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Prospective, randomized comparison of two supplemental oxygen methods during gastro-scopy with propofol mono-sedation in obese patients

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World Journal of Clinical Cases 2021年第20期9卷 5479-5489页

作者： liu-jia-zi Shao Fang-Xiao Hong Fu-Kun liu Lei Wan Fu-Shan Xue Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Hypoxemia is a common complication in obese patients during gastroscopy with *** Wei nasal jet tube(WNJT)is a new special nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall *** aim of this study was to compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese *** To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese *** A total of 103 obese patients with a body mass index of 30 kg/m2 or more undergoing elective gastroscopy under propofol mono-sedation were randomly assigned to receive supplemental oxygen at 5 L/min through either a WNJT(WNJT group,n=51)or a nasal cannula(nasal cannula group,n=52).The lowest pulse oxygen saturation(SpO2)and mild and severe hypoxemia during gastroscopy were *** primary outcome was the incidence of *** The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula *** incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula *** than a higher incidence of epistaxis in the WNJT group,the occurrence of adverse events was similar between the *** neither device demonstrated a statistically significant difference in satisfaction among patients,the WNJT did result in improved satisfaction among anesthetists and *** During gastroscopy with propofol mono-sedation in obese patients,the WNJT,when compared with a nasal cannula for supplemental oxygen,can significantly reduce the occurrence of hypoxemia and improve both arterial oxygenation and satisfaction among anesthetists and *** use of the WNJT may,however,lead to epistaxis

关键词： Supplemental oxygen Gastroscopy Sedation Obese patients

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Determination of the ED95 of intranasal sufentanil combined with intranasal dexmedetomidine for moderate sedation during endoscopic ultrasonography

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World Journal of Clinical Cases 2022年第9期10卷 2773-2782页

作者： Yi Zou Na Li liu-jia-zi Shao Fu-Kun liu Fu-Shan Xue Xing Tao Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Sedation during endoscopic ultrasonography(EUS)poses many challenges and moderate-to-deep sedation are often *** conventional method to preform moderate-to-deep sedation is generally intravenous benzodiazepine alone or in combination with ***,this combination has some *** medication delivery may be an alternative to this sedation *** To determine,by continual reassessment method(CRM),the minimal effective dose of intranasal sufentanil(SUF)when combined with intranasal dexmedetomidine(DEX)for moderate sedation of EUS in at least 95%of patients(ED95).METHODS Thirty patients aged 18-65 and scheduled for EUS were recruited in this *** received intranasal DEX and SUF for *** dose of DEX(1μg/kg)was fixed,while the dose of SUF was assigned sequentially to the subjects using CRM to determine *** sedation status was assessed by modified observer’s assessment of alertness/sedation(MOAA/S)*** adverse events and the satisfaction scores of patients and endoscopists were *** The ED95 was intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,with an estimated probability of successful moderate sedation for EUS of 94.9%(95%confidence interval:88.1%-98.9%).When combined with intranasal 1μg/kg DEX,probabilities of successful moderate sedation at each dose level of intranasal SUF were as follows:0μg/kg SUF,52.8%;0.1μg/kg SUF,75.4%;0.2μg/kg SUF,89.9%;0.3μg/kg SUF,94.9%;0.4μg/kg SUF,98.0%;0.5μg/kg SUF,99.0%.CONCLUSION The ED95 needed for moderate sedation for EUS is intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,based on CRM.

关键词： Moderate sedation Intranasal administration Dexmedetomidine Sufentanil Continual reassessment method Endoscopic ultrasonography

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Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index

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World Journal of Gastroenterology 2020年第43期26卷 6867-6879页

作者： liu-jia-zi Shao Yi Zou Fu-Kun liu Lei Wan Shao-Hua liu Fang-Xiao Hong Fu-Shan Xue Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common *** Wei nasal jet tube(WNJT)is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall *** available evidence indicates that with a low oxygen flow,compared with nasal cannula,the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol *** date,there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is *** To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass *** This study was performed in 291 patients undergoing elective gastroscopy with propofol *** were randomized into one of two groups to receive either the WNJT(WNJT group,n=147)or the nasal cannula(nasal cannula group,n=144)for supplemental oxygen at a 5-L/min flow during *** lowest SpO2 during gastroscopy was *** primary endpoint was the incidence of hypoxemia or severe hypoxemia during *** The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group(P=0.000).The lowest median SpO2 during gastroscopy was significantly higher(98%;interquartile range,97-99)in the WNJT group than in the nasal cannula group(96%;interquartile range,93-98).Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any *** two groups were comparable in terms of the satisfaction of physicians,anesthetists and *** With a moderate oxygen flow,the WNJT

关键词： Gastroscopy Hypoxemia Wei nasal jet tube Nasal cannula Supplemental oxygen Adverse outcomes

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Perioperative anaphylaxis:a potential hazard to the safety of surgical patients

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Chinese Medical Journal 2020年第5期133卷 609-612页

作者： Yi Zou liu-jia-zi Shao Fu-Shan Xue Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

Anaphylaxis is a rare,but severe,potentially lifethreatening allergic reaction,which most commonly presents with multi-system involvements,such as cutaneous,cardiovascular,respiratory,gastrointestinal and central nervous system signs and *** can hardly be recognized when occurring in the perioperative period due to the many influencing factors,for example,the cutaneous changes concealed by sterile drapes,inability to describe their symptoms when patients are sedated or anesthetized,and the application of anesthetics leading to sympathetic blockade which presents with blood pressure *** of the above reasons make the identification and immediate treatment of perioperative anaphylaxis difficult and are partially attributable to high mortality.

