 ml (266 mg) plus normal saline 10 ml, while BH group received an injection of bupivacaine hydrochloride 20 ml (100 mg) plus normal saline 10 ml. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the QoR-15 score at 3 days postoperatively, time to first patient-controlled analgesia press, and total opioid consumption within the first 3 days postoperatively. Other outcomes assessed were the time to ambulation, duration of chest tube placement, length of hospital stay, patient satisfaction scores at discharge, and development of adverse reactions during hospitalization. Results:Compared to BH group, QoR-15 scores were significantly increased at 24 h and 3 days postoperatively, the time to first patient-controlled analgesia press was significantly prolonged, the consumption of opioid was reduced within the first 3 days postoperatively, the time to ambulation was shortened, and patient satisfaction scores at discharge were increased in BL group ( P<0.05). There were no statistically significant differences between the two groups in terms of the chest tube duration, length of hospital stay, and incidence of adverse reactions during hospitalization ( P>0.05). Conclusions:Bupivacaine liposome for erector spinae plane block can improve the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.

Objective:To identify the effective concentrations of Ropivacaine in the modified fascial iliac compartment block(FICB)that would not affect the movement of the affected limb but would offer effective pain relief after total knee arthroplasty(TKA)in elderly patients.In addition, adverse reactions within 24 hours of FICB were examined.Methods:This study was a prospective, single-arm sequential trial.Forty-five elderly patients treated with TKA at the First Affiliated Hospital of Soochow University between September 2021 and March 2022 were selected, with an American Society of Anesthesiologists(ASA)score of Ⅰ or Ⅱ.All patients were given ultrasound-guided FICB on the surgical side under general anesthesia and 10 minutes before the operation, and the injection volume was 30 ml.According to preliminary experiments and relevant literature, the initial concentration of Ropivacaine was 0.1%, and the concentration for the next patient was determined using a modified Dixon sequential method.If the quadriceps femoris muscle strength score of the first patient was ≥4, there was no resting pain[visual analogue scale(VAS)score ≤1], and the VAS score during activity was ≤3, the concentration for the next patient would be reduced.Conversely, the concentration would be increased.The Ropivacaine concentration was increased or decreased by 0.01% each time and the trial would be stopped after 12 reentries.The median effective concentration(ED50), 95% effective concentration(ED95)and corresponding 95% confidence interval(CI)of ropivacaine were calculated using the probit model.Meanwhile, adverse reactions within 24 hours of FICB were monitored.Results:Of 43 elderly patients who completed the trial, the intervention was effective in 23 and ineffective in 20.While ensuring that postoperative limb movement in elderly patients was not affected, a single injection of 30 ml ropivacaine through FICB was able to effectively inhibit postoperative pain, and the ED50 and ED95 of ropivacaine were 0.072%(95% CI: 0.065%-0.078%)and 0.093%(95% CI: 0.084%-0.124%), respectively.Within 24 hours of FICB, 2 patients had lower limb weakness and could not get out of bed and walk, and 5 patients had severe pain and needed additional analgesics.No other adverse reactions were found. Conclusions:The effective ED50 and ED95 of Ropivacaine for postoperative pain relief in elderly patients after TKA are 0.072% and 0.093%, respectively.And the incidence of adverse reactions is low.

