［Abstract］　Objective　To observe the application effects of low-dose midazolam combined with sufentanil on inpatients undergoing transesophageal echocardiography(TEE) examination. Methods　A total of 260 inpatients undergoing TEE examination in the Second Hospital of Hebei Medical University from February 2017 to September 2017 were included by adopting a prospective cohort study method. The inpatients were divided into simple topical anesthesia group(group C, 54 cases), midazolam group(group M, 27 cases) and midazolam combined with sufentanil group(group MS, 179 cases). All the patients in the three groups were given topical anesthesia using tetracaine plasmagel at the oropharynx. Group C was not given any other treatment. Group M was given intravenous injection of midazolam at dose of 0.03 mg/kg. Group MS was given intravenous injection of midazolam at dose of 0.03 mg/kg and intravenous injection of sufentanil at dose of 0.1 μg/kg. Group M and group MS were decided whether to add drugs during the operation based on the patients′ response. Non-invasive systolic blood pressure(NSBP), heart rate(HR), and pulse oxygen saturation(SpO₂) were recorded in the three groups after the patients entered the examination room(T₀), when the probes were successfully inserted(T₁) and 5 minutes after successful probe insertion(T₂). The difficulty of probe insertion, TEE examination time, intraoperative adverse events and examiners′ satisfaction were recorded. After examination, the modified Aldrete scale was used to judge the recovery degree of the patients. The patients were followed up for their degree of satisfaction with anesthesia and for the occurrence of postoperative adverse reactions 24 hours after surgery. Results　There were significant differences among the three groups in the difficulty of probe insertion, examiners′ satisfaction scores and patients′ postoperative satisfaction with anesthesia scores(P<0.05). Compared with those in group C at the same time point, NSBP and SpO₂ in group M and group MS at T₁ and T₂ time points were decreased, and HR in group MS at T₁ and T₂ time points was decreased, and the differences were statistically significant(P<0.05). Compared with that in group M at the same time point, SpO₂ in group MS at T₂ time point was decreased, and the difference was statistically significant(P<0.05). In group C, compared with that at T₀ time point, HR was increased at T₁ and T₂ time points. In group MS, compared with that at T₀ time point, HR was decreased at T₂ time points. In group M and group MS, compared with that at T₀ time point, NSBP was decreased at T₁ and T₂ time points. In group MS, compared with that at T₀ time point, SpO₂ was decreased at T₁ and T₂ time points. The differences were statistically significant(P<0.05).There were no significant differences in the incidence rates of intraoperative adverse events among the three groups(P>0.05), and the three groups did not experience any bradycardia and tachycardia that needed to be treated during surgery. The patients′ incidence rate of postoperative nausea in group C was significantly higher than that in group M and group MS, and the patients′ incidence rate of postoperative pharyngeal discomfort in group C was significantly higher than that in group MS(P<0.05). After timely treatment of intraoperative adverse events and postoperative adverse reactions, all the patients returned to normal, and no adverse consequences occurred. Conclusion　On the basis of topical anesthesia, both low-dose midazolam and midazolam combined with sufentanil can be safely and effectively applied in hospitalized patients undergoing TEE examination, and midazolam combined with sufentanil has better effects, but attention should be paid to possible hypoxemia.]]> 2024/4/30 11:24:22 1, WANG Jing², FENG Rui², ZHANG Chunxia², YIN Hongning², LIU Haitao¹, KANG Rongtian¹]]> LI Xuze¹, WANG Jing², FENG Rui², ZHANG Chunxia², YIN Hongning², LIU Haitao¹, KANG Rongtian¹ 5true ［Abstract］　Objective　To explore the anesthesia management in children of different ages with spontaneous breathing and undergoing direct laryngoscopy and bronchoscopy under total intravenous anesthesia. Methods　A total of 71 pediatric patients with airway malformation who were admitted to Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from May 2022 to January 2023 were selected. The pediatric patients were classified by the American Society of Anesthesiologists(ASA)as grade Ⅱ-Ⅲ, with ages ranging from 1 month to 10 years old. According to the ages, the pediatric patients were divided into younger than 1 year group(group