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Respiratory complications of propofol, sevoflurane, and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years: a randomized trial

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南方医科大学学报 2024年

作者： Amir Shafa Mohammad Montasery Sedighe Shahhosseini Majid Keivanfar Asieh Maghami Mehr Mahtab Ebrahim Babaei Mohammad Jafari department of anesthesiology anesthesiology and critical care Research Center department of Pediatrics Isfahan University of Medical Sciences department of Statistics Yazd University departments of Obstetrics and Gynecology Shahrekord University of Medical Sciences

Objective To evaluate the effect of propofol, sevoflurane, and dexmedetomidine on respiratory complications in children undergoing fiberoptic bronchoscopy(FOB). Methods This double-blind randomized clinical trial was conducted among 120 children aged 1 month to 3 years undergoing FOB. The patients were randomized into 3 groups(n=40) for anesthesia induction with sevoflurane inhalation, 1 mg/kg propofol, or 1 μg/kg dexmedetomidine before bronchoscopy, and the changes in hemodynamic parameters, sedation level, and respiratory complications during and after the procedure were assessed. Results The patients' heart rate during bronchoscopy was significantly lower and the mean arterial blood pressure significantly higher in dexmedetomidine group than in sevoflurane and propofol groups(P<0.05). Cough during bronchoscopy did not occur in any of the cases in propofol group, while the highest frequency of cough was recorded in dexmedetomidine group. The incidence of laryngospasm in the propofol group(12.5%) was significantly lower than those in sevoflurane and dexmedetomidine groups(30% and 32.5%, respectively)(P<0.05). Conclusion Sevoflurane and propofol are safe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve better sedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

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Respiratory complications of propofol,sevoflurane,and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years:a randomized trial

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南方医科大学学报 2024年第9期44卷 1631-1636页

作者： Amir Shafa Mohammad Montasery Sedighe Shahhosseini Majid Keivanfar Asieh Maghami Mehr Mahtab Ebrahim Babaei Mohammad Jafari department of anesthesiology anesthesiology and critical care Research Center department of Pediatrics Isfahan University of Medical SciencesIsfahanIran department of Statistics Yazd UniversityYazdIran departments of Obstetrics and Gynecology Shahrekord University of Medical SciencesShahrekordIran

Objective To evaluate the effect of propofol,sevoflurane,and dexmedetomidine on respiratory complications inchildren undergoing fiberoptic bronchoscopy(FOB).Methods This double-blind randomized clinical trial was conductedamong 120 children aged 1 month to 3 years undergoing *** patients were randomized into 3 groups(n=40)foranesthesia induction with sevoflurane inhalation,1 mg/kg propofol,or 1μg/kg dexmedetomidine before bronchoscopy,andthe changes in hemodynamic parameters,sedation level,and respiratory complications during and after the procedure *** The patients'heart rate during bronchoscopy was significantly lower and the mean arterial blood pressuresignificantly higher in dexmedetomidine group than in sevoflurane and propofol groups(P<0.05).Cough duringbronchoscopy did not occur in any of the cases in propofol group,while the highest frequency of cough was recorded indexmedetomidine *** incidence of laryngospasm in the propofol group(12.5%)was significantly lower than those insevoflurane and dexmedetomidine groups(30%and 32.5%,respectively)(P<0.05).Conclusion Sevoflurane and propofol aresafe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve bettersedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

关键词： fiberoptic bronchoscopy propofol sevoflurane dexmedetomidine children

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Neuroprotective effects of chaperone-mediated autophagy in neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1291-1298页

作者： Qi Jia Jin Li Xiaofeng Guo Yi Li You Wu Yuliang Peng Zongping Fang Xijing Zhang department of anesthesiology and Perioperative Medicine and department of Intensive care Unit Xijing Hospital The Fourth Military Medical University department of critical care Medicine Translational Research Institute of Brain and Brain-Like Intelligence Shanghai Fourth People's Hospital School of Medicine Tongji University

Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins. Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis, while providing nutrients and support for cell survival. Chaperone-mediated autophagy activity can be detected in almost all cells, including neurons. Owing to the extreme sensitivity of neurons to their environmental changes, maintaining neuronal homeostasis is critical for neuronal growth and survival. Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases. It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction. Under certain conditions, regulation of chaperone-mediated autophagy activity attenuates neurotoxicity. In this paper, we review the changes in chaperone-mediated autophagy in neurodegenerative diseases, brain injury, glioma, and autoimmune diseases. We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.

