Lidocaine HCl-Loaded Polyelectrolyte Complex -Poloxamer Thermoresponsive Hydrogel: In Vitro- In Vivo Anesthetic Evaluations for Tooth Socket Wound Delivery.

Local anesthesia is essential in dental practices, particularly for managing pain in tooth socket wounds, yet improving drug delivery systems remains a significant challenge. This study explored the physicochemical characteristics of lidocaine hydrochloride (LH) incorporated into a polyelectrolyte complex and poloxamer thermosensitivity hydrogel, assessing its local anesthetic efficacy in mouse models and its onset and duration of action as topical anesthetics in clinical trials. The thermoresponsive hydrogel exhibited a rapid phase transition within 1-3 minutes and demonstrated pseudo-plastic flow behavior. Its release kinetics followed Korsmeyer-Peppas, with 50% of biodegradation occurring over 48 h. In mouse models, certain thermogels showed superior anesthetic effects, with rapid onset and prolonged action, as evidenced by heat tolerance in tail-flick and hot plate models. In clinical trials, the LH-loaded thermoresponsive hydrogel provided rapid numbness onset, with anesthesia (Ton) beginning at an average of 46.5 ± 22.5 seconds and lasting effectively (Teff) for 202.5 ± 41.0 seconds, ranging from 120 to 240 seconds, indicating sustained release. These results highlight the promising properties of these formulations: rapid onset, prolonged duration, mucoadhesion, biodegradability, and high anesthesia effectiveness. This study demonstrates the potential for advancing local anesthesia across various medical fields, emphasizing the synergy between material science and clinical applications to improve patient care and safety.

The optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia in great saphenous varicose vein surgery, based on hemodynamics and anesthesia efficacy: a randomized, controlled, double-blind clinical trial.

Objective: This study aimed to explore the optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia on perioperative hemodynamics and anesthesia efficacy in patients undergoing great saphenous varicose vein surgery. Methods: A total of 90 patients were randomly divided into three groups: 0.25 µg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED1 group), 0.5 µg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED2 group), and 0.75 µg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED3 group). Hemodynamics, anesthesia efficiency, and adverse reactions were recorded. Main results: Compared with the ED1 group, the ED2 group had lower systolic blood pressure at T1-3 (T1, 95%CIs, 6.52-21.93, p < 0.001; T2, 95%CIs, 2.88-18.21, p = 0.004; T3, 95%CIs, 0.49-18.17, p = 0.035), and the diastolic blood pressure at T1-2 was decreased (T1, 95%CIs, 4.55-14.36, p < 0.001; T2, 95%CIs, 0.37-12.17, p = 0.033). Compared with the ED2 group, the ED3 group had higher systolic blood pressure at T1-2 (T1, 95%CIs, 5.90-21.46, p < 0.001; T2, 95%CIs, 2.07-17.55, p = 0.008) and higher diastolic blood pressure at T1-3 (T1, 95%CIs, 2.91-12.81, p = 0.001; T2, 95%CIs, 1.32-13.23, p = 0.011; T3, 95%CIs, 0.14-11.52, p = 0.043). Compared with the ED2 group, the heart rate was significantly decreased at T1-4 in the ED3 group (T1, 95%CIs, 2.25-15.72, p = 0.005; T2, 95%CIs, 2.35-13.82, p = 0.003; T3, 95%CIs, 0.50-9.79, p = 0.025; T4, 95%CIs, 1.46-10.36, p = 0.005). The myocardial oxygen consumption in all three groups was significantly decreased at each time point compared to T0 (p < 0.05 or < 0.001), and no significant between-group differences were detected (P>0.05). Compared with the ED1 group, the anesthesia efficiency of ED2 and ED3 groups was markedly enhanced, but the risk of bradycardia in ED2 and ED3 groups was dramatically increased (6 of 28 [21.4%] vs. 14 of 30 [46.7%] and 14 of 27 [51.9%], p = 0.023), one patient in the ED3 group experienced difficulty urinating, and remaining adverse reactions were mild in all three groups. Conclusion: A measure of 0.5 µg/kg dexmedetomidine is the optimal dose as a 0.59% ropivacaine adjuvant for epidural anesthesia in patients undergoing great saphenous varicose vein surgery. Clinical trial registration: http://www.chictr.org.cn/, registration number: ChiCTR2200060619.

