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Objective To investigate the degree of difficult intubations for patients with ankylosing spondylitis (AS) and to predict the related factors influencing the selection of intubation methods. Methods A total of 347 patients(276 males, 71 females), aged 15-77 years, ASA Ⅰ-Ⅲwith AS underwent surgical procedure from January 2008 to January 2017 were included. During general anesthesia induction, patients were divided into two groups according to the application of non-visual devices (179 cases) and visual devices (168 cases). Patient data were collected, including gender, age, kyphosis, degree of mouth opening, Mallampatti classification, neck mobility and the duration of the AS. Multivariate regression analysis of variables was conducted to find the relevant predictors of intubations method selection in AS patients with difficult endotracheal airway. Results The older patients, kyphosis, limited mouth opening, limited neck range of motion, and longer duration of AS, the utilization rate of the visual group was significantly higher than that of the non-visual group (P＜0.05). Multi-factor Logistic regression analysis suggested that moderate limitation of neck range of motion(OR=5.41,95% CI: 2.32-13.10,P＜0.001)and severe limitation of neck range of motion (OR=9.22,95% CI: 4.37-20.25,P＜0.001) were related factors for tracheal intubation with visual devices in patients with difficult airway. Conclusions Neck mobility has a great influence on whether or not to use visual intubation tools. When neck mobility decreases, anesthesiologists are more likely to use visual devices such as video laryngoscope, McCoy laryngoscope, visual rigid and fiberoptic bronchoscope.

Objective To evaluate the emergence agitation and recovery quality of patients with 3 endocrine types of pituitary tumor after transnasal transsphenoidal hypophysectomy. Methods Patients who received pituitary adenoma resection under general anesthesia were enrolled and categorized into three groups: growth hormone group (GH), adrenocorticotropic hormone group (ACTH) and non-functional group (control). Riker Sedation-Agitation Scale (RSAS), the severity of the emergence coughing, headache (by VAS), medical staff satisfaction were recorded in the post-anesthesia care unit. QoR-40 score, headache(by VAS), nausea score (by VRS) and vomiting score, and patient satisfaction were recorded at 24 h postoperatively. Results 163 cases were enrolled in the analysis, including 51 in GH group, 44 in ACTH group and 68 in control group. No significant difference was found regarding the emergence agitation among 3 groups. The ACTH group showed significantly higher nausea VRS score at 24 h after surgery than control group (P＜0.01). The headache VAS score of ACTH group was significantly higher than that in control group (P＜0.001). The incidence of postoperative sore throat in ACTH group was significantly higher than that in control group (P＜0.05). The postoperative QoR-40 score of ACTH group was significantly lower than that of control group (P＜0.01). Conclusions The incidences of postoperative nausea, headache and sore throat are significantly increased and the score of QoR-40 is significantly reduced in patients with ACTH pituitary adenoma.

Objective To evaluate and compare the incidence of postoperative residual curarisation (PORC) after administration of neostigmine or sugammadex by diaphragmatic ultrasonography.Methods A total of 100 patients with American Society of Anesthesiologists grade Ⅰ or Ⅱ who underwent elective joint replacement surgery from March to August in 2021 were randomly enrolled into the neostigmine+atropine group(N+A group, n =51) and sugammadex group(SUG group, n =49) according to a random number table.Muscle relaxation was monitored by train of four(TOF) stimulation of adductor pollicis muscle during anesthesia.The patients in N+A group were administrated with neostigmine 50 μg/kg + atropine 15 μg/kg and those in SUG group with sugammadex 2 mg/kg for reversing muscle relaxation.Endotracheal tube was removed only when TOF ratio≥0.9. Diaphragmatic ultrasonography was performed before surgery,10 min and 30 min after extubation.The right diaphragm excursion during deep breathing(DE-DB) and the diaphragm movement velocity during sniffing(V-S) were measured,with the low-frequency probe placed at the intersection of the right midclavicular line and the right costal margin.The diaphragmatic thickening fraction during deep breathing(TF-DB) was measured with the high-frequency probe placed at zone of apposition.The incidence of PORC was taken as the primary outcome,and DE-DB,TF-DB,and V-S as the secondary outcomes.Results When PORC was defined as TF-DB≤36%,the incidence of PORC in the SUG group was lower than that in the N+A group 10 min(4.3% vs. 31.1%; χ 2 =11.541, P =0.001) and 30 min(0 vs. 17.6%; P =0.001) after extubation.When PORC was defined as TF-DB≤36% or DE-DB≤4 cm,the incidence of PORC in the SUG group was also lower than that in the N+A group 10 min(8.2% vs. 33.3%; χ 2 =9.543, P =0.002) and 30 min(0 vs. 19.6%; χ 2 =8.608, P =0.003) after extubation.The DE-DB in the SUG group was higher than that in the N+A group 10 min[(6.5±1.6) cm vs. (5.6±1.4) cm; t =-3.185, P =0.002] and 30 min[(6.9±1.5) cm vs. (6.1±1.4) cm; t =-2.712, P =0.008] after extubation.The TF-DB in the SUG group was also higher than that in the N+A group 10 min[(60.1±18.8)% vs. (49.1±20.0)%; t =2.739, P =0.007] and 30 min[(65.0±20.1)% vs. (49.9±19.1)%, t =-3.686, P <0.001] after extubation.Conclusion Compared with neostigmine,sugammadex can significantly improve the postoperative diaphragm movement and decrease the incidence of PORC.

Objective To investigate the understanding of the head and face protection of the health care workers in operating room of Peking Union Medical College Hospital during the corona virus disease-19(COVID-19) pandemic.Methods The knowledge of head and face protection of health care workers in the operating room was evaluated based on the non-registered questionnaires for protection measures collected on-line.Results The survey was conducted in two phases.In the first phase(COVID-19 outbreak),153 questionnaires were collected.In the second phase(when Beijing lowered the emergency response to level 3 and normalized the epidemic prevention and control),101 questionnaires were collected.The results showed that 98% of health care workers had used any form of protective devices during the pandemic and anesthesiologists had the highest usage rate(93.0%)of ear-loop face mask with eye shield.During the pandemic,health care workers mainly used goggles(71.2%)for protection to diagnose and treat the patients with fever and ear-loop face mask with eye shield(56.2%)for protection to diagnose and treat the non-fever patients.In the first-and second-phase survey,43% and 68% of health care workers still used protection,and they mainly used face shield(50.0% and 56.5%)and ear-loop face mask with eye shield(56.1% and 68.1%).Conclusions During the pandemic,more than 90% of the health care workers in the operating room of Peking Union Medical College Hospital were aware of head and face protection.Different healthcare workers in the operating room had different choices of head and face protection,and more than 40% of them would still keep such protection during the normalized stage of pandemic prevention and control.

Dilutional hyponatremia caused by excess absorption of hypo-osmotic irrigation fluids is one of the severe complications during hysteroscopic surgery. Appropriate delivery system and distending media,proper distending pressure,and reducing destruction of uterine venous sinus may remarkably lower the morbidity. Meanwhile,early detection and timely treatment of moderate and severe hyponatremia to avoid the occurrence of secondary nervous system demyelination are particularly important during the surgery. This review summarizes the risk factors and the prevention and treatment strategies of dilutional hyponatremia during hysteroscopic surgery.