Publications by authors named "Yuguang Huang"

133 Publications

Association between perioperative allogeneic red blood cell transfusion and infection after clean-contaminated surgery: a retrospective cohort study.

Br J Anaesth 2021 Jul 3. Epub 2021 Jul 3.

Department of Anaesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. Electronic address:

Background: Allogeneic red blood cell (RBC) transfusion can induce immunosuppression, which can then increase the susceptibility to postoperative infection. However, studies in different types of surgery show conflicting results regarding this effect.

Methods: In this retrospective cohort study conducted in a tertiary referral centre, we included adult patients undergoing clean-contaminated surgery from 2014 to 2018. Patients who received allogeneic RBC transfusion from preoperative Day 30 to postoperative Day 30 were included into the transfusion group. The control group was matched for the type of surgery in a 1:1 ratio. The primary outcome was infection within 30 days after surgery, which was defined by healthcare-associated infection, and identified mainly based on antibiotic regimens, microbiology tests, and medical notes.

Results: Among the 8098 included patients, 1525 (18.8%) developed 1904 episodes of postoperative infection. Perioperative RBC transfusion was associated with an increased risk of postoperative infection after controlling for 27 confounders by multivariable regression analysis (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.39-1.84; P<0.001) and propensity score weighing (OR: 1.64; 95% CI: 1.45-1.85; P<0.001) and matching (OR: 1.70; 95% CI: 1.43-2.01; P<0.001), and a dose-response relationship was observed. The transfusion group also showed higher risks of surgical site infection, pneumonia, bloodstream infection, multiple infections, intensive care admission, unplanned reoperation, prolonged postoperative length of hospital stay, and all-cause death.

Conclusions: Perioperative allogeneic RBC transfusion is associated with an increased risk of infection after clean-contaminated surgery in a dose-response manner. Close monitoring of infections and enhanced prophylactic strategies should be considered after transfusion.
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http://dx.doi.org/10.1016/j.bja.2021.05.031DOI Listing
July 2021

The nature and reported incidence of suspected perioperative allergic reactions: A cross-sectional survey.

J Clin Anesth 2021 Jun 23;74:110404. Epub 2021 Jun 23.

Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address:

Study Objective: Perioperative allergic reactions (POHs) are common and can lead to severe intraoperative instability and even mortality. In contrast to the situation in developed countries, where databases of perioperative anaphylaxis are well documented and analyzed, relevant data are lacking in China. Therefore, we aimed to conduct a national survey to explore the characteristics of perioperative allergic reactions, as well as the knowledge and attitudes toward management and reporting among anesthesiologists.

Design: Cross-sectional survey.

Setting: Anesthesia department.

Patients: A nationally representative sample comprising anesthesiologists from 12 province-level regions was selected.

Measurements: A 20-item questionnaire was designed and validated using the Delphi method. Survey distribution was performed between June 2019 and January 2020 by the Chinese Society of Anesthesiology (CSA), which is the official academic society of Chinese anesthesiologists. Responses were compiled and analyzed.

Main Results: We received responses from 4389 anesthesiologists across China. The estimated rate of suspected POH was 2/1000 patients (0.2%). On average, an anesthesiologist encountered 2.1 suspected POH cases per year. Neuromuscular blocking agents (NMBAs) were perceived as the most common causative agents, followed by antibiotics and succinylated gelatin. The rates of referral and allergy consultations were very low. Institutional support, including protocol development, cognitive aids, and tool kits, was not ideal. Additionally, the management of POH varied substantially. Most anesthesiologists believed that reporting and documenting POH was necessary.

Conclusions: Our survey revealed that POH is commonly encountered by Chinese anesthesiologists, but few patients are referred to allergy specialists or clinics for further investigation. A standardized recommendation based on research and data derived from Chinese patients is required.
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http://dx.doi.org/10.1016/j.jclinane.2021.110404DOI Listing
June 2021

Predictors of prolonged hypotension requiring vasopressor support after resection of pheochromocytoma and paraganglioma.

Clin Endocrinol (Oxf) 2021 Jun 23. Epub 2021 Jun 23.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Objective: Prolonged hypotension is a common complication after resection of pheochromocytoma (PCC) or paraganglioma (PGL). The objective of our study was to identify preoperative or intraoperative clinical factors that can predict prolonged hypotension after PCC/PGL resection.

Patients And Methods: A total of 414 patients who underwent resection of PCC or PGL at our institution between January 2013 and January 2020 were included. Patients were divided into two groups according to whether or not vasopressor support was required postoperatively. Associations between preoperative and intraoperative variables and prolonged hypotension were evaluated.

Results: Two hundred and one (48.6%) patients had postoperative hypotension that required vasopressor support with a median duration of 20 h. Multivariable analysis demonstrated that increased 24-h urinary norepinephrine (NE) levels (odds ratio [OR] = 1.091, 95% confidence interval [CI]: 1.052-1.132, p < .001), longer operative time (OR = 1.008, CI: 1.004-1.011, p < .001) and lower preoperative phenoxybenzamine dose (OR = 0.336, CI: 0.150-0.753, p = .008) were predictors of prolonged hypotension. Moreover, operative time, body mass index, 24-h urinary level of NE and preoperative phenoxybenzamine dose were significantly correlated with the duration of postoperative vasopressor support.

Conclusions: Increased urine NE level, longer operative time and lower preoperative phenoxybenzamine dose were predictors of prolonged hypotension requiring vasopressor support. Clinicians can identify these factors to manage their patients better and prevent severe complications.
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http://dx.doi.org/10.1111/cen.14542DOI Listing
June 2021

A retrospective cohort study on red blood cell morphology changes in pre-school age children under nitrous oxide anesthesia.

