Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia

BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Effects of Total Intravenous Anesthesia and Static Aspiration Combined General Anesthesia on Postoperative Cognitive Function and Psychological State of Elderly Patients with Esophageal Cancer

Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.

Cerebrospinal fluid and plasma propofol concentration during total intravenous anaesthesia of patients undergoing elective intracranial tumor removal

Objective： The aim of this paper is to compare the propofol concentration in plasma and cerebrospinal fluid （CSF） in patients scheduled for intracranial tumor removal and anaesthetized using propofol as part of a total intravenous anaesthesia technique. Methods： Twenty-seven patients （ASA Ⅰ-Ⅱ） scheduled for elective intracranial tumor removal were studied. Anesthesia was induced with 2 mg/kg propofol for 5 min and infused at 10 mg/（kg·h） for 5 min and then stopped. CSF and arterial blood were collected simultaneously before infusion of propofol and at different time points after infusion ofpropofol according to bispectral index （BIS） values. Concentrations of propofol in plasma and CSF were measured by HPLC with fluorescence detection. The correlation coefficient and regression equation between plasma and CSF concentration of propofol were worked out by linear simple regression. Results： The propofol CSF concentration that we measured was 1.46% of the plasma concentration. The coefficient of relation between plasma and CSF concentration was 76.7%. Conclusions： The propofol CSF concentration was positively correlated with and much lower than the plasma concentration. Discrepancies may result from high plasma protein binding of propofol, intracranial pathology and sampling volume.

Anesthesia management in a pediatric patient with Becker muscular dystrophy undergoing laparoscopic surgery:A case report

BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patients with BMD are also prone to respiratory depression after general anesthesia.Thus,it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients,particularly in pediatric BMD patients.Here,we present successful anesthesia management using transversus abdominis plane block(TAPB)combined with total intravenous anesthesia(TIVA)in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.CASE SUMMARY A 2-year-old boy,weighing 15 kg,with BMD,was scheduled for laparoscopic inguinal hernia repair.TIVA was used for induction,and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance.Moreover,TAPB provided good postoperative analgesia.The patient underwent uneventful surgery and anesthesia,and over the 17 mo follow-up period showed no anesthesia-induced complications.CONCLUSION TAPB combined with TIVA,using short-acting intravenous anesthetic agents,can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.

Anesthesia of a patient with congenital cataract,facial dysmorphism,and neuropathy syndrome for posterior scoliosis:A case report

BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.