Remimazolam has similar anesthetic effect and superior safety compared to propofol in elderly patients: A meta-analysis of randomized controlled trials.

BACKGROUND: The superiority between remimazolam and propofol for anesthesia is controversial in elderly patients (≥60 years). This meta-analysis aimed to systematically compare anesthetic effect and safety profile between remimazolam and propofol in elderly patients under any surgery. METHODS: Cochrane Library, Web of Science, and PubMed were searched until December 25, 2023 for relevant randomized controlled trials. RESULTS: Ten studies with 806 patients receiving remimazolam (experimental group) and 813 patients receiving propofol (control group) were included. Time to loss of consciousness [standard mean difference (SMD) (95% confidence interval (CI): 1.347 (-0.362, 3.055), p = 0.122] and recovery time [SMD (95% CI): -0.022 (-0.300, 0.257), p = 0.879] were similar between experimental and control groups. Mean arterial pressure at baseline minus 1 min after induction [SMD (95% CI): -1.800 (-3.250, -0.349), p = 0.015], heart rate at baseline minus 1 min after induction [SMD (95% CI): -1.041 (-1.537, -0.545), p < 0.001], incidences of hypoxemia [relative risk (RR) (95% CI): 0.247 (0.138, 0.444), p < 0.001], respiratory depression [RR (95% CI): 0.458 (0.300, 0.700), p < 0.001], bradycardia [RR (95% CI): 0.409 (0.176, 0.954), p = 0.043], hypotension [RR (95% CI): 0.415 (0.241, 0.714), p = 0.007], and injection pain [RR (95% CI): 0.172 (0.113, 0.263), p < 0.001] were lower in the experimental group compared to the control group. Postoperative nausea and vomiting was not different between groups [RR (95% CI): 1.194 (0.829, 1.718), p = 0.341]. Moreover, this meta-analysis displayed a low risk of bias, minimal publication bias, and good robustness. CONCLUSION: Remimazolam shows comparative anesthetic effect and better safety profile than propofol in elderly patients under any surgery.

Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer.

BACKGROUND: Radical laparoscopic gastrectomy is an important treatment modality for gastric cancer. Surgery requires general anesthesia, and patients are susceptible to the effects of anesthetic drugs and carbon dioxide insufflation during the procedure, leading to inflammation or severe pain, which can affect patient outcome. AIM: To explore the efficacy of combining dexmedetomidine (DEX) with nalbuphine in patients underwent laparoscopic radical gastrectomy for gastric cancer. METHODS: Patients scheduled to undergo laparoscopic radical gastrectomy were selected and randomly assigned to A or B group. In A group, patients received an intravenous injection of nalbuphine 0.2 mg/kg + DEX 0.4 µg/kg 10 min before the end of surgery; in B group, patients received only an intravenous injection of nalbuphine. The trends in hemodynamic parameter fluctuations, awakening quality during the recovery period, serum inflammatory markers, agitation scores, cough severity, incidence, and duration of postoperative delirium (POD) were compared. RESULTS: The mean arterial pressure and heart rate in the A group were more stable (P < 0.05). The A group had a lower average awakening time, extubation time, and agitation scores during recovery than the B group. Agitation control in the A group was more effective at different time points (P < 0.05). Patients in the A group had lower serum interleukin (IL)-6, tumour necrosis factor alpha, and IL-10 levels at 1 h after surgery than the B group. The incidence of coughing and duration of POD were lower and shorter in the A group than in the B group. Adverse reactions caused by the two anesthesia methods were less frequent in the A group than in the B group (P < 0.05). CONCLUSION: The use of DEX and nalbuphine in patients undergoing laparoscopic radical gastrectomy for gastric cancer help reducing the inflammatory response, cough severity, and agitation and helps maintain hemodynamic stability.

The use of ultrasound for noninvasive monitoring of anesthetic effects in renal ischemia-reperfusion injury.

