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A letter to the editor of the journal Perioperative Medicine discusses a randomized controlled trial comparing the analgesic efficacy of two regional blocks after modified radical mastectomy. The study found that the transverses thoracic muscle plane-pectoral nerve block (TTP-PECS) provided improved postoperative analgesia compared to the thoracic paravertebral nerve block (TPVB), with decreased opioid consumption and increased quality of recovery. However, the letter raises concerns about the study's design and results, including the lack of standardized factors that could influence the primary outcome assessment, small differences in pain scores between the two groups, the use of an opioid-based analgesia regimen, and the limited assessment of other outcome variables. The authors argue that the clinical significance of the findings is debatable and that the study does not answer whether the improved pain control and recovery can translate into postoperative benefits for patients. [Extracted from the article]

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 recent article in the Journal of Clinical Medicine by Matsumoto et al. compared the effectiveness of remimazolam and propofol in preventing postoperative nausea and vomiting (PONV) in patients who underwent laparoscopic gynecological surgery. The study found that remimazolam was as effective as propofol in preventing PONV. However, there are some concerns with the study. The authors used data from previous studies comparing inhalational anesthesia and propofol-based anesthesia to determine the sample size, which may have underestimated the sample size needed. The study also did not provide information on preoperative fasting time or the occurrence of intraoperative hypotension, which are factors that can affect the risk of PONV. Additionally, the study did not use a standardized opioid-sparing multimodal analgesia strategy, which may have implications for the results. Overall, while the study provides valuable insights, there are some limitations that should be considered. [Extracted from the article]

Background: Postreperfusion hyperkalemia (PRHK) has garnered increasing attention in regard to deceased liver transplantation (LT), especially for LT using the expanded criteria donor grafts. However, the impact of the effluent potassium (eK+) concentration on PRHK has been largely overlooked. We evaluated whether elevated eK+ concentrations are associated with PRHK in deceased LT. Methods: In this single-institution, retrospective cohort study, we included all adults who underwent deceased LT with intraoperative eK+ concentration monitoring between November 2016 and December 2018. The eK+ concentrations were obtained from the effluent samples collected following a standard portal vein flush. PRHK was defined as any serum potassium (sK+) level of > 5.5 mmol/L following reperfusion. Logistic regression was performed to identify predictors for PRHK, and linear regression was used to examine predictors of the maximum percentage increase in the sK+ level following reperfusion. Results: Of the 86 patients who met the inclusion criteria, 54 (62.8%) developed PRHK. Independent predictors for PRHK included greater graft weight (OR 1.283 [95% CI 1.029–1.599] per 100 g, P = 0.027), an elevated eK+ concentration (OR 1.291 [95% CI 1.068–1.561] per mol/L, P = 0.008), and a higher sK+ level before reperfusion (OR 4.459 [95% CI 1.543–12.884] per mol/L, P = 0.006). An eK+ concentration of more than 6.9 mmol/L had a sensitivity of 59.26% and a specificity of 78.12% for predicting PRHK (area under the receiver operating characteristic curve, 0.694). Multiple linear regression analyses indicated that the eK+ and sK+ levels before reperfusion were significant predictors of the maximum percentage increase in the sK+ level following reperfusion. In addition, PRHK was associated with an increased risk of postreperfusion significant arrhythmias, severe postreperfusion syndrome, and postoperative early allograft dysfunction. Conclusions: This study shows that the eK+ concentration could predict the risk of PRHK in deceased LT. Further prospective studies are warranted to clarify these associations. [ABSTRACT FROM AUTHOR]

The letter to the editor made several comments regarding possible methodological issues in the recent article by Lin et al. determining the association between blood glucose variability and postoperative delirium in patients undergoing acute aortic dissection surgery with cardiopulmonary bypass, which is published in Journal of Cardiothoracic Surgery. 2021; 16(1):82. Our concerns included the lack of some important perioperative factors associated with postoperative delirium, the process of establishing multivariate model and the method of using the receiver operating characteristic curve analysis to assess the predictive performance of the standard deviation of blood glucose for the development of POD. We would like to invite the authors to comment on these and believe that clarifying these issues would improve the transparency of this study and interpretation of findings. [ABSTRACT FROM AUTHOR]

