Observation of the Effects of Anesthesia Recovery Nursing Combined with Heat Preservation Measures in Patients Undergoing General Anesthesia Surgery

Objective:To observe the application effects of anesthesia recovery nursing with heat preservation measures in patients undergoing general anesthesia surgery.Methods:300 cases of general anesthesia surgery patients in our hospital from March 2023 to February 2024 were selected and divided into the control group and the observation group according to the random number table method,each with 150 cases.The control group adopted conventional care,while the observation group was given anesthesia recovery care and heat preservation measures on the basis of conventional care.The wake-up time,extubation time,hospitalization time,and the incidence of adverse reactions were compared between the two groups and statistically analyzed.Results:The wake-up time of patients in the control group was 9.71±1.20 hours,and that of the observation group was 6.51±1.02 hours,with statistically significant differences(P<0.05);the extubation times of patients in the observation group and the control group after awakening were 8.52±0.41 min and 10.42±1.12 min,respectively,with statistically significant differences(P<0.05)The hospital stay after the operation in the observation group and the control group was 32.91±4.71 days and 37.24±3.34 days respectively,and the difference was statistically significant(P<0.05),and the incidence rate of adverse reactions after extubation in the observation group(3.33%)was significantly lower than that in the control group(10.00%)(P<0.05).Conclusion:In general anesthesia surgery patients,the implementation of anesthesia recovery nursing with heat preservation measures can significantly improve the physical condition of patients,effectively shorten the duration of surgery and patients’wake-up time,and improve their quality of life,which is worthy of clinical promotion and application.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies:A case report

BACKGROUND The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year.Due to their strong magnetic attraction,if multiple gastrointestinal foreign bodies enter the small intestine,it can lead to serious complications such as intestinal perforation,necrosis,torsion,and bleeding.Severe cases require surgical intervention.CASE SUMMARY We report a 6-year-old child who accidentally swallowed multiple magnetic balls.Under timely and safe anesthesia,the magnetic balls were quickly removed through gastroscopy before entering the small intestine.CONCLUSION General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h.In order to prevent magnetic foreign bodies from entering the small intestine,timely and effective measures must be taken to remove the foreign bodies.

Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy:Preliminary results of a prospective comparative study

Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.

Life-threatening delayed mediastinal and subcutaneous emphysema after general anesthesia in a rheumatoid arthritis patient: a case report

Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.

Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

Meta-analysis and trial sequential analysis of randomized evidence comparing general anesthesia vs regional anesthesia for laparoscopic cholecystectomy

BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.

General anesthesia mediated by effects on ion channels

Although it has been more than 165 years since the first introduction of modern anesthesia to the clinic, there is surprisingly little understanding about the exact mechanisms by which general anesthetics induce unconsciousness. As a result, we do not know how general anesthetics produce anesthesia at different levels. The main handicap to understanding the mechanisms of general anesthesia is the diversity of chemically unrelated compounds including diethyl ether and halogenated hydrocarbons, gases nitrous oxide, ketamine, propofol, benzodiazepines and etomidate, as well as alcohols and barbiturates. Does this imply that general anesthesia is caused by many different mechanisms? Until now, many receptors, molecular targets and neuronal transmission pathways have been shown to contribute to mechanisms of general anesthesia. Among these molecular targets, ion channels are the most likely candidates for general anesthesia, in particular γ-aminobutyric acid type A, potassium and sodium channels, as well as ion channels mediated by various neuronal transmitters like acetylcholine, amino acids amino-3-hydroxy-5-methyl-4-isoxazolpropionic acid or N-methyl-D-aspartate. In addition, recent studies have demonstrated the involvement in general anesthesia of other ion channels with distinct gating properties suchas hyperpolarization-activated, cyclic- nucleotide-gated channels. The main aim of the present review is to summarize some aspects of current knowledge of the effects of general anesthetics on various ion channels.

Lumbar-Sacral Plexus Block Anesthesia versus General Anesthesia for Total Hip Arthroplasty: Case Control Study

Background: Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. Methods: 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. Results: 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). Conclusions: In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.