OBJECTIVE: Compared with the use of ultrasound for noninvasive monitoring of the anesthetic sodium pentobarbital versus tribromoethanol in an animal model of renal ischemia-reperfusion injury in rats. METHODS: Adult rats were randomly assigned to a renal ischemia-reperfusion injury model, and preoperative anesthetics were administered as either sodium pentobarbital or tribromoethanol. Color Doppler ultrasound and spectral Doppler ultrasound were used to detect changes in respiratory rate and heart rate during and after the surgery, as well as measure renal hemodynamic parameters including peak systolic velocity, end-diastolic velocity, and resistance index. RESULTS: The frequency of changes in respiration and heart rate was significantly higher in the sodium pentobarbital anesthesia group compared to the tribromoethanol anesthesia group. The peak systolic velocity and end-diastolic velocity values in the sodium pentobarbital anesthesia group were significantly lower than those in the tribromoethanol group. However, the resistance index in the sodium pentobarbital group was higher than that in the tribromoethanol group. CONCLUSION: Ultrasound can be used to dynamically monitor the effects of anesthesia during the experiment, including changes in respiratory rate and heart rate, as well as semi-quantitatively monitor hemodynamic changes in the kidneys, which indirectly reflects whole-body hemodynamic changes in rats.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection.

BACKGROUND: Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer. However, there is a debate concerning their differential effects on cognitive function, anxiety, and depression in patients undergoing this procedure. AIM: To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function, anxiety, depression, and organ function in patients undergoing radical resection of gastric cancer. METHODS: A total of 80 patients were involved in this research. The subjects were divided into two groups: Propofol group and sevoflurane group. The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment (LOTCA), and anxiety and depression were assessed with the aid of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Hemodynamic indicators, oxidative stress levels, and pulmonary function were also measured. RESULTS: The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group. Additionally, the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group. The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group. Moreover, the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group. CONCLUSION: Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer. Propofol anesthesia has a minimal effect on patients' pulmonary function, consequently enhancing their postoperative recovery. Sevoflurane anesthesia causes less impairment on patients' cognitive function and mitigates negative emotions, leading to an improved postoperative mental state. Therefore, the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Effect of remimazolam on anesthetic efficacy of painless bronchoscopy in elderly patients / 中国现代医生

Objective To investigate the effect of remimazolam on anesthetic effect and postoperative cognitive function during painless bronchoscopy in elderly patients.Methods A total of 90 patients with painless bronchoscopy admitted to Wenzhou People's Hospital were selected.And randomly dividing into 45 patients in control group,45 patients in observation group.The control group was given propofol,and the observation group was given remimazolam.Mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO2)were monitored.Effective time after induction,recovery time after withdrawal and discharge time were compared.Patient's cognitive function was assessed using the mini-mental state examination(MMSE),auditory word learning test(AVLT),shape connection test(STT),and animal language fluency test(AFT).Enzyme linked immunosorbent assay(ELISA)was used to determine substance P(SP),C-reactive protein(CRP),noradrenaline(NE),tumor necrosis factor-α(TNF-α)in serum,interleukin(IL)-6 and prostaglandin E2(PGE2)concentrations.Results Compared with the control group,the MAP of the observation group patients at time points T2 and T3 showed statistically significant differences(P<0.05);HR was especially significant at T2,T3 and T6 periods(P<0.05).SpO2 at T2 and T3(P<0.05).The awakening time,discharge time of the observation were shorter than control(P<0.05).At 1 day after surgery,the MMSE score,STT score,AFT score were significantly higher(P<0.05);The serum levels of SP,PGE2 and NE and IL-6,TNF-α and CRP were decreased in the control(P<0.05).The incidence of adverse reactions was 17.78％in control group and 8.89％in observation group(χ2=7.654,P=0.031).Conclusion Remazolam is used in painless bronchoscopy in elderly patients,intraoperative hemodynamics is stable,having little impact on postoperative cognitive function,and inhibits the release of inflammatory factors and the secretion of pain mediators,which is worthy of clinical use.

Effect of acute normovolemic hemodilution on anesthetic effect, plasma concentration, and recovery quality in elderly patients undergoing spinal surgery.