The letter to the editor was written in response to "Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium (POD) among acute type a aortic dissection patients treated with open surgical repair", which is recently published by Lv et al. (J Cardiothorac Surg 16(1):146, 2021). In this article, Lv et al. conclude that plasma IL-6 is a potential biomarker for prediction of POD. However, we note several issues in this study that would have made interpretation of their results questionable. Our main concerns include the use of a short POD assessment time, no providing the data of analgesics and sedatives used in the ICU, application of incorrect statistical methods when assessing predictive ability of plasma IL-6 for the development of POD, and incorrect interpretation for the area under the receiver operating characteristic curve. We believe that addressing these issues will improve the transparency of this study and help the interpretation of findings. [ABSTRACT FROM AUTHOR]

The letter to the editor was written in response to "The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial", which was recently published by Li et al. (J Cardiothorac Surg 18(1):128, 2023). In this article, Li et al. showed that addition of a preoperative intercostal nerve block to the multimodal analgesic strategy significantly reduced the pain scores within 48 h after surgery. However, we noted several issues in this study that were not well addressed. They were no use of a standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery protocols for thoracic surgery, the lack of clear description for reasonable selection of rescue analgesics, the interpretion of between-group differences in the postoperative pain scores based on only statistical differences rather than clinically meaningful differences, inclusion of patients who were not blinded to study intervention, not reporting cumulative opioid consumption and complications of intercostal nerve block. We believe that clarification of these issues is not only useful for improving design quality of randomized clinical trials which assess postoperative analgesic efficacy of nerve blocks, but also is helpful for the readers who want to use an opioid-sparing multimodal protocol including a nerve block in patients undergoing thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Dear Editor, By a retrospective analysis, Du et al. [[1]] assessed the incidence and risk factors of early-onset acute kidney injury (AKI) during the first week after lung transplantation and its association with postoperative mortality. First, the study objects are patients with end-stage lung disease undergoing lung transplantation. [Extracted from the article]

The present study aimed to evaluate the effects of hypercholesterolemia on cardioprotection of ischemic preconditioning and α7 nicotinic acetylcholine receptor (α7nAChR) agonist postconditioning and explore the potential mechanisms that hypercholesterolemia affected their cardioprotection. Hypercholesterolemic and normal rats were divided into the four groups that received the following treatments: i) Hypercholesterolemic control and normal control groups; ii) hypercholesterolemic ischemia/reperfusion (HI) and normal ischemia/reperfusion (NI) groups; iii) hypercholesterolemic ischemic preconditioning (HIPC) and normal ischemic preconditioning (NIPC) groups; and iv) hypercholesterolemic PNU282987 postconditioning (HPNU) and normal PNU282987 postconditioning (NPNU) groups. Serum lactate dehydrogenase (LDH), creatine kinase isoenzyme MB (CK-MB), cardiac troponin I (cTnI), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) levels after ischemia/reperfusion were assayed. Furthermore, infarct size and expression levels of Akt, phosphorylated (p)-Akt and endothelial nitric oxide synthase (eNOS) in ischemic myocardium were assessed. Compared with the NI group, serum LDH, CK-MB, cTnI, TNF-α and IL-6 levels and infarct size were significantly decreased, and myocardial p-Akt/Akt and eNOS/GAPDH ratios were significantly increased in the NIPC and NPNU groups. Compared with the HI group, serum CK-MB, cTnI, TNF-α and IL-6 levels and infarct size were significantly decreased in the HIPC group; however, myocardial p-Akt/Akt and eNOS/GAPDH ratios did not significantly change in the HIPC group. Furthermore, there were no significant difference between the HI and HPNU groups in serum LDH, CK-MB, cTnI, TNF-α and IL-6 levels, infarct size, myocardial p-Akt/Akt and eNOS/GAPDH ratios. In conclusion, hypercholesterolemia could aggravate myocardial ischemia/reperfusion injury, attenuate cardioprotection of ischemic preconditioning and eliminate cardioprotection from α7nAChR agonist postconditioning by enhancing inflammation and inhibiting PI3K/Akt/eNOS pathway. [ABSTRACT FROM AUTHOR]