BMC Anesthesiol 2021 Jun 16;21(1):171. Epub 2021 Jun 16.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Megaloblastic anemia or bone marrow changes could occur after prolonged nitrous oxide inhalation via vitamin B inactivation related DNA synthesis impairment. Previous researches have studied hematological changes with nitrous oxide exposure, but only in adults or adolescents. Pre-school age children with active hematopoietic red bone marrow are more vulnerable to potential side effects of nitrous oxide and might experience growth impairment. The purpose of our study was to analyze red blood cell morphology changes under nitrous oxide anesthesia in pre-school age children.

Methods: One hundred thirty-six children under 5 years old scheduled for hemivertebra resection were analyzed. According to fresh gas type in anesthesia records, 71 children who received nitrous oxide in oxygen during anesthesia maintenance were categorized into the nitrous oxide group and the other 65 who received air in oxygen were the air group. Complete blood counts in perioperative period were assessed for anemia, macrocytosis, microcytosis, anisocytosis, hyperchromatosis and hypochromatosis. The peak value and change percentage were calculated for mean corpuscular volume and red cell distribution width.

Results: Forty-two children in the air group (64.6%) and 30 in the nitrous oxide group (42.3%) developed anemia (P = 0.009). None developed macrocytosis in both groups. Postoperative mean corpuscular volume peaked (mean [95% confidence interval]) at 83.7(82.9-84.4) fL, and 83.2(82.4-83.9) fL and postoperative red cell distribution width at 13.8% (13.4-14.2%), and 13.9% (13.6-14.2%) for the air group and the nitrous oxide group. Both the relative change of mean corpuscular volume (P = 0.810) and red cell distribution width (P = 0.456) were similar between the two groups.

Conclusions: No megaloblastic red blood cell changes were observed with nitrous oxide exposure for 4 h in pre-school age children undergoing hemivertebra resection.
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http://dx.doi.org/10.1186/s12871-021-01388-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207597PMC
June 2021

Lack of Spinal Neuropeptide Y Is Involved in Mechanical Itch in Aged Mice.

Front Aging Neurosci 2021 28;13:654761. Epub 2021 May 28.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Neuropeptide Y (NPY) signaling plays an essential role in gating the pruritic afferent information in the spinal cord. Recent studies revealed that the aging process down-regulated the expression of NPY in the central nervous system. We propose that the lack of spinal NPY may be involved in certain types of pruritus in the elderly population. This study was designed to investigate the role of NPY in aging-induced itch using the senile mouse model. The expression of NPY in the spinal dorsal horn was compared between young (2 months old) and aged (24 months old) mice. Western blotting and immunohistochemistry showed that the expression of NPY was significantly reduced in the spinal dorsal horn in aged mice. In addition, a neuronal maker of apoptosis, TUNEL, was detected in the NPY positive neurons only in the aged spinal cord. Behavioral assay indicated that light mechanical stimulus evoked significantly more scratching in the aged than in the young mice, whereas chemical-evoked itch and pain-related behaviors were not altered. Intrathecal injection of either NPY or LP-NPY, a NPY receptor 1 (NPY1R) agonist, significantly alleviated the mechanically evoked itch in aged mice without altering the responses to chemical pruritogens. Our study suggested that downregulation of spinal NPY in the aged mice might play a role in the higher incidence of the mechanically evoked itch than that in the young mice. Therapies targeting the NPY system might serve as a potential strategy for alleviating the pruritic symptoms among the elderly population.
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http://dx.doi.org/10.3389/fnagi.2021.654761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192807PMC
May 2021

Ultrasound-guided nusinersen administration for spinal muscular atrophy patients with severe scoliosis: an observational study.

Orphanet J Rare Dis 2021 06 13;16(1):274. Epub 2021 Jun 13.

Cardiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Shuaifuyuan 1#, Beijing, 100730, China.

Background: This observational study describes our experience delivering nusinersen through lumbar puncture with real-time ultrasound guidance in spinal muscular atrophy (SMA) patients with severe scoliosis.

Results: Intrathecal nusinersen via real-time ultrasound-guided lumbar puncture was given to three patients who had severe thoracic and lumbar scoliosis: a 34-year-old female with type 3a SMA, a 28-year-old male with type 2a SMA, and a 14-year-old girl with type 3a SMA. Lumbar puncture was performed without sedation under ultrasound guidance using a 22G echogenic needle in the interlaminar aspect of the L4-L5 or L5-S1 interspace and a full dose of nusinersen (12 mg/5 mL) was injected after visualizing free cerebrospinal fluid flow. Patients completed their four loading doses and one maintenance dose of nusinersen. All 15 procedures were successful and well tolerated.

Conclusions: Real-time ultrasound-guided lumbar puncture is an effective and radiation-free technique to administer intrathecal nusinersen in SMA patients with severe scoliosis when done by practitioners with expertise in this procedure.
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http://dx.doi.org/10.1186/s13023-021-01903-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201867PMC
June 2021

Use of double-lumen tube adaptor to enable cross-field two-lung ventilation through two endotracheal tubes in carinal tumor resection: A case report.

J Clin Anesth 2021 Oct 1;73:110357. Epub 2021 Jun 1.

Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China.

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http://dx.doi.org/10.1016/j.jclinane.2021.110357DOI Listing
October 2021

Ultrasound-guided supra-anterior superior iliac spine fascia iliaca compartment block with convex array transducer: A case series.

J Clin Anesth 2021 Sep 8;72:110276. Epub 2021 Apr 8.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

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http://dx.doi.org/10.1016/j.jclinane.2021.110276DOI Listing
September 2021

Identifying the Gap Between Novices and Experts in Fiberoptic Scope Control.

J Educ Perioper Med 2021 Jan-Mar;23(1):E655. Epub 2021 Jan 1.

Background: Fiberoptic intubation (FOI) is key in managing difficult airways. Good scope control increases efficiency and patient safety. Understanding the gap between novices and experts in scope control would help medical educators develop a feedback-based teaching approach for novices. We designed and used a checklist for evaluating the gap in fiberoptic scope control between novices and experts.