OBJECTIVE: To explore the effect of acute normovolemic hemodilution (ANH) on the anesthetic effect, plasma concentration, and postoperative recovery quality in elderly patients undergoing spinal surgery. METHODS: A total of 60 cases of elderly patients aged 65 to 75 years who underwent elective multilevel spinal surgery were assigned randomly into the ANH group (n = 30) and control group (n = 30). Hemodynamic and blood gas analysis indexes were observed and recorded before ANH (T1), after ANH (T2), immediately after postoperative autologous blood transfusion (T3), 10 min (T4), 20 min (T5), 30 min (T6), 40 min (T7), and 50 min (T8) after the transfusion, and at the end of the transfusion (i.e., 60 min; T9). At T3 ~ 9, bispectral index (BIS) and train-of-four (TOF) stimulation were recorded and the plasma propofol/cisatracurium concentration was determined. The extubation time and recovery quality were recorded. RESULTS: The ANH group presented a lower MAP value and a higher SVV value at T2, and shorter extubation and orientation recovery time (P < 0.05) compared with the control group. BIS values at T8 and T9 were lower in the ANH group than those in the control group (P < 0.05). TOF values at T7 ~ 9 were lower in the ANH group than those in the control group (P < 0.05). There were no statistically significant differences in the postoperative plasma concentrations of propofol and cisatracurium between the groups (P > 0.05). CONCLUSION: During orthopedic surgery, the plasma concentration of elderly patients is increased after autologous blood transfusion of ANH, and the depth of anesthesia and muscle relaxant effect are strengthened, thus leading to delayed recovery of respiratory function and extubation.

Effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia.

OBJECTIVE: To determine the effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia. METHODS: The data of 98 children who received painless gastroscopy in the Children's Hospital of Nanjing Medical University from May 2022 and November 2022 were analyzed retrospectively. Patients anesthetized with propofol (1.5-2 mg/kg) combined with sufentanil (0.03-0.05 µg/kg) were assigned to a study group (n=52), and patients anesthetized with propofol (1.5-2 mg/kg) combined with fentanyl (0.3-0.5 µg/kg) were included in a control group (n=46). The changes in hemodynamic levels (mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) at T0 (before anesthesia), T1 (1 min after anesthesia induction), T2 (start of examination), T3 (2 min after the start of examination), and T4 (end of examination) in the two groups were analyzed and compared. The Ramsay sedation score was adopted to evaluate the sedation of the two groups at the anesthesia recovery and at 1 h and 2 h after the anesthesia recovery. The anesthetic effects (time to loss of consciousness, eye opening, and recovery of orientations) of the two groups were analyzed and compared. The excellent and good anesthesia outcomes, hospitalization time and dosage of propofol were compared between the two groups, and the adverse reactions in the two groups during and after the examination were analyzed. RESULTS: At T0, the two groups were not significantly different in the levels of MAP, HR and SpO2 (P>0.05), but at T1, T2, T3, and T4, the study group showed a significantly higher MAP level than the control group (P<0.05). At T1 and T3, the study group exhibited a significantly higher HR level than the control group (P<0.05), and at T2 and T4, the HR level of the two groups was not greatly different (P>0.05). The SpO2 levels at T0, T1, T2, T3, and T4 were not greatly different between the two groups (P>0.05). There was no significant difference in Ramsay score between the two groups at anesthesia recovery and at 1 h and 2 h after the anesthesia recovery (P>0.05). Additionally, the study group experienced significantly earlier time to loss of consciousness, eye opening, and recovery of orientations than the control group (P<0.05). The number of patients with excellent anesthetic outcome in the study group was notably higher than that in the control group (P<0.05). Compared with the control group, the study group consumed less propofol, experienced shorter hospitalization time, and showed a notably lower incidence of adverse reactions (P<0.05). CONCLUSION: For children undergoing painless gastroscopy under general anesthesia, sufentanil combined with propofol can deliver better anesthetic effect than propofol combined with fentanyl, with less effect on hemodynamics and fewer gastroscopy-related adverse reactions.

Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery.

BACKGROUND: A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact, general anesthesia can easily induce complications such as cognitive dysfunction, which is not conducive to postoperative recovery. AIM: To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery. METHODS: A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group (49 cases) and observation group (49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation. The postoperative recovery and adverse events of the two groups were statistically analyzed. RESULTS: Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h (P < 0.05); the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation (P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation (P < 0.05). The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1ß and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation (P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group (P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade II muscle strength, recovery time of grade III muscle strength and hospitalization time in the observation group were shorter than those in the control group (P < 0.05). CONCLUSION: Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body's inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.

Anesthesia Analysis of Compound Lidocaine Cream Alone in Adult Male Device-Assisted Circumcision.

