Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial.

Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 µg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 µg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial.

Purpose: Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy. Patients and Methods: A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded. Results: Propofol consumption was 274.4±22.6 mg and 201.3±16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4±2.3 s and 17.8±1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2±1.1 min and 4.8±1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58±0.49 vs 3.71±0.83) and (4.75±0.44 vs 3.33±0.92), respectively. Conclusion: The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application. Clinical Trials Registration: ChiCTR 2200062547.

Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report.

Background: Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly applied worldwide owing to its benefits of enhanced recovery after surgery (ERAS). Anesthetic management for patients with asthma should focus on minimizing airway stimulation. Case description: A 23-year-old male patient with a history of asthma was diagnosed with left-sided spontaneous pneumothorax. The patient then underwent left-sided NIVATS bullectomy under general anesthesia with preserved spontaneous breathing. Left thoracic paravertebral nerve block (TPVB) with an injection of 0.375% ropivacaine (30 ml) was performed in the 6th paravertebral space under ultrasound guidance. Anesthesia induction commenced until the cold sensation in the surgical area had disappeared. General anesthesia was induced by midazolam, penehyclidine hydrochloride, esketamine, and propofol and then maintained using propofol and esketamine. Surgery commenced after the patient was positioned in the right lateral recumbency. The collapse of the left lung was satisfactory, and the operative field was ensured after artificial pneumothorax. The surgical procedure was uneventful, intraoperative arterial blood gases were within normal ranges, and vital signs were stable. The patient awakened rapidly without any adverse reactions at the end of the surgery and was then transferred to the ward. During the postoperative follow-up, the patient experienced mild pain 48 h after surgery. The patient was discharged from the hospital 2 days postoperatively and developed no nausea, vomiting, or any other complications. Conclusion: The present case suggests the feasibility of TPVB in combination with non-opioid anesthetics to provide high-quality anesthesia in patients undergoing NIVATS bullectomy.

PZT-Film-Based Piezoelectric Micromachined Ultrasonic Transducer with I-Shaped Composite Diaphragm.

We proposed a PZT-film-based piezoelectric micromachined ultrasonic transducer (pMUT) with an I-shaped composite diaphragm to improve the sensitivity and resonant frequency of pMUTs with the same diaphragm area. The finite element method (FEM) simulation results indicated that the pMUT with an I-shaped composite diaphragm had relatively high sensitivity and resonant frequency. The pMUT with an I-shaped diaphragm had a 36.07% higher resonant frequency than a pMUT with a circular diaphragm. The pMUT with an I-shaped diaphragm had a 3.65 dB higher loop gain (loss) than a pMUT with a rectangular diaphragm. The piezoelectric layer thickness of the pMUT with an I-shaped composite diaphragm was then optimized. Maximum loop gain (loss) was reached when the piezoelectric layer thickness was 8 µm. The pMUT with an I-shaped composite diaphragm was fabricated using the MEMS method, and its performance was evaluated.

Predictor of postoperative dyspnea for Pierre Robin Sequence infants.

The aim of this retrospective study is to determine the predictive factors of postoperative dyspnea in infants with Pierre Robin sequence (PRS). Forty children with PRS, who underwent general anesthesia, were retrospectively analyzed. The patient's physiological status and anesthesiology data were collected accordingly, demographic characteristics including age, gender, height and weight at surgery, weight gain, preoperative airway status, tracheal intubation route, American Society of Anesthesiologists grading and airway Cormack-Lehane classification. Weight gain, dyspnea before the operation, Cormack-Lehane grade distribution showed a significant difference between patients with and without postoperative dyspnea (p = 0.0175, p = 0.0026, and p = 0.0038, respectively). Incompetent weight gain was identified as a predictor (p = 0.0371) of PRS postoperative dyspnea through the binary logistic regression model. In conclusion, this study established an early alerting model by monitoring the weight gain, dyspnea before the operation, Cormack-Lehane grade as potential combinations to predict the risk of postoperative dyspnea for PRS.

Design and Fabrication of Piezoelectric Micromachined Ultrasound Transducer (pMUT) with Partially-Etched ZnO Film.

A square piezoelectric composite diaphragm was analyzed by the finite element method to enhance the sensitivity of a piezoelectric micromachined ultrasound transducer (pMUT). The structures of electrode and piezoelectric film were optimized and a centric electrode was designed to avoid the counteraction of stress in the centre and edges. In order to further improve the sensitivity; a pMUT with partially-etched piezoelectric film was adopted. The receive and transmit sensitivities of the pMUT were analyzed in details. The receive sensitivity of pMUT with partially-etched ZnO film is 3.3 dB or 6.8 dB higher than those with a centric and whole electrode, respectively; and the amplitude of a partially-etched ZnO film pMUT under a certain voltage is 5.5 dB and 30 dB higher than those with centric and whole electrode separately. Two pMUT-based ZnO films were fabricated by micromachining technology and their receive and transmit sensitivities were tested. The ZnO films deposited by direct current (DC) magnetron sputtering exhibit a densely packed structure with columnar crystallites. The test results show that the structure of the square diaphragm with partially-etched piezoelectric layer can significantly improve the transducer sensitivity. The receive sensitivity and transmit sensitivity are -238.35 dB (ref. 1 V/µPa) and 150.42 dB (ref. 1 µPa/V); respectively.

Design and Analysis of MEMS Linear Phased Array.

A structure of micro-electro-mechanical system (MEMS) linear phased array based on "multi-cell" element is designed to increase radiation sound pressure of transducer working in bending vibration mode at high frequency. In order to more accurately predict the resonant frequency of an element, the theoretical analysis of the dynamic equation of a fixed rectangular composite plate and finite element method simulation are adopted. The effects of the parameters both in the lateral and elevation direction on the three-dimensional beam directivity characteristics are comprehensively analyzed. The key parameters in the analysis include the "cell" number of element, "cell" size, "inter-cell" spacing and the number of elements, element width. The simulation results show that optimizing the linear array parameters both in the lateral and elevation direction can greatly improve the three-dimensional beam focusing for MEMS linear phased array, which is obviously different from the traditional linear array.

Identification of ZapD as a cell division factor that promotes the assembly of FtsZ in Escherichia coli.

The tubulin homolog FtsZ forms a polymeric membrane-associated ring structure (Z ring) at midcell that establishes the site of division and provides an essential framework for the localization of a multiprotein molecular machine that promotes division in Escherichia coli. A number of regulatory proteins interact with FtsZ and modulate FtsZ assembly/disassembly processes, ensuring the spatiotemporal integrity of cytokinesis. The Z-associated proteins (ZapA, ZapB, and ZapC) belong to a group of FtsZ-regulatory proteins that exhibit functionally redundant roles in stabilizing FtsZ-ring assembly by binding and bundling polymeric FtsZ at midcell. In this study, we report the identification of ZapD (YacF) as a member of the E. coli midcell division machinery. Genetics and cell biological evidence indicate that ZapD requires FtsZ but not other downstream division proteins for localizing to midcell, where it promotes FtsZ-ring assembly via molecular mechanisms that overlap with ZapA. Biochemical evidence indicates that ZapD directly interacts with FtsZ and promotes bundling of FtsZ protofilaments. Similarly to ZapA, ZapB, and ZapC, ZapD is dispensable for division and therefore belongs to the growing group of FtsZ-associated proteins in E. coli that aid in the overall fitness of the division process.