Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients:A meta-analysis

BACKGROUND Remimazolam is characterized by rapid action and inactive metabolites.It is used as the general anesthetic for many clinical surgeries.In this study,we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older patients.AIM To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older adults.METHODS The PubMed,Web of Science,the Cochrane Library databases were queried for the relevant key words"remimazolam,""and propofol,""and gastrointestinal endoscopy or gastroscopy."The search scope was"Title and Abstract,"and the search was limited to human studies and publications in English.Seven studies wherein remimazolam and propofol were compared were included for the metaanalysis.RESULTS We selected seven randomized controlled trials involving 1445 cases for the analysis.Remimazolam reduced the hypotension(relative risk,RR=0.44,95%CI:0.29-0.66,P=0.000),respiratory depression(RR=0.46,95%CI:0.30-0.70,P=0.000),injection pain(RR=0.12,95%CI:0.05-0.25,P=0.000),bradycardia(RR=0.37,95%CI:0.24-0.58,P=0.000),and time to discharge[weighted mean difference(WMD)=-0.58,95%CI:-0.97 to-0.18,P=0.005],compared to those after propofol administration.No obvious differences were observed for postoperative nausea and vomiting(RR=1.09,95%CI:0.97-1.24,P=0.151),dizziness(RR=0.77,95%CI:0.43-1.36,P=0.361),successful sedation rate(RR=0.96,95%CI:0.93-1.00,P=0.083),or the time to become fully alert(WMD=0.00,95%CI:-1.08-1.08,P=0.998).CONCLUSION Remimazolam appears to be safer than propofol for gastroenteroscopy in older adults.However,further studies are required to confirm these findings.

In vivo imaging reveals a synchronized correlation among neurotransmitter dynamics during propofol and sevoflurane anesthesia

General anesthesia is widely applied in clinical practice.However,the precise mechanism of loss of consciousness induced by general anesthetics remains unknown.Here,we measured the dynamics of five neurotransmitters,includingγ-aminobutyric acid,glutamate,norepinephrine,acetylcholine,and dopamine,in the medial prefrontal cortex and primary visual cortex of C57BL/6 mice through in vivo fiber photometry and genetically encoded neurotransmitter sensors under anesthesia to reveal the mechanism of general anesthesia from a neurotransmitter perspective.Results revealed that the concentrations of γ-aminobutyric acid,glutamate,norepinephrine,and acetylcholine increased in the cortex during propofol-induced loss of consciousness.Dopamine levels did not change following the hypnotic dose of propofol but increased significantly following surgical doses of propofol anesthesia.Notably,the concentrations of the five neurotransmitters generally decreased during sevoflurane-induced loss of consciousness.Furthermore,the neurotransmitter dynamic networks were not synchronized in the non-anesthesia groups but were highly synchronized in the anesthetic groups.These findings suggest that neurotransmitter dynamic network synchronization may cause anesthetic-induced loss of consciousness.

The neuroscience of pain,addiction,and anesthesia

Researchers and clinicians have long been interested in the mechanisms of pain,anesthesia,and addiction.The International Association for the Study of Pain(IASP)defines pain as an unpleasant sensory and emotional experience associated with,or resembling that associated with,actual or potential tissue damage(Raja et al.,2020).Drug addiction refers to a condition of reliance that develops from regular drug consumption,which may lead to withdrawal symptoms when use is halted.Anesthesia involves the complete loss of consciousness induced by an inhaled or intravenous anesthetic(Tosello et al.,2022).In this special collection,Zoological Research presents research findings focused on pain,addiction,and anesthesia.