Methods: Twelve first-year anesthesiology residents (novice group) attended a lecture, followed by hands-on practice with a fiberoptic scope on a manikin. Five staff anesthesiologists (expert group) only did the hands-on practice. After practice, each participant was video-recorded while conducting an FOI on the manikin. Two senior anesthesiologists developed and used a 7-item checklist to assess the FOIs. Checklist scores and total times for FOIs were compared between groups using the Mann-Whitney test. Internal consistency of the checklist items, interrater reliability, and the relationship between checklist score and total time for FOI were assessed with Cronbach alpha, Cohen kappa, and the Pearson correlation coefficient, respectively.

Results: Experts had higher checklist scores than novices ( = .0016). The item with the lowest success rate for novices (50%) was keeping the scope straight. Novices spent more time on the FOI than experts ( = .0005). Cronbach alpha, Cohen kappa, and the Pearson correlation coefficient were 0.8699, 0.75, and -0.9454, respectively.

Conclusions: Our checklist was used to detect differences in fiberoptic scope control skills between novices and experts. With a video-based assessment method, it can be used to develop a feedback-based teaching method for fiberoptic scope control.
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http://dx.doi.org/10.46374/volxxiii_issue1_haobomaDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983185PMC
January 2021

Induction and maintenance of procedural sedation in adults: focus on remimazolam injection.

Expert Rev Clin Pharmacol 2021 Apr 17;14(4):411-426. Epub 2021 Mar 17.

Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.

: Procedural sedation (PS) is a humane way to help patients get through painful medical procedures by the administration of sedative drugs combined with analgesics. However, each of the currently used medications has certain shortcomings, urging the search for a new drug. Remimazolam, a novel benzodiazepine, is an ultra-short-acting hypnotic agent invented out of the 'soft drug' development.: This presented review provides an overview of the drugs used in clinical practice for the induction and maintenance of procedural sedation in adults, focusing on the newly investigated benzodiazepine remimazolam. Literature search was conducted using the MEDLINE and ClinicalTrial.gov databases from January 2007 to December 2020.: Based on the reported clinical trials so far, remimazolam has demonstrated its effectiveness and safety with promising properties including rapid onset, short duration of action, predictable and consistent recovery profile, metabolism almost unaffected by liver or renal function, with non or minimal cardiorespiratory depression, and availability with a reversal drug. With marketing approval received recently, remimazolam is expected to have a place in the practice for procedural sedation in the near future if its efficacy and safety are further confirmed by more clinical trials and post-market analyses.
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http://dx.doi.org/10.1080/17512433.2021.1901575DOI Listing
April 2021

Suppression of TLR4-MyD88 signaling pathway attenuated chronic mechanical pain in a rat model of endometriosis.

J Neuroinflammation 2021 Mar 5;18(1):65. Epub 2021 Mar 5.

Department of Human Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.

Background: As a classic innate immunity pathway, Toll-like receptor 4 (TLR4) signaling has been intensively investigated for its function of pathogen recognition. The receptor is located not only on immune cells but also on sensory neurons and spinal glia. Recent studies revealed the involvement of neuronal TLR4 in different types of pain. However, the specific role of TLR4 signaling in the pain symptom of endometriosis (EM) remains obscure.

Methods: The rat endometriosis model was established by transplanting uterine horn tissue into gastrocnemius. Western blotting and/or immunofluorescent staining were applied to detect high mobility group box 1 (HMGB1), TLR4, myeloid differentiation factor-88 adaptor protein (MyD88), and nuclear factor kappa-B-p65 (NF-κB-p65) expression, as well as the activation of astrocyte and microglia. The antagonist of TLR4 (LPS-RS-Ultra, LRU) and MyD88 homodimerization inhibitory peptide (MIP) were intrathecally administrated to assess the behavioral effects of blocking TLR4 signaling on endometriosis-related pain.

Results: Mechanical hyperalgesia was observed at the graft site, while HMGB1 was upregulated in the implanted uterine tissue, dorsal root ganglion (DRG), and spinal dorsal horn (SDH). Compared with sham group, upregulated TLR4, MyD88, and phosphorylated NF-κB-p65 were detected in the DRG and SDH in EM rats. The activation of astrocytes and microglia in the SDH was also confirmed in EM rats. Intrathecal application of LRU and MIP alleviated mechanical pain on the graft site of EM rats, with decreased phosphorylation of NF-κB-p65 in the DRG and reduced activation of glia in the SDH.

Conclusions: HMGB1-TLR4-MyD88 signaling pathway in the DRG and SDH may involve in endometriosis-related hyperpathia. Blockade of TLR4 and MyD88 might serve as a potential treatment for pain in endometriosis.
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http://dx.doi.org/10.1186/s12974-020-02066-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934423PMC
March 2021

Attenuation of Muscle Mass and Density Is Associated With Poor Outcomes Among Patients Undergoing Major Gynecologic Surgery: A Retrospective Cohort Study.

Anesth Analg 2021 06;132(6):1692-1699

From the Departments of Anesthesiology.

Background: The aim of this study was to explore the associations of preoperative sarcopenia (muscle mass depletion) and myosteatosis (muscle quality attenuation) with the incidence of postinduction hypotension (PIH) and postoperative complications among patients undergoing major gynecologic surgery.

Methods: Based on a previous prospective surgical registry of gynecologic patients, we included patients with an available preoperative abdominal computed tomography (CT) scan performed within 3 months before surgery. The cross-sectional muscle mass and density at the third lumbar vertebra (L3) level were measured from the CT scan. The primary outcome was PIH, which was defined as a blood pressure reduction >30% from baseline. The secondary outcome was postoperative complications based on the Clavien-Dindo classification. Multivariable logistic regression analyses were performed to identify the associations between the muscle parameters and outcomes.