【Objective】 To investigate the correlation between perioperative zero red blood cell(RBC) transfusion and the prognosis of patients with acute Stanford type A aortic dissection. 【Methods】 A retrospective analysis was made on 96 patients who underwent one-stop Hybrid surgery for acute Stanford type A aortic dissection in our hospital from May 2021 to May 2022. The patients were divided into two groups according to whether they received perioperative RBC transfusion: zero RBC transfusion group (group A, n=26) and RBC transfusion group (group B, n=70). The preoperative general data and laboratory indexes were recorded and the propensity score matching method was used to screen the patients with the same preoperative baseline data, with comparison of operation-related indicators, intraoperative and postoperative blood component dosage and prognostic indicators. 【Results】 With BMI index, hemoglobin, platelet count, and troponin T as co variables, 48 patients were included in the study after matching according to 1∶1 propensity score: Group A (n=24) and Group B (n=24). Compared with group A, hemoglobin and hematocrit in group B decreased significantly at the end of operation and 24 h after operation, with a statistically significant difference (P<0.05). There was no significant difference between the two groups in operation-related indicators, intraoperative and postoperative blood component dosage, in-hospital mortality, continuous renal replacement therapy, incidence of infection and cerebral infarction (P>0.05). 【Conclusion】 The perioperative hemoglobin of patients with acute Stanford type A aortic dissection with zero RBC transfusion did not significantly decrease, and the postoperative complications and mortality did not increase.

【Objective】 To investigate the effects of dexmedetomidine (DEX) intervention on the expressions of chondrocytes and related factors in vitro and its possible molecular mechanisms. 【Methods】 C28/I2 normal human chondrocyte lines were cultured in vitro, and dexmedetomidine at the concentration of 1 μmol/L was selected to intervene for 24 h and 48 h, respectively. The morphology and cell density of chondrocytes were observed after DEX culture at different time points. Immunofluorescence technique was used to detect the expression levels of disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) in chondrocytes in each group. The expression levels of Adamts5, aggrecan (Acan), versican (Vcan), Furin, proprotein convertase subtilisin/kexin type 6 (Pcsk6), collagen type Ⅰ alpha 1 (Col1a1), collagen type Ⅱ alpha 1 (Col2a1), collagen type X alpha 1 (Col10a1), and SRY2 related high mobility group box gene9 (Sox9) were detected by RT-PCR. Adamts5 gene knockout chondrocytes were constructed by lentivirus transfection technology and treated with DEX; RT-PCR was used to detect the effects of DEX on the expression levels of Acan, Vcan, Furin, Pcsk6 and Sox9 after Adamts5 gene knockout. 【Results】 After 24 and 48 h of intervention with 1 μmol/L DEX, the morphology and size of chondrocytes did not change significantly, but the cell density increased slightly. Immunofluorescence assay showed that the expression of ADAMTS5 increased at first and then decreased after DEX treatment for 24 and 48h, respectively (P=0.032). RT-PCR results showed that with the extension of intervention time, the expression of Adamts5 first increased and then decreased. The expression difference between 48 and 24 h after culture was statistically significant (P=0.032). The change trend of Pcsk6 was the same as that of Adamts5, while the change trend of Acan expression was opposite that of Adamts5. Chondrocytes knocked out Adamts5 gene and intervened with DEX for 24 and 48 h. The results of RT-PCR showed that the expression of Pcsk6 decreased while that of Acan increased and the changes were significant. 【Conclusion】 Dexmedetomidine may activate ADAMTS5 zymogen through Pcsk6, thereby promoting proteoglycan degradation in chondrocytes.

Background::Whether anesthetic depth affects postoperative outcomes remains controversial. This meta-analysis aimed to evaluate the effects of deep vs. light anesthesia on postoperative pain, cognitive function, recovery from anesthesia, complications, and mortality. Methods::PubMed, EMBASE, and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients. The co-primary outcomes were postoperative pain and delirium (assessed using the confusion assessment method). We conducted a meta-analysis using a random-effects model. We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression. We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results::A total of 26 trials with 10,743 patients were included. Deep anesthesia compared with light anesthesia (a mean difference in bispectral index of -12 to -11) was associated with lower pain scores at rest at 0 to 1 h postoperatively (weighted mean difference = -0.72, 95% confidence interval [CI] = -1.25 to -0.18, P= 0.009; moderate-quality evidence) and an increased incidence of postoperative delirium (24.95% vs. 15.92%; risk ratio = 1.57, 95% CI = 1.28-1.91, P < 0.0001; high-quality evidence). No publication bias was detected. For the exploratory secondary outcomes, deep anesthesia was associated with prolonged postoperative recovery, without affecting neurocognitive outcomes, major complications, or mortality. In the subgroup analyses, the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively, without statistically significant subgroup differences, and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries, without statistically significant subgroup differences. Conclusions::Deep anesthesia reduced early postoperative pain but increased postoperative delirium. The current evidence does not support the use of deep anesthesia in clinical practice.

