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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 psychology.It is a comprehensive term for cognitive impairments identified in the perioperative period.The 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 impairments.Therefore,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

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

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 laryngoscopy.By 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 laryngoscopy.Furthermore,difficult laryngoscopy might occur when this angle was less than 50°.

关键词： patients prediction ultrasound

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 induction.This 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 induction.Methods: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 study.After adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min.After motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were graded.The anatomic position of SAD was assessed using a fiberoptic bronchoscope.Results:The SAD was successfully inserted at the first attempt in all patients.Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),respectively.The 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

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 AKI.Given that AKI has been significantly associated with morbidity and mortality of patients with AMI,[2]their findings have potential clinical implications.Other 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

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 POCD.Given 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 implications.However,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

Prediction of short-term mortality after valve surgery

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Chinese Medical Journal 2019年第5期132卷 624-625页

作者： Liu-Jia-Zi Shao Fu-Shan Xue Rui-Juan Guo Li Zheng Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

To the Editor: In a single-center perspective study by Chen et al[1] determining the risk factors and predictors of shortterm mortality after valve surgery, multivariate logistic regression analysis showed that pre-op... 详细信息

关键词： short-term mortality valve surgery risk factors

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 required.The conventional method to preform moderate-to-deep sedation is generally intravenous benzodiazepine alone or in combination with opioids.However,this combination has some limitations.Intranasal medication delivery may be an alternative to this sedation regimen.AIM 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 study.Subjects received intranasal DEX and SUF for sedation.The dose of DEX(1μg/kg)was fixed,while the dose of SUF was assigned sequentially to the subjects using CRM to determine ED95.The sedation status was assessed by modified observer’s assessment of alertness/sedation(MOAA/S)score.The adverse events and the satisfaction scores of patients and endoscopists were recorded.RESULTS 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

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 sedation.The 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 channels.The 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 patients.AIM To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.METHODS 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 recorded.The primary outcome was the incidence of hypoxemia.RESULTS The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula group.The incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula group.Other than a higher incidence of epistaxis in the WNJT group,the occurrence of adverse events was similar between the devices.While neither device demonstrated a statistically significant difference in satisfaction among patients,the WNJT did result in improved satisfaction among anesthetists and physicians.CONCLUSION 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 physicians.The use of the WNJT may,however,lead to epistaxis in a few patients.In view of this clinically acc

关键词： Supplemental oxygen Gastroscopy Sedation Obese patients