Perioperative sleep disorders in gynaecological daycase surgery patients and analysis of risk factors: protocol for a cross-sectional study.

INTRODUCTION: Sleep disorders are clinical syndromes of disturbed sleep-wake rhythms and abnormal sleep quality. They have various causes, but their main manifestations are difficulty falling asleep, sleep disruption and daytime fatigue. These are common clinical symptoms in perioperative patients, especially in gynaecological patients. There is a lack of research on the factors influencing perioperative sleep disorders in gynaecological patients. The aim of this study is to assess the prevalence of sleep disorders in gynaecological surgery patients and to analyse the possible factors influencing them to provide new ideas for improving sleep disorders in this patient population. METHODS AND ANALYSIS: This cross-sectional, descriptive and observational survey is planned to include 480 gynaecological day surgery patients. All patients who meet the inclusion criteria are eligible to join the study. The study will record preoperative diagnosis, surgical procedure, duration of surgery, type of anaesthesia, anaesthetic drugs, sleep quality, anxiety and depression levels and pain indices 30 days before and 1, 2, 3 and 30 days after surgery. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University (Approval Number: sjtkyll-lx-2022(109)) before the start of recruitment. The results of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ChiCTR2200064533.

Computational and solubility equilibrium experimental insight into Ca2+-fluoride complexation and their dissociation behaviors in aqueous solutions: implication for the association constant measured using fluoride ion selective electrodes.

Although the Ca2+-F- association is of great importance for aqueous environments and industrial systems containing F-, as well as for defluorination processes, many details of the association solvation structures and behavior remain unclear. Herein, a combination of classical/ab initio molecular dynamics simulations and density functional theory calculations was used to investigate the structure and hydration of CaFx2-x (x = 1, 2) and the association/dissociation behavior of Ca2+-F- in aqueous CaF2 solutions. The primary shell of Ca2+ is found to be very flexible in the association of Ca2+-F-, with coordination numbers dynamically oscillating in the range of 6-9, with 6 and 7 being the most favorable. The calculations show that for CaF(H2O)14+, the contact ion pair (CIP) is more favorable and occurs with no energy barrier, whereas the formation of CaF2(aq.) must overcome a ∼3.6 kJ mol-1 energy barrier; moreover, the CIP and solvent shared ion pair (SSIP) dynamically coexist for CaF2(H2O)14 in aqueous CaF2 solutions. Calculations for the dissociation process of CaF(H2O)6+ show a dramatic energy increase going from SSIP to free Ca2+ and F-, ascribed to the surprisingly long-range electrostatic attraction between Ca2+ and F- rather than to special F⋯H interactions. The energy increase results in the estimated association constant of CaF+ being larger than that previously measured using fluoride ion selective electrodes. This is attributed to the fact that the latter value might correspond to the ligand reaction of free Ca2+ and F- to form the Ca2+-F- SSIP. The combination of these results with CaF2(s) solubility measurements suggests that the higher-order Ca2+-F- complexes are absent in aqueous CaF2 solutions.

Occipital Nerve Blockade for the Treatment of Occipital Neuralgia-Like Acute Postcraniotomy Headache: A Retrospective Study.

Objective: The therapeutic effectiveness and safety of occipital nerve blockade (ONB) on occipital neuralgia- (ON-) like acute postcraniotomy headache (ON-APCH) was evaluated. Background: Persistent occipital neuralgia is a subclassification of chronic postcraniotomy headache and has been investigated sporadically in previous publications. The long-lasting neuralgic pain significantly impairs postoperative recovery and quality of life. However, little is known regarding ON-APCH and its management. Methods: All data were retrospectively acquired from consultation records and electronic institutional medical documents. Forty-one patients, who developed drug-resistant ON-APCH after elective craniotomy and received ONB with lidocaine for diagnoses, were included in this study, all of whom were treated using dexamethasone and lidocaine. Pain intensity and ONB correlated complications and side effects were collected and analyzed at three different time points: before ONB, at 1 day after ONB, and at discharge. Results: Nineteen males and twenty-two females aged 49.6 ± 15.2 years were diagnosed with drug-resistant ON-APCH. The mean NRS was 8.0 ± 0.9 before ONB, which later significantly decreased to 2.1 ± 1.4 and 1.6 ± 0.6 at 1 day after ONB and on discharge, respectively. At 1 month after ONB, thirty patients (73%) obtained complete pain relief without medication. At 3 months after ONB, only two (5%) patients had to continue oral medications to maintain pain relief. No adverse effects or complications were observed immediately after, or within 3 months, of the nerve blockade. Conclusions: For drug-resistant ON-APCH, early occipital nerve blockade with dexamethasone and lidocaine is an effective and safe technique, which provides adequate pain relief and may prevent further development of persistent presentation of refractory ON.

