Knowledge, attitude and practice toward to artificial intelligent patient-controlled analgesia among anesthesiologists: a cross-sectional study in east China's Jiangsu Province.

BACKGROUND: Inadequate postoperative analgesia greatly affects the recovery of patients, can poses a substantial health and economic burden. Patient-controlled analgesia is the most commonly used method for postoperative pain relief. However, the situation of inadequate analgesia still exists. Artificial intelligent Patient-controlled analgesia (Ai-PCA) system can make it easier for medical staff to understand the pain level of patients in order to deal with it in time. So far, several studies have investigated anesthesiologists' knowledge and management of Ai-PCA. OBJECTIVE: This study aimed to assess the degree of anesthesiologists' knowledge, attitude and their practice (KAP) towards Ai-PCA in east China's Jiangsu Province. METHODS: This cross-sectional study was conducted among 396 anesthesiologists working in tertiary hospitals. The data were collected using a pretested, structured and self-administered KAP questionnaire. The data were analyzed using Independent t-test, analysis of variance, Pearson's correlation and multiple linear regression tests. RESULTS: Five hundred twelve questionnaires were collected, 396 anesthesiologists (190 Male, and 206 Female) were included in our study for statistical analysis. The score of knowledge, attitude, practice was 5.49 ((SD = 1.65; range:0-8), 37.45 (SD = 4.46; range:9-45), and 26.41 (SD = 9.61; range:9-45), respectively. Among the participants, 309 (78%) and 264 (66.7%) had good knowledge and positive attitudes toward Ai-PCA, respectively. However, only 81 (20.5%) of the participants exhibited good practice regarding Ai-PCA. Participation in Ai-PCA training showed a significant correlation with knowledge, attitude and practice scores. Besides, age, years of experience and professional titles of anesthesiologists were correlated with knowledge scores. The title of the anesthesiologist was associated with attitude scores. And the marital status of anesthesiologists was correlated with practice scores. CONCLUSION: Our findings revealed the score of practice regarding Ai-PCA are very poor among anesthesiologists in east China's Jiangsu Province. The utilization of Ai-PCA was found to be impacted by whether the individual had received training. This calls for a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of anesthesiologist on using Ai-PCA and more Ai-PCA training to be included in the daily learning. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( www.chictr.org.cn ; 27/10/2023; ChiCTR2300077070).

Placement of bronchial occluder outside the tracheal tube in a patient combined with airway compression undergoing mediastinal tumors resection: a case report.

BACKGROUND: Mediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway obstruction, which in severe cases can lead to cardiac arrest. We reported a case of anesthetic management using a bronchial blocker placed outside the tracheal tube. In this case report, the patient's trachea was so severely compressed that the airway was extremely narrow, only 4 mm at its narrowest point. By reporting the anesthetic management of this patient, we intend to provide an unusual approach for airway management. CASE PRESENTATION: A 52-year-old male patient was admitted to the hospital due to cough and expectoration for one year. Additionally, the patient experienced chest tightness and asthma after physical activity. The enhanced computed tomography revealed there existed an irregular soft tissue mass in the right upper mediastinum, which significantly compressed the trachea and esophagus. The results of the mediastinal puncture pathology showed the presence of mesenchymal tumors. According to the results above, the patient was diagnosed with a mediastinal tumor and scheduled to undergo tumor resection under general anesthesia. We used a bronchial occluder outside the tracheal tube for general anesthesia. After surgery, the patient received thorough treatment and was subsequently discharged from the hospital. CONCLUSION: In patients with severe airway compression from a mediastinal tumor airway compression, positioning a bronchial occluder externally to the tracheal tube is an effective method of airway management. However, we still need more clinical practice to help the process become more standardized.

Down-regulating lncRNA KCNQ1OT1 relieves type II alveolar epithelial cell apoptosis during one-lung ventilation via modulating miR-129-5p/HMGB1 axis induced pulmonary endothelial glycocalyx.