关键词： chaperone-mediated autophagy neurodegenerative disease neuronal homeostasis neuroprotection

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Sodium Leak Channel in Glutamatergic Neurons of the Lateral Parabrachial Nucleus Helps to Maintain Respiratory Frequency Under Sevoflurane Anesthesia

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Neuroscience Bulletin 2024年第8期40卷 1127-1140页

作者： Lin Wu Donghang Zhang Yujie Wu Jin Liu Jingyao Jiang Cheng Zhou department of anesthesiology West China HospitalSichuan UniversityChengdu 610041China Laboratory of Anesthesia and critical care Medicine National-Local Joint Engineering Research Centre of Translational Medicine of AnesthesiologyWest China HospitalSichuan UniversityChengdu 610041China

The lateral parabrachial nucleus(PBL)is implicated in the regulation of respiratory *** leak channel(NALCN)mutations disrupt the respiratory rhythm and influence anesthetic sensitivity in both rodents and ***,we investigated whether the NALCN in PBL glutamatergic neurons maintains respiratory function under general *** results showed that chemogenetic activation of PBL glutamatergic neurons increased the respiratory frequency(RF)in mice;whereas chemogenetic inhibition suppressed *** knockdown in PBL glutamatergic neurons but not GABAergic neurons significantly reduced RF under physiological conditions and caused more respiratory suppression under sevoflurane *** knockdown in PBL glutamatergic neurons did not further exacerbate the respiratory suppression induced by propofol or *** sevoflurane anesthesia,painful stimuli rapidly increased the RF,which was not affected by NALCN knockdown in PBL glutamatergic *** study suggested that the NALCN is a key ion channel in PBL glutamatergic neurons that maintains respiratory frequency under volatile anesthetic sevoflurane but not intravenous anesthetic propofol.

关键词： Glutamatergic neurons Lateral parabrachial nucleus NALCN Respiration General anesthesia

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A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

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Open Journal of anesthesiology 2024年第4期14卷 118-125页

作者： Kunal Tewari Om Bahadur Thapa Deepak Mishra Manjot Multani Jyotsna Sharma Akash Ray Mohapatra Sandhya Khwaunju department of anesthesiology and critical care Armed Forces Medical College Pune India department of anesthesiology and critical care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of anesthesiology 2024年第3期14卷 41-50页

作者： Kunal Tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani department of anesthesiology and critical care Armed Forces Medical College Pune India department of anesthesiology and critical care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

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Chinese expert consensus on sedation and analgesia for neurocritical care patients

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Chinese Medical Journal 2024年第11期137卷 1261-1263页

作者： Linlin Zhang Shuai Liu Shuya Wang Jian-Xin Zhou the National Center for Healthcare Quality Management in Neurological Diseases Chinese Society of critical care Medicine Working group of the Expert Consensus on Sedation and Analgesia for Neurocritical care Patients department of critical care Medicine Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China department of critical care Medicine Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China 不详

Sedation and analgesia therapy are essential in neurocritical care,but there are ongoing controversies surrounding assessment,administration,and *** advances in neurocritical care medicine,updated evidence-based medicine,considering the variability in knowledge and practice,the National Center for Healthcare Quality Management in Neurological Diseases and the Chinese Society of critical care Medicine organized experts in neurocritical care to form a working group[Supplementary File 1,http://***/CM9/B958]to update the“Expert Consensus on Sedation and Analgesia for Patients with Severe Brain Injury(2013)”.