Pre-Emptive Incision-Site Infiltration with Ropivacaine Plus Dexamethasone for Postoperative Pain After Supratentorial Craniotomy: A Prospective Randomized Controlled Trial.

BACKGROUND: Incision-site infiltration with local anesthetics prevents pain on incision site, but pain relief is limited to the first few postoperative hours. Dexamethasone as an adjuvant to local infiltration successfully achieves better postoperative pain relief; however, this has not been studied in craniotomy patients yet. STUDY DESIGN AND METHODS: This is a prospective, single-center, blinded, randomized, controlled trial included patients aged between 18 and 64 years, ASA physical status of I-II, scheduled for elective supratentorial tumor craniotomy under general anesthesia. We screened patients for enrollment from April 4, 2019 through August 15, 2019. The final study visit of the last patient was conducted on February 13, 2020. We randomly assigned eligible participants (1:1) to either the dexamethasone group who received incision-site infiltration of 0.5% ropivacaine plus 0.033% dexamethasone (N=70) or the control group who received 0.5% ropivacaine alone (N=70). Primary outcome was the cumulative sufentanil consumption (µg) within 48 hours postoperatively. Primary analysis was performed based on the modified intention-to-treat (MITT) principle. RESULTS: Baseline characteristics were similar between the groups (p>0.05). Sufentanil consumption during the first 48 hours postoperatively was 29.0 (10.7) µg in the dexamethasone group and 38.3 (13.7) µg in the control group (mean difference -9.3, 95% CI -13.4 to -5.1; p<0.001). There was no serious adverse effect directly associated with incision-site infiltration or local dexamethasone use. CONCLUSION: The addition of dexamethasone to pre-emptive incision-site infiltration with the local anesthetic can reduce about 27% of opioids consumption and the postoperative pain scores within 72 hours after craniotomy. TRIAL REGISTRATION: ClinicalTrials.Gov (NCT03618264).

Thromboelastography-guided blood transfusion during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: study protocol for a prospective randomised controlled trial.

INTRODUCTION: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a well-established treatment for peritoneal cancer (PC). However, this kind of combination therapy is associated with a high incidence of complications. Moreover, relative studies have indicated that traditional laboratory testing is insufficient to demonstrate the overall haemostatic physiology of CRS/HIPEC. Thromboelastography (TEG), administered by monitoring dynamic changes in haemostasis, has been shown to contribute to reducing transfusion requirements and improving survival. However, there is no evidence to verify whether TEG can be applied to guide transfusion strategies during CRS/HIPEC. Therefore, we aim to investigate whether TEG-guided blood product transfusion (TEG-BT) therapy is superior to traditional blood product transfusion (T-BT) therapy for guiding perioperative blood transfusion treatment and improving the prognosis of patients undergoing CRS/HIPEC. METHODS AND ANALYSIS: The TEG-BT versus T-BT study is a single-centre, randomised, blinded outcome assessment clinical trial of 162 patients with PC, aged 18-64 years and undergoing CRS/HIPEC. Participants will be randomly allocated to receive TEG-BT or T-BT. The primary outcome will be the evaluation of perioperative blood transfusion, which refers to the total amount of blood transfusion given from the time patients enter the operating room up to 72 hours postoperatively. The secondary outcomes will include the transfusion volume during surgery, total amount of intraoperative infusion, amount of blood lost during the operation, total blood transfusion between 0 and 72 hours after surgery, lowest haemoglobin level within 72 hours after surgery, intensive care unit duration, overall length of stay, total cost of hospitalisation and adverse events. Data will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION: The study protocol has been approved by the Scientific Research Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University (Approval Number: sjtkyll-lx-2020-3). The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR2000028835).

The impact of ultrasound-guided bilateral rectus sheath block in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - a retrospective study.