Sir, By a retrospective cohort study, Wu and colleagues [[1]] assessed predictive role of preoperative estimated glomerular filtration rate (eGFR) for postoperative acute kidney injury (AKI) in very elderly surgical patients and showed that eGFR could be used as an index for AKI risk stratification. It must be emphasized that duration of AKI, especially for persistent AKI, is more important factors affecting postoperative short- and long-term adverse outcomes of patients. Assessing association of preoperative estimated glomerular filtration rate with postoperative acute kidney injury in very elderly surgical patients: Re: Wu Q, et al. [Extracted from the article]

The article discusses a study that assessed the postoperative analgesic efficacy of a regional block called serratus posterior superior intercostal plane block (SPSIPB) for video-assisted thoracoscopic surgery. The authors raise concerns about the study's methodology, including the lack of a control group in the pilot study and the non-standard application of non-opioid analgesics in the comparator groups. They also argue that the study's use of an opioid-dominated analgesic strategy is not in line with recommended protocols for thoracic surgery. Additionally, the authors question why the target of postoperative analgesia was not achieved in the control group. [Extracted from the article]

The letter to the editor made several comments on possible issues in the recent article by Zhang et al. determining the risk factors of acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass, which has been published in Journal of Cardiothoracic Surgery at December 30, 2019. [ABSTRACT FROM AUTHOR]

Background: Postoperative delirium (POD) is a common complication that is characterized by acute onset of impaired cognitive function and is associated with an increased mortality, a prolonged duration of hospital stay, and additional healthcare expenditures. The incidence of POD in elderly patients undergoing laparoscopic radical colectomy ranges from 8 to 54%. Xenon has been shown to provide neuroprotection in various neural injury models, but the clinical researches assessing the preventive effect of xenon inhalation on the occurrence of POD obtained controversial findings. This study aims to investigate the effects of a short xenon inhalation on the occurrence of POD in elderly patients undergoing laparoscopic radical colectomy. Methods/design: This is a prospective, randomized, controlled trial and 132 patients aged 65–80 years and scheduled for laparoscopic radical colectomy will be enrolled. The participants will be randomly assigned to either the control group or the xenon group (n = 66 in each group). The primary outcome will be the incidence of POD in the first 5 days after surgery. Secondary outcomes will include the subtype, severity, and duration of POD, postoperative pain score, Pittsburgh Sleep Quality Index (PQSI), perioperative non-delirium complications, and economic parameters. Additionally, the study will investigate the activation of microglial cells, expression of inflammatory factors in colon tissues, plasma inflammatory factors, and neurochemical markers. Discussion: Elderly patients undergoing laparoscopic radical colectomy are at a high risk of POD, with delayed postoperative recovery and increased healthcare costs. The primary objective of this study is to determine the preventive effect of a short xenon inhalation on the occurrence of POD in these patients. Trial registration: Chinese Clinical Trial Registry ChiCTR2300076666. Registered on October 16, 2023, http://www.chictr.org.cn. [ABSTRACT FROM AUTHOR]

The article presents a study which shows the association of risk factors with postoperative acute kidney injury arthroplasty patients (AKI). It mentions the use of multivariable logistic regression analysis to determine body mass index, preoperative estimated glomerular filtration rate, and duration of operation which are independent risk factors for AKI.

