Objective:To evaluate the optimization strategy of anesthesia for laparoscopic nephrectomy in elderly patients using ultrasound-guided erector spinae plane block combined with total intravenous anesthesia.Methods:This was a prospective randomized controlled study. Seventy elderly patients, aged 60-80 yr, with a body mass index of 22-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective/limited laparoscopic nephrectomy under total intravenous anesthesia in our hospital from April to October 2023, were divided into a total intravenous anesthesia group (TIVA group) and an ultrasound-guided erector spinae plane block combined with total intravenous anesthesia group (ESPB group) using a random number table method, with 35 cases in each group. Two groups used the same general anesthesia regimen. The ultrasound-guided erector spinae plane block was performed at the T 11 level after general anesthesia, and 0.3% ropivacaine 30 ml was injected after the successful puncture in ESPB group. The postoperative quality of recovery was assessed using the 15-item Quality-of-Recovery scale. The postoperative rescue analgesia and occurrence of adverse reactions were recorded. Results:Compared with TIVA group, the 15-item Quality-of-Recovery scale score was significantly increased, the rate of postoperative rescue analgesia was decreased, and the incidence of adverse reactions was decreased in ESPB group ( P<0.05). Conclusions:Ultrasound-guided erector spinae plane block combined with total intravenous anesthesia is beneficial for the postoperative outcomes of elderly patients undergoing laparoscopic nephrectomy.

Objective:To evaluate the effectiveness of ultrasound assessing the risk of gastric content aspiration in patients undergoing emergency abdominal surgery.Methods:This was a prospective self-control study. Seventy-three American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged >18 yr, who underwent emergency abdominal surgery in Beijing Daxing District People′s Hospital from June 2022 to December 2023, were selected. Time method assessment: The time and category of fasting and no-drinking were inquired, the patient′s gastric emptying status and risk of gastric content aspiration were assessed based on the time of fasting and no-drinking, and a preliminary anesthesia plan was formulated. Ultrasound method assessment: The properties of gastric contents were determined, the cross-sectional area of the gastric antrum was measured, the volume of gastric fluid was estimated, the Perlas grading of the gastric antrum was performed to assess the risk of gastric content aspiration, and a final anesthesia plan for implementation was formulated.Results:The number of patients with a high-risk of gastric content aspiration determined by the time method and ultrasound method was 2 cases (3%) and 11 cases (15%), respectively, with a statistically significant difference between the two methods ( P<0.05). The risk class of gastric content aspiration changed after ultrasound examination in 11 patients. One patient with a high risk determined by the time method was identified as having a low risk by the ultrasound method, and the other 10 patients with a low risk determined by the time method were identified as having a high risk by the ultrasound method. There was a statistically significant difference in the anesthesia induction plans formulated based on two methods ( P<0.05), while there was no statistically significant difference in the airway maintenance plans between the two methods ( P>0.05). Regurgitation of gastric contents occurred only in one case (1.4%), and no gastric content aspiration was found in any case. Conclusions:Preoperative gastric ultrasound examination can be used to assess the risk of gastric content aspiration and guide the formulation of anesthesia plans for the patients undergoing emergency abdominal surgery.