Pressure-Controlled Inverse Ratio Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

Background: Studies have shown that pressure-controlled ventilation improves alveolar gas distribution. And inverse ratio ventilation has advantages of improving oxygenation in acute respiratory distress syndrome (ARDS) patients. However, the effects that pressure-controlled inverse ration ventilation in patients undergoes endotracheal intubation general anesthesia have not been assessed. Objective: To investigate whether pressure-controlled inverse ratio ventilation (PIV) would improve ventilatory and oxygenation parameters as well as lung function compared to conventional ventilation in patients undergoing open abdominal surgery. Interventions: In the conventional ventilation (CV) group, the ventilation strategy involved zero end-expiratory pressure and volume-controlled ventilation. In the pressure-controlled inverse ratio ventilation (PIV) group, the strategy involved P high starting at 7 cm H2O, P low starting at 4 cm H2O, T high at 4 s, T low at 2 s, and an inspiratory-to-expiratory time ratio of 2:1. The ΔP value was adjusted according to VT. Pressure levels were increased by 2 cm H2O until a maximal VT was observed. Inspired oxygen fraction (FIO2) was 1.0 and tidal volume (VT) was 6 mL/kg in both groups. Main Outcome Measures: The primary outcome is pulmonary function tests. Hemodynamic, ventilatory and oxygenation parameters were measured;visual analog scale (VAS) scores, and nausea and vomiting scores were also measured. Results: The PIV group tolerated pressure-controlled inverse ratio ventilation without significant hemodynamic instability. Mean airway pressure and static compliance were significantly higher in the PIV group than those in CV group (P P 2 h was well tolerated and improved respiratory compliance and lung function on the first postoperative day.

Effects of Dexmedetomidine combined with Sufentanil on the hemodynamics and stress state in the wake of general anesthesia in elderly patients with lower limb fracture surgery

Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied.Methods:From June 2017 to July 2018, 95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected. According to their different anesthesia methods, 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group), and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group). Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor, E, FIns and HOMA-IR). The the changes of pain mediators (NO,β-EP, SP) and helper T cytokines (IFN-γ, TNF-α) were compared between the two groups before and 24 hours after surgery. Results:In the combined group, HR, SpO2, MAP and sufentanil groups showed little change in SpO2 during anesthesia, with no significant difference. The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3. The stress indicators Cor, E, FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance. The serum stress indexes of Cor, E, FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group. The IFN-γ level of the combined group was significantly higher than that of the sufentanil group, and the TNF-α level was significantly lower than that of the control group. Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery. Serum pain mediators NO,β-EP and SP in the combined group were significantly lower than those in the sufentanil group before and 24 h after surgery.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.

Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.

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.

General Anesthesia for Cesarean Section in a Pregnant Woman with Immune Thrombocytopenic Purpura (ITP): A Case Report and Review of the Literature

Background: Management of immune thrombocytopenia (ITP) during pre- gnancy can be challenging, particularly by identifying a threshold for safe administration of neuraxial/general anesthesia and minimizing postpartum hemorrhage. There is controversy over the safety of cesarean section (CS) in ITP patients. In this case report, we discuss general anesthesia management in a patient with ITP with severe thrombocytopenia. Case Presentation: A 28-year-old female with relapsed/refractory ITP and severe thrombocytopenia underwent general anesthesia and emergent cesarean section with successful outcomes and minimal bleeding. Platelet counts before CS were 5000 × 109 L, the patient received 1 unit of platelets before the procedure and 1 unit of platelet and tranexamic acid 500 mg was injected slowly during the procedure. No evidence of bleeding and no complications were observed in the patient or newborn. Conclusions: In an emergent circumstance, general anesthesia and cesarean section procedure were performed safely in a patient with severe thrombocytopenia, no hemorrhagic complications were seen for this patient or neonate. Objective of This Manuscript: To share our experience of a safe emergent CS procedure and general anesthesia in a patient with severe thrombocytopenia. Our experience may guide the management of ITP patients in emergent delivery circumstances.

Effect of Right Supine Tracheal Extubation on Respiratory Complications and Airway Pressure in the Waking Period of General Anesthesia in Pediatric Stomatology

Objective: The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. Methods: Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO2 of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. Results: The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH2O. Conclusion: For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.