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A letter to the editor of the journal "Pain & Therapy" discusses a recent article by Zhu et al. that examined the benefits of ultrasound-guided multipoint fascial plane block in elderly patients undergoing combined thoracoscopic-laparoscopic esophagectomy. The authors of the letter raise concerns about certain aspects of the study, including the lack of clear description regarding trocar site infiltration of local anesthetic, the use of parecoxib as a rescue analgesic, the definition of chronic pain, and the absence of important outcomes related to fast functional recovery and adequate pain control. The authors conclude that further clarification is needed to determine if the addition of multipoint fascial plane block improves the targets of current enhanced recovery after surgery (ERAS) protocols. [Extracted from the article]

Effect of transcutaneous electrical acupoint stimulation combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery: a randomized controlled trial. Controlled Trial" References 1 Xing R, Yang Y, Zhang M. Effect of transcutaneous electrical acupoint stimulation combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery: a randomized controlled trial. [Extracted from the article]

A letter to the editor of the World Journal of Surgery discusses a randomized controlled trial that examined the effects of preoperative carbohydrate drinks and postoperative chewing gum on postoperative nausea and vomiting (PONV) in patients undergoing day care laparoscopic cholecystectomy. The study found that these interventions significantly reduced the severity of PONV and the need for antiemetics. However, the letter raises concerns about the methodology and results of the study, including the lack of information on preoperative risk factors, intraoperative fluid volumes, and the use of analgesics and antiemetics. The authors argue that addressing these issues would improve the interpretation of the study's results. [Extracted from the article]

A letter to the editor of the World Journal of Surgery discusses a recent study comparing the effects of different endotracheal tubes on postoperative sore throat (POST) in patients undergoing thyroidectomy. The study found that a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) resulted in a higher incidence and severity of POST compared to a standard endotracheal tube. However, the letter raises questions about the methodology and results of the study, including the lubrication of the tubes, the use of nerve blocks for analgesia, and the assessment of analgesic medication for POST. The letter also highlights the need to evaluate other outcomes, such as patient recovery and satisfaction, in future studies. [Extracted from the article]

Dear Editor, In the recent article by Zorrilla-Vaca et al. [[1]] examining the risk factors of postoperative acute kidney injury (AKI) in patients undergoing colorectal surgery with an enhanced recovery pathway, we noted that several methodological issues were not addressed well. Third, by multivariable analysis, age > 60 years, male gender, American Society of Anesthesiologists physical status classifications III-IV, chronic kidney disease and hypoalbuminemia were identified as independent risk factors of postoperative AKI. As the diagnostic criteria of chronic kidney disease were not provided in the Methods section, it was unclear whether patients with occult or mild chronic kidney disease (stages 1 and 2) were included in the study. [Extracted from the article]

This letter to the editor critiques a study on postoperative pain control after laparoscopic colon cancer surgery. The authors raise concerns about the methodology and results of the study, including the lack of information on pain assessment during activity, the absence of non-opioid analgesics in the epidural analgesia group, the use of a weak non-opioid analgesic as a rescue medication, and the potential underestimation of the benefits of multimodal analgesia due to the continued use of intravenous fentanyl. The authors suggest that the study design may have influenced the outcomes and argue for the inclusion of non-opioid analgesics and adherence to current practices for postoperative pain management. [Extracted from the article]

This document is a letter to the editor of the Journal of Anesthesia, commenting on a study that compared different intercostal nerve block modalities for postoperative analgesia in patients undergoing thoracoscopic pulmonary resection. The authors of the letter raise several concerns about the study, including the use of high concentration ropivacaine, the lack of incisional local anesthetic infiltration in the control group, the assessment of postoperative pain levels, the clinical significance of the opioid-sparing effect, and the inconsistent use of non-opioid basic analgesics. The authors also note that the results of the multivariable logistic regression analysis were not provided. It is important for library patrons to consider these limitations and potential biases when interpreting the findings of the original study. [Extracted from the article]

A comment was made on a small-sample randomized controlled trial that evaluated the postoperative analgesic efficacy of a combination of continuous paravertebral block (PVB) and multilevel single-shot intercostal nerve block (ICNB) compared to PVB alone for patients who underwent thoracotomy. The comment raises several issues that need clarification, such as the lack of information on the thoracotomy approaches and surgical types, the difference in the administration of the blocks, and the clinical significance of opioid sparing with the combination of PVB and ICNB. The comment suggests that adding ICNB to an erector spinae plane block may be worth considering for pain control after thoracotomy. [Extracted from the article]

