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Objective To explore the effects of sufentanil on cardiac function and apoptosis of myocardial cells in rats with acute myocardial infarction (AMI) based on fatty acid synthase (Fas)/fatty acid synthase ligand (FasL) signaling pathway. Methods Totally 108 healthy male SD rats were randomly divided into the control group, model group, lowdose sufentanil group, high-dose sufentanil group, high-dose sufentanil +Fas negative control group, high-dose sufentanil + Fas lentivirus group, with 18 rats in each group. In the model group, low-dose sufentanil group, high-dose sufentanil group, high-dose sufentanil + Fas negative control group, high-dose sufentanil + Fas lentivirus group, we established AMI models by ligation of left anterior descending branch of coronary artery; the steps of the control group were the same as those of AMI model except that the left anterior descending coronary artery was not lapped. Rats in the low-dose sufentanil group and high-dose sufentanil group were intraperitoneally injected with 0. 1 and 1 µg/kg sufentanil, respectively. After AMI models were successfully made, rats in the high-dose sufentanil + Fas negative control group and high-dose sufentanil + Fas lentivirus group were injected with 1 µg/kg sufentanil intraperitoneally,200 nmol/kg NC shRNA lentivirus or 200 nmol/kg Fas lentivirus intravenously, respectively; while rats in the control group and model group were intraperitoneally injected with the same amount of normal saline. The tail venous blood of rats was collected at 72 h after operation, and the serum troponin T was detected by ELISA. Left ventricular ejection fraction (LVEF), left ventricular shortening fraction (LVFS), left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) were measured by echocardiography. After the cardiac function of the rats was detected, blood was collected from the abdominal aorta and serum TNF-α and IL-6 were detected by ELISA. All the rats were decapitated and their hearts were taken, the heart tissues of six rats were randomly collected and TTC staining was performed to detect the myocardial infarction size; the cardiac tissues of six rats was randomly selected, HE staining was used to observe the pathological changes of myocardial tissues, and apoptosis was detected by TUNEL method; the expression levels of apoptosis-related proteins Bcl-2, Bax, Caspase-3 and Fas/FasL signaling pathways were detected in the heart tissues of the remaining six rats by Western blotting. Results Compared with the control group, the serum troponin T level increased, LVEDd and LVESd increased, LVEF and LVFS decreased, serum TNF-α and IL-6 levels increased, myocardial infarction area increased, apoptosis rate and protein expression levels of Bax, Caspase-3, Fas and FasL increased, Bcl-2 protein expression decreased in the model group (all P<0. 05). Compared with the control group, the myocardial cells in the model group were blurred, the texture disappeared, the arrangement was disordered, the small blood vessels between the myocardium were dilated, the number of cells decreased, and a large number of inflammatory cells infiltrated. Compared with the model group, serum troponin T level, LVEDd and LVESd decreased, LVEF and LVFS increased, serum TNF-α and IL-6 levels decreased, and myocardial infarction size decreased, the apoptosis rate and the expression levels of Bax, Caspase-3, Fas and FasL decreased, while the expression of Bcl-2 increased in the low-dose sufentanil group and high-dose sufentanil group (all P<0. 05). Compared with the model group, the morphology, texture, arrangement, vasodilation, cell number and inflammatory cell infiltration of cardiomyocytes in the low-dose and high-dose sufentanil groups were significantly improved. Compared with the highdose sufentanil + Fas negative control group, serum troponin T level, LVEDd and LVESd increased, LVEF and LVFS decreased, serum TNF- α and IL-6 levels increased, myocardial infarction size increased, the apoptosis rate and the expression levels of Bax, Caspase-3, Fas and FasL increased, while the expression of Bcl-2 decreased in the high-dose sufentanil + Fas lentivirus group (all P<0. 05). Compared with the high-dose sufentanil + Fas negative control group, the cardiomyocytes in high-dose sufentanil + Fas lentivirus group had blurred morphology, disappeared texture, disordered arrangement, dilated small blood vessels between myocardium, reduced cell number, and obvious inflammatory cell infiltration. Conclusion Sufentanil can improve cardiac function and inhibit myocardial cell apoptosis in AMI rats, and the effect of 1 µg/kg sufentanil is better than that of 0. 1 µg/kg sufentanil. Inhibition of Fas/FasL signaling pathway may be one of its mechanisms. [ABSTRACT FROM AUTHOR]

The efficacy and safety of combining dexmedetomidine with sufentanil for patients undergoing ureteroscopic holmium laser lithotripsy was investigated. A total of 90 consecutive patients who underwent this procedure were retrospectively selected. These patients were categorised into two groups based on their chosen anesthesia method: dexmedetomidine combined with sufentanil under non-intubated anesthesia group (DEX+SUF group) and the conventional intubated general anesthesia group (control group). Several parameters including efficacy, adverse effects, hemodynamics, inflammatory factors and variations in T lymphocytes were compared between the two groups. Patients in the DEX+SUF group exhibited notable advantages over those in the control group. They experienced significantly reduced operation time, awakening time, hospital stay, time to first feeding, time to ambulation, catheter-related bladder discomfort score, as well as lower incidences of hypotension, arrhythmia, gastrointestinal symptoms, impaired consciousness, and chills. The DEX+SUF group displayed greater stability in heart rate, mean arterial pressure and oxygen saturation at the mentioned time points compared to the control group. Regarding inflammatory factors, post-treatment levels of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-a), interferon-gamma (IFN-γ), cluster of differentiation 3 (CD3+), cluster of differentiation 4 (CD4+) and cluster of differentiation 8 (CD8+) in the DEX+SUF group were elevated compared to their pre-treatment levels. Furthermore, post-treatment IL-6, TNF-a and IFN-γ levels in the DEX+SUF group were significantly lower than those in the control group, while CD3+, CD4+ and CD8+ levels were significantly higher in the DEX+SUF group than in the control group. The combination of dexmedetomidine and sufentanil in ureteroscopic holmium laser lithotripsy significantly enhanced the hemodynamic stability of patients and reduced complications associated with anesthesia. This approach offers notable efficacy and safety while having a minimal impact on body inflammation and immune function. [ABSTRACT FROM AUTHOR]