Results: Of the 167 gynecologic surgical patients included in this study, the mean (standard deviation [SD]) age was 53.0 (12.2) years. Sarcopenia was present in 86 (51.5%) patients. Fifty-six (33.5%) patients experienced PIH, and 89 (53.3%) patients experienced different degrees of postoperative complications. Multivariable analysis showed that myosteatosis was significantly associated with an increased risk of PIH (odds ratio [OR] = 2.95, 95% confidence interval [CI], 1.24-7.04; P = .015), and sarcopenia was associated with an increased risk of postoperative complications (OR = 2.30; 95% CI, 1.16-4.57; P = .018).

Conclusions: Muscle assessments using preoperative CT scans may help identify high-risk patients and determine perioperative management strategies among gynecologic patients.
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http://dx.doi.org/10.1213/ANE.0000000000005380DOI Listing
June 2021

A fan-shape dynamic needle tip tracking technique combined with color doppler imaging function used in ultrasound-guided maxillary nerve block with an infra-zygomatic out-of-plane approach.

J Clin Anesth 2021 Jun 22;70:110169. Epub 2021 Jan 22.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

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http://dx.doi.org/10.1016/j.jclinane.2021.110169DOI Listing
June 2021

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study.

BMC Anesthesiol 2021 01 12;21(1):17. Epub 2021 Jan 12.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China.

Background: This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia.

Methods: This case-control study included surgical patients who underwent unplanned reintubation in the operating room and postanesthesia care unit after general anesthesia between January 1, 2014, and December 31, 2018. Cases due to AAC were matched 1:4 with randomly selected controls.

Results: A total of 123,068 patients were included, and reintubation due to AAC was performed in 36 patients (approximate incidence 0.03%). Univariable analysis revealed that male sex, age > 65, ASA physical status 3, sepsis, heart disease history, cerebral infarction history, Cormack Lehane grade, surgery type, fresh frozen plasma infusion, increased intubation duration, white blood cell count, and creatinine clearance rate were related to AAC-caused unplanned reintubation. Multivariable analysis revealed that age > 65 (OR = 7.50, 95% CI 2.47-22.81, P < 0.001), ASA physical status 3 (OR = 6.51, 95% CI 1.18-35.92, P = 0.032), head-neck surgery (OR = 4.94, 95% CI 1.33-18.36, P = 0.017) or thoracic surgery (OR = 12.56, 95% CI 2.93-53.90, P < 0.001) and a high fluid load (OR = 3.04, 95% CI 1.16-7.99, P = 0.024) were associated with AAC-caused unplanned reintubation. AAC-caused unplanned reintubation patients had longer postoperative hospital (OR = 5.26, 95% CI 1.57-8.95, P < 0.001) and intensive care unit days (OR = 3.94, 95% CI 1.69-6.18, P < 0.001).

Conclusions: Age > 65, ASA physical status 3, head-neck or thoracic surgery and high fluid load were found to be associated with AAC-caused unplanned reintubation.
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http://dx.doi.org/10.1186/s12871-021-01238-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802267PMC
January 2021

First annual report of Chinese haemovigilance network.

Vox Sang 2021 Jul 10;116(6):718-724. Epub 2021 Jan 10.

Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.

Background And Objectives: Haemovigilance involves surveillance of the whole chain of blood transfusion with the aim of identifying adverse events and errors and improving outcomes for patients. The Chinese Haemovigilance Network, founded in August 2017, has witnessed a rapid development in the last three years.

Materials And Methods: Based on the 1,022 cases in 2019, we analysed the adverse reactions (ARs) by blood component, clinical outcome severity and demography of recipients in an effort to publish the first annual Chinese haemovigilance report.

Results: The AR rate associated with blood transfusion in 2019 was 0·2% in China. Allergic reactions and FNHTR were the two most common adverse symptoms, accounting for 97·7% of the reports. Two-thirds of the TAD, AHTR and TACO and all of the HTR and DHTR resulted in hospitalization or prolongation of hospitalization. Plasma and AP were usually associated with allergic reaction (81·1%), whereas red cells more commonly cause FNHTR (68·8%) and all the AHTR, HTR, DSTR and DHTR. 84·1% of patients were aged 16 years or over, and the majority of the TAD, AHTR, TACO and HTR involved patients aged 60 and above. The ratio of serious adverse reactions (SARs) was 8·2%. Allergic reaction and FNHTR were top two (85·7%) SARs. The first case related to anti-D immunoglobulin was detected in a DHTR report.

Conclusion: This report provides the world's first overview of transfusion-related adverse reactions in China. This report is useful for better understanding transfusion risks in China.
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http://dx.doi.org/10.1111/vox.13059DOI Listing
July 2021

Neuromuscular Blockade Correlates with Hormones and Body Composition in Acromegaly.

Int J Endocrinol 2020 9;2020:2912839. Epub 2020 Dec 9.

Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng, Beijing 100730, China.

Tumor resection is the first-line therapy for acromegaly patients. In some cases, unsatisfactory intraoperative neuromuscular blockades (NMBs) lead to failed operations. The purpose of this study was to investigate and quantify the NMB status of acromegaly patients and explore the relationship between NMB status and hormone levels and body composition. Twenty patients with untreated acromegaly and seventeen patients with nonfunctioning pituitary adenomas as controls were enrolled in this study. NMB was assessed using the train-of-four (TOF) technique with TOF-Watch® SX. The onset time of NMB, deep neuromuscular blockade duration (DNMBD), and clinical neuromuscular blockade duration (CNMBD) were monitored. We found a significantly longer onset time (110.25 ± 54.90 vs. 75.00 ± 27.56, s, =0.017), shorter DNMBD (21.99 ± 5.67 vs. 34.96 ± 11.04, min, < 0.001), and shorter CNMBD (33.26 ± 8.09 vs. 46.21 ± 10.89, min, < 0.001) in acromegaly patients compared with the controls. DNMBD and CNMBD decreased in patients with decreasing body fat percentage and increasing growth hormone (GH) level, insulin-like growth factor 1 (IGF-1) level, and GH and IGF-1 burden. The onset time increased with increasing IGF-1 level and GH and IGF-1 burden. Taken together, a unique NMB status was identified in acromegaly patients with the following characteristics: prolonged onset time and shortened DNMBD and CNMBD. Changes in the levels and burdens of GH and IGF-1 and body composition were linearly correlated with intraoperative NMB in acromegaly patients.
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http://dx.doi.org/10.1155/2020/2912839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752264PMC
December 2020

Composition and risk assessment of perioperative patient safety incidents reported by anesthesiologists from 2009 to 2019: a single-center retrospective cohort study.