OBJECTIVE: Endothelial glycocalyx (EG) maintains vascular homeostasis and is destroyed after one-lung ventilation (OLV)-induced lung injury. Long noncoding RNAs (lncRNAs) are critically involved in various lung injuries. This study aimed to investigate the role and regulatory mechanism of KCNQ1 overlapping transcript 1 (KCNQ1OT1) in OLV-induced lung injury and LPS-induced type II alveolar epithelial cell (AECII) apoptosis. METHODS: The rat OLV model was established, and the effects of KCNQ1OT1 on OLV-induced ALI in vivo were explored. Bax and Caspase-3 expression in rat lung tissues was measured by immunochemistry (IHC). AECIIs were isolated from rat lungs and treated with LPS or normal saline (control) for in vitro analysis. The expression of KCNQ1OT1, miR-129-5p, and HMGB1 was measured by quantitative real-time PCR (qRT-PCR) or Western blot (WB). Cell proliferation and apoptosis were examined by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di- phenytetrazoliumromide (MTT) and flow cytometry. The downstream targets of KCNQ1OT1 were predicted by bioinformatics, and the binding relationship between KCNQ1OT1 and miR-129-3p was verified by dual-luciferase reporter assays. The potential target of miR-129-5p was further explored on the Targetscan website and revealed to target HMGB1. Enzyme-linked immunosorbent assay (ELISA) or WB was adopted to determine the levels of IL-1ß, TNF-α, MDA, SOD, heparanase (HPA), matrix metalloproteinase 9 (MMP9), heparan sulfate (HS) and syndecan-1 (SDC-1). RESULTS: KCNQ1OT1 and HMGB1 were up-regulated during OLV-induced lung injury, and their expression was positively correlated. KCNQ1OT1 knockdown reduced OLV-induced pulmonary edema and lung epithelial cell apoptosis, increased vascular permeability, reduced IL-1ß, TNF-α, MDA, and SOD levels and glycocalyx markers by targeting miR-129-5p or upregulating HMGB1. Overexpressing KCNQ1OT1 promoted cell apoptosis, reduced cell proliferation, aggravated inflammation and oxidative stress, and up-regulated HMGB1, HPA and MMP9 in LPS-treated AECIIs, while the HMGB1 silencing showed the opposite effects. MiR-129-5p mimics partially eliminated the KCNQ1OT1-induced effects, while recombinant HMGB1 restored the effects of miR-129-5p overexpression on AECIIs. Additionally, KCNQ1OT1 was demonstrated to promote the activation of the p38 MAPK/Akt/ERK signaling pathways in AECIIs via HMGB1. CONCLUSION: KCNQ1OT1 knockdown alleviated AECII apoptosis and EG damage during OLV by targeting miR-129-5p/HMGB1 to inactivate the p38 MAPK/Akt/ERK signaling. The findings of our study might deepen our understanding of the molecular basis in OLV-induced lung injury and provide clues for the targeted disease management.

Conservative management of a rare case of post thyroidectomy tracheal injury with coagulation abnormalities.

Background: Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy. Case presentation: A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction. Conclusion: Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.

Anesthetic management of thyroid carcinoma invading the upper tracheal segment: A case report.

INTRODUCTION AND IMPORTANCE: Intratracheal tumors account for approximately 0.2 % of respiratory tumors, including primary and secondary tumors. Secondary tumors of the upper trachea are most commonly derived from advanced thyroid cancer. Surgical resection is currently the general curative modality for thyroid cancer with tracheal invasion. Patients with tracheal tumors invading and protruding into the lumen may have reduced oxygen reserve capacity, leading to a shorter safe window for general anesthesia induction. Establishing an appropriate artificial airway is essential to ensure intraoperative safety for these patients. Here, we report a case of tracheal tumor caused by differentiated papillary thyroid carcinoma invading the upper segment of the trachea and the non-conventional approach used for intraoperative airway management without traditional endotracheal intubation. PRESENTATION OF CASE: A 59-year-old female presented with bilateral neck masses and hemoptysis. The CT scan revealed suspicious malignant thyroid nodules, and tracheoscopy showed an approximately 50 % obstruction of the tracheal lumen. The patient's physical examination and biochemical examination showed no significant abnormalities. Based on imaging studies and pre-anesthetic assessment, a multidisciplinary team decided against performing endotracheal intubation in the patient due to the risk of tumor bleeding during the procedure. Instead, they opted for a modified endotracheal tube and the insertion of a laryngeal mask airway (LMA). The anesthesia induction and maintenance proceeded smoothly, with stable intraoperative hemodynamics. The tumor was successfully resected and tracheal anastomosis was performed without any complications. CLINICAL DISCUSSION: The strategy adroitly evades the risk of bleeding and dislodgement due to tumor contact during the intubation process. In this case report, the anesthetic highlight is the employment of a reverse insertion technique for endotracheal intubation, facilitated by a sterile suction catheter and complemented by an innovative modification to the tracheal tube. CONCLUSION: For patients with thyroid cancer invading the upper segment of the trachea, and in whom rapid induction anesthesia is anticipated not to cause tumor collapse, the use of laryngeal mask airway combined with modified tracheal tube mechanical ventilation is both safe and feasible.

A case of arytenoid dislocation after ProSeal laryngeal mask airway insertion: A case report.