To the Editor, We read with interest the recent article by Yoneyama et al. [[1]] determining two novel urinary biomarkers for acute kidney injury (AKI) and prediction of clinical outcomes following pediatric cardiac surgery. To determine if a biomarker is predictive for postoperative adverse outcome, however, significant association of a biomarker with postoperative adverse outcome must be firstly obtained by multivariate model for adjustment of confounders before performing the ROC curve analysis. [Extracted from the article]

A letter to the editor of the European Spine Journal raises questions about a study conducted by Stewart et al. on the benefits of adding bilateral erector spinae plane blocks (ESPBs) to postoperative pain management after open lumbar laminectomy. The letter highlights concerns about the methodology and results of the study, including the use of standardized anesthetic and analgesic management, the assessment of postoperative pain levels, the achievement of pain control goals, and discrepancies in the reported results. The authors of the letter request clarification and responses from the original study authors. [Extracted from the article]

A letter to the editor is presented in response to an article by MacDonald et al which assessed the epidemiology of acute kidney injury (AKI) after pediatric heart transplant surgery in terms of risk factors and outcome.

Objective: Sepsis may often result in acute lung injury (ALI), with a high mortality and morbidity. Available evidence indicates that activation of NLRP3 inflammasome to induce macrophage inflammation plays a crucial role in the inflammation progression of ALI and lidocaine can attenuate inflammatory responses. We hypothesized that lidocaine may attenuate inflammatory response and sepsis-induced ALI by inhibiting potassium efflux-dependent NLRP3 activation. Methods: C57BL/6N mice were randomized and divided into six groups (n = 6) receiving different treatments. Lung vascular permeability and histological changes in the lungs were evaluated by Evans blue dye, bronchoalveolar lavage analysis and hematoxylin and eosin staining. J774A.1 macrophages were divided into 12 groups receiving different treatments. The expression of both NLRP3 inflammasome activation-related protein and P2X7 in the macrophages was measured by immunofluorescence staining and Western blots. The whole cell currents were determined by a voltage-patch clamp technique. Results: Challenge with LPS led to ALI in mice with an increased lung injury score (0.54 ± 0.09), which was significantly attenuated by lidocaine pretreatment (0.20 ± 0.08, P < 0.0001). Lidocaine pretreatment significantly decreased the NLRP3 activation and IL-1β release in the macrophages. Furthermore, lidocaine pretreatment down-regulated the expression of P2X7 receptors, inhibited LPS- and ATP-induced sodium (Na+) inward flow, and maintained the intracellular K+ level in the macrophages. In addition, activation of Na+ influx did not eliminate anti-inflammatory effect of lidocaine. The activation of NLRP3 could be suppressed by extracellular K+ level in a dose-dependent model. However, lidocaine pretreatment eliminated NLRP3 activation and IL-1β release induced by K+ efflux, and decreased outward K+ current and extracellular K+ level in the macrophages challenged by LPS/ATP. Conclusions: Lidocaine pretreatment can attenuate the sepsis-induced ALI by an anti-inflammatory mechanism of inhibiting K+ efflux-dependent NLRP3 activation. [ABSTRACT FROM AUTHOR]

Third, in this study, intravenous tramadol (1 mg/kg) was administered as rescue analgesia, if the NRS pain score was 4 or more and the proportion of patients needing rescue analgesia was significantly reduced in the M-TAPA group. As opioid sparing is one of the main objectives of postoperative multimodal analgesia protocols including a nerve or fascial plane block [[3]], the authors should provide whether morphine milligram equivalent of tramadol for rescue analgesia was significantly different between groups. Keywords: Laparoscopic cholecystectomy; Postoperative analgesia; Thoracoabdominal nerves block through perichondrial approach; Local infiltration EN Laparoscopic cholecystectomy Postoperative analgesia Thoracoabdominal nerves block through perichondrial approach Local infiltration 495 496 2 06/01/23 20230601 NES 230601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03158-0. [Extracted from the article]

A letter to the editor is presented in response to the article "The effect of dexmedetomidine pretreatment on the median effective bolus dose of propofol for facilitating laryngeal mask airway insertion" written by Gui‑Zhen Yang.

A letter to the editor is presented in response to the article "A comparison of single-handed chin lift and two-handed jaw thrust for tracheal intubation using a lightwand" written by S.M. Yang, which includes techniques for anesthesia patients.