BMC Anesthesiol 2021 01 7;21(1). Epub 2021 Jan 7.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China.

Background: Patient safety incident (PSI) reporting has been an important means of improving patient safety and enhancing organizational quality control. Reports of anesthesia-related incidents are of great value for analysis to improve perioperative patient safety. However, the utilization of incident data is far from sufficient, especially in developing countries such as China.

Methods: All PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and August 2019 were collected from the incident reporting system. We reviewed the freeform text reports, supplemented with information from the patient medical record system. Composition analysis and risk assessment were performed.

Results: In total, 847 PSIs were voluntarily reported by anesthesiologists during the study period among 452,974 anesthetic procedures, with a reported incidence of 0.17%. Patients with a worse ASA physical status were more likely to be involved in a PSI. The most common type of incident was related to the airway (N = 208, 27%), followed by the heart, brain and vascular system (N = 99, 13%) and pharmacological incidents (N = 79, 10%). Those preventable incidents with extreme or high risk were identified through risk assessment to serve as a reference for the implementation of more standard operating procedures by the department.

Conclusions: This study describes the characteristics of 847 PSIs voluntarily reported by anesthesiologists within eleven years in a Chinese academic hospital. Airway incidents constitute the majority of incidents reported by anesthesiologists. Underreporting is common in China, and the importance of summarizing and utilizing anesthesia incident data should be scrutinized.
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http://dx.doi.org/10.1186/s12871-020-01226-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789294PMC
January 2021

Ultrasound Measured Depth of Pelvic Free Fluid Correlates Well with Blood Loss Volume in Patients with Ectopic Pregnancy.

Emerg Med Int 2020 10;2020:8874581. Epub 2020 Dec 10.

Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China.

Purpose: The ultrasonic finding of pelvic free fluid which suggests the possibility of internal haemorrhage helps the determination of the severity of patients.

Methods: We conducted a retrospective study investigating ultrasonic measurements and haemorrhage volumes in patients having an ectopic pregnancy in a single centre from January 2013 to November 2016. The logistic regression model was used to establish the prediction model for haemorrhage volumes. The diagnostic accuracy was evaluated by area under ROC curve (AUC) analysis. We employed 800 ml as the cut-off point of the haemorrhage and further set it to 1000 ml and 1200 ml in the sensitivity analysis.

Results: The mean pelvic free fluid depths measured by TVS and TAS were 4.45 ± 2.15 cm and 4.45 ± 2.56 cm in the haemorrhage ≥800 ml group, while they were 2.48 ± 1.51 cm and 2.55 ± 1.19 cm in <800 ml group. AUCs and the corresponding cut-off points were 0.741 (95% CI 0.677 to 0.804) and 0.118 when predicted by the standardised depths of TVS and TAS, 0.784 (95% CI 0.696-0.872) and 2.95 cm by the raw depths of TVS, and 0.748 (95% CI 0.665-0.831) and 3.35 cm by the raw depths of TAS.

Conclusions: The depth of pelvic free fluid measured by TVS and TAS can be used to predict blood loss volume in patients having an ectopic pregnancy. TVS may perform better than TAS.
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http://dx.doi.org/10.1155/2020/8874581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746468PMC
December 2020

Validation of a Novel NeurOs Cerebral Oximetry Monitor Against the INVOS Monitor During Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 Jul 27;35(7):2009-2018. Epub 2020 Oct 27.

Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY. Electronic address:

Objectives: To compare the performance of a novel NeurOs cerebral oximetry monitor against the INVOS monitor during the entire intraoperative phase of cardiac surgery, including periods of known fluctuation in brain oxygenation, such as preoxygenation, induction, cannulation, and cardiopulmonary bypass.

Design: This study was a prospective, nonrandomized, healthcare-provider and outcome-assessor blinded study.

Setting: Tertiary care university hospital; single institutional study.

Participants: Twenty-three patients who underwent cardiac surgery with cardiopulmonary bypass.

Interventions: Both self-adhesive INVOS sensors and the assembled NeurOs sensors were placed accordingly when the patient arrived in the operating room.

Measurements And Main Results: Ten out of 13 cases under the normal mode and eight out of the 10 cases under the high- sensitivity mode showed significant correlations between the NeurOs and INVOS groups (p < 0.05, r value from 0.24-0.88). When all cases were combined, NeurOs demonstrated significant correlation with INVOS (r = 0.5, 95% confidence interval [CI] 0.44-0.56, p < 0.01 for normal mode; r = 0.69, 95% CI 0.64 to 0.74, p < 0.01 for high-sensitivity mode) in both modes. To evaluate the data diversity, the authors performed a cluster analysis and found much less variation existed in the NeurOs normal mode when compared with INVOS (standard deviation [SD] 16.6% in INVOS, 4% in NeurOs normal mode) but similar patterns in the high-sensitivity mode (SD 17.6% in INVOS, 15.2% in NeurOs high-sensitivity mode). Bland-Altman plot analysis showed that most of the data fell between ± 1.96 SD lines, which demonstrated good consistency between these two methods under both modes of NeurOs (-28.8 to 30.8 in the normal mode; -36.6 to 32.7 in high-sensitivity mode). In the normal mode of NeurOs monitoring, receiver operating characteristic analysis suggested a 2% cutoff point was most optimal from the baseline for detecting hyperoxia (sensitivity 73%; specificity 66%) and minus 1% (sensitivity 66%; specificity 67%) for detecting hypoxia. Whereas in the high-sensitivity mode, the optimal cutoff point was 3% from baseline for detecting hyperoxia (sensitivity 75%; specificity 68%), and minus 3% for detecting hypoxia (sensitivity 90%; specificity 45%).

