Correlation Between Depth of Dexmedetomidine Anesthesia and Cognitive Function in Patients Undergoing Laparoscopic Myomectomy under General Anesthesia.

Purpose: To analyze the correlation between the depth of dexmedetomidine anesthesia and cognitive function in patients undergoing laparoscopic myomectomy under general anesthesia. Methods: According to the inclusion and exclusion criteria, 180 patients who underwent laparoscopic myomectomy under general anesthesia using dexmedetomidine in the gynecology department of our hospital from February 2021 to February 2022 were retrospectively analyzed as study subjects. All patients were monitored by BIS intraoperatively, and the patients were divided into 3 groups according to BIS: group I (n=48), group II (n=105), and group III (n=27). The MMSE scores of patients in the three groups were measured 1 d before anesthesia, 1 d, 3 d, and 5 d after surgery, respectively, and the TMT completion times of patients in the three groups were measured 1 d before anesthesia and 1 d after surgery, and the mean postoperative anesthesia wakefulness time of patients in the three groups and the incidence of cognitive dysfunction in the three groups were recorded. Finally, the BIS of patients in the three groups was compared with the MMSE scores of patients at 5 d after surgery, the TMT completion time at 1 d after surgery, the anesthesia wakefulness time, and the rate of cognitive dysfunction was correlated. Results: There was a significant difference in MMSE scores between the three groups at 1 d, 3 d, and 5 d postoperatively (P < .05); meanwhile, the MMSE scores were significantly higher in group I compared with groups II and III at 1 d, 3 d, and 5 d postoperatively (all P < .05). At 1 d postoperatively for the three groups TMT completion time compared with preoperative time, the difference between the groups was significant (P < .05); meanwhile, compared with 1 d postoperatively in groups II and III, TMT completion time was significantly lower in group I (P < .05). The rate of cognitive dysfunction and the mean postoperative anesthesia awake time of patients in group I were significantly reduced compared with groups II and III (P < .05). BIS was negatively correlated with the MMSE score at 5 d postoperatively, positively correlated with the TMT completion time at 1 d postoperatively, and positively correlated with the anesthesia awake time, and had no significant correlation with the rate of cognitive dysfunction in the three groups. Conclusion: The postoperative cognitive function of patients is closely related to the depth of anesthesia and is negatively correlated with the depth of anaesthesia, i.e. the deeper the depth of anaesthesia, the more pronounced the impairment of the cognitive function of the patient, and the more difficult it is to recover.

CXCL13/CXCR5 promote chronic postsurgical pain and astrocyte activation in rats by targeting NLRP3.

Chronic postsurgical pain (CPSP) with high incidence negatively impacts the quality of life. X-C motif chemokine 13 (CXCL13) has been associated with postsurgery inflammation and exacerbates neuropathic pain in patients with CPSP. This study was aimed to illustrate the relationship between CXCL13 and nod-like receptor protein-3 (NLRP3), which is also involved in CPSP. A CPSP model was constructed by skin/muscle incision and retraction (SMIR) in right medial thigh, and the rats were divided into three groups: Sham, SMIR, and SMIR + anti-CXCL13 (intrathecally injected with anti-CXCL13 antibody). Then, the paw withdrawal threshold (PWT) score of rats was recorded. Primary rat astrocytes were isolated and treated with recombinant protein CXCL13 with or without NLRP3 inhibitor INF39. The expressions of CXCL13, CXCR5, IL-1ß, IL-18, GFAP, NLRP3, and Caspase-1 p20 were detected by real-time quantitative reverse transcription PCR, western blot, ELISA, immunocytochemistry, and immunofluorescence analyses. The anti-CXCL13 antibody alleviated SMIR-induced decreased PWT and increased expression of GFAP, CXCL13, CXCR5, NLRP3, and Caspase-1 p20 in spinal cord tissues. The production of IL-1ß, IL-18, and expression of CXCL13, CXCR5, GFAP, NLRP3, and Caspase-1 p20 were increased in recombinant protein CXCL13-treated primary rat astrocytes in a dose-dependent manner. Treatment with NLRP3 inhibitor INF39 inhibited the function of recombinant protein CXCL13 in primary rat astrocytes. The CXCL13/CXCR5 signaling could promote neuropathic pain, astrocytes activation, and NLRP3 inflammasome activation in CPSP model rats by targeting NLRP3. NLRP3 may be a potential target for the management of CPSP.

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara.

Purpose: To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara. Methods: 300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T 0), at full opening of the uterus (T 1), at the end of the second stage of labor (T 2), and at the end of the third stage of labor (T 3); stress response indicators at T 0 and T 1: epinephrine (E), norepinephrine (NE), glucose (Glu), and ß-endorphin (ß-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2); incidence of postpartum depression (PPD) at 6 weeks after delivery. Results: At T 1, T 2, and T 3, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W (P < 0.05). At T 0, there was no significant difference in the comparison of E, NE, Glu, and ß-EP levels among the three groups (P > 0.05). At T 1, the levels of E, NE, Glu, and ß-EP were higher in the three groups than in the same group at T 0, the levels of E, NE, and Glu were lower, the levels of ß-EP were higher in groups W and WM than in group A, and the levels of ß-EP were higher in group WM than in group W (P < 0.05). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W (P < 0.05). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference (P > 0.05). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference (P > 0.05). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference (P > 0.05). Comparing the PH, BE, PaO2, and PaCO2 of three groups of newborns after delivery, there were no significant differences (P > 0.05). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) (P < 0.05). Conclusion: The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.