Anesthesia,Anesthetics,and Postoperative Cognitive Dysfunction in Elderly Patients

Postoperative cognitive dysfunction(POCD)remains a major issue that worsens the prognosis of elderly surgery patients.This article reviews the current research on the effect of different anesthesia methods and commonly utilized anesthetics on the incidence of POCD in elderly patients,aiming to provide an understanding of the underlying mechanisms contributing to this condition and facilitate the development of more reasonable anesthesia protocols,ultimately reducing the incidence of POCD in elderly surgery patients.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer

BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Pharmacokinetic Characterization of Xylazine in Goats with Simultaneous Anesthesia Studies

The aim was to study the pharmacokinetics of xylazine as a stable anesthetic in goats.In this study,goats were injected with xylazine at the rate of 0.3 mL·kg-1 intramusculally,and blood samples were collected at 1,3,5,10,20,30,45,60,90,120,180,and 240 min after administration,respectively.Xylazine was extracted by liquid-liquid extraction and separation method,and blood concentration was determined by high performance liquid chromatography(HPLC).The pharmacokinetic characteristics of xylazine in healthy goats were analyzed by pharmacokinetic software.The results showed that the chromatographic peak time of xylazine chromatography was 9-11 min.The specificity of the method was good.The linear correlation coefficient R2 of the standard curve was 0.9982 when the concentration of xylazine was in the range of 10-1×1000 ng.The pharmacokinetic model of xylazine in goats was a one-chamber model with first-order rate absorption,distribution half-life t1/2Ka was(0.49±0.041)min,elimination half-life t1/2Ke was(23.3±2.5)min,and the peak time(Tp)of the highest concentration was(2.8±0.2)min.The total drug clearance CL/F was(0.00016±0.000016)mg·kg-1·min-1(ng·mL-1),and the minimum effective blood concentration was 56.6 ng·mL-1,which was consistent with the clinical anesthetic effect.The results showed that xylazine had the characteristics of rapid absorption,wide distribution,short peak time,slow clearance rate,and long anesthetic time in goats,which could be used as the basic drug for the development of goat complex anesthetic preparation.

Dosage Formula in Anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in Anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in Anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formula in nesthesia for MVA, it appears that the dosage formula of Bukavu, in case of intrathecal spinal analgesia of MVA for incomplete abortion provides precision on the specificity of the doses of bipuvacaine hypobarre 0.1% and Fentanyl 50 µg% reported to each patient according to her weight and height. Its application could therefore reduce morbidity and mortality and improve patient-practitioner comfort in the event of MVA for incomplete abortion following the dosage precision it provides.

Pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries under topical anesthesia

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.

Obstetric Anesthesia Practice Significantly Evolved: A Field for Cesarean Delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.

Current evidence on artificial intelligence in regional anesthesia

The recent advancement in regional anesthesia(RA)has been largely attributed to ultrasound technology.However,the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer.Even with adequate training,experience,and knowledge,human-related limitations such as fatigue,failure to recognize the correct anatomical structure,and unintentional needle or probe movement can hinder the overall effectiveness of RA.The amalgamation of artificial intelligence(AI)to RA practice has promised to override these human limitations.Machine learning,an integral part of AI can improve its performance through continuous learning and experience,like the human brain.It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA.AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images,and it can also assist in needle tracking and accurate deposition of local anesthetics.The future of RA with AI integration appears promising,yet obstacles such as device malfunction,data privacy,regulatory barriers,and cost concerns can deter its clinical implementation.The current mini review deliberates the current application,future direction,and barrier to the application of AI in RA practice.

Management of Square Carcinoma of the Lower Lip Using Camille-Bernard Flap under Local Anesthesia: When Constraints Dictate Our Attitude

Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.

Artificial intelligence and robotics in regional anesthesia

Artificial intelligence(AI)technology is vital for practitioners to incorporate AI and robotics in day-to-day regional anesthesia practice.Recent literature is encouraging on its applications in regional anesthesia,but the data are limited.AI can help us identify and guide the needle tip precisely to the location.This may help us reduce the time,improve precision,and reduce the associated side effects of improper distribution of drugs.In this article,we discuss the potential roles of AI and robotics in regional anesthesia.

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.

Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis

Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.

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.

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.

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.

Regional anesthesia in a patient with primary ciliary dyskinesia:A case report

BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.