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Objective To investigate the effects of esketamine on respiration, complications and acute phase inflammatory factors in patients undergoing single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration. Methods Ninety patients, aged 16 ~ 74 years, BMI 18 ~ 28 kg/m2, ASA physical status ? or ?, who were scheduled to undergo single-port thoracoscopic surgery under general anesthesia were selected. Patients were randomly divided into two groups by random number table: esketamine group (group E, n = 45) and control group (group C, n = 45) . Esketamine 0.5 mg/kg was given for induction of anesthesia, and 0.25 mg/kg again before cutting skin. In group C, sufentanilwas given at 0.15 μg/kg for induction of anesthesia. Other anesthesia induction and maintenance durgs in both groups were the same.Sp02, PaCO2 and PaO2 were recorded at the patient's entrance (T0), before pleuraopening (T1), 15 min after pleuraopening (T2), 30 min after pleuraopening (T3), and beforelaryngeal mask removal (T4) . 3 mL of blood was extracted from themedian cubital vein at T0 and 24 h after surgery (T5) to detect the concentrations of TNF- α and IL-6. The length of spontaneous respiration recovery and laryngeal mask removal, the number of respiratory intervention, the incidence of body movement during operation, nausea, vomiting, psychiatric symptom, awareness, the length of hospital stay was recorded. Results Compared with group C, PaO2 was significantly decreased and PaCO2 was significantly increased in group E at T1, PaO2 was significantly increased and PaCO2 was significantly decreased at T2 (P < 0.01). Compared with group C, the length of spontaneous respiration recovery was significantly shortened and the number of respiratory intervention was significantly decreased in group E (P < 0.01). Compared with group C, the concentrations of TNF-α and IL-6 in venous blood in group E at T5 was significantly decreased (P < 0.01). There were no significant difference in the length of laryngeal mask removal, and the incidenceofcomplications,hospitalstay between the two groups. Conclusion Esketamine reducesintraoperative respiratory depression, shortens spontaneous respiration recovery, maintains respiratory stability and reduces acute inflammatory response in patients under general anesthesia with preserved spontaneous respiration for single-port thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Objectives The research aimed to determine the effects of different surgical procedures on postsurgical pain and early prognosis. We reviewed the perioperative data of patients who underwent single/two-port television-assisted thoracoscopic pulmonary nodule surgery in the day surgery ward of Nanjing Drum Tower Hospital. Methods The clinical and follow-up data of 693 patients undergoing thoracoscopic for pulmonary nodules in the day surgery ward under the centralized management model of our hospital were retrospectively analyzed during the period of January 2021 to December 2022. The patients were divided into a single-port and a two-port thoracoscopy group. The propensity-matching was used to balance the baseline data and analyze the differences in postoperative pain and prognosis of the patientsin the two groups. Results After propensity score matching, the single-port group had lower intraoperative fentanyl consumption [0.5 (0.35, 0.50) mg vs. 0.5 (0.40, 0.50) mg, P = 0.034], remifentanil consumption [0.48 (0.33, 0.63) mg vs. 0.53 (0.35, 0.73) mg, P = 0.031], intraoperative hemorrhage [20 (10, 50) mL vs. 50 (20, 50) mL, P = 0.001], and Visual Analogue Scale on postoperative third day [2 (2, 4) point vs. 3 (2, 4) point, P = 0.007], which were statistically different. There were no statistically significant differences between the two groups in terms of postoperative rescue analgesia, chest drainage volume, length of hospitalization, pain on postoperative 1st, 5th, 9th, and 30th days, postoperative cough, pulmonary complications within 30 days after surgery, and unplanned hospital visits. Conclusion Compared with two-port thoracoscopy, single-port thoracoscopic day surgery for pulmonary nodules is a safe and feasible procedure that can significantly reduce the use of intraoperative opioid analgesics and the pain level of patients on postoperative 3rd day. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of protective ventilation strategies based on individualized positive end expiratory pressure (PEEP) regulated by driving pressure (Pd) in infants under OLV. Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into the control group and driving pressure group, with 30 cases in each group. The two groups were compared in terms of MAP, HR, tidal volume (Vt), PEEP, Pd, airway peak pressure (Pk), and static lung compliance (Cs), and arterial blood gas during OLV before the artificial pneumothorax (T0), 10 min (T,), 30 min (T2), and 60 min (T3) after the artificial pneumothorax, and right at the end of the artificial pneumothorax (T4). Results There were no significant differences in MAP, HR, and Vt between the two groups at all the time points (P > 0.05). Both groups showed the increase in Pd and Pk and decresase in Cs at T,, T2, and T3 (all P < 0.05). PaO2 and OI in both group were decreased and PaCO2 was increased at T2 (all P < 0.05). Compared with the control group, the driving pressure group presented lower Pd and Pk, higher PEEP and Cs at T,, T2, and T3 (P < 0.05), and higher PaO2 and OI (P < 0.05) and no significant differences in PaCO2 and FiO2 at T2 (P < 0.05). The rate of rescue ventilation during OLV was lower in the driving pressure group (2 cases) than in the control group (9 cases) (6.9% versus 32.4%, P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P < 0.05). Conclusion The individualized positive end expiratory pressure (PEEP) regulated by Pd can optimize the PEEP settings upon infant individuals under OLV and improve the compliance and oxygenation of ventilated lung. [ABSTRACT FROM AUTHOR]