Objective:To explore the postoperative analgesic effect of Dexmedetomidine on elderly patients with colorectal cancer under the guidance of the concept of rapid recovery after surgery.Methods:A total of 230 elderly patients with colorectal cancer who underwent laparoscopic surgery in our hospital from March 2018 to September 2020 were randomly divided into an observation group(receiving Dexmedetomidine auxiliary general anesthesia, n=115)with aged(66.6±4.6)years, male 59, and control group(receiving normal saline auxiliary general anesthesia, n=115), with aged(67.0±4.6)years, male 61.The analgesic effect, hemodyna mic index, postoperativeout of bed activity time, gastrointestinal fuction recovery time postoperative hospital stay and adverse reactions were observed.Results:The pain scores at 4, 8, 12, 24 and 48 h after operation were lower in the observation group than in control group(all P<0.05). The recovery rate of postoperative analgesic drugs was 13.9% in the observation group and 24.3% in the control group( χ2=4.047, P<0.05). Ramesay scores were higher in the observation group than in the control group( P<0.05). Fluctuations of postoperative heart rate and blood pressure were lower in the observation group than in the control group( P<0.05). The total incidence of adverse reactions was lower in the observation group(11.3%)than in the control group(24.3%)( χ2=6.678, P<0.05). Conclusions:Under the guidance of the concept of rapid recovery after surgery, Dexmedetomidine can improve the postoperative analgesic effect in elderly patients with colorectal cancer, reduce the incidence of adverse reactions, and have stable hemodynamics.

Objective:To investigate the effects of Dexmedetomidine on postoperative pain and stress response in elderly patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 150 elderly patients who had undergone laparoscopic radical resection of colorectal cancer in our hospital from June 2019 to December 2020 were divided into two groups using the random number table method, the control group(n=75)and the study group(n=75). In the study group, Dexmedetomidine 0.5 μg/kg was injected intravenously over 10 min before induction of anesthesia and maintained at 0.5 μg/kg/h until 30 min before the end of surgery.Changes in heart rate, mean arterial pressure, postoperative pain and stress response index scores were compared between the two groups.Results:The MAP and HR in the study group at T1(10 min after administration), T2(immediately after endotracheal intubation), T3(30 min after pneumoperitoneum)and T4(leaving the operating room)were significantly lower than in the control group( P<0.05); The concentrations of norepinephrine and epinephrine in the study group were lower than those in the control group at T2, T3 and T4(all P<0.05); Pain scores of patients in the study group were lower than those in the control group at T4 and T5( P<0.05); Compared with the control group, the study group used less intraoperative Sufentanil[(65.5±7.0)μg vs.(76.2±7.6)μg, t=8.968, P=0.000], needed a lower number of PCIA compressions 24 h after surgery[(6.3±2.3) vs.(9.5±3.0), t=7.331, P=0.000]and had a shorter length of PACU stay[(23.4±4.0)min vs.(30.2±5.7)min, t=8.457, P=0.000]. Conclusions:Dexmedetomidine used in laparoscopic colorectal cancer surgery in elderly patients can reduce the use of sufentanil and the length of PACU stay time, improve postoperative pain scores and reduce stress response, and therefore should be recommended.