Sufentanil has been found to have anti-tumor effects, but its role in osteosarcoma progression and its underlying molecular mechanisms remain largely unknown. Circular_0000735 and microRNA-513a-5p expression was analyzed by quantitative real-time polymerase chain reaction. Osteosarcoma cells (U2OS) were grouped as control group, different concentrations of sufentanil (10, 20 and 40 ng/ml) group, small interfering-negative control group, small interfering-circular_0000735 group and sufentanil+plasmid cloning deoxyribonucleic acid-circular_0000735 group. Cell growth was analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay, plate cloning assay and flow cytometry. Cleaved-caspase-3 protein level was tested by Western blot. Circular_0000735 and microRNA-513a-5p interaction was confirmed by dualluciferase reporter assay. Circular_0000735 was upregulated while microRNA-513a-5p was downregulated in osteosarcoma tissues (p<0.05). Sufentanil inhibited U2OS cell proliferation and circular_0000735 expression, while promoted apoptosis rate, cleaved caspase-3 level, and microRNA-513a-5p expression (p<0.05). Circular_0000735 knockdown enhanced microRNA-513a-5p expression, apoptosis rate and cleaved-caspase-3 level, while it reduced cell proliferation (p<0.05). Overexpression of circular_0000735 could reverse the effect of sufentanil on osteosarcoma cell proliferation and apoptosis. Besides, circular_0000735 targeted microRNA-513a-5p to regulate negative microRNA-513a-5p expression. Sufentanil restrained osteosarcoma cell growth through circular_0000735/microRNA-513a-5p axis. [ABSTRACT FROM AUTHOR]

Objective The study tried to compare the effectiveness and safety of target controlled infusion of sufentanil with traditional remifentanil in improving postoperative pain relief and recovery quality in patients undergoing daytime laparoscopic cholecystectomy. Methods This study is a prospective randomized controlled study, which selecting 100 patients who underwent laparoscopic cholecystectomy in the day ward of our hospital from October 2019 to October 2022 as the observation subjects. Patients were divided into two groups using a random digitization method, with 50 patients receiving intraoperative target controlled infusion of remifentanil (conventional group) and 50 patients receiving intraoperative target controlled infusion of sufentanil (study group). Observe the postoperative pain, nausea and vomiting, spontaneous breathing recovery time, awakening time, extubation time, directional force recovery time, as well as changes in blood pressure and heart rate during the perioperative period (before anesthesia induction (T0), 5 minutes after anesthesia induction (T1), intubation operation (T2), skin incision (T3), abdominal observation (T4), and extubation (T5) in two groups of patients. Results The visual analog scale (VAS) within 3 hours after surgery in the study group was lower than that in the control group (P < 0.05). However, the recovery time of spontaneous breathing, awakening time, extubation time, and directional force recovery time in the research group were longer than those in the conventional group (P < 0.05). After 5 minutes of anesthesia induction (T1), the blood pressure in the control group was lower than that in the study group. At extubation (T5), the blood pressure and heart rate in the control group were higher than those in the study group (P < 0.05). There was no difference in the incidence of perioperative adverse events between the two groups of patients. Conclusions Targeted infusion of sufentanil for patients undergoing daytime laparoscopic cholecystectomy has the advantages of smoother hemodynamics and significant analgesic effects. However, early discontinuation of the medication is necessary due to the prolonged postoperative recovery time of patients. [ABSTRACT FROM AUTHOR]

Background: Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists' concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients. Methods: A total of 188 patients aged 3–12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5. Results: The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively. Conclusions: Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg. Trial registration: This study was approved by the Institutional Review Board of Yichang Central People's Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006). [ABSTRACT FROM AUTHOR]

Introduction: since ancient times opioids have been part of anesthesia. The development of new drugs based on the piperidine class prototype fentanyl has resulted in more potent and specific opioids. One such example is sufentanil. Sufentanil is presented as a further option for perioperative anesthetic management in different clinical scenarios from general anesthesia to sedation or critical care. Its wide therapeutic range, analgesic potency and predictable adverse effects make it a comparable or superior option to other opioids like fentanyl. The dosage recommended by the FDA and other sources are broad but in a wide variety of situations opting for the minimum effective dosage is the most recommended. Objective: a review of the pharmacokinetic and pharmacodynamic aspects of sufentanil, its applications and recommendations based on literature and clinical practice. To spread knowledge of the clinical use of sufentanil in order to promote a change in the classical paradigm of opioid use in anesthesia. Conclusions: Sufentanil is one of the best options for pain management in different clinical scenarios, from short-term procedures such as sedations to highly complex surgeries, its pharmacokinetic profile very similar to fentanyl, with a wide therapeutic margin and greater analgesic potency, make it a more than adequate option for contemporary anesthetic practice. [ABSTRACT FROM AUTHOR]

Remimazolam, a novel intravenous anesthetic, has been proven to be safe and efficacious in the gastroscopy setting among the elderly. However, reports comparing the effectiveness and safety of using equivalent doses of remimazolam with propofol have not been seen. The aim of this study was to compare the sedation efficacy and safety of the 95% effective doses (ED95) of remimazolam versus propofol combined with sufentanil in the gastroscopy setting among the elderly. In the first step of this two-step study, a modified up-and-down method was used to calculate the ED95 of remimazolam and propofol when combined with 0.1 µg/kg sufentanil in inhibiting body movement of elderly patients undergoing gastroscopy. In the second step, ED95 of both agents calculated in the first step were administered, endpoints of efficacy, safety, and incidence of adverse events were compared. A total of 46 individuals completed the first step. The ED95 of remimazolam was 0.163 mg/kg (95% CI 0.160–0.170 mg/kg), and that of propofol was 1.042 mg/kg (95% CI 1.007–1.112 mg/kg). In the second step, 240 patients completed the trial. The anesthetic effective rates of the remimazolam group and the propofol group were 78% and 83%, respectively, with no statistical difference (P = 0.312). Patients in the remimazolam group had more stable circulatory functions (P < 0.0001) and a lower incidence of pain on injection (3.3% vs. 19.5%, P < 0.0001). The incidence of hypotension was low in the remimazolam versus propofol group (15.6% vs. 39.0%, P < 0.0001). Overall adverse event was low in the remimazolam versus propofol group (21.3% vs. 62.7%, P < 0.0001).In this study, we found that when anesthesia was administered to elderly gastroscopy patients based on 95% effective doses of remimazolam and propofol, remimazolam was as effective as propofol, but was safer with a lower incidence of adverse events. Study registration: Chinese Clinical Trial Registry, ChiCTR2000034234. Registered 29/06/2020, https://www.chictr.org.cn. [ABSTRACT FROM AUTHOR]