BACKGROUND: Rectus sheath block (RSB) is known to attenuate postoperative pain and reduce perioperative opioid consumption. Thus, a retrospective study was performed to examine the effects of bilateral rectus sheath block (BRSB) in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: A total of 178 patients undergoing CRS/HIPEC at our hospital were included. Patient information and anaesthesia-related indicators were collected from the electronic medical record (EMR) system. All subjects were divided into the following two groups: the G group (general anaesthesia) and the GR group (RSB combined with general anaesthesia). Patients in the GR group received 0.375% ropivacaine for BRSB before surgery. The primary outcomes included the total amount of remifentanil and rocuronium, the total consumption of dezocine after surgery, the visual analogue scale (VAS) score and the patient-controlled intravenous analgesia (PCIA) input dose at 1 h (T6), 6 h (T7), 12 h (T8), 24 h (T9) and 48 h (T10) after surgery. Other outcomes were also recorded, such as patient demographic data, the intraoperative heart rate (HR) and mean arterial pressure (MAP), and postoperative complications. RESULTS: Compared with the G group, the GR group showed a shorter time to tracheal extubation (P < 0.05), a decreased total amount of remifentanil and rocuronium (P < 0.05), and a reduced VAS score, PCIA input dose and number of PCIA boluses at 1 h, 6 h and 12 h after surgery (P < 0.05). However, at 24 h and 48 h after surgery, there were no differences in the VAS score of pain at rest or during motion between the two groups (P > 0.05). Moreover, the incidence of hypertension, emergence agitation, delayed recovery, hypercapnia, and nausea and vomiting was lower in the GR group than in the G group (P < 0.05). There were no differences in the changes in MAP and HR during the surgery between the two groups (P > 0.05). No complications associated with nerve block occurred. CONCLUSION: BRSB could provide short-term postoperative analgesia, reduce perioperative opioid consumption and reduce the incidence of postoperative complications. It is an effective and safe procedure in CRS/HIPEC.

[Endoscopic treatment for fourth ventricular outlet obstruction].

OBJECTIVE: To explore the therapeutic efficacies of endoscope for fourth ventricular outlet obstruction (FVOO). METHODS: Endoscopic third ventriculostomy (ETV) was performed for 30 cases. The circumstances of third ventricular floor and basal cistern were observed and recorded intra-operatively. Meanwhile the fourth ventricular exploration and fistulation were performed across enlarged aqueduct. And the velocity and flow rate of aqueduct, fourth ventricular outlet and stoma were evaluated post-operatively with Cine-MR (magnetic resonance). RESULTS: Standard ETV was performed successfully in 28 patients. Fourth ventricular exploration (n = 6) and outlet membrane fistulation (n = 2) were carried out. The mean follow-up period was 2.3 years (range: 0.5 - 4.0). The overall success rate was 78.6%. CONCLUSION: ETV is a viable therapeutic option for FVOO patients. The therapeutic effects of outlet membrane fistulation require further observations.

[Neuroendoscopic treatment of different types of quadrigeminal cistern arachnoid cysts].

OBJECTIVE: To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts (QCAC) with neuroendoscope. METHODS: A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type III cases with a varying level of symptoms. The follow-up period was 6 - 24 months. Cine-MRI (magnetic resonance imaging) examination was performed both preoperatively and post-operatively. RESULTS: Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Seven feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. CONCLUSION: In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.

[Endoscopic microvacular decompression for trigeminal neuralgia].

OBJECTIVE: To explore the feasibility, operating technique and precautions of endoscopic microvascular decompression for trigeminal neuralgia. METHODS: A retrospective analysis was conducted for 21 patients with primary trigeminal neuralgia. All underwent neuroendoscopic microvascular decompression for trigeminal nerves. RESULTS: The pains disappeared upon awaking post-anesthesia in 19 patients. In 2 patients, pains became significantly alleviated and disappeared after taking carbamazepine for 1 - 3 months. No patient suffered the injuries of trigeminal nerve and other cranial nerves. None had cerebellum edema or death. During the follow-up period, there was no recurrence of pains. CONCLUSION: Neuroendoscopic surgery may accomplish microvascular decompression for trigeminal nerve independently. As a minimally invasive and effective technique, it offers a clearer vision of local anatomy and decreases the probability of damaging nerves and vessels. There is no need for pulling cerebellum. It brings minimal damage to normal brain tissue compared with microsurgery. Further popularization is warranted.