Effect of ciprofol on induction and maintenance of general anesthesia in patients undergoing kidney transplantation.

OBJECTIVE: This study aims at evaluating the effects of ciprofol on the induction and maintenance of general anesthesia in patients undergoing kidney transplantation. PATIENTS AND METHODS: This prospective, randomized, single-blind study enrolled 120 patients aged 18-65 years who underwent general anesthesia for kidney transplantation. The patients were randomized into a ciprofol group (group C) and a propofol group (group P). Anesthesia induction: group C had injected IV with ciprofol 0.4 mg/kg, group P had injected IV with propofol 2.0 mg/kg, while both groups had injected IV with sufentanil 0.4-0.5 µg/kg and cisatracurium 0.2 mg/kg. Anesthesia maintenance: ciprofol was injected IV with 0.8-2.4 mg•kg-1•h-1 in group C, propofol was injected IV with 4-12 mg•kg-1•h-1 in group P, while remifentanil was injected IV with 8-15 µg•kg-1•h-1 and cisatracurium was injected IV with 0.1-0.2mg•kg-1•h-1, with the bispectral index (BIS) maintained at 40-60 during the operation. RESULTS: The success rate of sedation in both groups was 100%. Compared with the P group, in group C the time of disappearance of the eyelash reflex and a decline in the BIS to 60 was shorter (p<0.001); the time of awakening was prolonged (p<0.001); the number of sedative drugs administered was reduced (p<0.001); MAP fluctuated less five mins after transplantation (p<0.01); the incidence of injection pain during induction was reduced (p<0.001) and intraoperative hypotension was decreased(p<0.01). CONCLUSIONS: Ciprofol is safe and effective for anesthesia induction and maintenance in kidney transplantation and its sedative effect is better than that of propofol.

[The role of EBUS-TBNA in the systematic evaluation of lymph node staging and resectability analysis in non-small cell lung cancer].

Objective: To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lymph node staging and resectability assessment of patients with non-small cell lung cancer (NSCLC). Methods: The clinical data of 154 patients with NSCLC who underwent EBUS-TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. EBUS-TBNA and CT were used for preoperative staging and resectability evaluation. Results: The sensitivity, specificity and accuracy of EBUS-TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively. The differences were statistically significant (P<0.05). The sensitivity, specificity and accuracy of EBUS-TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P<0.05). The staging of 62 patients was changed, 27 cases were up-regulated and 35 cases were down-regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS-TBNA showed excellent consistency with that of pathological results (Kappa=0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion: EBUS-TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.

Avascular necrosis of bone in severe acute respiratory syndrome.

AIM: To report the incidence of avascular osteonecrosis (AVN) in severe acute respiratory syndrome (SARS) patients. MATERIALS AND METHODS: Sixty-seven SARS patients who had large joint pain between March 2003 and May 2003 underwent both plain radiographs and magnetic resonance imaging (MRI) examination on the same day. All patients received steroids and ribavirin treatment. All plain radiographs and MR images were analysed by two experienced musculoskeletal radiologists. Any abnormalities, location, extent, morphology, the number, size and signal intensity of lesions were evaluated. RESULTS: Twenty-eight patients were identified with AVN, The mean time to diagnosis of AVN was 119 days after the onset of SARS, or 116 days after steroid use. Three patients had early bilateral AVN of the femoral head, four patients of one femoral head, five patients of the bilateral hips and knees, four patients of the ipsilateral hip and knees, 10 patients of the knee(s), one patient of the right proximal fibula, and one patient of the knees and talus. Results of hip, knee and ankle plain radiographs were negative. CONCLUSION: AVN can occur in the patients with SARS. AVN had a strong association with steroid use. More studies are required to confirm whether the virus itself can also lead to AVN.