Pulmonary arterial pressure (PAH) usually increases after cardiopulmonary bypass (CPB), but this normally does not affect weaning off CPB. Here we report a case of severe PAH in a patient with normal left atrial pressure. Prolonging CPB by 45 min did not lead to lower PAH. Given that lung injury can stimulate secretion of vasoconstrictors that trigger PAH, we decided to gradually increase blood flow into the lungs in an effort to restore the balance between pulmonary vasoconstrictors and vasodilators. Pulmonary artery pressure gradually decreased, allowing the patient to be weaned off CPB, after which she recovered uneventfully. Our experience suggests an approach for managing acute, severe PAH after CPB without the need for mechanical circulatory support. [ABSTRACT FROM AUTHOR]

This study investigates the impact of sufentanil on endometrial cancer (EC) cells. Human EC cell lines (HEC-1A and Ishikawa) were exposed to different concentrations (10, 20 and 40 nM) of sufentanil for 48 hours, following which cell-counting-kit 8 (CCK8), clone formation and transwell assays as well as and western blot were conducted. The findings revealed that sufentanil reduced the cell viability, colony formation, migration and invasion of both HEC-1A and Ishikawa cells. Moreover, sufentanil treatment resulted in decreased levels of matrix metallo proteinase 9 (MMP-9), MMP-2, N-cadherin and alpha smooth muscle actin (a-SMA) proteins while increasing the expression of E-cadherin in treated cells. Furthermore, sufentanil treatment was associated with decreased phosphorylation of phosphatidylinositol 3-kinase (PI3K), Akt and mammalian target of rapamycin (mTOR), suggesting that its inhibitory effects on the proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) of EC cells could be attributed to the inactivation of the PI3K/Akt/mTOR pathway. [ABSTRACT FROM AUTHOR]

Objective: Ciprofol is a new sedative anesthetic drug that can be used for gastrointestinal endoscopy and induction of general anesthesia, but the appropriate dosage for use in elderly patients has not been determined. Sufentanil is a commonly used opioid in clinical practice, and this study was designed to induce anesthesia in elderly patients using sufentanil in combination with ciprofol. However, the optimal dosage of ciprofol when it is co-administered with sufentanil has not yet been established. This study was designed to find the median effective dose (ED50) and 95% confidence interval (95% CI) of ciprofol for intravenous anesthesia when combined with sufentanil. Methods: We studied 57 patients who were scheduled to undergo a diagnostic upper gastrointestinal endoscopy. According to age, it was divided into two groups: 65∼74 years old (group A) and over 75 years old (group B). Using the modified Dixon sequence test method, intravenous bolus of 0.1 μg/kg sufentanil was given 3 min before ciprofol is administered, the initial dose of ciprofol was 0.4 mg/kg, the upper gastrointestinal endoscopy was placed after reaching the depth of sedation, and vital signs and adverse events were recorded at each perioperative time point (T0-T7). Results: In the group A, when combined with 0.1 μg/kg sufentanil, the ED50 of ciprofol to inhibiting responses to insertion of upper gastrointestinal endoscopy was 0.23 mg/kg, and the 95% CI was 0.09∼0.30 mg/kg; in the group B, the ED50 was 0.18 mg/kg, and the 95% CI was 0.13∼0.22 mg/kg. Conclusion: The ED50 of ciprofol in combination with sufentanil (0.1 μg/kg) for upper gastrointestinal endoscopy in elderly patients: 0.23 mg/kg in group A and 0.18 mg/kg in group B. [ABSTRACT FROM AUTHOR]

The optimal analgesia regimen after open cardiac surgery is unclear. The aim of this study was to investigate the beneficial effects of continuous transversus thoracis muscle plane (TTMP) blocks initiated before surgery on open cardiac surgery outcomes. A group of 110 patients were randomly allocated to either receive bilateral continuous TTMP blocks (TTP group) or no nerve block (SAL group). The primary endpoint was post‐operative pain at 4, 8, 16, 24, 48 and 72 h after extubation at rest and exercise. The secondary outcome measures included analgesia requirements (sufentanil and flurbiprofen axetil administration), time to extubation, incidence of reintubation, length of stay in the ICU, incidence of post‐operative nausea and vomiting (PONV), time until return of bowel function, time to mobilization, urinary catheter removal and length of hospital stay. The length of stay in the ICU and length of hospital stay were significantly longer in the SAL group than in the TTP group. NRS scores at rest and exercise were significantly lower in the TTP group than in the SAL group at all time points. The TTP group required significantly less intraoperative and post‐operative sufentanil and post‐operative dynastat consumption than the SAL group. Time to extubation, time to first flatus, time until mobilization and time until urinary catheter removal were significantly earlier in the TTP group than in the SAL group. The incidence of PONV was significantly lower in the TTP group. Bilateral continuous TTMP blocks provide effective analgesia and accelerate recovery in patients undergoing open heart valve replacement surgery. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the action of sufentanil (Fen) pretreatment on inducible myocardial apoptosis by ischemia-reperfusion (I/R) in rats. 120 male rats (mean age = 3 months) were randomly assigned to six conditions: control group (group S), I/R group, normal saline (NS) I/R group, and low, medium and high dose Fen groups, where in high dose group: Fen1:2µg/kg; Fen2:4µg/kg; Fen3:6µg/kg. The measured items included heart rate (HR), mean arterial pressure (MAP), left ventricular developed pressure (LVDP), ±dp/dtmax, malondialdehyde (MDA), superoxide dismutase (SOD) activity, creatine phosphokinase MB (CK-MB) and cardiac troponin-I (cTnI). The total apoptotic cardiomyocytes, B cell lymphoma 2 (Bcl-2) and Bax protein and mRNA expression were detected in the myocardial ischemia (MI) region. The HR and the MAP of the Fen group exceeded that of the I/R group, while the LVDP and ±dp/dtmax were approximate to the basic values. The MDA concentrations and CK-MB values of the Fen group went down and the SOD activity went up when was compared with the I/R group. Whereas, cTnI concentrations of Fen1 and Fen2 groups sharply decreased (all P<0.05); the myocardial injury of the Fen group was less the I/R group. Whereas, the MI region and apoptosis indexes of Fen1 and Fen2 groups dropped significantly (all P<0.05); moreover, Bcl-2 protein and mRNA expression rose significantly in the Fen group by being compared to the I/R group, while Bax protein and mRNA expression were declined clearly (all P<0.05). Regulating Bcl-2 and Bax of Fen pretreatment can inhibit I/R-induced myocardial apoptosis of rats. As a result, Fen may be a potential drug to treat of I/R injuryrelated heart disease. [ABSTRACT FROM AUTHOR]