OBJECTIVE: to evaluate the anesthetic effect among adult male patients with the single use of compound lidocaine cream in device-assisted circumcision, hoping to provide an anesthetic method for the simplification of the surgical process. METHODS: Male adult patients undergoing device-assisted circumcision through prepuce local anesthesia using lidocaine cream in Xiangya Hospital of Central South University from December 2020 to August 2021 were selected. According to different age groups and different surgical procedures, the anesthetic effect of compound lidocaine cream was analyzed considering the aspects of anesthetic cost, anesthetic time, anesthetic duration, anesthetic effect, anesthetic side effects and anesthetic satisfaction. RESULTS: In the study, 99.1% of 649 patients needed only 1 application of compound lidocaine cream to complete the operation. The time taken for anesthesia was short; the whole anesthesia process only required approximately 2-5 min. However, for patients with severe phimosis, the time to complete the anesthesia procedure was correspondingly longer. The pain degree caused by anesthesia was low, and the patients with a pain score of ≤3 points accounted for 96.7%. The anesthetic effect lasted for a sufficiently long period, and the time of algesia recovery from local anesthesia was almost 1 h after surgery. The anesthesia effect was sufficient, and patients with an intraoperative pain score of ≤3 accounted for 98.7%, which could meet the surgical requirements. There were few side effects of the anesthesia. The overwhelming majority of patients were pleased with the anesthesia, and 98.9% of patients had an anesthesia satisfaction score of ≥7. CONCLUSION: The compound lidocaine cream, as a local anesthetic, is safe and effective for most adult male device-assisted circumcisions. More useful information needs to be corroborated by more advanced evidence, especially for severe phimosis.

Effect of Vanillin on the Anaesthesia of Crucian Carp: Effects on Physiological and Biochemical Indices, Pathology, and Volatile Aroma Components.

The anaesthetic effect of vanillin on crucian carp was investigated using different concentrations of vanillin, with a nonvanillin control. The effective concentration range of vanillin anaesthesia was determined from the behavioural characteristics of crucian carp during the anaesthesia onset and recovery phases. Physiological and biochemical indices, and the electronic nose response to the fish muscle, were measured over the range of effectiveanaestheticc concentrations. An increased concentration of vanillin shortened the time taken to achieve deep anaesthesia but increased the recovery time. The levels of white blood cells, red blood cells, haemoglobinn, platelets, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, phosphorus, potassium, magnesium, total protein, and serum albumin were lower than the control in the vanillin treatment group. Triglycerides and total cholesterol were not significantly affected. Histology showed no effect of vanillin on the liver, except at 1.00 g/L vanillin. Vanillin resulted in a nondose-responsive effect on the gill tissue, increasing the width and spacing of the gill lamellae. E-Nose analysis of the carp-muscle flavour volatiles was able to distinguish between different vanillin treatment concentrations. GC-IMS identified 40 flavour compounds, including 8 aldehydes, 11 alcohols, 10 ketones, 2 esters, and 1 furan. Vanillin had aanaestheticic effect on crucian carp and these findings provide a theoretical basis for improving the transport and experimental manipulation of crucian carp.

Effects of posterior lumbar plexus block on anesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric comminuted fractures.

To study the effect of posterior lumbar plexus nerve block on anaesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures. The research subjects selected 48 patients with postmenopausal osteoporotic subtrochanteric comminuted fractures who were hospitalized between January 2020 and January 2022, and were allocated to clusters according to the random number TBL approach. The controlling cluster (24 situations) underwent dura mater Under external anesthesia, the test cluster (24 situations) underwent posterior lumbar plexus block, and the block effect, anesthesia effect, sedation effect, hemodynamics, vital signs and reactions of adverse nature were contrasted involving the two clusters. In comparison to the control group, the test group had a longer duration of anesthesia and motor block, higher oxygenation indices but lower ITBVI, GEDVI, and ScrO2 values, lower MAP levels, and lower BIS contraction values at 5, 15, and 30 minutes following anesthesia (P < 0.05). The test group had shorter induction time and block onset time compared to the control group (P < 0.05), and a lower incidence of adverse reactions (16.67% vs. 29.17% in the control group), but the variation was not noTBL (P < 0.05). Posterior lumbar plexus nerve block in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures has a better sedative effect, shortens the induction time of anaesthesia and the onset of block, promotes sTBL haemodynamic indexes and has fewer adverse effects to ensure safety.