Conclusions: In conclusion, the novel NeurOs system was found to correlate with INVOS cerebral oximetry measurements during cardiac surgery.
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http://dx.doi.org/10.1053/j.jvca.2020.10.043DOI Listing
July 2021

[Advances in the Pathogenesis,Prevention,and Treatment of Transfusion-related Acute Lung Injury].

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020 Oct;42(5):674-680

Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

Transfusion-related acute lung injury(TRALI)is a severe pulmonary complication of transfusion and has been one of the leading causes of transfusion-associated deaths.However,the pathogenesis of TRALI is still unclear,and treatment and prevention of this condition also face huge challenges.Many recent studies have explored the roles of various effector cells and effector molecules in TRALI and possible related mechanisms based on various hypotheses,in order to find the key factors that induce TRALI and the potential prevention measures.This article reviews the pathogenesis,prevention,and treatment of TRALI.
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http://dx.doi.org/10.3881/j.issn.1000-503X.11413DOI Listing
October 2020

Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study.

Anesth Analg 2020 11;131(5):1573-1581

From the Department of Anesthesiology and.

Background: It remains unclear whether the benefits of performing perioperative allogeneic red blood cell (RBC) transfusion outweigh the risks of postoperative wound infection. The aim of this study was to assess the impact of perioperative RBC transfusion as well as dose-response relationship on wound infections in surgical patients in a large cohort.

Methods: As a retrospective observational study, the national Hospital Quality Monitoring System database was used to retrieve information about in-hospital surgical patients without limitations on surgical types in the People's Republic of China between 2013 and 2018. Patients were divided into the perioperative RBC transfusion and non-RBC transfusion groups, and wound infection rates (the primary end point) were compared. Secondary end points included in-hospital mortality, nosocomial infections, and length of hospital stay. Furthermore, patients who underwent RBC transfusion were subdivided into 6 groups based on the volume of transfused RBCs to investigate the dose-response relationship between RBC transfusions and wound infections. The association between RBC transfusion and patient outcomes were analyzed using multivariable logistic regression models adjusted for potential confounders.

Results: A total of 1,896,584 patients from 29 provinces were included, among whom 76,078 (4.0%) underwent RBC transfusions; the overall wound infection rate was 0.7%. After adjusting for confounding factors, perioperative RBC transfusion was associated with higher odds of wound infection (odds ratio [OR] = 2.24, 95% confidence interval [CI], 2.09-2.40; P < .001). As the volume of transfused RBCs increased, so did the odds of wound infection with a clear dose-response relationship (OR of >0 and ≤1 U, >1 and ≤2 U, >2 and ≤4 U, >4 and ≤8 U, >8 U transfusion compared with no RBC transfusion were 1.20, 95% CI, 0.76-1.91; 1.27, 95% CI, 1.10-1.47; 1.70, 95% CI, 1.49-1.93; 2.12, 95% CI, 1.83-2.45 and 3.65, 95% CI, 3.13-4.25, respectively). RBC transfusion was also found to be associated with higher odds of in-hospital mortality, nosocomial infection, and longer hospital stay.

Conclusions: RBC transfusion was associated with an increased odd of postoperative wound infection in surgical patients, and a significant dose-related relationship was also observed. While there are still essential confounders not adjusted for and the results do not necessarily indicate a causal relationship, we still recommend to lessen perioperative blood loss and optimize blood conservation strategies.
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http://dx.doi.org/10.1213/ANE.0000000000005122DOI Listing
November 2020

Liposomal Bupivacaine-Based Erector Spinae Block for Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 05 20;35(5):1555-1559. Epub 2020 Sep 20.

Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.

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http://dx.doi.org/10.1053/j.jvca.2020.09.115DOI Listing
May 2021

Continuous block at the proximal end of the adductor canal provides better analgesia compared to that at the middle of the canal after total knee arthroplasty: a randomized, double-blind, controlled trial.

BMC Anesthesiol 2020 10 9;20(1):260. Epub 2020 Oct 9.

Anesthesiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, China.

Background: The optimal position for continuous adductor canal block (ACB) for analgesia after total knee anthroplasty (TKA) remians controversial, mainly due to high variability in the localization of the the adductor canal (AC). Latest neuroanatomy studies show that the nerve to vastus medialis plays an important role in innervating the anteromedial aspect of the knee and dives outside of the exact AC at the proximal end of the AC. Therefore, we hypothesized that continuous ACB at the proximal end of the exact AC could provide a better analgesic effect after TKA compared with that at the middle of the AC (which appeared to only block the saphenous nerve).

Methods: Sixty-two adult patients who were scheduled for a unilateral TKA were randomized to receive continuous ACB at the proximal end or middle of the AC. All patients received patient-controlled intravenous analgesia with sufentanil postoperatively. The primary outcome measure was cumulative sufentanil consumption within 24 h after the surgery, which was analyzed using Mann-Whitney U tests. P-values < 0.05 (two-sided) were considered statistically significant. The secondary outcomes included postoperative sufentanil consumption at other time points, pain at rest and during passive knee flexion, quadriceps motor strength, and other recovery related paramaters.

