Abstract:Remifentanil is a novel anesthetic analgesics classified as an ultrashort-acting μ-opioid receptor agonist.It has unique pharmacokinetic characteristics such as rapid onset,rapid clearance,and no significant accumulation after continuous infusion.With minimal impact on respiratory and circulatory systems in pediatric patients,it ensures prompt recovery and rapid awakening,making it an ideal anesthetic agent for pediatric surgical patients.This article reviews recent research advancements in remifentanil for pediatric anesthesia in different age groups,such as the effect,optimal dose,adverse effects and precautions,aiming to provide precise dosing guidance for its application in pediatric anesthesia.

Abstract:Iatrogenic airway injury(IAI)frequently results in palpable adverse complaints from patients,readily fueling doctor-patient disputes.It is related to a multitude of patient-specific and treatment-related factors.However,there is currently no unified international clinical guideline consensus.In response,the IAI Prevention and Treatment Expert Consensus Task Force of the Innovation and Promotion Branch of the Chinese Society of Cardiovascular and Thoracic Anesthesiology compiled the first international consensus using the improved Delphi method.This consensus encompasses a comprehensive range of IAI risk alerts,management strategies,and interventions,distilling these into 21 actionable recommendations,which serve as a guide for the prevention and treatment of IAI.Furthermore,the group also advocate clinical anesthesiologists to actively carry out large-scale,multi-center clinical trials to provide more detailed evidence for the warning and intervention of IAI in the future.

Abstract:Objective To investigate the safety and feasibility of percutaneous kyphoplasty(PKP)in the ambulatory surgery mode.Methods A retrospective analysis was performed,131 patients,with body mass index(BMI)＜30 kg/m2,of American Society of Anesthesiologists(ASA)physical status Ⅰ-Ⅲ,undergoing PKP in General Hospital of Northern Theater Command from January 2023 to January 2025 for osteoporotic vertebral compression fracture(OVCF).According to different hospitalization modes,the patients were divided into the inpatient management group(control group,n=69)and the day-case management group(day-case group,n=62).Patients in the control group were admitted to the orthopedic ward according to the ordinary inpatient process,while patients in the day-case group were admitted to the day-case ward according to the day-case surgery process:patients who met the day-case surgery criteria after being evaluated at the orthopedic outpatient department and the preoperative evaluation at the anesthesiology outpatient department before surgery.The operative time,hospital stay,hospital cost,visual analogue scale(VAS)score at 6,24 and 72 h after surgery,incidence of sleep disorders,score of Athens insomnia scale(AIS),postoperative complications and other indicators of patients in both groups were recorded.Results Both groups of operations were successfully completed.There was no significant difference in operation time,postoperative VAS score and postoperative complications between the two groups(P＞0.05).Compared with the control group,the length of hospitalization and hospitalization cost in the day-case group were significantly reduced,and the satisfaction was significantly increased in the day-case group,with statistical significance(P＜0.05).Compared with the control group,the sleep disorder score of the day-case group was significantly decreased at 24 and 72 h after surgery,with statistical significance(P＜0.05).Conclusion It is safe and feasible to conduct PKP in ambulatory surgery mode,which can significantly shorten the hospital stay of patients,reduce hospitalization costs,improve postoperative sleep disorders,enhance rapid recovery of patients and improve patient satisfaction.

Abstract:This review summarizes the clinical advances in opioid-free anesthesia(OFA),encompassing its fundamental concept,clinical benefits,current applications across various surgical procedures,ongoing challenges,and future directions.It aims to enhance anesthesiologists'understanding of OFA,and serve as a valuable reference for optimizing anesthesia protocols.