Background: Tussis, which increases the incidence of airway spasm, aspiration, nausea, and vomiting, is a common complication faced during upper gastrointestinal (GI) endoscopy. However, sedatives and analgesics exhibit inhibitory actions against airway reflexes to different degrees. Our assumption is a combination of propofol and small doses of sufentanil, esketamine, or lidocaine, especially the combination of propofol and esketamine, might reduce tussis incidence. Method: The study will be performed as a randomised controlled three-blind, two-centre trial. Patients undergoing upper GI endoscopy, ≥ 18 years old, with American Society of Anesthesiologists (ASA) classification I–III will be randomised to four groups: P group (single administration of propofol), P + S group (administration of propofol and sufentanil in combination), P + K group (administration of propofol and esketamine in combination), and P + L group (administration of propofol and lidocaine in combination) (N = 100 per group). The primary endpoints include the frequency of tussis, nausea and vomiting, and/or body movements observed at the insertion of the endoscope into the pharyngeal cavity or within 5 min of endoscope insertion. Secondary outcomes are recovery assessment, patients' and endoscopists' satisfaction with the procedure, MMSE scores, MET scores, sleep condition, and the number of sedation-related events. Data on sedation-related events are collected by recording of vital signs. Satisfaction parameters and mental states are collected by means of questionnaires and evaluation scales before and after the procedure and on different following days. Discussion: Esketamine can reduce tussis occurrence with good tolerability and relax the bronchus and also provides high clearance rates and low possibility of adverse reactions. We aim to demonstrate that the combination of esketamine with propofol for sedation in patients subjected to upper GI procedure is nevertheless superior to only administration of propofol or a combination of propofol with other anaesthetics, such as opioids or lidocaine. Trial registration: ClinicalTrials.gov. NCT05497492, Registered 09 August 2022. [ABSTRACT FROM AUTHOR]

To observe the protective effects of dexmedetomidine (Dex) postconditioning on myocardial ischemia/reperfusion injury (IRI) and to explore its potential molecular mechanisms. One-hundred forty-seven male Sprague-Dawley rats were randomly divided into five groups receiving the different treatments: Sham, ischemia/reperfusion (I/R), Dex, Brusatol, Dex + Brusatol. By the in vivo rat model of myocardial IRI, cardioprotective effects of Dex postconditioning were evaluated by assessing serum CK-MB and cTnI levels, myocardial HE and Tunel staining and infarct size. Furthermore, the oxidative stress-related markers including intracellular ROS level, myocardial tissue MDA level, SOD and GSH-PX activities were determined. Dex postconditioning significantly alleviated myocardial IRI, decreased intracellular ROS and myocardial tissue MDA level, increased SOD and GSH-PX activities. Dex postconditioning significantly up-regulated myocardial expression of Bcl-2, down-regulated Bax and cleaved caspase-3 and decreased cardiomyocyte apoptosis rate. furthermores, Dex postconditioning promoted Nrf2 nuclear translocation, increased myocardial expression of Sirt3 and SOD2 and decreased Ac-SOD2. However, brusatol reversed cardioprotective benefits of Dex postconditioning, significantly decreased Dex-induced Nrf2 nuclear translocation and reduced myocardial expression of Sirt3 and SOD2. Dex postconditioning can alleviate myocardial IRI by suppressing oxidative stress and apoptosis, and these beneficial effects are at least partly mediated by activating the Nrf2/Sirt3/SOD2 signaling pathway. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA" by Fu-Shan Xue and colleagues published in a previous issue is presented.

A letter to the editor in response to the article "Changes in mortality patterns following total hip or knee arthroplasty over the past two decades: a nationwide cohort study" in the February 2014 issue is presented.

Background: Oxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy.Methods: We will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction.Discussion: Propofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy.Trial Registration: Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021. [ABSTRACT FROM AUTHOR]

Background: Available literature indicates that long-term drinkers demand a higher dose of propofol for induction of anesthesia than non-drinkers. However, there is no study having assessed the influence of long-term high-risk drinking (LTHRD) on the effective doses of propofol for successful insertion of gastroscope with sedation. This study was designed to compare the effective doses of propofol for successful insertion of gastroscope between LTHRD and non-drinking (ND) Chinese male patients. Methods: Thirty-one LTHRD patients and 29 ND male patients undergoing elective gastroscopy with propofol sedation were enrolled. The modified Dixon's up-and-down method was applied to determine the calculated median effective dose (ED50) of propofol for successful insertion of gastroscope. Furthermore, the isotonic regression analysis was used to establish the dose–response curve of propofol and assess the effective doses of propofol where 50% (ED50) and 95% (ED95) of gastroscope insertions were successful. Results: The calculated ED50 of propofol for successful insertion of gastroscope was 1.55 ± 0.10 mg/kg and 1.44 ± 0.11 mg/kg in the LTHRD and ND patients. The isotonic regression analysis further showed that ED50 and ED95 of propofol for successful insertion of gastroscope was 1.50 mg/kg (95%CI, 1.40–1.63) and 1.80 mg/kg (95%CI, 1.74–1.90) in the LTHRD patients, respectively; 1.40 mg/kg (95% CI, 1.27–1.57) and 1.60 mg/kg (95%CI, 1.56–1.65) in the ND patients. The ED50 of propofol for successful insertion of gastroscope was not significantly different between LTHRD and ND patients. Conclusions: This study demonstrates that the difference in the estimated ED50 of propofol for successful insertion of gastroscope between LTHRD and ND Chinese male patients was not statistically significant. Trial registration: The study was registered on November 28, 2020 (ChiCTR2000040382) in the Chinese Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