Objective To compare the sedative efficacy and safety of dexmedetomidine and sufen-tanil combined with propofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Sixty elderly patients from July to October 2022,aged 65-90 years,BMI 15-33 kg/m2,ASA physical status Ⅰ-Ⅲ,had normal cardiac function or NHYA grade Ⅰ or Ⅱ,underwent ERCP were enrolled.Patients were divided into two groups by random number table method:the dexmedeto-midine group(group D)and the sufentanil group(group S),30 patients in each group.Group D received an intravenous infusion of dexmedetomidine 0.5 μg/kg for 10 minutes followed by intravenous propofol 1 mg/kg for sedation induction.Group S received intravenous sufentanil 0.12 μg/kg followed by intravenous propofol 1 mg/kg for sedation induction.The operation time,total dosage of propofol,incidence of body movement were recorded.The lowest SpO2,use of airway interventions,incidence of hypoxemia were recor-ded.Adverse cardiovascular events(tachycardia,bradycardia,hypertension,hypotension,and arrhythmia)were recorded.Awakening time,VAS pain scores at rest 15 minutes after entering PACU,incidence of mod-erate to severe postoperative pain,and postoperative nausea and vomiting in PACU were recorded.Results Adequate deep sedation was successfully achieved in the two groups(Ramsay scale≥5 scores).Compared with group S,the lowest SpO2 and bradycardia were significantly increased(P＜0.05),the use of airway interventions,hypoxemia,tachycardia,and hypotension were significantly decreased in group D(P＜0.05).There were no significant differences in operation time,total dosage of propofol,incidence of body movement,hypertension,VAS pain scores at rest 15 minutes after entering PACU,moderate to severe post-operative pain,and postoperative nausea and vomiting in PACU between the two groups.Conclusion Dexmedetomidine or sufentanil combined with propofol can provide adequate deep sedation for ERCP proce-dure.Dexmedetomidine combined with propofol can keep intraoperative cardiovascular function more stable,and reduce the occurrence of intraoperative hypoxemia and cardiovascular adverse events.

Endoscopy, Gastrointestinal ; Anesthesia ; Surveys and Questionnaires ; Anesthesiology ; Hospitals, Public ; China ; Endoscopy

To investigate the clinical efficacy and safety of Wei nasal jet tube (WNJT) in painless gastroscopy in patients over age of 60, 80 patients aged 60 years or older scheduled for gastroscopy under propofol mono-sedation in Beijing Friendship Hospital were divided into WNJT group ( n=40) and nasal cannula group ( n=40) according to the random number table method from January to June 2021. The main observation indicator was the difference in the incidence of hypoxemia between the two groups, the secondary observation indicators included the lowest pulse blood oxygen saturation (SpO 2), interventions related to hypoxemia, adverse events such as body movement, cough, epistaxis, sore throat, and the satisfaction of physicians, anesthetists and patients. The results showed that the procedure time and total dosage of propofol were no significant differences between the two groups ( P>0.05). Compared with the nasal cannula group, the incidence of hypoxemia in the WNJT group was significantly lower [2.5% (1/40) VS 25.0% (10/40), χ2=8.538, P=0.003], the lowest SpO 2 was significantly higher (97.7%±2.5% VS 92.6%±5.8%, t=5.093, P<0.001), and the use of jaw lift was reduced [5.0% (2/40) VS 35.0% (14/40), χ2=11.250, P=0.001]. The adverse events were not significantly different between the two groups ( P>0.05), but no case of epistaxis and sore throat occurred in the nasal cannula group. The two groups were comparable in terms of the satisfaction of patients, anesthetists and physicians ( P>0.05). In conclusion, WNJT can be used safely during gastroscopy with propofol mono-sedation in patients over 60 years old, with less incidence of hypoxemia and the number of airway interventions. But violent operation should be avoided to reduce the incidence of epistaxis and sore throat.

Background::Post-operative acute kidney injury (AKI) is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality. This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine (Dex) administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.Methods::The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched for studies comparing the effects of Dex vs. placebo on kidney function after non-cardiac surgery, and a pooled fixed-effect meta-analysis of the included studies was performed. The primary outcome was the occurence of post-operative AKI. The secondary outcomes included the occurence of intra-operative hypotension and bradycardia, intensive care unit (ICU) admission, duration of ICU stay, and hospital length of stay (LOS). Results::Six studies, including four randomized controlled trials (RCTs) and two observational studies, with a total of 2586 patients were selected. Compared with placebo, Dex administration could not reduce the odds of post-operative AKI (odds ratio [OR], 0.44; 95% confidence interval (CI), 0.18-1.06; P= 0.07; I2= 0.00%, P= 0.72) in RCTs, but it showed a significant renoprotective effect (OR, 0.67; 95% CI, 0.48-0.95; P = 0.02; I2 = 0.00%, P = 0.36) in observational studies. Besides, Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay. However, there was no significant difference in the odds of intra-operative hypotension, ICU admission, and hospital LOS. Conclusions::This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery. However, the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations. Thus, large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.