Results: Sixty patients eventually completed the study (30/group). The 24-h sufentanil consumption was 0.22 μg/kg (interquartile range [IQR]: 0.15-0.40 μg/kg) and 0.39 μg/kg (IQR: 0.23-0.52 μg/kg) in the proximal end and middle groups (P = 0.026), respectively. There were no significant inter-group differences in sufentanil consumption at other time points, pain at rest and during passive knee flexion, quadriceps motor strength, and other recovery related paramaters.

Conclusions: Continuous ACB at the proximal end of the AC has a better opioid-sparing effect without a significant influence on quadriceps motor strength compared to that at the middle of the AC after TKA. These findings indicates that a true ACB may not produce the effective analgesia, instead, the proximal end AC might be a more suitable block to alleviate pain after TKA.

Trial Registration: This study was registered at ClinicalTrials.gov ( NCT03942133 ; registration date: May 06, 2019; enrollment date: May 11, 2019).
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http://dx.doi.org/10.1186/s12871-020-01165-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545931PMC
October 2020

Perioperative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial.

BMJ Open 2020 10 8;10(10):e037879. Epub 2020 Oct 8.

Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.

Introduction: Both regional analgesia and intravenous analgesia are frequently used perioperatively for patients with critical limb ischaemia (CLI). Nevertheless, the comparison of perioperative effect of regional and intravenous analgesia has not yet been thoroughly illustrated. This study will comprehensively compare patient-controlled regional analgesia (PCRA) and patient-controlled intravenous analgesia (PCIA) as two different perioperative analgesia approaches for patients with CLI. It investigates their effects on analgesia, reperfusion and the quality of recovery perioperatively, also aims to provide clinical evidence to those non-surgical patients with non-reconstructable arteries.

Methods And Analysis: This trial is a randomised, single-centre, open-label, parallel trial with target sample size of 52 in total. Eligible participants will be randomly allocated to the PCRA group (group R) or the PCIA group (group I) after admission. Participants in group R will receive ultrasound-guided subgluteal sciatic catheterisation, followed by continuous PCRA infusion (0.2% ropivacaine 15 mL as loading dose, 8 mL/hour as background with a patient-controlled bolus of 6 mL). Participants in group I will receive PCIA (morphine is given in boluses of 1 mg as needed, background infusion at 1 mg/hour). Data will be collected at baseline (T0), 2 hours before revascularisation treatment (T1) and 2 hours before discharge (T2). The primary outcomes include the Numerical Rating Scale pain score at T1 and T2. The secondary outcomes include the perioperative transcutaneous oxygen pressure, the Tissue Haemoglobin Index, Hospital Anxiety and Depression Scale at T1 and T2; the Patient Global Impression of Change and patient satisfaction at T1 and T2; the perioperative cumulative morphine consumption, the length of postoperative hospital stay and adverse events.

Ethics And Dissemination: This study received authorisation from the Institutional Review Board of Peking Union Medical College Hospital on 21 March 2017 (approval no. ZS-1289X). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

Trial Registration Number: Chinese Clinical Trial Registry (ChiCTR2000029298).

Protocol Version: V.4CP.B2 (15 June 2020).
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http://dx.doi.org/10.1136/bmjopen-2020-037879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545635PMC
October 2020

Corrigendum to 'N-methyl-d-aspartate receptor subunit 2B on keratinocyte mediates peripheral and central sensitization in chronic post-ischemic pain in male rats' [Brain Behav. Immun. 87 (2020) 579-590].

Brain Behav Immun 2021 Jan 5;91:799-800. Epub 2020 Oct 5.

Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China.

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http://dx.doi.org/10.1016/j.bbi.2020.09.019DOI Listing
January 2021

Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial.

BMC Anesthesiol 2020 09 14;20(1):231. Epub 2020 Sep 14.

Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

Background: Ultrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques.

Methods: A total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures.

Results: The first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86-1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3-109.4) seconds] than in the AD group [47.6 (24.9-103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42-0.82).

Conclusions: There were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group.

Trial Registration: The trial was registered at www.clinicaltrials.gov (No: NCT03656978 ). Registered 4 September 2018.
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http://dx.doi.org/10.1186/s12871-020-01152-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491138PMC
September 2020

The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial.

Am J Transl Res 2020 15;12(8):4594-4603. Epub 2020 Aug 15.

Department of Anesthesiology, Henan Provincial People's Hospital Zhengzhou 450003, Henan, China.

This study aimed to evaluate the efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy. In this multicentered, blinded, randomized, active-controlled, non-inferior phase III trial, 384 eligible patients who were about to undergo colonoscopy were randomized as a ratio of 1:1 into remimazolam and propofol group. Procedure success was assessed and defined as the completion of colonoscopy without administration of rescue sedative agent or more than 5 top-ups of trial drug in any 15 minute-period after initial administration of trial drug. Sedation quality was evaluated by Modified Observer's Assessment of Alertness/Sedation score. Treatment-emergent adverse events were recorded. Procedure success rate was 96.91% (188/194) in remimazolam group and 100% (190/190) in propofol group, and the difference in rate was -3.09% with 95% confidence interval (CI) of -5.53%~-0.66%. Since the lower limit of 95% CI was greater than the non-inferiority margin of -8.00%, the efficacy of remimazolam tosylate was non-inferior to propofol. Besides, induction time of sedation was increased (<0.001), while hypotension and respiratory depression was decreased in remimazolam group compared to propofol group; however, time to fully alert (>0.05) or time to discharge (>0.05) were unchanged. For safety assessment, total treatment-emergent adverse events were decreased in remimazolam group compared to propofol group (<0.001); specifically, administration site pain (<0.001), increased bilirubin (=0.019), decreased respiratory rate (<0.001) and decreased SpO (<0.001) were less frequent in remimazolam group compared with propofol group. In conclusion, remimazolam tosylate is non-inferior in sedation efficacy while safer than propofol in patients undergoing colonoscopy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476156PMC
August 2020

Perioperative Cardiac Complications in Patients Over 80 Years of Age with Coronary Artery Disease Undergoing Noncardiac Surgery: The Incidence and Risk Factors.