Abstract:Objective To explore the application effect of a nomogram risk prediction model for emergence agitation(EA)in pediatric patients undergoing general anesthesia.Methods Using convenience sampling,486 pediatric patients who entered the post anesthesia care unit(PACU)after general anesthesia from January 2021 to June 2022 in the Second Affiliated Hospital of Guangxi Medical University were classified into the internal validation group,and 189 pediatric patients who entered the PACU from July 2022 to December 2022 were classified into the external validation group.The clinical characteristics of the internal and external validation groups were compared.The application effect of the model was tested using the area under the curve(AUC)of the receiver operating characteristic(ROC curve),and external validation was performed using the validation group data.Results There were no statistically significant differences in the clinical characteristics between the internal and external validation groups(all P＞0.05).AUC was 0.827(95%CI:0.777-0.900).At a risk probability threshold of 0.119,the Youden index reaches its maximum value of 0.588,with a sensitivity of 86.7%and a specificity of 72.1%.The Hosmer-Lemeshow test yielded χ2=5.925,P=0.656,and the external validation C-index was 0.827.Conclusion The model demonstrates good application performance and is suitable for clinical use.It can predict the risk of EA at the time of PACU admission,providing a reference for healthcare providers to implement preventive interventions and nursing strategies for high-risk pediatric patients postoperatively.

Abstract:Objective To explore the effects of ultrasound-guided pericapsular nerve group(PENG)block of the hip joint combined with epidural anesthesia on the anesthetic effect,postoperative cognitive function and immune function in elderly patients undergoing femoral head replacement surgery.Methods A total of 120 elderly patients,aged＞60 years,of American Society of Anesthesiologists(ASA)physical status classification Ⅰor Ⅱ,who underwent femoral head replacement surgery at Chengdu Hospital of Integrated Traditional Chinese and Western Medicine from June 2021 to July 2024 were selected.The patients were randomly divided into the control group(n=60)and the study group(n=60)using a random number table method.The study group received ultrasound-guided PENG block combined with epidural anesthesia,while the control group only received epidural anesthesia.The hemodynamic indicators(heart rate,mean arterial pressure),immune function[CD4+,CD4+/CD8+,regulatory T cells(CD4+CD25+)],mini mental state examination score(MMSE),incidence of postoperative cognitive dysfunction(POCD),visual analogue scale(VAS)were compared between the two groups.Results The fluctuation of heart rate and mean arterial pressure in the study group was lower than that in the control group after anesthesia(P＜0.05).The research group exhibited elevated CD4+and CD4+/CD8+ratios but reduced CD4+CD25+levels at 6,24,72 h postoperatively versus the control group(P＜0.05).Compared with the control group,the research group demonstrated higher MMSE scores at 6,24,48 h post-operatively and lower POCD incidence at 6,24 h after the operation(P＜0.05).Compared with the control group,the research group showed reduced VAS scores at 30 min and 2 h after the operation,(P＜0.05);there was no statistically significant difference in VAS scores between the two groups at 24 h after the operation(P＞0.05).Conclusion Ultrasound guided PENG block combined with epidural anesthesia is more effective,with good analgesic effects,which is conducive to reducing the impacts on hemodynamics and immune function,enhancing faster cognitive recovery,and reducing the incidence of postoperative cognitive dysfunction.

Abstract:Objective To investigate the safety and efficacy of transnasal humidified rapid insufflation ventilatory exchange(THRIVE)in the induction of general anaesthesia.Methods Sixty patients,aged 18-65 years old,of American Society of Anesthesiologists(ASA)physical status classification Ⅰ or Ⅱ,who underwent elective surgery under general anaesthesia at Xi'an People's Hospital(Xi'an Fourth Hospital)from January to December 2023 were selected as the research subjects.The patients were divided into pressurized mask assisted ventilation group(PF group)and THRIVE group according to the strategy of oxygenation during general anaesthesia,with 30 cases in each group.The mean arterial partial pressure of oxygen(PaO2),the mean arterial partial pressure of carbon dioxide(PaCO2),the pH value,the mean arterial pressure,heart rate,pulse oxygen saturation(SpO2),the safe apnoea time,the incidence of adverse events related to of body movement and gastric insufflation during induction were compared 5 min before pre-oxygenation(T1),10 min after pre-oxygenation(T2),and 3 min after induction(T3).Results At T3,the PaO2,PaCO2,and pH values in the THRIVE group and PF group were(334.20±93.00)mmHg and(280.30±79.40)mmHg,(48.28±5.98)mmHg and(36.97±5.20)mmHg,(7.33±0.04)and(7.39±0.04),respectively.The level of PaO2 and PaCO2 were significantly higher in THRIVE group than those in PF group(P＜0.05),with pH significantly lower in the THRIVE group(P＜0.05).The safe apnoea time in the PF group and THRIVE group were(379.39±51.82)s and(517.73±47.15)s.Compared to the PF group,the safe apnoea time was significantly prolonged in the THRIVE group(P＜0.05).The incidence of adverse events such as body movement and gastric insufflation significantly decreased in the THRIVE group(P＜0.05).Conclusion The application of THRIVE in the induction of general anaesthesia by endotracheal intubation can effectively prolong the time of safe apnoea,matain the stability of hemodynamics and internal environment,and reduce the incidence of body movement and gastric air intake.

