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Jingru Pan,1,* Ziqing Hei,1,* Liping Li,1 Dan Zhu,1 Hongying Hou,2 Huizhen Wu,1 Chulian Gong,1 Shaoli Zhou1 1Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Obstetrics, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shaoli Zhou; Chulian GongDepartment of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, People’s Republic of ChinaTel +86-20-85252297Fax +86-20-87580876Email shaolizhou@139.com; gongchulian@163.comObjective: Theaimofthisstudywasto test whether the implementation of an enhanced recovery after surgery (ERAS) protocol for patients undergoing elective cesarean delivery has a positive impact on the postoperative status of the patients in terms of pain management, hospital stay, hospitalization costs, and adverse reactions.Methods: Patients who underwent elective cesarean delivery were randomized into two groups – ERAS group and control group –and the groups were managed with the ERAS protocol and traditional protocol, respectively.Results: Compared to the control group, the ERAS group had significantly fewer patients with intraoperative nausea, pain of visual analog scale (VAS) scores, and VAS grade > 3 during rest in the first 24 h and during motion in the first 24 and 48 h after surgery. There were no intergroup differences in the requirement of extra analgesics, the incidence of vomiting, shivering, hypotension, postoperative nausea, and pruritus. None of the patients in either group had postoperative vomiting. Patient satisfaction rated as per the VAS was significantly higher in the ERAS group than in the control group. The total length of stay, postoperative length of stay, and the cost of anesthesia in both groups were comparable. Further, the average daily hospitalization cost was significantly lower in the ERAS group than in the control group.Conclusion: TheERAS protocol shows promise and appears to be worthwhile for widespread implementation among patients undergoing elective cesarean delivery; it was found to be beneficial in reducing the postoperative pain, incidence of intraoperative nausea, and average cost of hospitalization and also improved patient satisfaction.Keywords: enhanced recovery after surgery, ERAS, cesarean delivery, pain

Background: Postpartum depression (PD) is a common disorder associated with severe adverse infant and maternal outcomes, which is becoming an important public health problem. However, studies on the clinical relevance of anesthesia and PD are very limited. This study aimed to examine risk factors for PD amongst Chinese parturients of caesarean section from the perspective of anesthesiology, especially during the standard Chinese postpartum recuperation period known as “doing the month”.Methods: Prospective cohort study of 125 women who received caesarean sections aged from 21 to 46 years. The Edinburgh Postnatal Depression Scale were evaluated at the day before caesarean section and 6 weeks postpartum. Demographic, clinical, and treatment, including postoperative prognostic data and conditions during “doing the month”, were recorded and compared between PD and non-PD groups. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with the occurrence of PD. Results: 44 (34.9%) patients were diagnosed PD at 6 weeks postpartum. Occurrence of PD was associated with postoperative pain, pruritus, dissatisfaction with “doing the month”. Multivariate regression analysis showed that lumbago (OR 5.68, 95% CI 1.69-19.06; p=0.005), maternal total dissatisfaction during “doing the month”(OR 6.87, 95% CI 2.48-19.04; p=0.001), and dissatisfaction with mother in-law during “doing the month”(OR 3.22, 95% CI 1.43-16.16; p=0.020) were independent risk factors for PD, while mild activity pain was independent protective factor for PD 6 weeks postpartum (OR 0.018, 95% CI 0.01-0.25; p=0.003). Conclusions: PD was a commonly experienced psychological disorders for women undergoing caesarean section. Postpartum lumbago, maternal total dissatisfaction and dissatisfaction with mother in-law during “doing the month” and mild activity pain were main factors for PD at 6 weeks postpartum.

BACKGROUND Effects of liver dysfunction on target-controlled infusion (TCI) with Marsh parameters of propofol remain poorly documented. The purpose of this study was to evaluate the performance of propofol TCI in a cohort of Chinese patients with severe hepatic insufficiency. MATERIAL AND METHODS We assigned 32 patients who underwent liver transplantation to 3 groups according to Child-Turcotte-Pugh (CTP) score. Anesthesia, preceding liver transplantation, was induced and maintained with TCI of 3 µg/mL propofol. Plasma propofol concentration was assessed. Propofol TCI system performance was analyzed in terms of error size, bias, and divergence. Data on plasma propofol concentrations were analyzed, and population pharmacokinetic parameters of propofol were fitted by NONMEM software. RESULTS In the CTP C group, measured concentrations of propofol were much higher than those of predictive concentrations, with significantly higher overshoots compared to CTP A patients. Overall, TCI system performance was significantly lower in CTP C patients. Linear regression equations of Cm vs. Cp and a regression model of pharmacokinetics were obtained. CONCLUSIONS Propofol TCI device performance with Marsh parameters was clinically acceptable in CTP A patients but may not be suitable for patients with severe hepatic impairment.

Current analgesic strategies for propofol injection pain may cause adverse reactions during electroconvulsive therapy (ECT), such as shortening seizure duration. This study investigated whether dexmedetomidine could attenuate propofol injection pain in ECT. Participants were randomly allocated to receive 0.2 μg/kg dexmedetomidine (Dex-0.2 group), 0.5 μg/kg dexmedetomidine (Dex-0.5 group) or saline (control group) prior to ECT. The composite pain scale and objective Surgical Pleth Index (SPI) were used to measure the intensity of injection pain, and the percentage of patients with pain score > 2 was the primary outcome. Of 137 patients recruited, 46 were assigned to each of the Dex-0.2 or Dex-0.5 groups, while 45 were in the control group. The percentage of pain score > 2 was reduced from 68.9% (31/45) in the control group to 34.8% (16/46) in the Dex-0.2 group (P

Background Remifentanil is widely used for ultrasound-guided percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC). We determined whether dexmedetomidine could be an alternative to remifentanil for RFA of HCC under general anesthesia with sevoflurane. Methods We prospectively randomized patients scheduled to undergo RFA for HCC to a dexmedetomidine (DEX) group or remifentanil (REMI) group (47 patients each). In the DEX group, a bolus infusion (0.4 μg kg− 1) was started 15 min before anesthesia induction and continued at 0.2 μg kg− 1 h− 1 until 10 min before the end of surgery. In the REMI group, 3 μg kg− 1 h− 1 of remifentanil was administered from 15 min before anesthesia induction to the end of the surgery. The primary endpoint was postoperative pain intensity. Secondary endpoints included analgesic requirement, postoperative liver function, patient comfort, and hemodynamic changes. Group allocation was concealed from patients and data analysts but not from anesthesiologists. Results Postoperative pain intensity, analgesic consumption, comfort, liver function, and time to emergence and extubation did not differ between the two groups. Heart rate, but not mean arterial pressure, was significantly lower in the DEX group than in the REMI group, at 1 min after intubation and from 30 min after the start of the surgery until anesthesia recovery. Sevoflurane concentration and dosage were significantly lower in the DEX group than in the REMI group. Conclusion During RFA for HCC, low-dose dexmedetomidine reduced the heart rate and need for inhalational anesthetics, without exacerbating postoperative discomfort or liver dysfunction. Although it did not exhibit outstanding advantages over remifentanil in terms of pain management, dexmedetomidine could be a safe alternative adjuvant for RFA under sevoflurane anesthesia. Trial registration Chinese Clinical Trial Registry, ChiCTR-OPC-15006613. Registered on 16 June 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-3010-z) contains supplementary material, which is available to authorized users.

CONSORT-Equity flow diagram. Intervention A denotes remifentanil and intervention B denotes dexmedetomidine. (DOC 70 kb)

CONSORT-Equity checklist. (DOCX 18 kb)

Aims The objective of this study was to determine the accuracy of the Pangao PG-800A11 wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the protocol of the British Hypertension Society (BHS). Methods The device evaluations were performed in 85 participants, 33 of whom were included according to the ESH-IP revision 2010 and 52 of whom were included on the basis of the requirements of the BHS protocol. The validation procedure and data analysis followed the protocols precisely. Results The device achieved an A/A grading for the BHS protocol and passed all phases of the ESH-IP revision 2010 protocol. The mean difference ±SD for the ESH and BHS protocols, respectively, was -0.6±4.5 and -0.8±6.2 mmHg for systolic pressure and 1.2±4.6 and -0.5±5.1 mmHg for diastolic pressure. The device maintained its A/A grading throughout the low, medium, and high-pressure ranges. Conclusion The Pangao PG-800A11 wrist blood pressure monitor passed all requirements of the ESH-IP revision 2010 and achieved A/A grade of the BHS protocol in an adult population.

Reference evapotranspiration (ET0) is a crucial parameter for hydrological modeling, land-atmospheric interaction investigations and agricultural irrigation management. This study investigated changes in ET0 and attributed those changes to climate variations in a coastal area (Zhejiang province) of China by a numerical experiment method. The results indicated that annual ET0 increased significantly (p < 0.05) at a rate of 1.58 mm·year−1 from 1973 to 2013, which was mainly caused by an obvious increase in ET0 in spring. Air temperature and water vapor pressure deficits increased significantly (p < 0.05) at rates of 0.04 °C·year−1 and 0.005 kPa·year−1, respectively, at an annual time scale during the study period, while wind speed and solar radiation decreased significantly (p < 0.05) at rates of −0.01 m/s·year−1 and −3.94 MJ·m−2·day−1·year−1, respectively. The contributions of changes in air temperature, wind speed, water vapor pressure deficits and solar radiation to increases in ET0 were 0.39, −0.56, 2.62 and −0.61 mm·year−1, respectively. The decrease in wind speed and solar radiation negatively affected the increase in ET0, which was offset by the positive effects of the air temperature and water vapor pressure deficits increase, where the water vapor pressure deficits was the dominant factor in increasing ET0 in the coastal area. Moreover, the impact of topography on ET0 was further discussed. ET0 changes at plain stations were approximately 5.4 times those at hill stations, which may be due to the impact of a large water body and the augment of surface roughness from intense human activities in the well-developed plain area. The results are helpful for investigating spatial and temporal changes in the evaporative demand for well-developed regions under energy-limited conditions.