A, 25 cases), older than or equal to 1 year and younger than 4 years group(group B, 23 cases) and older than or equal to 4 years group(group C, 23 cases ). Anesthesia was induced by intravenous infusion of lidocaine, sufentanil and dexmedetomidine combined with intravenous drip of propofol, and maintained by pump infusion of propofol at 10-12 mg/(kg·h).Vocal cord surface anesthesia was performed with 2.4% lidocaine aerosol. The pediatric patients′ incidence rates of apnea, laryngeal spasm, choking cough and hypoxemia after anesthesia were compared among the three groups. The pediatric patients′ indicators of vital signs were recorded at awake state(T₀), rigid laryngoscope insertion(T₁) and direct laryngoscopy and bronchoscopy(T₂). Results　After anesthesia, there were no significant differences in the pediatric patients′ incidence rates of apnea, laryngeal spasm and choking cough among the three groups(P>0.05). The dose of propofol used for inducing anesthesia in the pediatric patients of group A was significantly reduced compared with that in the pediatric patients of group B and the pediatric patients of group C, while the incidence rate of hypoxemia in the pediatric patients of group A was significantly higher than that in the pediatric patients of group C(P<0.05). In the pediatric patients of group A, heart rate(HR) at T₁ and T₂ time points was significantly lower than that at T₀ time point, and in the pediatric patients of group B, HR at T₂ time point was significantly lower than that at T₀ time point(P<0.05). Systolic blood pressure(SBP) and diastolic blood pressure(DBP) at T₁ and T₂ time points were significantly lower than those at T₀ time point in the three groups(P<0.05). Conclusion　The technique of total intravenous anesthesia with the patients′ spontaneous breathing preserved can be used for direct laryngoscopy and bronchoscopy in children, but it should be noted that the incidence rate of hypoxemia in infants under 1 year of age is higher than that in children aged 1 year and above.]]> 2024/4/30 0:00:00 1,2, ZHANG Ruidong²]]> FU Dayong^1,2, ZHANG Ruidong² 4true ［Abstract］　Objective　To explore the application effect of dexmedetomidine combined with ropivacaine four-point nerve block on laparoscopic surgery of liver tumors. Methods　A total of 84 patients undergoing laparoscopic surgery of liver tumors under general anesthesia in the People′s Hospital of Guangxi Zhuang Autonomous Region from August 2021 to July 2022 were selected and randomly divided into dexmedetomidine combined with ropivacaine group(group A, 30 cases), ropivacaine group(group B, 30 cases) and control group(group C, 24 cases). Both group A and group B underwent ultrasound-guided four-point nerve block in the right low serratus anterior, right transversus abdominis plane below the rib margin, and bilateral posterior rectus sheath, and group C did not receive any nerve block. The hemodynamic changes at the time for intraoperative anesthesia(T₁), 5 minutes before skin incision(T₂), 5 minutes after skin incision(T₃), at the time for hepatectomy(T₄) and at the time for skin suture(T₅), and the Visual Analogue Scale(VAS) scores at rest and in motion within 48 hours after surgery(2 hours, 6 hours, 12 hours, 24 hours and 48 hours), the pressing times of the analgesic pump within 48 hours after surgery, and the occurrence of adverse reactions were compared among the three groups. Results　At T₁-T₅ time points, the levels of mean arterial pressure(MAP) and heart rate(HR) showed a trend of first increasing and then decreasing in the three groups, and there were no statistically significant differences in the two indicators at different time points between groups(P>0.05). The VAS scores at rest showed a trend of first increasing and then decreasing in the three groups after surgery. The VAS scores at rest in group B and group C were significantly higher than those in group A at 6 hours, 12 hours and 24 hours after surgery(P<0.05). The VAS scores at rest in group B were still significantly higher than those in group A at 48 hours after surgery, but there were no statistically significant differences between group A and group C(P>0.05). The VAS scores in motion showed a trend of first increasing and then decreasing in the three groups after surgery. The VAS scores in motion in group C were significantly higher than those in group A at 2 hours, 6 hours and 48 hours after surgery(P<0.05). The VAS scores in motion in group B were significantly higher than those in group A only at 6 hours after surgery(P<0.05). Compared with group C, both group A and