The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into group A and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P<0.05), but there was no statistical difference in the dosage of sufentanil and the awakening time between the two groups (P>0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P<0.05). At T1, T2 and T3, the Ramsay score of group A was lower than that of group B (P<0.05), and there was no significant difference between the two groups at T4 (P>0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P<0.05). There was no significant difference in the incidence of adverse reactions between group A and group B (P>0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing. [ABSTRACT FROM AUTHOR]

Objective To investigate different doses of the analgesic effects of dezocine comparing with sufentanil after laryngectomy. Methods A total of 129 patients who underwent elective partial laryngectomy from Feb 2022 to Jan 2023 were randomly assigned to dezocine 0.5 mg/kg group(group D1), dezocine 0.6 mg/kg group(group D2) and sufentanil 2 μg/kg group (group S). Twenty-four hours amount of drugs, the visual analogue scale(visual analogue scale, VAS)and 48 h total pressing times of PCA (patient-controlled intravenous analgesia, PCIA) were compared among the three groups at 6,12, 24 and 48 h after operation,and the postoperative adverse reactions (nausea,vomiting,dizziness,urinary retention and respiratory depression)were recorded. Results There was no significant difference in 24 h amount of drugs among the three groups. The VAS score of group D1 was higher than that of group S at 6 h postoperatively (P＜0.05), but did not differ significantly among the three groups at 12,24 and 48 h. There was no significant differences in the number of compressions and postoperative adverse reactions among the three groups. Conclusion Compared with sufentanil, 0.6 mg/kg dezocine can provide the same degree of analgesic effect. However, no advantage was found to reduce adverse reactions. [ABSTRACT FROM AUTHOR]

BackgroundThis study aimed to investigate the effect of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia in developmental hip dislocation in children after Salter osteotomy.MethodsThe clinical data of 98 children with developmental hip dislocation, who underwent Salter osteotomy in our center between January 2020 and February 2023, were selected. The children were randomly divided into four groups based on the application of patient-controlled intravenous analgesia (sufentanil + granisetron ± dexmedetomidine). All children received 1 µg/kg/day of sufentanil and 3 mg of granisetron. Group A did not receive dexmedetomidine, and Groups B, C, and D received 0.5, 0.75, and 1.0 µg/kg/day of dexmedetomidine, respectively. The pain indicators and immune factor levels of children in each group were compared.ResultsThe heart rate (HR) and respiratory rate (RR) 2 h after operation in Groups C and D were significantly lower than those in Groups A and B (P

Abstract Background Inguinal hernia repair is a common pediatric procedure. We studied postoperative recovery times in children undergoing laparoscopic inguinal hernia repair with anesthesia induced by fentanyl versus sufentanil. Methods We performed a pilot randomized clinical trial between February and December 2022. Eligible children were assigned into two age groups, 2–6 and 6–12 years old groups. Then, children in each age group were randomly assigned into either the fentanyl (2 µg/kg) or sufentanil (0.2 µg/kg) group for anesthesia induction. Baseline characteristics were collected. The primary outcome was the postoperative recovery time, which was recorded as the time period from extubation to a Steward recovery score reaching 6. Secondary outcomes included surgical duration, anesthetic duration, intubation duration, and intraoperative hemorrhage. Results There were 300 children, with 75 children in each group. In the 2–6 years old group, children who received fentanyl had statistically significantly shorter postoperative recovery times than children who received sufentanil (0.9 ± 0.4 versus 1.5 ± 0.3 h, P

Meng Li, Xue Li, Yong Wu, Tianyu Zhang, Mengya Li, Ying Chen Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of ChinaCorrespondence: Ying Chen, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 East Zhenhua Road, Lianyungang, Jiangsu, People’s Republic of China, Email yingchen20825@163.comObjective: To investigate the correlation between the amount of sufentanil used during anesthesia and intraoperative hemodynamic fluctuation and postoperative recovery in patients undergoing cardiopulmonary bypass (CPB).Materials and Methods: A retrospective analysis was performed on 454 patients undergoing elective heart surgery under CPB. Patients were divided into two groups according to the amount of sufentanil used during anesthesia: Group L (induced sufentanil 0.4– 0.6 ug /kg, maintained sufentanil 0.01– 0.02 ug/kg/min, n = 223) and Group H (induced sufentanil 4– 6 ug/kg, maintained sufentanil 0.02– 0.03 ug/kg/min, n = 231). Propensity score matching (PSM) was used at a 1:1 nearest-neighbor ratio to compare the two groups. Intraoperative use of vasoactive drugs, spontaneous heart rebound, secondary endotracheal intubation, postoperative mechanical ventilation time, the length of stay (LOS) in ICU, postoperative LOS in hospital, postoperative in-hospital mortality were analyzed.Results: After matching, a total of 144 patients were included (72 patients in Group L, and 72 patients in Group H). Multivariate logistic regression analysis showed that the dosage of sufentanil during anesthesia was significantly correlated with the utilization rate of intraoperative vasoactive drugs (P < 0.001) and the success rate of spontaneous heart rebound (p = 0.001). The utilization rate of vasoactive drugs decreased significantly in Group H (OR, 0.062; 95% CI, 0.019– 0.200) compared to that of Group L. The success rate of spontaneous heart rebound (OR, 0.187; 95% CI, 0.071– 0.491) was higher in Group H. There were no differences on postoperative recovery outcomes between the two groups.Conclusion: On the basis of our data, the use of high-dose sufentanil is beneficial to keep the cardiovascular response of patients in a stable state, but there is no significant effect on the quality of early postoperative recovery.Keywords: sufentanil, extracorporeal circulation, cardiac anesthesia