A letter to the editor is presented in response to the article "Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps," by Z. İ. Arslan and colleagues.

A letter to the editor is presented in response to the article "Face-to-face tracheal intubation in adult patients: A comparison of the Airtraq, Glidescope and Fastrach devices," by Z.I. by Arslan et al., published in a previous issue of the journal.

The available evidence indicates that preoperative pain is common among patients undergoing arthroscopic shoulder surgery and both preoperative pain severity and opioid use are the strongest independent risk factors of postoperative pain [[2]]. Keywords: Remifentanil; Shoulder arthroplasty; Postoperative analgesia; Analgesic consumption EN Remifentanil Shoulder arthroplasty Postoperative analgesia Analgesic consumption 665 666 2 09/30/22 20221001 NES 221001 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03085-0. [Extracted from the article]

As adequate movement pain control is very important for postoperative functional recovery in patients undergoing AKT, we were very interested in knowing why designed goal of postoperative pain control was not achieved in some time points, especially for patients receiving ACB alone. Keywords: iPACK; Adductor canal block; Periarticular block; Postoperative analgesia; Total knee arthroplasty EN iPACK Adductor canal block Periarticular block Postoperative analgesia Total knee arthroplasty 447 448 2 06/03/22 20220601 NES 220601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03047-6. Adductor canal block, Postoperative analgesia, Total knee arthroplasty, iPACK, Periarticular block. [Extracted from the article]

Within the airway management field, simulation has been used as a tool of training for over 40 years. Simulation training offers a chance of active involvement for the trainees. It can effectively enhance and upgrade the knowledge and skills of the trainees in airway management, and subsequently decrease medical errors and improve patients' outcomes and safety through a variety of airway management training modalities, such as common airway skills, difficult airway management strategies, and crisis management skills. To perform simulation-based airway management training effectively, not only are task trainers and high-fidelity simulators required but also instructors with rich experience in airway management simulation training and optimal curriculum design are essential. [ABSTRACT FROM AUTHOR]

Various combined interventions to acquire enhanced cardioprotection are prevalent focuses of current research. This randomized experiment assessed whether combined vagal stimulation perconditioning (VSPerC) and limb remote ischemic perconditioning (LRIPerC) improved cardioprotection compared to the use of either treatment alone in an in vivo rat model of myocardial ischemia/reperfusion injury. A total of 100 male Sprague Dawley rats were randomly allocated into five groups: sham group, ischemia/reperfusion (IR) group, VSPerC group, LRIPerC group, and combined VSPerC and LRIPerC (COMPerC) group. Serum enzymatic markers, inflammatory cytokines, myocardial inflammatory cytokines, and infarct size were assessed. Infarct size decreased significantly in the COMPerC group compared to the VSPerC and LRIPerC groups. Serum intercellular adhesion molecule 1 (ICAM-1) level at 120 min of reperfusion, myocardial interleukin-1 (IL-1), ICAM-1, and tumor necrosis factor α (TNF-α) levels in the ischemic region decreased significantly in the COMPerC group compared to the VSPerC group, but myocardial IL-10 levels in the nonischemic region increased markedly in the COMPerC group. Serum TNF-α levels at 30, 60, and 120 min of reperfusion; serum IL-1, IL-6, ICAM-1, and high mobility group box-1 protein (HMGB-1) levels at 120 min of reperfusion; and myocardial IL-1, IL-6, ICAM-1, and TNF-α levels in the ischemic region decreased significantly in the COMPerC group compared to the LRIPerC group. However, myocardial IL-10 levels in both ischemic and nonischemic regions were evidently higher in the COMPerC group. This study concludes that combined VSPerC and LRIPerC enhances cardioprotection compared to either treatment alone. This result is likely attributable to a more potent regulation of inflammation. [ABSTRACT FROM AUTHOR]