group B showed a significant reduction in the pressing times of the analgesic pump(P<0.05). There were no statistically significant differences in the first exhaust time, recovery time of diet, time of getting out of bed for the first time and hospitalization time among the three groups(P>0.05). There were statistically significant differences in the total incidence rate of postoperative adverse reactions and nerve block-related complications among the three groups(P<0.05). Conclusion　Dexmedetomidine combined with ropivacaine four-point nerve block for laparoscopic surgery of liver tumors under general anesthesia has no significant differences in hemodynamic effects at various time points during the operation, but it improves postoperative upper abdominal analgesia, reduces the pressing times of the analgesic pump, and has no obvious adverse reactions, which is worthy of promotion.]]> 2024/4/30 0:00:00 HUANG Liuqing, LU Liuyu, QIN Xiaotong, WANG Yonghao, KANG Xiaoyu, GONG Zheng 3true ［Abstract］　Objective　To study the application value of bedside gastric antrum ultrasound in assessing the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy. Methods　A total of 616 patients undergoing elective painless digestive endoscopy for diagnosis and treatment in the Second Affiliated Hospital of Guilin Medical University from November 2021 to March 2022 were selected, and bedside gastric antrum ultrasound was performed on the patients 10 minutes before painless digestive endoscopy. Ultrasound examination results including the nature of gastric contents, Perlas gastric antrum grading, right lateral decubitus gastric antrum cross-sectional area(RLD CSA) and predicted gastric volume, and changes in anesthesia protocols were observed and recorded. The actual gastric volume aspirated during gastroscopy and the full stomach detected by gastroscopy were recorded. The correlations of RLD CSA and predicted gastric volume with actual gastric volume were assessed by using Pearson correlation analysis. The predictive value of RLD CSA for full stomach was assessed by receiver operating characteristic(ROC) curve analysis. Results　Nineteen patients did not obtain typical ultrasound images of the gastric antrum, and 597 patients were included in statistical analysis. The ultrasound exmination time for all the patients was (2.9±0.9)minutes. Forty-two patients(7.0%) were diagnosed by ultrasound as having a full stomach. The anesthesia regimens of the patients diagnosed with full stomach by ultrasound were changed, among whom 4 patients were given delayed anesthesia and 38 patients underwent ordinary gastroscopy. Under gastroscopy, 31 patients were found to have actual full stomach, of whom 28 patients were found to have liquid full stomach and 3 patients were found to have solid full stomach. No reflux and aspiration occurred in all the patients. Pearson correlation analysis showed that RLD CSA and predicted gastric volume were positively correlated with actual gastric volume(P<0.05). The results of ROC curve analysis showed that RLD CSA had the application value of predicting full stomach［the area under the curve(AUC)(95%CI)=0.926(0.864-0.987), P<0.001］, and the optimal cut-off value was 7.87 cm², and the corresponding sensitivity and specificity were 96.4% and 78.6%, respectively. Conclusion　Bedside gastric antrum ultrasound can be used to assess the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy. Bedside gastric antrum ultrasound is feasible and accurate, and has good clinical application value in assessing the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy.]]> 2024/4/30 11:24:22 1, LIANG Suzhen¹, ZHOU Zhihu¹, HUANG Liqiao¹, LONG Yufang¹, SHI Min¹, YANG Tiande²]]> ZHANG Xu¹, LIANG Suzhen¹, ZHOU Zhihu¹, HUANG Liqiao¹, LONG Yufang¹, SHI Min¹, YANG Tiande² 2true ［Abstract］　Hepatic ischemia-reperfusion injury(HIRI) is an inevitable pathophysiological process during traditional liver transplantation. Its severity can be affected by multiple factors involving both donors and recipients, and the most severe consequence can be early post-operative graft dysfunction. Human bone marrow mesenchymal stem cells(BMSCs) and their exosomes have been proven to be capable of promoting tissue regeneration and immune modulation in clinical trials, therefore, they have promising prospects in treating and preventing HIRI. We aim to review the current research progress in the potential mechanism as well as the future research direction of BMSCs and their exosomes in the prevention and treatment of HIRI.]]> 2024/4/30 11:24:22 ZHANG Yihan, YAO Weifeng 1true