Abstract:Emergence delirium(ED)is a syndrome of cerebral dysfunction that occurs in the very early stage after anesthesia recovery,which seriously affects the prognosis of patients.This study adopts the scoping review as the research method,focusing on studies related to the influencing factors of emergence delirium in adults.It reviews the influencing factors and assessment scales of ED,so as to provide a theoretical basis for medical personnel to formulate systematic prevention and management plans.

Abstract:Objective To evaluate the efficacy of a single-shot thoracic paravertebral nerve block(TPVB)with liposomal bupivacaine for postoperative analgesia after breast surgery.Methods Eighty female patients,aged 18-64 years,with body mass index(BMI)17-29 kg/m2,of American Society of Anesthesiologists(ASA)physical status Ⅰ-Ⅲ,underwent elective unilateral breast cancer resection at the Eighth Affilliated Hospital of Sun Yat-sen University from June 2023 to December 2024 were selected.Patients were divided into two groups,the ropivacaine group(group R,n=40)and the liposomal bupivacaine group(group LB,n=40),according to random number table method.All patients received ultrasound-guided T4-T5 TPVB on the affected side.Group LB received liposomal bupivacaine 133 mg,while group R received 0.5%ropivacaine 100 mg,both diluted with normal saline to 20 mL.The patients'age,BMI,operation time,anesthesia time,onset time of TPVB and recovery time were recorded.Heart rate(HR),pulse oxygen saturation(SpO2),the mean arterial pressure(MAP)before TPVB,after TPVB,at skin incision and after laryngeal mask removal were recorded.The numerical rating scale(NRS)scores at rest and during activity at 1,4,8,12,24,48 and 72 h after the operation were recorded.The postoperative hospital stay,the number of patients who received additional parecoxib sodium at 0-24 h,24-48 h,and 48-72 h after the operation,as well as the occurrence of adverse reactions such as nausea,vomiting,constipation,respiratory depression,and toxic reactions of local anesthetics were also recorded.Results There was no statistical significance in the comparisons of the general conditions,vital signs before TPVB,after TPVB,during skin incision,and after laryngeal mask removal between the two groups(P＞0.05).Compared with group R,the NRS scores at rest and during activity at 4,12,24,48,and 72 h after surgery in group LB were significantly lower(P＜0.05),meanwhile the usage rate of intravenous analgesia with parecoxib sodium at 0-24 h and 24-48 h after the operation was significantly decreased(P＜0.05).The incidence of postoperative fever,constipation,nausea,respiratory depression,and local anesthetic toxicity didn't increase.Conclusion A single-shot TPVB with liposomal bupivacaine for postoperative analgesia after breast surgery can provide long-acting analgesic effects,reduce the need for remedial analgesia and postoperative adverse reactions,and facilitate postoperative recovery of patients.

Abstract:With the strained medical resources and the rising awareness of health,the growing demand for non-invasive,convenient health monitoring devices has driven the development of diverse wearable multimodal intelligent physiological monitoring systems.This article briefly explores the current research status of wearable multimodal smart physiological monitoring systems in three aspects:monitoring parameters,material flexibility,and the intelligence physiological monitoring.It also introduces current clinical applications of wearable multimodal intelligent physiological monitoring devices,such as hybrid sensors for health and fitness monitoring,brain-body activity monitoring,wound healing monitoring,and stress response detection,demonstrating their potential and challenges in health survelliance.

