The Application Value of Esketamine and Dexmedetomidine in Preventing Postoperative Delirium and Hyperalgesia in Elderly Patients with Thoracic Anesthesia.

Objective: Our aim was to evauate the application value of esesketamine and dexmedetomidine in preventing postoperative hyperalgesia in elderly patients who received thoracic anesthesia. Methods: A total of 94 elderly patients who underwent thoracic anesthesia in Sanmen People's Hospital from January 2021 to October 2022 were selected and divided into a dexmedetomidine group (n = 47) and an esketamine group (n = 47) by the random number table method. All patients were continuously received intravenous (IV) remifentanil. In the dexmedetomidine group, dexmedetomidine 0.7 µg/kg was administered IV, followed by 0.2 to 0.5 µg/kg/h to maintain anesthesia, while in the esketamine group, esketamine 0.5 mg/kg was given IV 20 min after induction of anesthesia was completed. Results: Visual analogue scale (VAS) scores in the esketamine group were lower than in the dexmedetomidine group at 1, 6, 12 and 24 h postoperatively (P < .05), and Ramsay sedation scores were not statistically different from those in the dexmedetomidine group (P > .05). At 3 d postoperatively, the Mini-Mental State Examination (MMSE) scores in the dexmedetomidine group were lower than 1 d preoperatively; at 5 d postoperatively, the negative mood and Pittsburgh Sleep Quality Index (PSQI) scores were significantly higher in both groups than 1 d preoperatively; at 14 d postoperatively, the PSQI scores were higher in both groups than 1 d preoperatively, and there was no statistical difference between the negative mood scores at 1 d before surgery (P > .05). At 5 d postoperatively in the esketamine group, the negative mood scores were lower than in the dexmedetomidine group at 5 d postoperatively and the PSQI scores at 5 and 14 d postoperatively were lower than in the dexmedetomidine group (P < .05). Conclusion: Both esketamine and dexmedetomidine can be used to prevent postoperative delirium and nociceptive hypersensitivity after anesthesia in elderly patients with thoracic surgery. However, esketamine is superior to dexmedetomidine in analgesic effect, improvement of negative mood and sleep and stabilization of intraoperative hemodynamics, leading to better effect in preventing delirium and hyperalgesia after anesthesia.

The 90% minimum effective volume of 0.5 ropivacaine for ultrasound-guided supraclavicular brachial plexus block : A biased coin up-and-down design.

BACKGROUND: Ultrasound-guided supraclavicular brachial plexus block is widely used in upper limb surgery; however, it requires a higher dose (20-30 mL) of local anesthetic. In this study, we aimed to determine the 90% minimum effective volume for ultrasound-guided supraclavicular brachial plexus block. METHODS: All patients received an ultrasound-guided two-point injection of 0.5% ropivacaine at a starting volume of 0.18 mL/mm2 cross-sectional nerve area. In cases of a successful block, the next patient had the same volume with a probability of 0.89, and the volume was reduced by 0.04 mL/mm2 cross-sectional nerve area with a probability of 0.11. When the block failed, the dose was increased by 0.04 mL/mm2 cross-sectional nerve area. After 45 cases of successful blocks, the 90% minimum effective volume of local anesthetic was calculated using the centered isotonic regression function. RESULTS: Centered isotonic regression analysis resulted in a 90% minimum effective volume and a 95% confidence interval of 0.189 mL/mm2 and 0.176-0.225 mL/mm2 for the supraclavicular brachial plexus block. CONCLUSION: A good blocking effect can be achieved with 0.189 mL/mm2 of 0.5% ropivacaine with more precise dosing, thereby reducing the risk of local anesthetic poisoning.

Taraxasterol suppresses the proliferation and tumor growth of androgen-independent prostate cancer cells through the FGFR2-PI3K/AKT signaling pathway.

Prostate cancer (PCa) is prevalent among older men and difficult to survive after metastasis. It is urgent to find new drugs and treatments. Several studies show that taraxasterol (TAX) has important anti-inflammatory, anti-oxidative and anti-tumor effects. However, the function and mechanisms of TAX in PCa remain unclear. Here, we found that TAX could significantly suppress the viability and growth of androgen-independent PCa cells and down-regulate the expression of c-Myc and cyclin D1 in vitro. Mechanistically, PI3K/AKT signaling pathway was weakened and the expression of FGFR2 was reduced after TAX treatment in androgen-independent PCa cells. Moreover, TAX evidently inhibited the tumor growth in nude mice and the expression of c-Myc, cyclin D1, p-AKT and FGFR2 were down-regulated in xenograft tumor. These results indicate that TAX suppresses the proliferation of androgen-independent PCa cells via inhibiting the activation of PI3K/AKT signaling pathway and the expression of FGFR2, which means TAX may be a novel anti-tumor agent for later PCa treatment.