Abstract:As the S-enantiomer of racemic ketamine,esketamine has a strong analgesic effect and has been increasingly used in the perioperative period in recent years.This article reviews the sedative and analgesic effects,antidepressant effects,anti-inflammatory effects,lung protective effects and adverse reactions of esmketamine under different anesthetic doses in recent years,and reviews the char-acteristics of the application of esmketamine under subanesthetic doses in the perioperative period,so as to provide theoretical basis for patients'safety and good perioperative analgesia.

Abstract:Objective To evaluate status of anesthesia quality and patient safety in China.Methods A questionnaire, concerning anesthesia staffing, preoperative evaluation, perioperative anesthesia monitoring, postoperative anesthesia monitoring, anesthesia incident reporting system, and anesthesia quality administration, was delivered through New Youth Anesthesia Forum to every member from March, 2016 to April, 2016.The respondents could complete the survey via mobile device or desktop with each IP address for only one questionnaire.Results A total of 8546 members read questionnaire invitations.Of them, 3647 respondents fully completed questionnaires, which represented an overall response rate of 43%.72.3% of the respondents reported the shortage of anesthesia providers, 78.3% reported the routine preoperative anesthesia assessment, and 69.2% reported routine preoperative airway evaluation.33.5% of the respondents admitted that more than half of the preoperative anesthesia assessments were performed in the operation room.Only 78.9% of the respondents reported that selective surgery patients had strictly followed NPO guideline.77.9% of the respondents reported the routine continuous electrocardiographic monitoring in all patients;while 99% reported the routine pulse oxygen saturation monitoring.Only 55% of the respondents reported that they routinely used end tidal carbon dioxide (ETCO2) monitoring for their patients under general anesthesia.30.3% of the respondents reported that their PACU was staffed with anesthesiologists based on the number of PACU beds, while 37.1% reported that they did not have PACU in their hospitals.43.6% reported that their PACU was equipped with code carts.48.4% of the respondents reported that they had specical pain management team for postoperative pain management.95% of the respondents believed that anesthesia incidents reporting systems could improve the patient safety.But only 42.3% of the respondents reported that their departments had anesthesia incidents reporting system.36.4% reported that they had the reporting system but without any implementation.Only 22.6% of the respondents reported that they had web-based anesthesia incidents reporting system.2.9% of the respondents reported that they did not use the surgical safety checklists.40.6% reported partial implementation and 56.5% reported complete implementation.Conclusion This is the first anesthesia quality survey in China.This survey revealed potential anesthesia safety issues in China.The results can serve as a benchmark for future studies about anesthesia quality and patient safety improvement in China.The evidence can help government health policy makers and hospital administers understand the challenges and develop a series of strategies to improve anesthesia patient safety.

Abstract:Objective Using the plan-do-check-action(PDCA) cycle theory to reduce the rate of unintended secondary intubation during resuscitation and improve the quality and safety of anesthesia.Methods A total of 73664 patients undergoing tracheal intubation in second affiliate hospital of Zhejiang university post-anesthesia care unit (PACU) from Jan.2014 to Dec.2015 were seleted.We analyzed 17 patients who underwent unintended secondary intubation and provided the prompt examination and summary to formulate a standardized protocol to guide clinical extubation.Results Compared with 2014, the rate of unintended secondary intubation was reduced from 0.04% to 0.01% and the quality and safety of anesthesia improved in 2015.Conclusion PDCA cycle theory can effectively reduce the rate of unintended secondary intubation during resuscitation.