Abstract Background Cervical conization is a brief but painful procedure that can be performed under sufficient sedation with propofol and opioids. However, this sedation approach comes with a high risk of sedation-related adverse events (SRAEs). Esketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, causes less cardiorespiratory depression than opioids. The aim of this study was to assess the efficacy and safety of adding a low dose of esketamine to propofol and sufentanil sedation as an opioid-reduced regimen. Methods A total of 122 consecutive patients with ASA I-II, body mass index

Xiaodong Xu,&ast; Yuan Tao,&ast; Yitian Yang, Jiaqiang Zhang, Mingyang Sun Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, 450003, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiaqiang Zhang; Mingyang Sun, Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, 450003, People’s Republic of China, Tel +0 371 6558 0728, Email zhangjiq@zzu.edu.cn; mingyangsun1986@163.comPurpose: We investigate the efficacy and safety of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via patient-controlled intravenous analgesia (PCIA) after hepatobiliary surgery, as compared with sufentanil.Patients and Methods: Postoperative follow-up data of hepatobiliary surgery patients in Henan Provincial People’s Hospital from March 2018 to June 2021 were collected retrospectively and divided into butorphanol group (group B) or sufentanil group (group S) according to the postoperative intravenous controlled analgesia scheme. The baseline characteristics and surgical information of the two groups were matched through propensity score matching (PSM).Results: A total of 3437 patients were screened, and PSM yielded 1816 patients after matching, including 908 in the butorphanol group and 908 in the sufentanil group. Compared with group S, the incidence of moderate-to-severe pain on the first postoperative day and the second postoperative day was lower in group B during rest (3.2% vs 10.9%, P< 0.001; 1.2% vs 4.6%, P< 0.001), and during movement (7.0% vs 18.9%, P< 0.001; 2.6% vs 8.7%, P< 0.001). Patients receiving butorphanol had a lower morphine consumption (50mg vs 120mg, P< 0.001). The bolus attempts of an analgesic pump in group B were significantly lower than in group S (1 vs 2, P< 0.001). Postoperative hospital length of stay was shortened in group B (11d vs 12d, P=0.017). The occurrence of postoperative vomiting was lower in group B (1.4% vs 3.0%, P=0.025) than in group S. However, more patients in group B experienced dizziness (0.9% vs 0.1%, P=0.019).Conclusion: Compared with sufentanil, the application of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via PCIA ameliorated postoperative pain after hepatobiliary surgery, with reduced opioid consumption and shorter postoperative hospital length of stay.Keywords: patient controlled intravenous analgesia, butorphanol, sufentanil, propensity score matching

Yong-Kang Gui,1,2,&ast; Xiao-Hui Zeng,1,2,&ast; Rui Xiao,3 Wen-Feng Xi,1– 3 Dan Zhang,1– 3 Yang Liu,1,2 Si-Hui Zhu,1,2 Xin Da,1,2 De-Wen Shi,1,2 Xu-Dong Hu,1,2 Guang-Hong Xu1,2 1Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China; 2Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China; 3Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236113, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guang-Hong Xu, 230032, Tel +86 13856949535, Fax +86 0551 62923704, Email xuguanghong2004@163.comPurpose: The application of sedation and analgesia in spinal anesthesia has many benefits, but the risk of respiratory depression (RD) caused by opioids cannot be ignored. We aimed to observe the effect of dezocine, a partial agonist of μ-receptor, on the median effective dose (ED50) of sufentanil-induced RD in patients undergoing spinal anesthesia combined with low-dose dexmedetomidine.Patients and Methods: Sixty-two patients were randomly assigned to dezocine group (DS) and control group (MS). After spinal anesthesia, mask oxygen (5 L/min) and dexmedetomidine (0.1 ug/kg) were given. Five minutes later, patients in the DS group received an Intravenous (IV) bolus of sufentanil and 0.05mg/kg dezocine, while patients in the MS group only received an IV bolus of sufentanil.Results: ED50 of DS group was 0.342 ug/kg, 95% confidence interval (CI) was (0.269, 0.623) ug/kg, and the ED50 of MS group was 0.291 ug/kg, 95% CI was (0.257, 0.346) ug/kg. There was no difference in the type and treatment measures of RD and hemodynamic changes between the two groups, and no serious adverse reactions occurred in either group.Conclusion: Dezocine can improve RD induced by sufentanil in patients with spinal anesthesia combined with low-dose dexmedetomidine, and increase the safety window of sufentanil use.Keywords: spinal anesthesia, respiratory depression, median effective dose, sufentanil, dezocine