关键词： patients involvement hazard

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New nomenclature of peri-operative cognitive impairments: possible impacts on further practice and research

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Chinese Medical Journal 2019年第15期132卷 1859-1861页

作者： Yi ZOU liu-jia-zi Shao Fu-Shan Xue Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Peri-operative neurocognitive disorders (PND) is a new term recommended by an international,multidisciplinary group named as Nomenclature Consensus Working Group including experts from multiple disciplines such as anesthesiology,neurology,geriatrics,psychiatry,neuropsychology,surgery,and *** is a comprehensive term for cognitive impairments identified in the perioperative *** recommendation of this new nomenclature has been published in several influential journals simultaneously in November 2018.[1-6] It is a tremendous change in the field of peri-operative cognitive ***,it is necessary to know the reasons and purposes of this new nomenclature,differences between old and new nomenclatures,and the possible impacts of new nomenclature on clinical and basic researches of peri-operative cognitive impairments in the future.

关键词： cognitive impairments practice research

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Anesthesia-induced developmental neurotoxicity in children: past, present, and future

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Chinese Medical Journal 2019年第16期132卷 1990-1992页

作者： liu-jia-zi Shao Yi Zou Fu-Shan Xue Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China.

Since 1999, a large body of evidence from various animal models indicates a link between anesthesia exposure in early stage of life and subsequent neurodevelopmental impairments1namely, almost all commonly used intravenous and inhalational anesthetics, including gamma- aminobutyric acid agonists and N-methyl-D-aspartate antagonists, can induce dose- and age-dependent neuronal apoptosis and death in vitro. Moreover, abundant data from nematodes to primate animals have shown a variety of anatomic and neurodevelopmental sequelae from anesthesia exposure in young animals.[2,3] In the rodents, the most prominent manifestations of anesthesia-induced developmental neurotoxicity (AIDN) are often observed at post-natal day 7 .

关键词： Anesthesia-induced neurotoxicity children

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A feasibility study of jaw thrust as an indicator assessing adequate depth of anesthesia for insertion of supraglottic airway device in morbidly obese patients

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Chinese Medical Journal 2019年第18期132卷 2185-2191页

作者： Lei Wan liu-jia-zi Shao Yang liu Hai-Xia Wang Fu-Shan Xue Ming Tian Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China Department of General Surgery Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Background:Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia *** prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational ***:Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this *** adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 *** motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were *** anatomic position of SAD was assessed using a fiberoptic ***:The SAD was successfully inserted at the first attempt in all *** conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),*** fiberoptic views of SAD position were adequate in 28 patients (93%).Conclusions:Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.

关键词： Obesity Inhalational induction Sevoflurane Supraglottic airway device Jaw thrust test

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Use of ultrasound for prediction of difficult laryngoscopy in adult patients

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Chinese Medical Journal 2020年第11期133卷 1369-1370页

作者： Lei Wan Fu-Shan Xue liu-jia-zi Shao He Yang Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

To the Editor:In a prospective,self-controlled,assessorblinded,observational study,Wang et al[1].evaluated the associations of ultrasound-measured indicators with difficult *** the multivariate logistic regression analyses and the receiving operator characteristic(ROC)curve analysis,they concluded that the magnitude of the angle between the epiglottis and glottis under ultrasound was highly associated with difficult ***,difficult laryngoscopy might occur when this angle was less than 50°.

关键词： patients prediction ultrasound

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Comparing the effects of different drugs on postoperative cognitive dysfunction in elderly patients

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Chinese Medical Journal 2019年第8期132卷 1007-1008页

作者： liu-jia-zi Shao Fu-Shan Xue Rui-Juan Guo Li Zheng Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

To the Editor:In a randomized controlled preliminary trial comparing effects of propofol,dexmedetomidine,and midazolam on postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip or knee arthroplasty with combined spinal-epidural anesthesia,Li et al[1]showed that intraoperative sedation with propofol compared to dexmedetomidine can significantly decrease risk of *** that POCD is associated with major adverse consequences,for example,an increased mortality rate,reduced quality of life,and delayed long-term recovery,[2]their findings have potential ***,we note that this finding is totally different from the results of a recent large randomized controlled study in elderly patients undergoing hip arthroplasty with the peripheral nerve block,in which patients sedated with dexmedetomidine have a lower risk of POCD than those sedated with propofol.

关键词： postoperative cognitive dysfunction(POCD) elderly patients spinal-epidural anesthesia

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Establishing a risk prediction model for acute kidney injury: methodology is important

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Chinese Medical Journal 2019年第22期132卷 2770-2771页

作者： Lei Wan Fu-Shan Xue liu-jia-zi Shao Rui-Juan Guo Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

To the Editor:By a retrospective study including 1124 hospitalized patients diagnosed with acute myocardial infarction(AMI),Wang et al[1] showed that the independent risk factors for acute kidney injury(AKI)were age>60 years,hypertension,chronic kidney disease(CKD),Killip class≥3,extensive anterior myocardial infarction,use of furosemide,non-use of angiotensin-converting enzyme inhibitors(ACEI)/angiotensin receptor blocker(ARB),and these factors could provide a prediction model"with good discriminative ability for the development of *** that AKI has been significantly associated with morbidity and mortality of patients with AMI,[2]their findings have potential clinical *** than the limitations described by authors in the discussion;however,we noted some methodological issues in their study that needed further clarifications.

关键词： kidney acute infarction

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