AbstractBackground: Propofol is a widely used intravenous anesthetic for procedural sedation in non-operating room settings, but its use is often accompanied by adverse events such as injection pain, respiratory depression, and hypotension. Ciprofol, a novel intravenous anesthetic, has gained attention as a potential alternative due to its favorable safety profile and comparable sedative efficacy. This systematic review and meta-analysis aimed to compare the efficacy, safety, and satisfaction outcomes of ciprofol and propofol in adults undergoing non-operating room procedures. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) comparing ciprofol and propofol. Data from eligible studies were extracted and analyzed using RevMan 5.3 and Stata 17. Risk ratio (RR) with 95% confidence interval (CI) were calculated for binary outcomes, and standard mean difference (SMD) with 95% CI were used for continuous outcomes. Heterogeneity was assessed using the I²statistic, with fixed-effects or random-effects models applied as appropriate. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity and ensure robustness. Results: Seven RCTs involving 1,458 participants were included. Ciprofol demonstrated comparable sedation success rates to propofol. Subgroup analyses indicated that combining ciprofol with short-acting opioids significantly improved sedation outcomes (RR 1.07, 95% CI 1.03–1.12; P < 0.01). Ciprofol was associated with significantly lower risks of injection pain (RR 0.13, 95% CI 0.06–0.28; P < 0.01), respiratory depression (RR 0.55, 95% CI 0.33–0.77; P < 0.01), and hypotension (RR 0.81, 95% CI 0.69–0.95; P < 0.01). No significant differences were observed between the two agents in induction time or time to full recovery. Conclusion: Ciprofol is a safe and effective alternative to propofol for non-operating room procedural sedation. Its superior safety profile, particularly in reducing injection pain, respiratory depression, and hypotension, makes it a promising option, especially when combined with short-acting opioids.
Abstract Background Minimising postoperative pulmonary complications (PPCs) after thoracic surgery is of utmost importance. A major factor contributing to PPCs is the driving pressure, which is determined by the ratio of tidal volume to lung compliance. Inhalation and intravenous administration of penehyclidine can improve lung compliance during intraoperative mechanical ventilation. Therefore, our study aimed to compare the efficacy of inhaled vs. intravenous penehyclidine during one-lung ventilation (OLV) in mitigating driving pressure and mechanical power among patients undergoing thoracic surgery. Methods A double-blind, prospective, randomised study involving 176 patients scheduled for elective thoracic surgery was conducted. These patients were randomly divided into two groups, namely the penehyclidine inhalation group and the intravenous group before their surgery. Driving pressure was assessed at T 1 (5 min after OLV), T 2 (15 min after OLV), T 3 (30 min after OLV), and T 4 (45 min after OLV) in both groups. The primary outcome of this study was the composite measure of driving pressure during OLV. The area under the curve (AUC) of driving pressure from T 1 to T 4 was computed. Additionally, the secondary outcomes included mechanical power, lung compliance and the incidence of PPCs. Results All 167 participants, 83 from the intravenous group and 84 from the inhalation group, completed the trial. The AUC of driving pressure for the intravenous group was 39.50 ± 9.42, while the inhalation group showed a value of 41.50 ± 8.03 ( P = 0.138). The incidence of PPCs within 7 days after surgery was 27.7% in the intravenous group and 23.8% in the inhalation group ( P = 0.564). No significant differences were observed in any of the other secondary outcomes between the two groups (all P > 0.05). Conclusions Our study found that among patients undergoing thoracoscopic surgery, no significant differences were observed in the driving pressure and mechanical power during OLV between those who received an intravenous injection of penehyclidine and those who inhaled it. Moreover, no significant difference was observed in the incidence of PPCs between the two groups.
Abstract Background There is a lack of reports in the literature regarding changes in radial artery blood flow after decannulation. The objective of this study was to investigate changes in radial and ulnar artery blood flow after radial artery decannulation using Doppler ultrasound and to explore the factors that influence radial artery blood flow recovery. Methods In current observational study, we used colour Doppler ultrasound to measure the cross-sectional area of the radial (S R ) and ulnar artery (S U ) and peak systolic velocity of the radial (PSV R ) and ulnar artery (PSV U ) for both hands at four time points in patients with radial artery cannulation: pre-cannulation (T0), 30 min after decannulation (T1), 24 h after decannulation (T2), and 7 days after decannulation (T3). Repeated measures analysis of variance and logistic regression analysis were performed to analyse the data. Results Overall, 120 patients were included in the present study. We obtained the following results on the side ipsilateral to the cannulation: compared with T0, the ratio of PSV U /PSV R increased significantly at T1 and T2 ( p < 0.01); compared with T1, the ratio of PSV U /PSV R decreased significantly at T2 and T3 ( p < 0.01); compared with T2, the ratio of PSV U /PSV R decreased significantly at T3 (p < 0.01). Female sex (OR, 2.76; 95% CI, 1.01–7.57; p = 0.048) and local hematoma (OR 3.04 [1.12–8.25]; p = 0.029) were factors that were significantly associated with the recovery of radial artery blood flow 7 days after decannulation. Conclusions There was a compensatory increase in blood flow in the ulnar artery after ipsilateral radial artery decannulation. Female sex and local hematoma formation are factors that may affect the recovery of radial artery blood flow 7 days after catheter removal.