Effect of different doses of midazolam combined with fentanyl during painless bronchoscopy in adults.

OBJECTIVE: To investigate the clinical effect of different doses of midazolam combined with fentanyl during painless bronchoscopy in adult patients. METHODS: In this retrospective study, a total of 200 patients who underwent painless bronchoscopy in The First People's Hospital of Wenling from January 2018 to January 2021 were selected as research subjects. These patients were assigned into an experimental group and a control group with 100 patients in each group. Patients from the experimental group were sedated with an intravenous infusion of 0.05 mg/kg midazolam and 0.2 µg/kg fentanyl, while patients from the control group were sedated using 0.1 mg/kg midazolam and 0.2 µg/kg fentanyl. The changes in heart rate (HR), saturation of pulse oximetry (SpO2), systolic blood pressure (SBP), and diastolic blood pressure (DBP) before and at 10 minutes after administration were compared between the two groups. Ramsay sedation scale, RSS agitation scale, awaking time, incidence of adverse reactions, and anesthetic effects were also compared. RESULTS: After medication, there was no significant difference in terms of HR, SBP, or DBP values between the two groups. The SpO2 value in the experimental group was higher than that in the control group (96.93±1.10% vs. 94.78±0.83%, P<0.05). Ramsay sedation scale of patients from the experimental group after medication was (3.88±0.66), which was significantly higher than that of the control group (2.32±0.63), while RSS agitation score in the experimental group was (1.08±0.16), lower than that of the control group (2.32±0.63). The awaking time in the experimental group was shorter than that in control group (43.60±3.30 min vs. 50.19±4.45 min, P<0.05). Moreover, the incidence of mild cough or no cough in the experimental group was significantly better than in the control group (P<0.05). The overall incidence of adverse reactions in the experimental group was lower than that of the control group (5.00% vs. 13.00%, P<0.05). In addition, the anesthetic effect in the experimental group was better than that of the control group (90% vs. 80%, P<0.05). CONCLUSION: The use of 0.05 mg/kg midazolam combined with 0.2 µg/kg fentanyl in adult painless bronchoscopy has little effect on SpO2 levels, possesses a good sedative and anesthetic effect, and reduces the awaking time, restlessness response, and adverse reactions.

Propofol combined with alfentanil for general anesthesia in vocal cord polypectomy under suspension laryngoscopy.

OBJECTIVE: To investigate the clinical effect of propofol combined with alfentanil in vocal cord polypectomy under suspension laryngoscopy. METHODS: A total of 308 patients undergoing vocal cord polypectomy under suspension laryngoscopy in the First Affiliated Hospital of Nanchang University were included in this prospective study, and the patients were randomly divided into an observation group and a control group. Patients in the observation group received alfentanil combined with propofol, while those in the control group were anesthetized with sufentanil combined with propofol. The heart rate (HR), mean arterial pressure (MAP), real portfolio project (RPP), and Steward postanesthetic recovery scores were compared between the two groups before anesthesia induction (T0), at intubation (T1), 5 min after intubation (T2), at the time of placing suspension laryngoscopy (T3), 1 min after placing the suspension laryngoscopy (T4), 1 min after extraction of support laryngoscope (T5), and 1 min after extubation (T6). In addition, the propofol dosage and peripheral plasma levels of epinephrine (E) and norepinephrine (NE) were also compared between the groups. RESULTS: The MAP, HR, and RPP of the patients in the observation group were higher than those in the control group at T1-T5 (all P<0.05), while there was no statistical difference at T0 and T6 (all P>0.05). The Steward postanesthetic recovery scores and the propofol dosage in the observation group were lower than those in the control group. In addition, there was a statistically significant difference in the E and NE levels between the two groups after surgery (P<0.001). There was also an interaction effect between the groups and among the time points (both P<0.001). CONCLUSION: Alfentanil can reduce the fluctuation of hemodynamics during vocal cord polypectomy under suspension laryngoscopy, and therefore improve anesthesia effect. Simultaneously, the usage of propofol was reduced, as well as the stress levels. CLINICAL TRIAL NUMBER: ChiCTR2100054186.

Anthelmintic Efficacy of Palmarosa Oil and Curcuma Oil against the Fish Ectoparasite Gyrodactylus kobayashii (monogenean).