Clin Interv Aging 2020 17;15:1181-1191. Epub 2020 Jul 17.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China.

Purpose: Ever-increasing noncardiac surgeries are performed in patients aged 80 years or over with coronary artery disease (CAD). The objective of the study was to explore the incidence and risk factors of perioperative cardiac complications (PCCs) for the oldest-old patients with CAD undergoing noncardiac surgery, which have not been evaluated previously.

Patients And Methods: A total of 547 patients, aged over 80 years, with a history of CAD who underwent noncardiac surgery were enrolled in this retrospective study. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCCs intraoperatively or within 30 days postoperatively, defined as any of the following complications: acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Multivariate logistic regression analysis and multivariate Cox regression model were both performed to estimate the risk factors of PCCs. The incidence of PCCs overtime was illustrated by the Kaplan-Meier curve with a stratified Log-rank test.

Results: One hundred six (19.4%) patients developed at least one PCC, and 15 (2.7%) patients developed cardiac death. The independent risk factors contributing to PCCs were age ≧85 years; body mass index ≧30 kg/m; the history of angina within 6 months; metabolic equivalents <4; hypertension without regular treatment; preoperative ST-T segment abnormality; anesthesia time >3 h and drainage ≧200 mL within 24 h postoperatively.

Conclusion: The incidence of PCCs in elderly patients over 80 years with CAD who underwent noncardiac surgery was high. Comprehensive preoperative evaluation, skilled surgical technique, and regular postoperative monitoring may help to reduce the occurrence of PCCs in this high-risk population.
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http://dx.doi.org/10.2147/CIA.S252160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398882PMC
December 2020

Anesthesia Considerations and Infection Precautions for Trauma and Acute Care Cases During the COVID-19 Pandemic: Recommendations From a Task Force of the Chinese Society of Anesthesiology.

Anesth Analg 2020 08;131(2):326-334

From the Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. During the ongoing COVID-19 epidemic, most hospitals have postponed elective surgeries. However, some emergency surgeries, especially for trauma patients, are inevitable. For patients with suspected or confirmed COVID-19, a standard protocol addressing preoperative preparation, intraoperative management, and postoperative surveillance should be implemented to avoid nosocomial infection and ensure the safety of patients and the health care workforce. With reference to the guidelines and recommendations issued by the National Health Commission and Chinese Society of Anesthesiology, this article provides recommendations for anesthesia management of trauma and emergency surgery cases during the COVID-19 pandemic.
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http://dx.doi.org/10.1213/ANE.0000000000004913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199776PMC
August 2020

[Effects of N-methyl-D-aspartate Receptor in Keratinocyte on TypeⅠComplex Regional Pain Syndrome].

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020 Jun;42(3):338-346

Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

To observe the cell origin of N-methyl-D-aspartic acid(NMDA)receptor expression in skin after chronic ischemic pain modeling in rats and explore the role of NMDA receptor in type Ⅰ complex regional pain syndrome. Forty-two adult male Sprague-Dawley rats were randomly divided into five groups:sham operation group(=12),chronic post ischemia pain(CPIP)group(=12),CPIP+normal saline(NS)group(=6),CPIP+NMDA group(=6),and CPIP+MK801 group(=6).Six rats in the sham operation group and CPIP group were sacrificed under deep anesthesia one day after modeling.The plantar skin and L3-L5 spinal cord tissue were used for NR1(NMDA receptor)subunit immunofluorescence detection and for Western blotting of NR1,interleukin(IL)-1β,and tumor necrosis factor(TNF)-α.For the remaining rats,the mechanical withdrawal threshold(MWT)values on the 2nd,6th,10th and 14th day after ischemia were recorded,and the corresponding drugs were injected subcutaneously from the 6th day after ischemia.The skin and L3-L5 spinal cords were collected on the 14th day,and the same detection methods were applied. Compared with the sham operation group,the CPIP group had significantly higher expressions of NR1(1.708±0.064;=12.120, <0.001),IL-1β(2.575±0.305;=5.158, =0.003),and TNF-α(2.691±0.217;=7.786, <0.001)in the skin on the first day after modeling.After intervention with NMDA and MK801,the MWT value was [(20.37±0.95)g] in the CPIP+NS group,which was significantly higher than that in CPIP+NMDA group [(15.85±1.09)g;=10.920, <0.001] but significantly lower than that in CPIP+MK801 group[(22.95±0.96)g;=6.421, <0.001] 10 days after modeling.On the 14th day,compared with the MWT of the CPIP+NS group [(21.57±0.96)g],the CPIP+NMDA group had significantly decreased MWT value [(16.53±1.63)g;=12.190, <0.001],and the CPIP+MK801 group had significantly increased MWT value [(23.27±1.28)g;=4.094, =0.025].Compared with the sham operation group,the CPIP group had significantly increased NR1 expression(1.708±0.064;=10.910, <0.001)and the CPIP+NS group had significantly increased expressions of IL-1β(2.518±0.147;=11.010, <0.001)and TNF-α(1.949±0.184;=10.870, <0.001).Compared with the CPIP+NS group,the CPIP+NMDA group had significantly increased expressions of IL-1β(4.816±0.607;=16.670, =0.003)and TNF-α(2.629±0.349;=7.790, <0.001)and the CPIP+MK801 group had significantly decreased expressions of IL-1β(1.048±0.257;=10.660, =0.003)and TNF-α(0.790±0.165;=13.280, <0.001). NMDA receptor activation in skin keratinocytes after chronic ischemia in rats hinders the expression of inflammatory cytokines such as IL-1β and TNF-α,which may be involved in central sensitization and pain conduction of type Ⅰ complex regional pain syndrome.
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http://dx.doi.org/10.3881/j.issn.1000-503X.12002DOI Listing
June 2020