Gang Chen

Background: Stellate ganglion block (SGB) may reduce postoperative atrial fibrillation (POAF) by modulating the autonomic nervous system. This study evaluated the efficacy of preoperative SGB in preventing POAF following cardiac surgery. Methods: In this single‐center, randomized, double‐blind, placebo‐controlled trial, 140 patients undergoing valve surgery with cardiopulmonary bypass were assigned (1:1) to ultrasound‐guided right SGB with 7 mL of 0.5% ropivacaine or 7 mL of normal saline. The primary outcome was the incidence of POAF from postoperative day 0 to day 7 or until discharge. Results: A total of 132 patients completed the study and were included in the modified intention‐to‐treat population (SGB group: n=65; saline group: n=67). POAF occurred in 43% of the SGB group and 40% of the saline group (odds ratio [OR], 0.99 [95% CI, 0.46–2.15], adjusted P =0.989). The SGB group demonstrated a lower incidence of intraoperative ventricular fibrillation/ventricular tachycardia requiring defibrillation after aortic cross‐clamp release (6% versus 19%; OR, 0.21 [95% CI, 0.06–0.80]; adjusted P =0.022), lower postoperative high‐sensitivity troponin I levels (median difference: −2562 ng/L [95% CI, −4301 to −45]; P =0.045), and a reduced risk of postoperative acute kidney injury (5% versus 18%; OR, 0.24 [95% CI, 0.06–0.98]; adjusted P =0.046). Conclusions: While preoperative SGB did not reduce the incidence of POAF, it was associated with potential benefits, including a lower requirement for intraoperative defibrillation attributable to ventricular arrhythmias, attenuated myocardial injury (as indicated by lower high‐sensitivity troponin I levels), and a decreased risk of postoperative acute kidney injury. Registration: URL: https://www.chictr.org.cn ; URL Identifier: ChiCTR2300068572.

Objectives: Transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed as a non-pharmacological intervention for postoperative pain, but its effects remain unclear. We conducted this study to evaluate the efficacy and safety of taVNS for postoperative pain management. Methods: A systematic literature search was performed in PubMed, Embase, the Cochrane Library, and Web of Science. Randomized controlled trials comparing perioperative taVNS with sham stimulation implemented using inactive electrical output, electrical insulation, transient stimulation followed by deactivation, or electrode placement at presumed non-vagal auricular sites in adult surgical patients were included. The review protocol was prospectively registered in PROSPERO (CRD420251129040). Outcomes included postoperative pain scores, postoperative opioid consumption, proportion of patients requiring rescue analgesia, incidence of rebound pain, and incidence of postoperative nausea and vomiting (PONV). Standardized mean differences (SMD) or mean differences (MD) with 95% confidence intervals (CI) were calculated for continuous outcomes, and risk ratios (RR) for dichotomous outcomes, using random-effects models. Results: Seven studies (684 patients) were included in the meta-analysis. The results showed that taVNS significantly reduced postoperative pain scores at early (MD − 0.79, 95% CI − 1.02 to − 0.56), middle (MD − 0.77, 95% CI − 1.10 to − 0.43), and late (MD − 0.88, 95% CI − 1.06 to − 0.70) time points. Postoperative opioid consumption was not significantly different between the taVNS and sham groups (SMD − 0.69, 95% CI − 1.40 to 0.03). taVNS reduced the need for rescue analgesia and the incidence of rebound pain and was associated with a borderline lower incidence of PONV. Conclusion: Perioperative taVNS may reduce postoperative pain intensity and the incidence of rescue analgesia, rebound pain, and PONV; however, it was not associated with a statistically significant reduction in postoperative opioid consumption. Given the moderate-to-very-low certainty of evidence and the exclusively Chinese origin of the included trials, larger multicentre and multinational RCTs using standardized stimulation and sham protocols are required before routine clinical adoption.

Primary palmar hyperhidrosis (PPH) is a chronic autonomic nervous system dysfunction characterized by excessive sweating of the palms beyond physiological needs, with a prevalence ranging from 1% t...

Dermatomyositis (DM) is a rare autoimmune disease, and its subtypes exhibit considerable heterogeneity in perioperative risk. The anti-transcription intermediary factor 1-gamma (TIF1-γ) antibody–positive subtype is particularly associated with an increased risk of underlying malignancy and poses unique anesthetic challenges because of its potential multisystem involvement. We report the perioperative anesthetic management of a 47-year-old woman with TIF1-γ antibody–positive DM complicated by breast cancer who underwent a modified radical mastectomy. The patient presented with classic cutaneous manifestations, proximal myopathy, and oropharyngeal dysphagia. Comprehensive pre-operative anesthetic assessment and meticulous perioperative management contributed to an uneventful surgical course and favorable outcome. This case highlights the marked clinical heterogeneity of DM subtypes and the corresponding differences in perioperative anesthetic risk. It also underscores the importance of recognizing the potential multisystem involvement of DM in patients undergoing anesthesia. Thorough pre-operative evaluation and individualized anesthetic management are therefore essential for optimizing perioperative outcomes.

Early-life sevoflurane exposure is associated with long-term cognitive deficits. Given that hippocampal development relies on precise critical windows, disruption of developmental processes during these periods is likely the origin of these impairments. However, the molecular mechanisms underlying sevoflurane-induced perturbations during critical development periods and their progression to lasting cognitive dysfunction remain elusive. Here, we determined that the first three postnatal weeks are a critical window of vulnerability to early-life sevoflurane exposure. Mechanistically, sevoflurane exposure suppressed the physiological upregulation of activity-regulated cytoskeleton-associated protein (Arc; also known as Arg3.1) during the critical period of hippocampal development, a process driven by glycogen synthase kinase-3 beta (GSK3β)-mediated protein degradation. We demonstrated that transient suppression of Arc via hippocampal injection of Arc antisense oligonucleotide (ASO) during the third postnatal week was sufficient to recapitulate the sevoflurane-induced phenotype, impairing microglial synaptic pruning and causing initial synaptic redundancy. This early pathology subsequently evolved into aberrant microglial phagocytic activation in adolescence and adulthood, resulting in excessive synaptic loss and cognitive deficits. Crucially, restoration of Arc expression specifically during this critical period using a doxycycline (Dox)-inducible Tet-On system successfully reversed this pathological pruning trajectory and prevented long-term cognitive impairment. Our findings highlight that Arc upregulation during this critical period is essential for microglial function and synaptic homeostasis, establishing Arc as a time-sensitive therapeutic target for preventing the developmental neurotoxicity associated with pediatric anesthesia. This diagram illustrates the role of the Arc protein in microglial synaptic pruning and cognitive development under physiological conditions (upper panel, blue; Arc is highly expressed during the critical period) and sevoflurane exposure (lower panel, red; Arc expression during the critical period is downregulated). Under normal conditions, Arc is expressed during the critical period and is localized to synapses, where it facilitates the tagging of redundant synapses for elimination. Synaptic pruning peaks during the critical period, followed by further refinement during adolescence, leading to mature cognitive function in adulthood. