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Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients

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World Journal of Gastrointestinal surgery 2024年第5期16卷 1320-1327页

作者： Yu-Fu Deng Xue-Run Jiang Zeng-Guang Feng Department of anesthesiology Xiangtan Central HospitalXiangtan 411100Hunan ProvinceChina

BACKGROUND surgery for obese patients carries a higher risk of anesthesia complications compared with surgery for nonobese ***,a safe and effective anesthesia strategy is necessary to improve the medical experience of such patients and ensure their *** To compared the effectiveness and safety of remimazolam besylate versus dexmedetomidine(DEX)in gastrointestinal surgery in obese *** The study cohort included 60 obese patients undergoing gastrointestinal surgery between July 2021 and April 2023,comprising 30 patients who received DEX intervention(control group)and 30 patients who received remimazolam besylate intervention(research group).Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),safety(nausea and vomiting,bradycardia,hypotension,and apnea),anesthesia and examination indices[induction time,anesthesia recovery time,and postanesthesia care unit(PACU)discharge time],sedation effect(Ramsay Sedation Scale),and postoperative pain visual analog scale were comparatively analyzed before anesthesia(T0),during anesthesia(T1),and after anesthesia(T2).RESULTS At T1,the research group showed significantly smaller changes in HR,RR,MAP,and SpO_(2) than the control group,with a significantly lower adverse reaction rate and shorter induction,anesthesia recovery,and PACU discharge ***,the intra-and postoperative Ramsay Sedation Scale scores were statistically higher in the research group than in the control *** Remimazolam besylate was significantly more effective than DEX in gastrointestinal surgery in obese patients and had a higher safety profile and value in clinical promotion.

关键词： Remimazolam besylate Dexmedetomidine Obesity Gastrointestinal surgery Effectiveness Safety

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

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World Journal of Gastrointestinal surgery 2024年第7期16卷 2065-2072页

作者： Yu-Juan Li Yong-Yan Chen Xia-Lan Lin Wei-Zhi Zhang Department of anesthesiology Shanxi Provincial Children’s HospitalTaiyuan 030013Shanxi ProvinceChina

BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in *** significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics *** To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for *** In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating ***,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were *** Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the *** ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.

关键词： Atropine Remifentanil Pediatric acute appendicitis surgery Clinical efficacy

Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients:A meta-analysis

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World Journal of Clinical Cases 2024年第7期12卷 1272-1283页

作者： Fang-Zhuo Li Cheng Zhao Yi-Xun Tang Ji-Tong Liu Department of anesthesiology The First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital)Changsha 410005Hunan ProvinceChina Department of anesthesiology Zhangjiajie People's HospitalZhangjiajie 427000Hunan ProvinceChina

BACKGROUND Remimazolam is characterized by rapid action and inactive *** is used as the general anesthetic for many clinical *** this study,we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older *** To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older *** The PubMed,Web of Science,the Cochrane Library databases were queried for the relevant key words"remimazolam,""and propofol,""and gastrointestinal endoscopy or gastroscopy."The search scope was"Title and Abstract,"and the search was limited to human studies and publications in *** studies wherein remimazolam and propofol were compared were included for the *** We selected seven randomized controlled trials involving 1445 cases for the *** reduced the hypotension(relative risk,RR=0.44,95%CI:0.29-0.66,P=0.000),respiratory depression(RR=0.46,95%CI:0.30-0.70,P=0.000),injection pain(RR=0.12,95%CI:0.05-0.25,P=0.000),bradycardia(RR=0.37,95%CI:0.24-0.58,P=0.000),and time to discharge[weighted mean difference(WMD)=-0.58,95%CI:-0.97 to-0.18,P=0.005],compared to those after propofol *** obvious differences were observed for postoperative nausea and vomiting(RR=1.09,95%CI:0.97-1.24,P=0.151),dizziness(RR=0.77,95%CI:0.43-1.36,P=0.361),successful sedation rate(RR=0.96,95%CI:0.93-1.00,P=0.083),or the time to become fully alert(WMD=0.00,95%CI:-1.08-1.08,P=0.998).CONCLUSION Remimazolam appears to be safer than propofol for gastroenteroscopy in older ***,further studies are required to confirm these findings.

关键词： Remimazolam Propofol Gastroenteroscopy Anesthesia Older adults Sedation Adverse events

Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients

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World Journal of Psychiatry 2024年第6期14卷 930-937页

作者： Fen Yan Li-Hua Yuan Xiao He Kai-Feng Yu Department of anesthesiology Wuhan Pulmonary HospitalWuhan Institute for Tuberculosis ControlWuhan 430000Hubei ProvinceChina

BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative *** agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative ***-anesthetic anxiety may be associated with the development of EA,but studies in this area are *** To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently *** used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,*** Riker Sedation-Agitation Scale(RSAS)examined EA after *** plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and *** performed a partial correlation analysis of HADS-A scores with RSAS *** NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at *** patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had ***-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and *** correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxie

关键词： Non-small cell lung cancer Operative treatment anesthesiology department Pre-anesthetic anxiety Emergence agitation Correlation study

Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 399-405页

作者： Zhu-Zeng Yin Yuan-Xing Gao Zhi-Ming Zhao Ming-Gen Hu Wen-Bo Tang Rong Liu Faculty of Hepato-Pancreato-Biliary surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China Institute of Hepatobiliary surgery of Chinese PLA Beijing 100853China Key Laboratory of Digital Hepatobiliary surgery of Chinese PLA Beijing 100853China