Monogeneans are a serious threat to the development of aquaculture due to the severe economic losses they cause. The prevention and treatment of this disease are increasingly difficult because of the environmental and health concerns caused by the use of chemical anthelmintics and the emergence of drug resistance. It is thus necessary to search for effective alternatives for the treatment of monogenean infections. In the current study, anthelmintic efficacy of 16 selected essential oils (EOs) was investigated using the goldfish (Carassius auratus)-Gyrodactylus kobayashii model. The screening experiment indicated that palmarosa oil and curcuma oil had satisfactory anthelmintic activity against G. kobayashii with EC100 values of 10 and 12 mg/L after 24-h exposure, respectively. The in vivo and in vitro assays indicated anthelmintic efficacy of palmarosa oil against G. kobayashii was in a time and dose-dependent manner. Interestingly, curcuma oil showed an anesthetic effect on G. kobayashii, and its anthelmintic activity was dose-dependent rather than time-dependent in the concentration range tested in this study. Additionally, the 24-h LC50 (50% lethal concentration) against goldfish of these two EOs was 8.19-fold and 5.54-fold higher than their corresponding EC50 (50% effective concentration) against G. kobayashii, respectively. Moreover, exposure to these two EOs at 100% effective concentration against G. kobayashii had no serious physiological and histopathological influence on goldfish. These results demonstrated a high safety for goldfish of these two EOs. Overall, palmarosa oil and curcuma oil could be potential candidates for the treatment of G. kobayashii infections in aquaculture.

Assessment of the anesthetic effect of modified pentothal sodium solution on Sprague-Dawley rats.

Clinically, pentothal sodium has been widely used for primary and general anesthesia induction. Also, it has been used to effectively inhibit convulsion. Pentothal sodium has a strong inhibitory effect on the respiratory center, excessive drug administration, and rapid dose rate that cause death of experimental animals on the respiratory depression. This study used a modified pentothal sodium solution to investigate its anesthetic effect. The pentothal sodium solution was modified based on pentothal sodium upon additions of magnesium sulfate, propylene glycol, and pure ethanol. The anesthetic effect of the modified pentothal sodium on Sprague-Dawley (SD) rats was investigated by comparing traditional pentothal sodium and ketamine; 60 SD rats were randomly divided into three groups. Each group was treated with traditional pentothal sodium, modified pentothal sodium, or ketamine, respectively, via intraperitoneal injection. The symptoms of experimental rats were observed, and onset time and anesthetic time were both recorded. The data were analyzed using statistical software. There were no significant differences in onset time and anesthetic time between the three groups. The variation of onset time and anesthetic time of the group treated with modified pentothal sodium was shorter than that of the other two groups. Furthermore, the number of anesthetic rats after the first injection was significantly higher than that of the other two groups. The modified pentothal sodium is capable of providing a stable anesthetic effect. The function and effect are much better than traditional pentothal sodium and ketamine.

Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation.

Objective: The objective of this article is to make a comparison of the anesthetic effects of the inside and outside fascia iliaca compartment block (FICB) in total hip arthroplasty (THA) and to study the effect of the different approaches of the FICB on postoperative cognitive dysfunction (POCD) and serum inflammatory cytokines in THA patients. Methods: A total of 60 patients who received THA treatment from January 2021 to December 2021 were divided into two groups, namely, Inside group (inside approach of the FICB) and Outside group (outside approach of the FICB), according to the different approaches of the FICB. Forty-eight hours after surgery, we compared the use of ropacaine dosage, visual analogue scale (VAS) score, the use of patient-controlled analgesia (PCA), mini-mental state examination (MMSE) score, the incidence of POCD, and the serum levels of IL-1, IL-6. Secondary indicators include surgical indicators and the quality of anesthesia cannula. Results: The ratio of re-fix the catheter, intubation time, and the use of ropacaine dosage at 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05), while the depth of cannulation in the Outside group was significantly lower than that in the Inside group (p < 0.05). VAS scores were comparable between the Inside and the Outside groups, except at 24 h after surgery. The use of PCA from 24 to 48 h after surgery in the Outside group was significantly higher than that in the Inside group (p < 0.05). The MMSE score and the incidence of POCD in the Outside group were higher than that in the Inside group. At the same time, the serum IL-1ß levels at 1 and 6 h after surgery and the serum IL-6 levels at 1, 6, 24, and 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05). Conclusion: Compared with the outside approach of the FICB, the inside approach of the FICB has better anesthetic effect, better postoperative analgesia, fewer postoperative analgesics, lower incidence of POCD, and lower serum cytokines during the treatment of THA patients.