Background: The combination of various interventions to obtain enhanced cardioprotection is always an important area of research focus. This randomized experiment was designed to assess whether combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury in an in vivo rat model, and to determine if κ-opioid receptors were implicated in the cardioprotection of these interventions. Methods: Seventy-two rats were exposed to a 30-min myocardial ischemia followed by a 180-min reperfusion. Half of the rats (36) were randomized into four different groups receiving control treatment, fentanyl postconditioning, limb remote ischemic postconditioning, and combined fentanyl and limb remote ischemic postconditioning. The remaining 36 rats were also randomized into four groups receiving the same interventions as the above groups following the intravenous administration of a κ-opioid receptor antagonist, nor-binaltorphimine, before myocardial ischemia. At the end of reperfusion, both serum cardiac troponin I and infarct size were determined. Results: Both fentanyl postconditioning and limb remote ischemic postconditioning significantly decreased the infarct size and serum cardiac troponin I level, and combined fentanyl and limb remote ischemic postconditioning produced enhanced cardioprotection on the infarct size-sparing effect. The use of nor-binaltorphimin to block κ-opioid receptors eliminated cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning, but did not change cardioprotection by limb remote ischemic postconditioning. Conclusions: Combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury. κ-Opioid receptors are essential for cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning; however, they do not play a pivotal role in cardioprotection by limb remote ischemic postconditioning. [ABSTRACT FROM AUTHOR]

Objective: To determine the optimal intervention time of the vagal stimulation (VS) attenuating myocardial ischemia/reperfusion injury (IRI). Methods: One hundred and twenty male SD rats were randomly allocated into six groups: sham group, IRI group, the VS performed at 15 min of ischemia (VSI15) group, the VS performed immediately before reperfusion (VSR0) group, the VS performed at 30 min of reperfusion (VSR30) group, and the VS performed at 60 min of reperfusion (VSR60) group. Rats in each group were further allocated into subgroups A and B. In each group, the hemodynamics and ventricular arrhythmias were continuously observed. In the subgroup A, serum inflammatory cytokine levels were tested, and infarct size was assessed. In the subgroup B, myocardial inflammatory cytokine levels in both ischemic and non-ischemic regions were assayed. Results: As compared to the IRI, VSR0, VSR30 and VSR60 groups, infarct size, serum HMGB-1 and ICAM-1 levels at 120 min of reperfusion, myocardial HMGB-1, IL-1 and IL-6 levels in non-ischemic region, myocardial ICAM-1 level in ischemic region were all significantly decreased in the VSI15 group. Compared with the IRI group, myocardial IL-10 levels in both ischemic and non-ischemic regions were significantly increased in the VSI15 group. Compared to the IRI, VSR0, VSR30 and VSR60 groups, incidence and score of ventricular arrhythmia during initial reperfusion were significantly decreased in the VSI15 group. Conclusions: The VS performed at 15 min of ischemia provides the best protection against myocardial IRI. Also, early modulation on inflammatory responses caused by myocardial IRI may contribute to this best cardioprotection. [ABSTRACT FROM AUTHOR]

Reference 1 Panghal R, Mitra S, Singh J, Sarna R, Goel B. Oral acetaminophen as an adjunct to continuous epidural infusion and patient-controlled epidural analgesia in laboring parturients: a randomized controlled trial. Given that labor pain is an acute pain and oral acetaminophen has a slow onset time, we argue that appropriate time of oral acetaminophen administration should be an important part of study design for achieving best effect of combined PCELA. Keywords: Acetaminophen; Patient-controlled epidural analgesia; Labor pain EN Acetaminophen Patient-controlled epidural analgesia Labor pain 328 328 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02975-z. [Extracted from the article]

Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? To the Editor: In recent article of Kang et al. [[1]] comparing deep sedation versus conscious sedation for gastroscopy in obese patients, patients' positions during gastroscopy were not provided. Keywords: Sedation; Gastroscopy; Obese patients EN Sedation Gastroscopy Obese patients 327 327 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02951-7. [Extracted from the article]

Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. Keywords: Emergence delirium; Emergence agitation; Children EN Emergence delirium Emergence agitation Children 156 156 1 02/02/22 20220201 NES 220201 Cho EA, et al. As postoperative pain is a known precipitating factor for ED in children, we were concerned that unbalanced postoperative pain treatments would have biased their findings. [Extracted from the article]