Background:Minimally invasive surgery is the optimal treatment for *** present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign ***:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was *** demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic ***:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic *** was the preferred surgical ***-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,*** enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic *** were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and *** a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a ***:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

关键词： Robotic surgical procedures Laparoscopy Insulinoma Enucleation Pancreatectomy

Clinical observation of gastrointestinal function recovery in patients after hepatobiliary surgery

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World Journal of Gastrointestinal surgery 2024年第1期16卷 76-84页

作者： Hua-Jun Zeng Jing-Jing Liu Ying-Chun Yang Department of General Practice Nanyang First People's HospitalNanyang 473000Henan ProvinceChina Department of anesthesiology Chinese People’s Armed Police Force Hospital of BeijingBeijing 100027China Department of anesthesiology Beijing Fengtai HospitalBeijing 100071China

BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and *** To investigate the recovery of gastrointestinal function in patients after hepato-biliary surgery and identify effective rehabilitation *** A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study *** were divided into a control group and a study group based on the extent of the surgery,with 100 patients in each *** control group received routine treatment,while the study group re-ceived targeted interventions,including early enteral nutrition support,drinking water before gas discharge,and large bowel enema,to promote postoperative gastrointestinal function *** recovery of gastrointestinal function was compared between the two *** Compared with the control group,patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa(Psurgery and reduce the incidence of complications,which is worthy of promotion.

关键词： Liver and gallbladder patients Gastrointestinal function Postoperative recovery

Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 288-292页

作者： Peng Liu Yong-Wei Chen Che Liu Yin-Tao Wu Wen-Chao Zhao Jian-Yong Zhu Yang An Nian-Xin Xia Faculty of Hepato-Pancreato-Biliary surgery the First Medical CenterChinese PLA General HospitalBeijing 100853China Institute of Hepatobiliary surgery of Chinese PLA Beijing 100853China Key Laboratory of Digital Hepetobiliary surgery of Chinese PLA Beijing 100853China

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving *** study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone ***:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively *** independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected *** C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone ***:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five *** results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone ***,the calibration curve showed good consistency between the predicted probability and actual ***:The nomogram model for

关键词： Gallstone Gallbladder-preserving surgery Recurrence Risk factors Nomogram

Impact of thoracic paravertebral block and sufentanil on outcomes and postoperative cognitive dysfunction in thoracoscopic lung cancer surgery

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World Journal of Psychiatry 2024年第6期14卷 894-903页

作者： Dan-Dan Wang Hong-Yu Wang Yan Zhu Xi-Hua Lu Department of anesthesiology The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer HospitalZhengzhou 450008Henan ProvinceChina

BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal ***,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain *** To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient *** This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January *** receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,*** compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after *** levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after *** Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after *** reactions were also *** There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest

关键词： Thoracic paravertebral block Sufentanil Thoracoscope Radical resection of lung cancer Postoperative cognitive dysfunction

Mitochondrial transplantation confers protection against the effects of ischemic stroke by repressing microglial pyroptosis and promoting neurogenesis

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Neural Regeneration Research 2024年第6期19卷 1325-1335页

作者： Li Sun Zhaoyan Zhao Jing Guo Yuan Qin Qian Yu Xiaolong Shi Fei Guo Haiqin Zhang Xude Sun Changjun Gao Qian Yang Department of Experimental surgery The Second Affiliated Hospital of Air Force Medical UniversityXi’anShaanxi ProvinceChina Department of anesthesiology The Second Affiliated Hospital of Air Force Medical UniversityXi’anShaanxi ProvinceChina

Transferring healthy and functional mitochondria to the lateral ventricles confers neuroprotection in a rat model of ischemia-reperfusion *** mitochondrial transplantation is also beneficial in pediatric patients with cardiac ischemia-reperfusion ***,transplantation of functional exogenous mitochondria may be a promising therapeutic approach for ischemic *** explore the neuroprotective effect of mitochondria transplantation and determine the underlying mechanism in ischemic stroke,in this study we established a photo-thrombosis-induced mouse model of focal ischemia and administered freshly isolated mitochondria via the tail vein or to the injury site(in situ).Animal behavior tests,immunofluorescence staining,2,3,5-triphenyltetrazolium chloride(TTC)staining,mRNA-seq,and western blotting were used to assess mouse anxiety and memory,cortical infarct area,pyroptosis,and neurogenesis,*** bioinformatics analysis,western blotting,co-immunoprecipitation,and mass spectroscopy,we identified S100 calcium binding protein A9(S100A9)as a potential regulator of mitochondrial function and determined its possible interacting *** between exogenous and endogenous mitochondria,as well as the effect of exogenous mitochondria on recipient microglia,were assessed in *** data showed that:(1)mitochondrial transplantation markedly reduced mortality and improved emotional and cognitive function,as well as reducing infarct area,inhibiting pyroptosis,and promoting cortical neurogenesis;(2)microglial expression of S100A9 was markedly increased by ischemic injury and regulated mitochondrial function;(3)in vitro,exogenous mitochondria enhanced mitochondrial function,reduced redox stress,and regulated microglial polarization and pyroptosis by fusing with endogenous mitochondria;and(4)S100A9 promoted internalization of exogenous mitochondria by the microglia,thereby amplifying their pro-proliferation and anti-inflammatory ***

关键词： ischemic stroke microglia mitochondria transplantation neurogenesis pyroptosis