Application effect of sevoflurane combined with remifentanil intravenous inhalation anesthesia in patients undergoing laparoscopic radical resection of cervical cancer.

OBJECTIVE: To determine the application effect of sevoflurane combined with remifentanil intravenous inhalation anesthesia in patients undergoing laparoscopic radical resection of cervical cancer (LRHCC). METHODS: The clinical data of 127 patients with cervical cancer (CC) who received LRHCC in Henan Provincial People's Hospital during January 2017 and June 2021 were retrospectively analyzed. Among them, 60 patients anesthetized by propofol combined with remifentanil were assigned to the control group (Con group), while the rest 67 anesthetized by sevoflurane combined with remifentanil to the research group (Res group). The following items of the two groups were compared: the changes of heart rate and blood pressure before anesthesia (T0), at 30 min after anesthesia (T1) and 10 min after surgery (T2), anesthetic effect, stress substance contents, anesthesia recovery, changes in brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), Mini-Mental State Examination (MMSE) scores, and adverse reactions. RESULTS: The heart rate and blood pressure at T1 and T2 were notably different between the two groups (P<0.05). In contrast to the Con group, the Res group showed a greatly better recovery effect of anesthesia and presented notably lower levels of adrenaline and GLU (all P<0.05). 10 min after surgery, the Con group showed lower levels of BDNF and NGF than the Con group. After surgery, the MMSE scores in the Res group were higher than that of the Con group, and the two groups had no significant difference in the incidence of adverse reactions (P>0.05). CONCLUSION: In contrast to propofol combined with remifentanil anesthesia, intravenous inhalational anesthesia with sevoflurane combined with remifentanil can exert a stronger anesthetic effect in patients receiving LRHCC, with a high safety.

Application of Dexmedetomidine combined with Propofol Intravenous Anesthesia in Laparoscopic Day Surgery in Pediatric Urology.

OBJECTIVES: To evaluate the sedative and analgesic effects of dexmedetomidine combined with propofol intravenous anesthesia in laparoscopic day surgery in pediatric urology. METHODS: Eighty male children with cryptorchidism and hydrocele who underwent laparoscopic daytime surgery in our hospital from January 2019 to January 2021 were selected and randomly divided into two groups: the experimental group and the control group. Children in the experimental group ranged in age from 5.7 to 11.3, with an average of 8.52±2.17 years old, while those in the control group ranged in age from 5.3 to 12.0, with an average of 8.60±2.07 years old. There were 12 cases of cryptorchidism and 28 cases of hydrocele in the experimental group, and 14 cases of cryptorchidism and 26 cases of hydrocele in the control group. Children in the control group received conventional propofol intravenous combined anesthesia, while those in the experimental group were given dexmedetomidine (2-5 ug/kg) intranasally on the basis of conventional propofol intravenous anesthesia. The anesthetic effect, analgesic effect, serum levels of inflammatory cytokines before and after surgery and adverse drug reactions in the two groups were compared and analyzed. RESULTS: The awakening time, extubation time and retention time in the resuscitation room of the experimental group were shorter than those of the control group, with a statistically significant difference (P<0.05); The VAS pain scores of the experimental group were significantly lower than those of the control group at 15minutes, 12hour and 24hour after awakening, with a statistically significant difference (P<0.05). In addition, the levels of TNF-a, CRP, IL-6 and other inflammatory factors in the control group were significantly higher compared with those in the experimental group 24h after surgery, with a statistical significance (TNF-a, P=0.02; CRP, P=0.00; IL-6, P=0.03); The incidence of adverse drug reactions in the experimental group was 17.5%, while that in the control group was 12.5%, which was not statistically significant (P=0.53). CONCLUSION: Dexmedetomidine combined with intravenous propofol anesthesia may be helpful to shorten the extubation time, the recovery time and the stay time in the anesthesia resuscative room, improve the analgesic effect, and may reduce the inflammatory response and the expression of serum inflammatory cytokines, with no significant increase in side effects.