This letter to the editor has made several comments regarding possible statistical issues in recent article by Wang et al. determining the risk factors of continuous renal replacement treatment after emergency surgery for type A acute aortic dissection, which is published in Journal of Cardiothoracic Surgery. 2020; 15(1):100. Our comments were involved in the issues of using the propensity score matched cohorts to adjust the covariates that can potentially confound the primary outcomes, process of establishing multivariate model and application of Kaplan-Meier curve analysis in this retrospective study. We would like to remind readers to pay special attention to these issues and invite the authors to comment on these. [ABSTRACT FROM AUTHOR]

Background: The incidence of postoperative pulmonary complications (PPCs) is higher in obese patients undergoing general anesthesia and mechanical ventilation due to the reduction of oxygen reserve, functional residual capacity, and lung compliance. Individualized positive end-expiratory pressure (iPEEP) along with other lung-protective strategies is effective in alleviating postoperative atelectasis. Here, we compared the best static lung compliance (Cstat) titration of iPEEP with electrical impedance tomography (EIT) titration to observe their effects on postoperative atelectasis in obese patients undergoing laparoscopic surgery.Methods: A total number of 140 obese patients with BMI ≥ 32.5kg/m2 undergoing elective laparoscopic gastric volume reduction and at moderate to high risk of developing PPCs will be enrolled and randomized into the optimal static lung compliance-directed iPEEP group and EIT titration iPEEP group. The primary endpoint will be pulmonary atelectasis measured and calculated by EIT immediately after extubation and 2 h after surgery. Secondary endpoints will be intraoperative oxygenation index, organ dysfunction, incidence of PPCs, hospital expenses, and length of hospital stay.Discussion: Many iPEEP titration methods effective for normal weight patients may not be appropriate for obese patients. Although EIT-guided iPEEP titration is effective in obese patients, its high price and complexity limit its application in many clinical facilities. This trial will test the efficacy of iPEEP via the optimal static lung compliance-guided titration procedure by comparing it with EIT-guided PEEP titration. The results of this trial will provide a feasible and convenient method for anesthesiologists to set individualized PEEP for obese patients during laparoscopic surgery.Trial Registration: ClinicalTrials.gov ChiCTR2000039144 . Registered on October 19, 2020. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC50 for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients. Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40-57 kg/m2 who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ETsev) was adjusted to a target value as to the modified Dixon's up-and-down method. Patients' response to SAD insertion was classified as "movement" or "no movement". The average of the midpoints of all crossover points was defined as calculated sevoflurane EC50 for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC50) and 95% (EC95) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD. Results: The calculated sevoflurane EC50 for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p<0.001). By the probit regression analysis, EC50 and EC95 of sevoflurane for successful SAD insertion were 1.59% (95% CI, 1.22-1.90%) and 2.15% (95% CI, 1.86-3.84%) in group D, respectively, and 2.81% (95% CI, 2.35-3.29%) and 3.32% (3.02-6.74%) in group S. Conclusion: When sevoflurane inhalational induction is performed in spontaneous breathing morbidly obese patients, intravenous DEX can reduce sevoflurane EC50 for successful SAD insertion by about 40%. Chinese Clinical Trial Registry: No. ChiCTR1800016868. [ABSTRACT FROM AUTHOR]