Bacground: Off-pump coronary artery bypass graft (OPCABG) has a high incidence of postoperative systemic inflammation response syndrome (SIRS), and perioperative endothelial glycocalyx layer (EGL) disruption can be one of the predisposing factors. We hypothesized that EGL shedding happened earlier in OPCABG which can influence on postoperative SIRS, and sevoflurane might preserve EGL better than propofol. Methods: We randomly allocated 50 patients undergoing OPCABG to receive either sevoflurane-sufentanil or propofol-sufentanil anesthesia. Plasma syndecan-1, heparan sulfate (HS), atrial natriuretic peptide (ANP), IL-6, and cardiac troponin I (cTnI) were measured. Blood samples were collected at 6 timepoints: induction (T1), before grafting (T2), after grafting(T3), surgery done (T4), postoperative day1 (POD1,T5) and POD2 (T6). SIRS criteria and sequential organ failure assessment (SOFA) score were examined. Results: There were neither differences of syndecan-1, HS, IL-6 nor of SIRS criteria or SOFA score between the sevoflurane and propofol groups. All patients were pooled as a single group for further statistical analyses, plasma syndecan-1 (P < 0.001) and IL-6 (P < 0.001) increased significantly as a function of time; syndecan-1 increasing correlated significantly with the duration of coronary graft anastomosis (r = 0.329, P = 0.026). Syndecan-1(T3) correlated significantly with ANP(T3) (r = 0.0.354, P = 0.016) and IL-6 (T5) (r = 0.570, P < 0.001). The maximum value of IL-6 correlated significantly with SIRS (r = 0.378, P = 0.010), the maximum value of SOFA score (r = 0.399, P = 0.006) and ICU days (r = 0.306, P = 0.039). The maximum value of SOFA score correlated significantly with the occurrence of SIRS (r = 0.568, P < 0.001) and ICU days (r = 0.338, P = 0.022). Conclusions: OPCABG intraoperative early EGL shedding caused of grafts anastomosis greatly affected postoperative SIRS and SOFA score, sevoflurane did not clinically preserve EGL better. Trial registration: ChiCTR-IOR-17012535. Registered on 01/09/2017. [ABSTRACT FROM AUTHOR]

Background: Esketamine is increasingly used in clinical anesthesia. The effect of esketamine on the blood flow velocity of the middle cerebral artery has a clinical guiding effect. To investigate the effect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood flow velocity of middle cerebral artery and hemodynamics during the induction period. Methods: The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood flow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four different time points: before induction of general anesthesia (T0), 1 min after the induction drug injected (T1), before endotracheal intubation (T2), and 1min after endotracheal intubation (T3). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented. Results: The variation of average CBFV from time T0 to T2(ΔVm1) and the variation from time T3 to T0 (ΔVm2) were not obviously different. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T1, the mean HR of group E was significantly higher than that of group C. At T2 and T3, the BP and HR of group E were obviously higher than that of group C. At T2, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was significantly reduced in the group E compared with the group C. There were no differences in the other outcomes. Conclusions: The induction of esketamine combined with propofol does not increase the blood flow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse effects. Trial Registration: 15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675. [ABSTRACT FROM AUTHOR]

Objective: Patient-controlled intravenous analgesia (PCIA) can alleviate pain to some extent, and several randomized controlled trials (RCTs) have examined the efficacy of esketamine-assisted sufentanil in postoperative PCIA. In this research, we conducted a meta-analysis of relevant RCTs to compare the effect and safety of esketamine-sufentanil versus sufentanil alone for postoperative PCIA. Methods: We systematically searched the Cochrane Library, PubMed, Embase, Web of Science, CNKI, and other libraries up to December 2023 to screen out RCTs examining the use of esketamine combined with sufentanil for PCIA. We analysed analgesia scores, sedation scores, adverse drug reactions and postpartum depression scores as outcome indicators Results: This meta-analysis included 32 RCTs. The results of the meta-analysis were as follows. 1) Visual Analog Scale: The VAS scores at 6, 12, 24, and 48 h were lower in the esketamine-sufentanil group than in the sufentanil alone group, and significant differences were found at all time points (p < 0.05). 2) Ramsay Sedation Scale: The sedation score of the esketamine-sufentanil group at 48 h after surgery was higher than that of the sufentanil group alone [mean difference (MD) = -0.09 points, confidence interval (CI): (-0.26, -0.07), p = 0.27], but this difference was not significant (p > 0.05). 3) Safety: Compared with sufentanil alone, the incidence rates of postoperative nausea-vomiting, dizzinessheadache, skin pruritus and respiratory depression were significantly lower in the esketamine-sufentanil group. 4) Postartum depression: The reduction in postpartum depression scores were significantly greater in the esketaminesufentanil group than in the sufentanil alone group at 3 days [MD = -1.35 points, CI: (-1.89, -0.81), p < 0.00001] and 7 days [MD = -1.29 points, CI: (-2.42, -0.16), p = 0.03]. Conclusion: The meta-analysis showed that the use of esketamine combined with sufentanil for postoperative PCIA could improve postoperative analgesia, alleviate postpartum depression and reduce the rate of postoperative adverse reactions, but there was no significant difference in sedation. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is a common pediatric procedure. We studied postoperative recovery times in children undergoing laparoscopic inguinal hernia repair with anesthesia induced by fentanyl versus sufentanil. Methods: We performed a pilot randomized clinical trial between February and December 2022. Eligible children were assigned into two age groups, 2–6 and 6–12 years old groups. Then, children in each age group were randomly assigned into either the fentanyl (2 µg/kg) or sufentanil (0.2 µg/kg) group for anesthesia induction. Baseline characteristics were collected. The primary outcome was the postoperative recovery time, which was recorded as the time period from extubation to a Steward recovery score reaching 6. Secondary outcomes included surgical duration, anesthetic duration, intubation duration, and intraoperative hemorrhage. Results: There were 300 children, with 75 children in each group. In the 2–6 years old group, children who received fentanyl had statistically significantly shorter postoperative recovery times than children who received sufentanil (0.9 ± 0.4 versus 1.5 ± 0.3 h, P < 0.001). However, in the 6–12 years old group, children who received fentanyl had statistically significantly longer postoperative recovery times than children who received sufentanil (1.2 ± 0.4 versus 0.8 ± 0.4 h, P < 0.001). Baseline characteristics and secondary outcomes were comparable between two groups. Conclusions: Anesthesia induction with fentanyl or sufentanil resulted in different postoperative recovery times after laparoscopic inguinal hernia repair in children in different age groups. More studies are required to determine the appropriate induction anesthetic in children of different ages. Trial registration: The study protocol was retrospectively registered online at the Chinese Clinical Trial Registry (registration number ChiCTR2300072177, retrospectively registered on 06/06/2023). [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) following a cesarean delivery is a frequently seen complication. Despite the prophylactic effects of ketamine, the impact of esketamine on PPD in women undergoing cesarean section remains uncertain. This study aimed to assess the effectiveness of esketamine as an adjunct to patient-controlled intravenous analgesia (PCIA) in preventing PPD in women undergoing caesarean section. Methods: A total of 275 parturients undergoing caesarean section and subsequent patient-controlled intravenous analgesia (PCIA) were randomly assigned to receive either the control treatment (sufentanil 2 µg/kg + tropisetron 10 mg) or the experimental treatment with additional esketamine (1.5 mg/kg). The primary outcome measured was the incidence of postpartum depression (PPD), classified by Edinburgh Postnatal Depression Scale (EPDS) scores equal to or greater than 13 indicating PPD. Secondary outcomes included cumulative sufentanil consumption during specific time periods (0–24 h, 24–48 h, and 0–48 h) after the surgical procedure and numerical rating scale (NRS) scores at rest and during movements. Results: The final analysis included a total of 246 postpartum women who had undergone caesarean delivery. On postoperative day 42, the incidence of depression among the control group was 17.6%, which was significantly higher compared to the esketamine group with a rate of 8.2% (P = 0.02). The EPDS scores also showed a significant difference between the two groups, with a mean score of 9.02 ± 2.21 in the control group and 6.87 ± 2.14 in the esketamine group (p < 0.0001). In terms of pain management, the esketamine group showed lower sufentanil consumption in the 0–24 h (42.5 ± 4.58 µg vs. 50.15 ± 5.47 µg, P = 0.04) and 0–48 h (87.40 ± 9.51 µg vs. 95.10 ± 9.36 µg, P = 0.04) postoperative periods compared to the control group. Differences in movement were also observed between the two groups at 24 and 48 h after the cesarean Sect. (3.39 ± 1.57 vs. 4.50 ± 0.80, P = 0.02; 2.43 ± 0.87 vs. 3.56 ± 0.76, P = 0.02). It is worth noting that the frequency of side effects observed in both groups was comparable. Conclusions: Esketamine at a dose of 1.5 mg/kg, when used as a supplement in PCIA, has been shown to significantly reduce the occurrence of PPD within 42 days. Additionally, it has been found to decrease cumulative consumption of sufentanil over a 48-hour period following cesarean operation, all without increasing the rate of adverse effects. Trial registration: Registered in the Chinese Clinical Trial Registry (ChiCTR2200067054) on December 26, 2022. [ABSTRACT FROM AUTHOR]