Objective:To assess the influence of age on the safety of propofol mono-sedation for adult patients undergoing painless gastroscopy.Methods:A retrospective study was conducted on data of 321 patients scheduled for painless gastroscopy with propofol mono-sedation. According to the age, patients were divided into youth group (116 cases, 18-44 years), middle-aged group (103 cases, 45-59 years) and elderly group (102 cases, 60-80 years). The procedure time, the total dosage of propofol, the occurrence of airway obstruction or hypoxemia, the use of airway interventions including airway opening maneuvers and facemask ventilation, lowest SpO 2, adverse cardiovascular events (including hypertension, hypotension, tachycardia, and bradycardia), and the use of ephedrine during painless gastroscopy were observed. Results:There was significant difference regarding the total dosage of propofol among youth group (173.2±47.0 mg), middle-aged group (158.8±41.3 mg) and elderly group (137.8±26.3 mg) ( F=21.761, P<0.001). The total dosage of propofol was significantly lower in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017), and that in the middle-aged group was significantly lower than that in the youth group ( P<0.017). The incidence of hypoxemia was 12.9% (15/116) in the youth group, 15.5% (16/103) in the middle-aged group and 25.5% (26/102) in the elderly group, with significant difference among three groups ( χ2=5.711, P=0.017). Moreover, the incidence of hypoxemia was significantly higher in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017). The incidences of hypotension, bradycardia and total adverse cardiovascular events were 5.2% (6/116), 4.9% (5/103) and 11.8% (12/102), 1.7% (2/116), 2.9% (3/103) and 7.8% (8/102), and 11.2% (13/116), 10.7% (11/103) and 20.6% (21/102) respectively in youth, the middle-aged and the elderly group. There were no significant differences in the above indicators among the three groups ( P>0.05). However, compared with those of the young and the middle-aged patients, the occurrence of hypotension, bradycardia and total adverse cardiovascular events in the elderly patients were on the rise. There were no significant differences among the three groups in other indices( P>0.05). Conclusion:Total dosage of propofol may need to be decreased gradually with the increase of age of patients undergoing gastroscopy with propofol mono-sedation. Compared with young and middle-aged patients, elderly patients have a significantly higher incidence of hypoxemia, with a tendancy of total adverse cardiovascular events increase, so the safety of painless gastroscopy is reduced for these patients.

Bone Cysts ; Cysts ; Endoscopy ; Humans ; Maxilla/surgery* ; Maxillary Sinus/surgery*

Objective:To evaluate left lateral position I-scope tracheal intubation for optimizing anesthesia time during the patient′s general anesthesia before endoscopic submucosal dissection.Methods:A total of 150 patients with early upper gastrointestinal cancer were enrolled in the study for endoscopic submucosal dissection in Beijing Friendship Hospital, Capital Medical University from March to December 2018. Patients were randomly divided into three groups with 50 patients in each group. The SL group underwent I-scope tracheal intubation in the left lateral position, SS group underwent I-scope tracheal intubation in the supine position, and MS group underwent Macintosh laryngoscope tracheal intubation in the supine position. Preoperative non-essential anesthesia time (the time between successful intubation and operation), attempts for tracheal intubation and complications related to intubation were analyzed.Results:The preoperative non-essential anesthesia time was 8.55±2.16 min in SL group, 10.44±2.43 min in SS group, and 10.56±3.20 min in MS group, with significant difference among three groups ( F=9.08, P<0.001), and the time in SL group was shorter than that in SS group ( P<0.001) and MS group ( P<0.001). However, there was no statistical difference in non-essential anesthesia time between the SS group and MS group ( P=0.819). The success rate of first attempt intubation was 96.0% (48/50) in SL group, 90.0% (45/50) in SS group, and 92.0% (46/50) in MS group, with no significant differences among three groups ( χ2=2.601, P=0.627). The incidences of cough and expectoration, dry mouth and mucosal injury showed no statistical differences among three groups during transference to the ward after tracheal catheter removal (all P>0.05). The incidence of sore throat in MS group (38.0%, 19/50) was higher than that in SL group (18.0%, 9/50, P<0.05) and SS group (18.0%, 9/50, P<0.05), while the difference was not statistically significant between SL group and SS group ( P>0.05). Conclusion:I-scope tracheal intubation in the left lateral position may shorten the preoperative anesthesia time in patients undergoing general anesthesia for the operation in the left lateral position, and optimize overall anesthesia time.