Background: Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation.Methods: The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes.Results: Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; P=0.99; high-quality evidence). There was no heterogeneity among studies (I2=0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; P=1.00; high-quality evidence) and oral intubations (RR, 1.00; P=0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, -40.4 seconds; P<0.01; low-quality evidence). There were no differences between groups for other outcomes (P>0.05).Conclusion: For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB. [ABSTRACT FROM AUTHOR]

Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1–0.2 μg/k·h, bolus 0.1–0.2 μg/kg; Morphine group was used with a background infusion of 10–20 μg/kg·h, bolus 10–20 μg/kg; while Tramadol group was used with a background infusion of 100–400 μg/kg·h, bolus 100–200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In comparison of all groups with each other, lower pain scores were shown at 1 h and 8 h after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P < 0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P < 0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 h of PCIA usage after operation (P = 0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI = 0.000–0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR = 1.161, 1.027–1.312, P = 0.017), occipital craniotomy (OR = 0.374, 0.155–0.905, P = 0.029), and morphine treatment (OR = 0.077, 0.021–0.281, P < 0.001) are the relevant factors. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn/index.aspx. [ABSTRACT FROM AUTHOR]

It has been reported that morphine pretreatment (MP) can exert neuroprotective effects, and that protein kinase C (PKC) participates in the initiation and development of ischemic/hypoxic preconditioning in the brain. However, it remains unknown whether PKC is involved in MP-induced neuroprotection. The aim of the present study, which included in vivo and in vitro experiments, was to determine whether the conventional γ isoform of PKC (cPKCγ) was involved in the protective effects of MP against cerebral ischemic injury. The present study included an in vivo experiment using a mouse model of middle cerebral artery occlusion and an in vitro experiment using neuroblastoma N2a cells with oxygen-glucose deprivation (OGD). Furthermore, a cPKCγ antagonist, Go6983, was used to determine the involvement of cPKCγ in the protective effects of MP against cerebral ischemic injury. In the in vivo experiment, neurological deficits, ischemic infarct volume, neural cell damage, apoptosis and caspase-3 activation were evaluated. In the in vitro experiment, flow cytometry was used to determine the activation of caspase-3 in N2a cells with OGD. It was found that MP protected against cerebral ischemic injury. However, intracerebroventricular injection of the cPKCγ antagonist before MP attenuated the neuroprotective effect of MP and increased the activation of cleaved caspase-3. These findings suggested that MP may provide protection against cerebral ischemic injury via a cPKCγ-mediated anti-apoptosis pathway. [ABSTRACT FROM AUTHOR]

Background: Hypoxemia is a major complication in obese patients undergoing gastrointestinal endoscopy under intravenous anesthesia or sedation due to altered airway anatomy. We design this randomized controlled trial (RCT) to compare efficacy and safety of the Wei nasal jet tube (WNJT) and nasal prongs for supplement oxygen during gastroscopy with intravenous propofol anesthesia in obese patients.Methods: The study will be a single-center, prospective RCT. A total of 308 obese patients will be recruited and randomly assigned to receive either the WNJT (group A) or nasal prongs (group B). During gastroscopy with intravenous propofol anesthesia, 5 L/min of oxygen will be delivered through the jet port of the WNJT in the group A and via the nasal prongs in the group B. The primary outcome is the incidence of hypoxemia and severe hypoxemia. The secondary outcomes are adverse events during the gastroscopy, postoperative complications, and satisfaction of the anesthetist, physician, and patient.Discussion: This RCT aims to clarify whether the WNJT can result in reduced incidences of hypoxemia and complications and provide improved satisfaction to the anesthetist, physician, and patient. Thus, it can be determined if the WNJT is a useful tool for supplement oxygen in obese patients undergoing gastroscopy with intravenous propofol anesthesia. The results will provide the evidence for anesthesiologists to make a decision regarding the choice of supplementary oxygen methods in this condition.Trial Registration: Chinese Clinical Trial, ChiCTR-IOR-17013089 . Registered on 23 October 2017. [ABSTRACT FROM AUTHOR]