Abstract:Objective To compare the onset time,block duration,and safety differences between nalbuphine combined with local anesthetics and dexamethasone combined with local anesthetics in ultrasound-guided interscalene brachial plexus block.Methods A total of 40 patients aged 18-64 years,with body mass index(BMI)＜25 kg/m2,of American Society of Anesthesiologists(ASA)physical statusⅠ or Ⅱ,undergoing ulnar and radial bone surgery at Longling County People's Hospital from March to November 2024 were enrolled and randomly divided into the nalbuphine group(group A,n=20)and the dexamethasone group(group B,n=20).Group A received 75 mg ropivacaine(10 mL)+100 mg lidocaine(5 mL)+10 mg nalbuphine(1 mL),diluted to 20 mL with 0.9%normal saline.Group B received the same dose of local anesthetics combined with 5 mg dexamethasone(1 mL),diluted to 20 mL with 0.9%normal saline.The onset time and duration of sensory and motor blocks,hemodynamic fluctuations,and adverse reactions were observed.Results Satisfactory anesthetic effects were achieved in both groups.The onset times of sensory block(4.85±0.99)min and motor block(7.65±2.01)min in group A were significantly shorter than those in group B(P＜0.05).However,the duration of analgesia(408.00±52.26)min and motor block(382.50±61.69)min in group A were significantly shorter than those in group B(P＜0.05).Satisfactory sensory and motor blocks were achieved within 10 min in group A.No obvious complications occurred in either group.Conclusion Nalbuphine can significantly accelerate the onset of ultrasound-guided brachial plexus block,while dexamethasone can prolong the duration of postoperative analgesia and motor block.Both have good safety,and the appropriate combined drugs can be selected clinically according to surgical needs.

Abstract:Since the National Health Commission strengthened the quality control of anesthesiology discipline,anesthesia care quality has become the core element of perioperative safety.This article takes the practice of Chongqing Municipal Anesthesia Medical Quality Control Center as an example to explore its high-quality development pathway featuring national standard benchmarking,grassroots-level investigation foundation,and regional collaboration support.Through establishing a quality control network via in-depth grassroots research,implementing case competitions to drive quality improvement,and advancing standardized protocols,multidisciplinary collaboration,and technological innovation,significant achievements have been made including improved intraoperative temperature management rates and reduced perioperative complication incidence rates,while promoting homogeneous enhancement of anesthesia quality across regions.The findings suggest that future anesthesia quality control should continuously strengthen grassroots capabilities,actively promote cross-disciplinary collaboration,and leverage new technologies like artificial intelligence,ultimately contributing to nationwide anesthesia quality improvement through standardized grassroots reinforcement and homogeneous quality elevation.

Abstract:Sedative drugs are indispensable for painless gastrointestinal endoscopy.However,their application in obese patients can cause respiratory depression and increase the risk of airway management.This article reviews the characteristics of sedative drugs and airway management during painless gastrointestinal endoscopy in obese patients based on domestic and international literature,aiming to enhance the safety of painless gastrointestinal endoscopy in obese patients and provide a reference for perioperative management.

Abstract:Objective To analyze the research status,research hotspots and research trends of emergence agitation(EA)during general anesthesia,and to provide guidance and reference for related research in China.Methods The literatures related to EA during general anesthesia were retrieved from the Web of Science core collection database,and the retrieval time was from 2015 to 2024.CiteSpace 6.4.R1 software was used to analyze the number of publications,institutions,keyword co-occurrence analysis,cluster analysis and burst word analysis.Results A total of 435 literatures were included,and the number of literatures showed an increasing trend year by year.The country with the largest number of publications was China(189 articles);the most influential country of cited literature is the United States;through keyword co-occurrence,cluster analysis and burst analysis,it is shown that there are six hotspots in EA:(1)high-risk population and risk factors exploration;(2)drug intervention measures;(3)non-drug management;(4)optimization of diagnostic tools and scales;(5)interdisciplinary management of the long-term effects of EA after surgery;(6)depth of anesthesia monitoring and precise control.Conclusion EA during general anesthesia has always been a research hotspot in the field of anesthesia.There is a big gap between domestic and foreign research fields.China should strengthen exchanges and cooperation,and extensively discuss the long-term impact of EA during general anesthesia to optimize clinical practice.