Bone cancer pain (BCP) is a pervasive clinical symptom which impairs the quality life. Long noncoding RNAs (lncRNAs) are enriched in the central nervous system and play indispensable roles in numerous biological processes, while its regulatory function in nociceptive information processing remains elusive. Here, we reported that functional modulatory role of ENSRNOT00000071132 (lncRNA71132) in the BCP process and sponging with miR-143 and its downstream GPR85-dependent signaling cascade. Spinal lncRNA71132 was remarkably increased in the rat model of bone cancer pain. The knockdown of spinal lncRNA71132 reverted BCP behaviors and spinal c-Fos neuronal sensitization. Overexpression of spinal lncRNA71132 in naive rat generated pain behaviors, which were accompanied by increased spinal c-Fos neuronal sensitization. Furthermore, it was found that lncRNA71132 participates in the modulation of BCP by inversely regulating the processing of miR-143-5p. In addition, an increase in expression of spinal lncRNA71132 resulted in the decrease in expression of miR-143 under the BCP state. Finally, it was found that miR-143-5p regulates pain behaviors by targeting GPR85. Overexpression of miR-143-5p in the spinal cord reverted the nociceptive behaviors triggered by BCP, accompanied by a decrease in expression of spinal GPR85 protein, but no influence on expression of gpr85 mRNA. The findings of this study indicate that lncRNA71132 works as a miRNA sponge in miR-143-5p-mediated posttranscriptional modulation of GPR85 expression in BCP. Therefore, epigenetic interventions against lncRNA71132 may potentially work as novel treatment avenues in treating nociceptive hypersensitivity triggered by bone cancer.
In adults undergoing noncardiac surgery, the correlation between intraoperative tidal volume and postoperative acute kidney injury (AKI) is unclear. This study aimed to investigate the effects of low tidal volume ventilation on the incidence of postoperative AKI compared with conventional tidal volume in adults undergoing noncardiac surgery.This was a two-center prospective randomized controlled trial on adult patients who underwent noncardiac surgery and had a mechanical ventilation of >60 min. Patients were randomized to receive either a tidal volume of 6 mL/kg pre-predicted body weight (PBW, low tidal volume) or a tidal volume of 10 mL/kg pre-predicted body weight (conventional tidal volume). The primary outcome was the incidence of AKI after non-cardiac surgery. Appropriate statistical methods were used for this study.Among the 1982 randomized patients, 943 with low tidal volume and 958 with conventional tidal volume were evaluable for the primary outcome. Postoperative AKI occurred in 12 patients (1.3%) in the low tidal volume group and 11 patients (1.1%) in the conventional tidal volume group, with an odds ratio of 0.889 (95%CI, 0.391-2.03) and a relative risk of 0.999 ([95%CI, 0.989-1.01]; P=0.804). Postoperative serum creatinine levels increased in 284 (30.0%) patients with low tidal volume compared to 316 (32.0%) patients with conventional tidal volume (P=0.251). No difference in postoperative serum creatinine levels was found between the two groups (57.5 [49.0-68.2] μmol/L vs. 58.8[50.4-69.5] μmol/L, P=0.056).Among adults undergoing noncardiac surgery, low tidal volume mechanical ventilation did not significantly reduce the incidence of postoperative AKI compared with conventional tidal volume.
Aim: Preoperative inferior vena cava collapsibility index (IVCCI) is effective in evaluating the volume status. We hypothesized that IVCCI-guided fluid management would reduce the incidence of postspinal anaesthesia hypotension in patients undergoing non-cardiovascular, non-obstetric surgery. Methods: A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of IVCCI for predicting hypotension after induction of spinal anaesthesia and to calculate the cut-off value. Based on the cut-off variation value, the following prospective randomized controlled trial aimed to compare the incidence of postspinal anaesthesia hypotension between the IVCCI-guided fluid administration group and the standard fluid administration group. Secondary outcomes included the rate of vasoactive drug administration, the amount of fluid administered, and the incidence of nausea and vomiting. Results: ROC curve analysis revealed that IVCCI had a sensitivity of 83.9%, a specificity of 76.3%, and a positive predictive value of 84% for predicting postspinal anaesthesia hypotension at a cut-off point of >42%. The area under the curve (AUC) was 0.834 (95% confidence interval: 0.740–0.904). According to the cut-off variation value of 42%, the IVCCI-guided group exhibited a lower incidence of hypotension than the standard group (9 [15.3%] vs. 20 [31.7%], P=0.032). Altogether, 11.9% of the patients in the IVCCI-guided group and 27.0% of the patients in the standard group required a vasoactive drug at least once (P=0.036).Total fluid administered was lower in the IVCCI-guided group than in the standard group (330 [0–560] mL vs. 345 [285–670] mL, P=0.030). Prespinal ultrasound scanning of the IVCCI provides a reliable predictor of hypotension following spinal anaesthesia at a cut-off point of >42%. IVCCI-guided fluid management before spinal anaesthesia can reduce the incidence of hypotension following spinal anaesthesia.