Background: Sufentanil in combination with dezocine or esketamine is often used for postoperative analgesia. However, there is a lack of clinical evidence of efficacy. This study compares the analgesic effects of esketamine and dezocine combined with sufentanil for relieving pain after laparoscopic cholecystectomy(LC). Methods: A total of 58 patients were randomly assigned to the esketamine group (ES group) and dezocine group (DE group). In the ES group, 1.5 mg/kg esketamine was used. In the DE group, 0.3 mg/kg dezocine was used. Primary outcome measures were Visual Analog Scale (VAS) score at 4 h, 8 h, 24 h and 48 h after surgery. The second outcome measures were Interleukin-6 (IL-6) and C-reactive protein (CRP) levels in the serum 10 minutes before anesthesia induction, and at 24 h and 48 h after surgery. Results: The VAS scores at 4 h, 8 h, 24 h and 48 h after the surgery in the ES group vs DE group were 2.70 vs 3.50(P=0.013),2.35 vs 3.15(P=0.004),1.69 vs 2.58(P=0.002), and 1.50 vs 2.26(P=0.002), respectively. The serum IL-6 concentrations 10 minutes before anesthesia induction, and at 24 h and 48 h after surgery in the ES group and DE group were 34.39 and 34.12(P=0.901),112.33 and 129.60(P=0.014), and 89.69 and 108.46(P<0.001), respectively. The CRP levels in serum 10 minutes before anesthesia induction, and at 24 h and 48 h after the surgery in the ES group and DE group were 5.99 and 5.86(P=0.639), 28.80 and 35.37(P<0.001), and 23.17 and 30.11(P<0.001), respectively. Conclusion: For postoperative pain after LC, 1.5mg/kg esketamine provided better analgesia and reduced inflammation levels than 0.3mg/kg dezocine. Trial registration: This trial was registered in the China Clinical Research Information Center in 31/05/2023 : https://www.chictr.org.cn/bin/home (Registration number: ChiCTR2300072011). [ABSTRACT FROM AUTHOR]

Background: Esketamine, recognized for its analgesic, sedative, and anti-inflammatory qualities, is integral in multimodal analgesia. However, the potential opioid-sparing effects of intravenous esketamine, along with its impact on inflammatory responses, and cognitive function during laparoscopic surgery, remain unexplored. Methods: In this study, 90 patients scheduled for laparoscopic cholecystectomy were equally randomized into three groups: a normal saline control group (NS), a low-dose esketamine group (LS) and a high-dose esketamine group (HS). Subsequently, we monitored several parameters: hemodynamics, levels of stress and inflammatory responses, intraoperative doses of sufentanil, remifentanil, and propofol, and 24-hour postoperative sufentanil requirements. We also evaluated alterations in cognitive function, perioperative indicators, and potential adverse reactions among the three groups. Results: Compared to their levels 5 minutes prior to anesthesia (T0) and 30 minutes post-operation (T4), the NS group exhibited a more significant decrease in Mean Arterial Pressure (MAP) and Heart Rate (HR) at various time intervals: 5 minutes after the skin incision (T1), 30 minutes post-incision (T2), and at the conclusion of the operation (T3), compared to the LS and HS groups(P < 0.05). Furthermore, the NS group exhibited a greater increase in levels of adrenaline (AD), noradrenaline (NE), endothelin (ET), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) at T1, T2, and T3, more so than the other two groups(P < 0.05). 24 hours after the surgery, patients in the LS group and HS group had significantly higher Montreal Cognitive Assessment (MoCA) scores than those in the NS group(P < 0.05). The LS and HS groups required lower doses of propofol, remifentanil, and sufentanil during surgery (P < 0.05), experienced shorter postoperative recovery times, and had lower incidences of nausea, vomiting, and respiratory depression compared to the NS group (P < 0.05). Conclusion: The administration of low-dose esketamine has been shown to be safe, effective, and dependable in the context of laparoscopic gallbladder surgery. It has the capacity to stabilize hemodynamic responses, ameliorate both stress and inflammatory reactions from surgery, and hastens anesthesia recovery. Furthermore, it fosters the restoration of postoperative cognitive function. Notably, when combined with nalbuphine, it exhibits opioid-sparing effects, reducing postoperative adverse outcomes. Trial registration: The trial is registered with the China Clinical Trials Registry Registration Number: ChiCTR2300067596. Retrospectively registered (date of registration: 12/01/2023). [ABSTRACT FROM AUTHOR]