Objective:To construct a Soochow University model of comfortable medical procedures during peri-anesthesia period for patients undergoing radical resection of lung cancer through thoracoscope.Methods:In this prospective study, eight hundreds and sixty patients undergoing radical resection of lung cancer through thoracoscope were enrolled in our hospital in 2018.During peri-anesthesia period, the 860 patients were randomly(by the random number table method)divided into the control group(the group C receiving routine medical procedures, n=430)and the comfort group(the group S receiving the comfortable medical procedures of Soochow University model, n=430). The scores of Visual Analogue Scale(VAS), Richmond Agitation-Sedation Scale(RASS), and Thirsty Analogue Scale(TAS)were recorded at 5 min after extubation(T1), at out of the post-anesthesia care unit(T2), at 1 h(T3), 6 h(T4), 12 h(T5), 24 h(T6), 2 d(T7)and 3 d after surgery(T8)in two groups.The incidences of postoperative sore throat(POST), nausea and vomiting(PONV), catheter-related bladder discomfort(CRBD), thirst and hypothermia were recorded at T2, T6 and T8, respectively.Meanwhile, the peri-anesthesia comfort questionnaire(PCQ)and peri-anesthesia satisfaction questionnaire(PSO)were completed at T6 and T8.Results:The incidences of POST(48.6% vs.16.2%), PONV(24.9% vs.13.0%), CRBD(78.8% vs.20.9%)and thirst(74.9% vs.20.0%)were higher in the group C than in the group S at T2( P<0.05). The comfort score and satisfaction score were lower in the group C than in the group S at T6(3.14±1.04 vs.4.92±1.42, 2.67±0.89 vs.3.30±1.01)and at T8(3.84±1.83 vs.5.05±1.77, 2.74±0.84 vs.3.26±1.06)( P<0.05). Conclusions:The Soochow University model of comfortable medical procedures during peri-anesthesia period for patients undergoing radical resection of lung cancer through thoracoscope has been successfully constructed, and this model can reduce the incidence of complications, and improve the comfort and satisfaction during peri-anesthesia period.

Objective:To evaluate the sedative effect of remimazolam for induction of general anesthesia in elderly patients.Methods:One hundred patients of both sexes, aged 65-75 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective general anesthesia requiring tracheal intubation, were divided into 4 groups ( n=25 each) using a random number table method: propofol group (group P) and three different doses of remimazolam groups (group R1, group R2 and group R3). In group P, general anesthesia was induced with propofol 1.5 mg/kg intravenously injected over 30 s, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when bispectral index (BIS) value ≤ 60, and endotracheal intubation was performed.In R1, R2 and R3 groups, general anesthesia was induced with 0.2, 0.3 and 0.4 mg/kg of remimazolam intravenously injected over 30 s, respectively, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when BIS value ≤ 60, and endotracheal intubation was performed.When the BIS value was > 60 during the induction of anesthesia, propofol 0.5 mg/kg was intravenously injected per time for rescue sedation in group P, and remimazolam 0.05 mg/kg was intravenously injected per time for rescue sedation until the BIS value ≤ 60, with the interval between the two injections > 1 min in R1, R2, and R3 groups.The onset time of propofol or remazolam was recorded.The occurrence of hypertension, hypotension, bradycardia, hypoxemia, injection pain and rescue sedation during the induction of anesthesia was recorded.The occurrence of intraoperative awareness was recorded during follow-up at 1 day after surgery. Results:Compared with group P, the rate of rescue sedation was significantly increased in group R1, the incidence of hypoxemia was significantly reduced in R1 and R2 groups, the onset time was significantly prolonged, and the incidence of hypotension, bradycardia and injection pain was decreased in R1, R2 and R3 groups ( P<0.05). Compared with group R1, the rate of rescue sedation was significantly decreased in R2 and R3 groups ( P<0.05). Compared with R1 and R2 groups, the incidence of hypoxemia was significantly increased in group R3 ( P<0.05). There was no significant difference in the incidence of hypotension, hypoxemia and injection pain among R1 group, R2 group and R3 group ( P>0.05). No hypertension and intraoperative awareness was found in the four groups. Conclusion:Remimazolam can be safely and effectively used for sedation during induction of general anesthesia in elderly patients, and the optimal dose is 0.3 mg/kg.