Abstract:Objective To explore the safety and efficacy of remimazolam combined with etomidate for elderly patients undergoing painless bronchoscopy.Methods A total of 80 elderly patients,aged≥70 years,of American Society of Anesthesiologists(ASA)physical status Ⅱ or Ⅲ,with body mass index(BMI)16.0-30.0 kg/m2,who underwent painless bronchoscopy at Shaanxi Second Provincial People's Hospital from March 2021 to June 2024 were selected and randomly divided into the control group(n=40)and the observation group(n=40)using a random number table method.Both groups received plasma target-controlled infusion of remifentanil at 5 ng/mL.After 3 min,the control group was given propofol+etomidate+mivacurium chloride,and the observation group was given remimazolam+etomidate+mivacurium chloride,and assisted ventilation was performed for 5 min after the disappearance of spontaneous breathing.A laryngeal mask was inserted,and the remifentanil effect chamber reached 5 ng/mL.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2),and bispectral index(BIS)before anesthesia induction(T0),immediately after anesthesia induction(T1),when entering the glottic region(T2),5 min after initiation of bronchossopy(T3),when the endoscopy was removed out of the glottic region(T4),the moment of removing the laryngeal mask(T5),and before leaving the bronchoscope exam room(T6)were recorded.The time from drug withdrawal to respiratory recovery of the patients,the time of extubation,and the time to reach the criteria for leaving the room were recorded.The number of cases of adverse reactions such as injection pain,hypotension,and bradycardia were recorded.The addition of sedative drugs and the use of atropine,norepinephrine and epinephrine were recorded.Results At T1,T2,T3,T4 MAP and HR of the observation group were higher than those of the control group(P＜0.05),while there was no statistically significant difference in SpO₂ and BIS between the two groups(P＞0.05);there was no statistically significant difference in the respiratory recovery time and extubation time between the two groups(P＞0.05);there was no statistically significant difference in the dosage and frequency of the additional sedative drug etomidate between the two groups(P＞0.05);the dosage of atropine,norepinephrine and epinephrine used in the observation group was lower than that in the control group,with statistically significant difference(P＜0.01).Conclusion Remimazolam combined with etomidate for elderly patients undergoing painless bronchoscopy has relatively stable hemodynamics,few adverse reactions,high safety,and can be promoted.

Abstract:Objective To explore the median effective dose(ED50)and 95%effective dose(ED95)of ciprofol combined with nalbuphine for inhibiting body movement responses during cervical dilatation.Methods A total of 25 patients,aged 18-50 years,with body mass index(BMI)18-24 kg/m2,of American Society of Anesthesiologists(ASA)physical status gradeⅠ or Ⅱ,scheduled for gynecological day-case minor surgeries requiring cervical dilatation in Guangdong Women and Children Hospital from December 2024 to January 2025 were enrolled.The patients were divided into the positive group(n=15)and the negative group(n=10)based on whether body movement occured during cervical dilatation.Nalbuphine 0.1 mg/kg was administered intravenously.The initial dose of ciprofol for the first patient was 0.4 mg/kg.The modified sequential method was used to calculate the ciprofol dose for the next patient with a concentration gradient of 0.02 mg/kg.The study continued until 8 crossover turning points were completed.ED50,ED95 and their 95%confidence intervals(95%CI)were calculated by Probit model.The changes in heart rate(HR),mean arterial pressure(MAP)and respiratory rate(RR)were observed upon admission to the operating room(T1),60 seconds after drug administration(T2)and during cerrical dilatation(T3).Intraoperative hypoxemia,apnea,glossopteris and postoperative NRS score were recorded.Results The ED50 of ciprofol combined with nalbuphine for inhibiting body movements during cervical dilatation was 0.51 mg/kg(95%CI 0.44-0.52 mg/kg),and the ED95 was 0.52 mg/kg(95%CI 0.51-0.60 mg/kg).Compared with T1,MAP and HR at T2 and T3 were significantly decreased in both groups(P＜0.05).Compared with T2,MAP increased and RR accelerated at T3 in the positive group(P＜0.05).No patient developed hypoxemia,and all patients were discharged on time.Conclusion The ED50 of ciprofol combined with nalbuphine for inhibiting body movements during cervical dilatation is 0.51 mg/kg(95%CI 0.44-0.52 mg/kg),and the ED95 is 0.52 mg/kg(95%CI 0.51-0.60 mg/kg).The patients have stable respiratory and circulatory functions with few adverse reactions,providing a reference for clinical medication.