Objective: To investigate the analgesic effect of esketamine combined with low-dose sufentanil in elderly patients after gastrointestinal surgery, and whether the anti-inflammatory effect of esketamine is involved in the mechanism of postoperative delirium. Method: We enrolled sixty elderly patients (age ≥ 65 years old, American Society of Anesthesiologists (ASA) grade I-III) who underwent gastrointestinal surgery. Patients were randomly assigned to Group C (control group) who received sufentanil 2 ug/kg, and Group E (experimental group) who received sufentanil 1.5 ug/kg + esketamine 1 mg/kg, with 30 patients in each group. All patients underwent total intravenous anesthesia during the surgery and were connected to a patient-controlled intravenous analgesia (PCIA) pump after surgery. The primary outcome was the evaluation of pain at 4, 24, 48 h after surgery which was evaluated by NRS scores. In secondary outcomes, inflammation was assessed by measuring IL-6 levels using ELISA. The postoperative delirium and the occurrence of adverse reactions were observed on the 1st and 3rd day after surgery. Results: The NRS scores at 4, 24, and 48 h after surgery in the experimental group [(4.53 ± 1.22), (3.46 ± 0.73), (1.37 ± 0.99)] were lower than that in the control group [(5.23 ± 1.16), (4.46 ± 0.77), (2.13 ± 0.78)] (P < 0.05). The concentration of serum IL-6 in the experimental group at 24 and 48 h after operation [(15.96 ± 4.65), (11.8 ± 3.24)] were lower than that in the control group [(23.07 ± 4.86), (15.41 ± 4.01)] (P < 0.05); the incidence of postoperative delirium in the experimental group was less than that in the control group (P < 0.05); there was no significant difference in the incidence of postoperative nausea and vomiting between the two groups (P > 0.05), and neither group had nightmares or delirium. Conclusion: Esketamine may enhance postoperative pain management compare with sufentanil, and esketamine has anti-inflammatory effects that reduce the incidence of postoperative delirium. Trial registration: Full name of the registry: Chinese Clinical Trial Registry. Trial registration number: ChiCTR2300072374. Date of registration:2023/06/12 [ABSTRACT FROM AUTHOR]

A green, efficient, sensitive and accurate detection method by HPLC–DAD and LC–MS/MS was developed and validated for the quantification of morphine, hydromorphone, oxycodone, ketamine tramadol, dezocine, ropivacaine, remifentanil, butorphanol, bupivacaine, droperidol, fentanyl, lornoxicam and sufentanil. The 14 mixtures were chromatographed via HPLC–DAD method which employed 0.05 mol/L potassium dihydrogen phosphate solution-acetonitrile as the mobile phase, the analytes were gradient elution on a SinoChrom ODS-BP C18 column with a total separation time of 35 min, and 14 mixtures showed a good linear relationship in the linear range. The Limit of Quantitation (LOQ) ranged from 0.10 to 20.0 µg/mL, the inter-day and intra-day precision of each analyte is within 1.1–2.0% and 0.4–1.3%, and the average absolute recovery of all compounds was above 98%. The LC–MS/MS method was used to successfully separate the 14 mixtures within 10 min which employed 0.1% formic acid-acetonitrile as the mobile phase, the analytes were gradient elution on a ACQUITY UPLC-BEH C18 column with a total separation time of 13 min, and 14 mixtures showed a good linear relationship in the linear range. The LOQ ranged from 0.005 to 0.2 ng/mL, the inter-day and intra-day precision of each analyte is within 1.2–4.1% and 0.6–3.3%, and the average absolute recovery of all compounds was above 93%. The proposed method has been successfully applied in the clinic and provides a strong technical basis for the quantitative detection of these 14 mixtures for detecting drug abuse, and for studying the stability and compatibility of analgesic solutions. The proposed methods were validated against ICH guidelines. [ABSTRACT FROM AUTHOR]

Background: Tussis, which increases the incidence of airway spasm, aspiration, nausea, and vomiting, is a common complication faced during upper gastrointestinal (GI) endoscopy. However, sedatives and analgesics exhibit inhibitory actions against airway reflexes to different degrees. Our assumption is a combination of propofol and small doses of sufentanil, esketamine, or lidocaine, especially the combination of propofol and esketamine, might reduce tussis incidence. Method: The study will be performed as a randomised controlled three-blind, two-centre trial. Patients undergoing upper GI endoscopy, ≥ 18 years old, with American Society of Anesthesiologists (ASA) classification I–III will be randomised to four groups: P group (single administration of propofol), P + S group (administration of propofol and sufentanil in combination), P + K group (administration of propofol and esketamine in combination), and P + L group (administration of propofol and lidocaine in combination) (N = 100 per group). The primary endpoints include the frequency of tussis, nausea and vomiting, and/or body movements observed at the insertion of the endoscope into the pharyngeal cavity or within 5 min of endoscope insertion. Secondary outcomes are recovery assessment, patients' and endoscopists' satisfaction with the procedure, MMSE scores, MET scores, sleep condition, and the number of sedation-related events. Data on sedation-related events are collected by recording of vital signs. Satisfaction parameters and mental states are collected by means of questionnaires and evaluation scales before and after the procedure and on different following days. Discussion: Esketamine can reduce tussis occurrence with good tolerability and relax the bronchus and also provides high clearance rates and low possibility of adverse reactions. We aim to demonstrate that the combination of esketamine with propofol for sedation in patients subjected to upper GI procedure is nevertheless superior to only administration of propofol or a combination of propofol with other anaesthetics, such as opioids or lidocaine. Trial registration: ClinicalTrials.gov. NCT05497492, Registered 09 August 2022. [ABSTRACT FROM AUTHOR]