INTRODUCTION AND IMPORTANCE: Arytenoid dislocation, typically manifested as hoarseness and coughing when drinking, is a rare perioperative scenario, with an incidence rate of 0.009 %-0.097 % and endotracheal intubation under general anesthesia being the most common cause. However, arytenoid dislocation caused by a laryngeal mask airway (LMA) is extremely rare. CASE DESCRIPTION: Herein, a 53-year-old female patient was admitted for a "right breast lump" and scheduled for "unilateral mastectomy with ipsilateral axillary sentinel lymph node biopsy" under general anesthesia. During the surgery, the patient was noted to snore mildly, and rocuronium (15 mg) was immediately administered intravenously. The snoring ceased after adjusting the position of the LMA. Postoperatively, the patient was diagnosed with arytenoid dislocation by flexible nasal endoscopy after presenting with a sore throat accompanied by hoarseness and coughing when drinking. Thereafter, the patient underwent two cricoarytenoid joint reductions with a video laryngoscope under intravenous anesthesia, along with anti-inflammatory medication and voice therapy. The voice of the patient returned to normal after 1 month. CLINICAL DISCUSSION: Despite being a supraglottic airway device, the LMA can still cause arytenoid dislocation in clinical practice. Hence, anesthesiologists should analyze the potential causes and understand the diagnosis and treatment of arytenoid dislocation. Although closed reduction surgery typically requires two or three attempts, with a shorter disease duration leading to better outcomes, it can also aid in voice recovery for a longer disease course. In the presented case, the patient achieved a good prognosis after two closed reduction surgeries. CONCLUSION: Anesthesiologists should be vigilant for arytenoid dislocation in patients who present with persistent hoarseness and coughing while drinking after the insertion of the LMA, necessitating prompt treatment after diagnoses to achieve the best results.

Knowledge, Attitudes and Practices Among Anesthesia and Thoracic Surgery Medical Staff Toward Ai-PCA.

Purpose: Artificial intelligence (AI) is increasingly influencing various medical fields, including anesthesiology. The Introduction of artificial intelligent patient-controlled analgesia (Ai-PCA) has been seen as a significant advancement in pain management. However, the adoption and practical application of Ai-PCA by medical staff, particularly in anesthesia and thoracic surgery, have not been extensively studied. This study aimed to investigate the knowledge, attitudes and practices (KAP) among anesthesia and thoracic surgery medical staff toward artificial intelligent patient-controlled analgesia (Ai-PCA). Participants and Methods: This web-based cross-sectional study was conducted between November 1, 2023 and November 15, 2023 at Jiangsu Cancer Hospital. A self-designed questionnaire was developed to collect demographic information of anesthesia and thoracic surgery medical staff, and to assess their knowledge, attitudes and practices toward Ai-PCA. Results: A total of 519 valid questionnaires were collected. Among the participants, 278 (53.56%) were female, 497 (95.76%) were employed in the field of anesthesiology, and 188 (36.22%) had participated in Ai-PCA training. The mean knowledge, attitude, and practice scores were 7.8±1.75 (possible range: 0-10), 37.43±4.16 (possible range: 9-45), and 28.38±9.27 (possible range: 9-45), respectively. Conclusion: The findings revealed that anesthesia and thoracic surgery medical staff have sufficient knowledge, active attitudes, but poor practices toward the Ai-PCA. Comprehensive training programs are needed to improve anesthesia and thoracic surgery medical staff's practices in this area.

Effects of Press Needling combined with general anesthesia on postoperative analgesia in thoracoscopic pulmonary resection for lung cancer: A randomized, single-blind, controlled trial.

OBJECTIVES: To investigate the effects of press needle therapy on postoperative analgesia and other relevant complications in patients undergoing thoracoscopic pulmonary resection. DESIGN: randomized, single-blind, controlled trial SETTING: Teaching hospitals affiliated with universities. INTERVENTIONS: Eighty-six patients were randomized into: the Acu group (press-needle group) and the control group MAIN OUTCOME MEASURES: Pain levels 24, 48, and three months after surgery were measured using the numeric rating scale (NRS). Perioperative hemodynamics, total and effective pressing numbers of patient-controlled intravenous analgesia (PCIA), and incidence of postoperative pulmonary complications were recorded. Peripheral blood samples were collected to measure the levels of inflammatory mediators RESULTS: Acu group had significantly lower NRS scores at 24 and 48 h after operation (NRS scores on movement at 24 h after surgery: Acu vs. Control, 3 (2,3) vs. 3 (3,5), Z = -3.393, P < 0.01 and NRS scores on movement at 48 h after surgery: 2 (1,3) vs. 3 (2,5), Z = -3.641, P < 0.01), lower number of PCIA attempts and effective rates (mean total pressing numbers: 4(2,8) vs. 6(3,19), Z = -1.994, P = 0.046 and mean effective pressing numbers: 3(2,8) vs. 6(3,16), Z = -2.116, P = 0.034). The Acu group had significantly reduced IL-1 (14.52 ± 3.84 vs. 16.36 ± 3.30, mean difference (MD): - 1.85, 95% confidence interval (CI): - 3.46, - 0.23, P = 0.026), HIF-1α (10.15 ± 1.71 vs. 10.96 ± 1.73, MD: -0.81, 95% CI: -1.59, -0.04, P = 0.040) and the incidence of pulmonary complications after surgery. CONCLUSION: Press needles are a non-invasive and feasible adjunctive intervention for postoperative analgesic management in patients undergoing thoracoscopic pulmonary resection.