Abstract:Objective To observe the application effect of medical humanities quality education in clinical anesthesia teaching and explore its clinical value.Methods A total of 50 rotating physicians at Kunshan Hospital of Traditional Chinese Medicine from February 1st,2021 to December 31st,2024 were selected and randomly assigned to the the control group(n=25)and the experimental group(n=25),according to random number table method.The control group received routine theoretical training,standardized patient(SP)application in classroom teaching,clinical practice,and mentoring.The experimental group developed Medical Humanistic Care List,and then designed Medical Humanistic Care in Clinical Anesthesia course by simulating different stages of clinical anesthesia scenarios.During practical training and teaching,medical humanistic care was integrated into clinical diagnostic procedures,including observation,inquiry,examination,and palpation.Based on the objective structured clinical examination(OSCE),the clinical communication skills,various clinical operational abilities,and clinical decision-making abilities of the two groups of rotating physicians were compared between both groups;Self-assessment and Teaching Satisfaction Questionnaires were used to compare the two groups of rotating physicians regarding their satisfaction with the teaching program and self-evaluated confidence in medical practice.Results The formative evaluation of clinical anesthesia practice operations(47.24±2.85),OSCE score(45.62±4.12),and total score(92.85±6.92)of the experimental group were higher than those of the control group,and the differences were statistically significant(P＜0.05).The experimental group received higher self-evaluation scores than the control group in terms of learning interest(8.02±0.76),clinical communication ability(6.72±1.12),problem-solving ability(7.03±0.87),medical humanities literacy(8.65±1.21),confidence in medical practice(8.08±0.52),and teaching satisfaction(8.52±0.64),and the differences were statistically significant(P＜0.01).Conclusion Integrating medical humanities quality education into clinical anesthesia practice teaching not only improves the medical humanities literacy of junior doctors,but also enhances their clinical technical operation level and confidence in engaging in clinical work,achieving the goal of"dual cultivation of humanities literacy and technical skills".

Abstract:This review examines the research progress of portable intelligent nerve block puncture systems in battlefield emergency care and explores their current applications and potentials for enhancing the precision,safety,and efficiency of nerve blocks.By integrating ultrasound imaging and artificial intelligence(AI)technologies,these systems can automatically identify and precisely locate nerve structures,thereby assisting clinicians in performing nerve blocks more efficiently and safely.In battlefield emergency settings,the system can rapidly assess injuries and provide analgesia while also serving as a training tool to enhance the skills of medical personnel.Additionally,intelligent nerve block techniques have shown significant advantages in anesthesia,postoperative pain management,and chronic pain treatment by reducing complications and improving patient outcomes.Future developments are expected to focus on integrating remote medical services,wearable devices,optimizing AI algorithms,and enhancing multi-device interoperability.These advancements are expected to expand its role in battlefield emergency care,driving the intelligent and precise advancement of nerve block techniques.

Abstract:This article examines risk management in clinical trials of anesthetic agents and products,aligned with the ICH GCP E6(R3)Guidelines.By analyzing risk characteristics specific to clinical trials of anesthetic agents and products,it outlines key risk management considerations across trial design,trial implementation,data governance and other related aspects.Emphasis is placed on the application of risk-based quality management approaches to enhance the quality of clinical trials,ensure participants'safety,and provide insights for related research.

Abstract:Tourniquets are widely used in limb surgeries.While they play a crucial role in hemostasis,they can also cause a series of adverse reactions and complications,which may negatively impact the patients'comfort and prognosis.To prevent the adverse reactions of tourniquets,various methods have been explored in clinical practice,among which the intervention of anesthesia methods and anesthetic drugs are the most commonly used and effective.This article reviews the clinical application progress of anesthesia management strategies in preventing and treating tourniquets-related adverse reactions aiming to provide references for reducing tourniquets-related adverse reactions and improving the surgical experience of patients.