Objective: To assess effects of postconditioning with the vagal stimulation (VS) on the local and systematic inflammatory responses to acute myocardial ischemia reperfusion injury (IRI). Methods: Sixty male Sprague-Dawley rats were randomly allocated into three groups: sham group, ischemia reperfusion group (IR group), and postconditioning with the VS group (POVS group). Serum levels of inflammatory cytokines during reperfusion and myocardial levels of inflammatory cytokines in both ischemic and non-ischemic regions at the end of the experiment were assayed. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. Results: The infarct size was significantly reduced in the POVS group compared to the IR group. Serum levels of TNF-α at 30, 60, and 120 min of reperfusion and serum levels of HMGB-1, ICAM-1, IL-1, and IL-6 at 120 min of reperfusion were significantly lower in the POVS group than in the IR group. Myocardial levels of TNF-α, HMGB-1, ICAM-1, IL-1, and IL-6 in both ischemic and non-ischemic regions were also significantly reduced in the POVS group compared with the IR group. Conclusions: Postconditioning with the VS can significantly attenuate the local and systemic inflammatory responses to myocardial IRI, and provide an obvious cardioprotection. [ABSTRACT FROM AUTHOR]

The inflammatory response plays a major role in ischemia-reperfusion injury (IRI). Considering that cholinergic stimulation can inhibit inflammatory response through the cholinergic anti-inflammatory pathway (CAP) and the α subunit-containing nicotinic acetylcholine receptor(α7nAChR) expressed by immune cells is an important component of CAP, we assessed the effect of postconditioning with α7nAChR agonist on systemic inflammatory response during the myocardial ischemia-reperfusion process in an in vivo rat model. Thirty Sprague Dawley rats were randomly divided into three groups: sham group, control group, and postconditioning with α7nAChR agonist group (PP group). In the groups other than the sham group, the left anterior descending coronary artery was ligated for 30 min followed by a 180-min reperfusion. At the end of the experiment, the serum levels of troponin I, tumor necrosis factor α, interleukin-6, and high-mobility group box 1 were assayed, and the infarct size was assessed. The results showed that postconditioning with α7nAChR agonist significantly attenuated the systemic inflammatory response to myocardial IRI, as evidenced by decreased serum levels of tumor necrosis factor α and high-mobility group box 1. Also, this treatment protected against myocardial IRI, as shown by reduced infarct size and serum troponin I level. [ABSTRACT FROM AUTHOR]

Keywords: Prediction; Risk factors; Difficult intubation EN Prediction Risk factors Difficult intubation 630 630 1 07/25/20 20200801 NES 200801 This comment refers to the article available at 10.1007/s00540-019-02721-6. In multivariate analysis, odds ratios of LNE for difficult laryngoscopy and intubation were significantly greater than those of low thyromental height test and high modified Mallampati test, but LNE was not identified as a risk factor. Second, difficult laryngoscopy is a main determinant of successful intubation with direct laryngoscopy, but incidence of difficult laryngoscopy (12%) in this study was lower than incidence of difficult intubation was 17%. [Extracted from the article]

Purpose: To evaluate the role of the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/hypoxia-inducible factor 1α (HIF-1α) signaling pathway in the protection by dexmedetomidine against lung ischemia-reperfusion injury (IRI) in rats. Methods: Forty-eight male Sprague-Dawley rats weighing 250-350 g were randomly divided into six groups ( n = 8 each group): sham group, IRI group, low-dose dexmedetomidine group (LD group), high-dose dexmedetomidine group (HD group), combined low-dose dexmedetomidine and LY294002 group (LDL group), and combined high-dose dexmedetomidine and LY294002 group (HDL group). A 30-min ischemia was induced by occluding the hilum of the left lung, followed by a 120-min reperfusion by removing occlusion of the hilum. After the left lung was removed, the wet/dry weight ratio (W/D) of the lung tissues was determined. Pathological changes of lung tissues were evaluated by light and electron microscopes and the expression of p-Akt and HIF-1α in the lung tissues was determined by western blotting. Results: Compared with the sham group, both the W/D ratio and lung injury were significantly increased, the p-Akt expression was down-regulated and HIF-1α expression was up-regulated in the five experimental groups. Compared with the LD and LDL groups, both the W/D ratio and lung injury were decreased, but the expression of p-Akt and HIF-1α was increased in the HD and HDL groups. Conclusions: Administration of dexmedetomidine before ischemia can provide a protection against lung IRI by re-installing the PI3K/Akt/HIF-1α signaling pathway. [ABSTRACT FROM AUTHOR]

A correction to the article "Early Administration of Propofol Protects Against Endotoxin-Induced Acute Lung Injury in Rats by Inhibiting the TGF-β1-Smad2 Dependent Pathway" is presented.

A letter to the editor is presented in response to an article by ME Menendez et al which assessed risk factors for in-hospital acute myocardial infarction (AMI) following total joint anthroplasty in a retrospective cohort study.