关键词： analgesia critical advances

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Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 364-371页

作者： Ji-Chun Tang Jia-Wei Ma Jin-Jin Jian Jie Shen Liang-Liang Cao department of anesthesiology The Affiliated Hospital of Jiangnan UniversityWuxi 214122Jiangsu ProvinceChina department of anesthesiology People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture 843599Xinjiang Uygur Autonomous RegionChina department of critical care Medicine Jiangnan University Medical CenterWuxi 214122Jiangsu ProvinceChina department of critical care Medicine People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture843599Xinjiang Uygur Autonomous RegionChina

BACKGROUND According to clinical data,a significant percentage of patients experience pain after surgery,highlighting the importance of alleviating postoperative *** current approach involves intravenous self-control analgesia,often utilizing opioid analgesics such as morphine,sufentanil,and *** for colo-rectal cancer typically involves general ***,optimizing anes-thetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative *** study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients'postoperative *** To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal *** Following the inclusion criteria and exclusion criteria,a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included,of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group,and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research *** data collection,the effects of postoperative analgesia,sedation,and recovery were *** Compared to the control group,the research group had shorter recovery times for orientation,extubation,eye-opening,and spontaneous respiration(P<0.05).The research group also showed lower Visual analog scale scores at 24 h and 48 h,higher Ramany scores at 6 h and 12 h,and improved cognitive function at 24 h,48 h,and 72 h(P<0.05).Additionally,interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group(P<0.05).Levels of CD3+,CD4+,and CD4+/CD8+were also lower in the research group at multiple time points(P<0.05).CONCLUSION For patients with colorectal cancer,g

关键词： Multimodal analgesia Anesthesia Colorectal cancer Postoperative pain

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Early and minimal changes in serum creatinine can predict prognosis in elderly patients receiving invasive mechanical ventilation:A retrospective observational study

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Journal of Intensive Medicine 2024年第3期4卷 368-375页

作者： Qinglin Li Guanggang Li Dawei Li Yan Chen Feihu Zhou department of critical care Medicine The First Medical CenterChinese PLA General HospitalBeijingChina department of critical care Medicine The Seventh Medical CenterChinese PLA General HospitalBeijingChina department of critical care Medicine The Sixth Medical CenterChinese PLA General HospitalBeijingChina department of anesthesiology The First Medical CenterChinese PLA General HospitalBeijingChina Medical Engineering Laboratory of Chinese PLA General Hospital BeijingChina

BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of critically ill patients in the geriatric *** conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival *** total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted a

关键词： Mechanical ventilation Aged Mortality Ratio △SCr

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The action mechanism by which C1q/tumor necrosis factor-related protein-6 alleviates cerebral ischemia/reperfusion injury in diabetic mice

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Neural Regeneration Research 2024年第9期19卷 2019-2026页

作者： Bo Zhao Mei Li Bingyu Li Yanan Li Qianni Shen Jiabao Hou Yang Wu Lijuan Gu Wenwei Gao department of anesthesiology Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina Central Laboratory Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina department of critical care Medicine Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina

Studies have shown that C1q/tumor necrosis factor-related protein-6 (CTRP6) can alleviate renal ischemia/reperfusion injury in mice. However, its role in the brain remains poorly understood. To investigate the role of CTRP6 in cerebral ischemia/reperfusion injury associated with diabetes mellitus, a diabetes mellitus mouse model of cerebral ischemia/reperfusion injury was established by occlusion of the middle cerebral artery. To overexpress CTRP6 in the brain, an adeno-associated virus carrying CTRP6 was injected into the lateral ventricle. The result was that oxygen injury and inflammation in brain tissue were clearly attenuated, and the number of neurons was greatly reduced. In vitro experiments showed that CTRP6 knockout exacerbated oxidative damage, inflammatory reaction, and apoptosis in cerebral cortical neurons in high glucose hypoxia-simulated diabetic cerebral ischemia/reperfusion injury. CTRP6 overexpression enhanced the sirtuin-1 signaling pathway in diabetic brains after ischemia/reperfusion injury. To investigate the mechanism underlying these effects, we examined mice with depletion of brain tissue-specific sirtuin-1. CTRP6-like protection was achieved by activating the sirtuin-1 signaling pathway. Taken together, these results indicate that CTRP6 likely attenuates cerebral ischemia/reperfusion injury through activation of the sirtuin-1 signaling pathway.

关键词： brain C1q/tumor necrosis factor-related protein-6 cerebral apoptosis diabetes inflammation ischemia/reperfusion injury neuron neuroprotection oxidative damage Sirt1

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