Objective To evaluate the relationship between autophagy and diabetes mellitus-caused influence on ischemic preconditioning ( IP )-induced cardioprotection in rats. Methods Clean-grade healthy male Sprague-Dawley rats, aged 12 weeks, weighing 290-320 g, were used in this study. Diabe-tes mellitus was induced by high-fat and high-sucrose diet ( lasting for 1 week) and intraperitoneal streptozo-tocin 50 mg∕kg ( for 2 consecutive days) and confirmed by fasting blood glucose level≥16. 65 mmol∕L ( for 1 week) . Thirty rats with diabetes mellitus, weighing 350-450 g, were divided into 3 groups ( n=10 each) using a random number table method: sham operation group ( DM-S group) , myocardial ischemia-reperfusion ( I∕R) group ( DM-IR group) and IP group ( DM-IP group) . Another 30 non-diabetic rats were selected and divided into 3 groups ( n=10 each ) using a random number table method: sham operation group (S group), myocardial I∕R group (IR group) and IP group. Myocardial ischemia was induced by ligation of the anterior descending branch of left coronary artery for 30 min followed by 120 min reperfusion. IP was produced by 3 cycles of 5-min ischemia followed by 5-min reperfusion prior to establishment of myo-cardial I∕R injury model in IP and DM-IP groups. Blood samples were collected from the internal jugular vein at the end of reperfusion for measuring serum concentrations of cardiac troponin I ( cTnI) and creatine kinase-MB ( CK-MB) . The rats were then sacrificed and myocardial tissues were obtained for determination of myocardial infarct size and expression of microtubule-associated protein 1 light chain 3 Ⅱ ( LC3 Ⅱ) , Beclin-1, phosphatidyl-inositol 3-kinase (PI3K), protein kinase B (Akt), phosphorylated Akt (p-Akt) and mammalian target of rapamycin ( mTOR) ( by Western blot) . p-Akt∕Akt ratio was calculated. Results Compared with S group, the serum cTnI and CK-MB concentrations were significantly increased, the percentage of myocardial infarct size was increased, the expression of LC3Ⅱand Beclin-1 in myocardial tis-sues was up-regulated, the expression of PI3K and mTOR was down-regulated, and p-Akt∕Akt ratio was decreased in IR group (P<0. 05). Compared with IR group, the serum cTnI and CK-MB concentrations were significantly decreased, the percentage of myocardial infarct size was decreased, the expression of LC3Ⅱand Beclin-1 in myocardial tissues was down-regulated, the expression of PI3K and mTOR was up-regulated, and p-Akt∕Akt ratio was increased in IP group ( P<0. 05) . Compared with DM-S group, the se-rum cTnI and CK-MB concentrations were significantly increased, the percentage of myocardial infarct size was increased, the expression of LC3Ⅱ and Beclin-1 in myocardial tissues was up-regulated, the expres-sion of PI3K and mTOR was down-regulated, and p-Akt∕Akt ratio was decreased in DM-IR group ( P<0. 05) . There was no significant difference in the parameters mentioned above between DM-IP group and DM-IR group (P>0. 05). Conclusion The mechanism by which diabetes mellitus abolishes IP-induced cardioprotection may be related to inhibiting activation of PI3K-Akt-mTOR signaling pathway and enhanced autophagy in rats.