Incidence of oxygen desaturation using a high-flow nasal cannula versus a facemask during flexible bronchoscopy in patients at risk of hypoxemia: a randomised controlled trial.

BACKGROUND: Patients with obstructive sleep apnoea (OSA), male sex, obesity, older age or hypertension are prone to hypoxemia during flexible bronchoscopy. This study investigated whether using a high-flow nasal cannula (HFNC) could reduce the incidence of oxygen desaturation during bronchoscopy under deep sedation in patients at risk of hypoxemia. METHODS: A total of 176 patients at risk of hypoxemia who underwent flexible bronchoscopy under deep sedation were randomly assigned to two groups: the HFNC group (humidified oxygen was supplied via a high-flow nasal cannula at a rate of 60 L/min and a concentration of 100%, n = 87) and the facemask group (oxygen was supplied via a tight-fitting facemask at a rate of 6 L/min and a concentration of 100%, n = 89). RESULTS: Oxygen desaturation occurred in 4 (4.6%) patients in the HFNC group and 26 (29.2%) patients in the facemask group (P < 0.001). The facemask group required more jaw thrust manoeuvres than the HFNC group (43[48.3%] vs. 5[5.7%], P < 0.001). 8 patients (9.0%) in the facemask group and none in the HFNC group required bag-mask ventilation (P = 0.012). CONCLUSION: The use of an HFNC can reduce the incidence of oxygen desaturation and the requirement for airway intervention in patients at risk of hypoxemia during flexible bronchoscopy under deep sedation. TRIAL REGISTRATION: www.chiCTR.org.cn Identifier: ChiCTR2100044105. Registered 11/03/2021.

Sufentanil Preconditioning Protects Against Hepatic Ischemia-Reperfusion Injury by Suppressing Inflammation.

BACKGROUND Inflammation is one of the most significant mechanisms of hepatic ischemia-reperfusion injury (IRI). Sufentanil has a protective effect against liver injury by reducing inflammatory response. In this study, we used a cellular hepatic ischemic/reoxygenated (IR) model to determine whether sufentanil preconditioning protects against hepatic IRI. MATERIAL AND METHODS The human normal liver cells line L-O2 was studied. The levels of glutamic oxaloacetic transaminase (AST), lactate dehydrogenase (LDH), malonaldehyde (MDA), and superoxide dismutase (SOD) were measured using corresponding assay kits. The protein levels of total and phosphorylated ERK1/2, JNK, and p38, and the expression of p65 and COX2 genes, were measured by Western blotting. The levels of inflammatory factors were examined by ELISA. The Cell Counting Kit-8 (CCK-8) was used to determine if the viability of L-O2 cells was affected by sufentanil. The effects of sufentanil on IR-induced cell apoptosis were examined by flow cytometry. RESULTS IR-induced caused L-O2 cells to become rounded and to have a lower adhesive rate than normal cells. The levels of AST, LDH, and MDA were higher but the level of SOD was lower in the IR group than in the control group. The phosphorylated protein levels of ERK1/2, JNK, and p38, along with the expression of p65 and COX2, were upregulated in the IR group compared to the normal group. In addition, a variety of inflammatory factors were secreted in L-O2 cells after IR. The viability of L-O2 cells decreased and cell apoptosis increased significantly after IR treatment. All indexes of cell injury were reversed by sufentanil in a concentration-dependent manner. CONCLUSIONS Sufentanil stimulation triggers downregulation of inflammatory factors such as HIF-1alpha, TNF-alpha, IL-1ß, and IL-6, possibly through suppressing the p38/ERK/JNK/NF-kappaB-p65/COX2 pathways, and thereby reduces the damage to IR hepatic cells.

[The effect of neoadjuvant chemotherapy on patient controlled intravenous analgesia postoperatively in ovarian cancer patients].

OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy on patient controlled intravenous analgesia (PICA) postoperatively in ovarian cancer patients. METHODS: Sixty three patients with ovarian cancer (ASA I--III grade) were selected. They were divided into 2 groups according to with or without neoadjuvant chemotherapy: neoadjuvant chemotherapy group (N) 33 cases, direct operation group (D) 30 cases. Both of them were completed with tumor cell reduction-extinction operation under total intravenous general anesthesia. Patients' chemotherapy-induced peripheral neuropathy (CIPN) was assessed by the total neuropathy score exclusively clinically-based (TNSc) preoperatively, the assessment of analgesic effect and side-effect was performed postoperatively. RESULTS: No statistically significant difference between the two groups (P > 0.05) on ages, body mass index, ASA grades and Karnofsky scores. Patients in group N were significantly lower than that of group D (P < 0.05) on the VAS scores at 2, 4, 8 h postoperatively, the pressure times and effective times of Bolus and the total consumption amount of analgesic drug in the whole process of analgesia treatment But the scores on nausea and vomiting of group N were significantly higher than that of group D (P < 0.05). There were no significant differences on Bruggemann comfort scale at 2, 4, 8, 12 h postoperatively, dizziness scores, pruritus scores and Ramsay Sedation scores between this two groups (P > 0.05). There was negative linear correlation between the total consumption amount of analgesic drug in the whole process of analgesia treatment and TNSc scores (r = -0.881, P = 0.048), and there was positive linear correlation between nausea scores and TNSc scores (r = 0.920, P = 0.027). CONCLUSION: Patients with neoadjuvant chemotherapy have peripheral neuropathy at different degree before operation. The more serious of peripheral neuropathy, the less demand of PCIA analgesic drug postoperatively and with more side effects occur, such as nausea.

Pharmacological interventions for phantom limb pain.

OBJECTIVE: To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. DATA SOURCES: Both Chinese and English language literatures were searched using MEDLINE (1982 - 2011), Pubmed (1982 - 2011) and the Index of Chinese Language Literature (1982 - 2011). STUDY SELECTION: Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. RESULTS: By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyl-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. CONCLUSIONS: Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyl-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.