Abstract Background The pathogenesis of Meige's syndrome (MS) remains unknown, posing a challenge for clinicians. The current classification system for MS causes confusion and difficulty in selecting target nerves for cranial nerve radiofrequency therapy. Therefore, to simplify the process of choosing radiofrequency therapy for MS, we suggest reorganizing the syndrome based on the affected cranial nerves. Methods The new classification of MS, which is based on the cranial nerves responsible, is more aligned with the requirements of radiofrequency therapy. Start by identifying the initial frequency of spasms from the patient's clinical symptoms, including muscles such as the frontal, orbicularis oculi, buccinator, orbicularis oris, latissimus, temporal, masseter, medial and lateral pterygoid, pharyngeal, lingual, sternocleidomastoid, and trapezius. Then, determine the involved cranial nerve based on the muscle's nerve innervation. Results The 117 MS patients were categorized into different groups based on their cranial nerve involvement: 73.50% were classified as the facial nerve type, 5.13% as the trigeminal nerve type, 2.56% as the sublingual nerve type, 0.85% as the glossopharyngeal nerve type, 4.27% as the accessory nerve type, and 13.67% as multiple groups of the cranial nerve complex. Conclusions The current classification of MS, which is based on clinical symptoms, does not make it easy to choose the target nerves for MS radiofrequency treatment. However, reclassifying MS according to the affected cranial nerves could simplify the process of radiofrequency treatment for MS.
Objective To investigate the efficacy of ventilation with selective lobar collapse for thoracic surgery in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Thirty ASA Ⅱ or Ⅲ patients with COPD,aged 65-80 yr,with a body mass index of 16-28 kg/m2,undergoing radical resection of esophagus cancer,were randomly divided into 2 groups (n=15 each):one-lung ventilation (OLV) group and ventilation with selective lobar collapse group (group SLC).In group OLV,OLV was performed,while in group SLC,the balloon of the blocker was placed at 0.5 cm below the opening of the upper lobe bronchus and the lower lobe was collapsed when chest was open.The patients were mechanically ventilated (VT =7-8 ml/kg,RR =14-16 bpm,I∶E=1∶1.5-2.0,FiO2 =100％).Peak pressure (Ppeak),plateau pressure (Pplat),airway resistance (Raw),and dynamic lung compliance (Cd) were measured at 10 min of two-lung ventilation in supine position (T0),at 5,45 and 90 min of OLV or selective lobar collapse (T1-3) and at 10 min of two-lung ventilation in lateral position after the end of operation (T4).Arterial blood samples were obtained at To,T3 and T4 for blood gas analysis.Oxygenation index (OI),alveolar-arterial oxygen gradiant (P(A-a)O2),and respiratory index (RI) were calculated.Results Ppeak,Pplat and Raw were significantly lower at T2-4,while Cd was significantly greater at T1-4,OI was significantly higher at T3,4,and P(A-a)O2 and RI were significantly lower at T3,4 in group SLC than in group OLV.Conclusion The thoracic operation can be completed safely using ventilation with selective lobar collapse and OLV,however,ventilation with selective lobar collapse can improve oxygenation and provides better ventilatory efficacy than OLV in elderly patients with COPD.
Key words:
Pulmonary ventilation; Pulmonary disease, chronic obstructive; Aged; Respiratory mechanics
OBJECTIVE To observe the effects of sufentanil combined anesthesia on the analgesia of the elderly patients during the perioperative period so as to guide the clinical medication as well as to propose prevention measures for infections.METHODS A total of 120 patients who underwent the abdominal surgery in the hospital from Feb 2010 to Feb 2012 were selected as the study objects,according to the different medication schemes,the participants were divided into the Bhutto butorphanol group,the sufentanil group and the sufentanil combination,with 40 cases in each group.The patients were treated with endotracheal intubation for total intravenous anesthesia,according to the different types of analgesic drugs used by the three groups,double blind method was employed to observe the visual analogue scale(VAS),ramsay sedation score and adverse reaction 3 hours,6 hours,12 hours,24 hours,and 48 hours after the surgery,then the statistical analysis was performed.RESULTS Of the three groups,the VAS score of 6 hours after the surgery was significantly better in the sufentanil composite group than in both the Bhutto butorphanol group and the sufentanil group,the difference was statistically significant(P0.05).The Ramsay sedation score of the Bhutto butorphanol group and the sufentanil composite group was better than that of the sufentanil group,the difference was statistically significant(P0.05).CONCLUSION The sufentanil anesthesia can achieve the mutual synergistic effect on the postoperative analgesia of the elderly patients with less side effects and can achieve very satisfactory analgesic effect.There are a variety of causes of the infections in the elderly patients during the perioperative period,thus it is necessary to take positive prevention measures based on the features of the infections in the elderly patients so as to reduce the incidence of infections during the perioperative period.
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