[Effects of preoperative quetiapine on postoperative delirium and sleep quality in elderly orthopaedic patients].

Objective: To investigate the effects of preoperative quetiapine on postoperative delirium (POD) and sleep quality in elderly orthopedic patients. Methods: Prospectively, 111 elderly patients, American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ, scheduled to undergo knee or hip surgery in the Affiliated Huangyan Hospital of Wenzhou Medical University under continuous spinal anesthesia from August 2021 to March 2023, were selected and randomly divided into two groups by random number table: control group (group C, 1 h preoperative placebo) and quetiapine group (group Q, 1 h preoperative quetiapine 12.5 mg). In group C, 54 cases were enrolled, including 25 males and 29 females, with an average age of (73.5±4.9) years. In group Q, 57 cases were enrolled, including 26 males and 31 females, with an average age of (74.8±5.0) years. The primary outcome measures were the incidence of POD evaluated by using confusion assessment method (CAM) at 24, 48, and 72 hours after surgery, and the secondary outcome measures included Pittsburgh sleep quality index (PSQI) scores at 24 and 48 hours after surgery and satisfaction of pain management within 24 hours after surgery. Results: The incidence of POD at 24, 48, and 72 h after surgery in group Q was 5.4% (3/57), 12.5% (7/57), 14.3% (8/57), respectively, while that in group C was 18.2% (10/54), 21.8% (12/54), 21.8% (12/54), respectively. The incidence of POD at 24 h after surgery in group Q was lower than that in group C (P=0.036). There was no significant difference in the incidence of POD at 48 and 72 h after surgery between two groups (all P>0.05). The PSQI score of patients in group Q at 24 and 48 h after surgery were (3.8±1.2) and (6.9±1.1) scores, respectively, which in group C were (10.5±2.8) and (7.3±1.3) scores, respectively. Compared with group C, the PSQI score of patients in group Q at 24 h after surgery was significantly higher (P<0.001), but there was no significant difference at 48 h after surgery (P=0.068). The satisfaction scores of pain management at 24 h after surgery in group Q was (91±7) scores, which was higher than that in group C of (81±6) scores (P<0.001). Conclusion: Oral intake of low-dose quetiapine 1 h preoperatively can reduce the incidence of POD, improve postoperative sleep quality and enhance postoperative satisfaction of pain management at 24 hours after surgery in elderly orthopedic patients undergoing knee or hip surgery.

[Relationship between intake volume of carbohydrates solution and gastric emptying time in termed parturients].

Objective: To investigate the relationship between intake volume of carbohydrates solution (CHO) and gastric emptying time in termed parturient, thus to optimize fasting time before anesthesia. Methods: This study was a prospective study. From May to July in 2016, a total of 100 termed parturients in Huangyan Hospital of Wenzhou Medical University, were divided into four groups equally by means of random number table: D1 (200 ml), D2 (300 ml), D3 (400 ml) and D4 (500 ml), based on the different intake volume of 12.5% CHO. All the parturients had been fasted preoperatively before the treatment of oral CHO. The cross-sectional area of gastric antrum (CSA) was measured with an ultrasound machine at baseline (T(0)), 3 min (T(1)), 30 min (T(2)), 60 min (T(3)), 90 min (T(4)), 120 min (T(5)) and 150 min (T(6)) after oral CHO, respectively. Gastric emptying in this study is defined as CSA at any time point is equal to or less than that at T(0). Results: Measurement was failed in eight parturients because of poor imaging quality, two each in D1 and D2 group and four in D4 group. The cubic curve was the best model for gastric emptying among several candidate models estimated with SPSS software, with R(2)>0.9 in all groups. Both the cubic curve and Kaplan-Meier curve indicated that gastric emptying time was prolonged as intake volume increased. Gastric emptying times in D1, D2, D3 and D4 were (76.96±17.69), (96.52±20.14), (109.20±14.70) and (122.86±16.17) min respectively, the difference was significant (F=50.471, P<0.001). All parturients in D1, D2 and D3 group had been in the status of gastric emptying 120 min after oral CHO, and all parturients in D4 group had been in the status of gastric emptying either 150 min after oral CHO. Conclusion: Gastric emptying time will be within two hours when 400 ml or less oral CHO is taken by termed parturient, and it will be prolonged as intake volume increases.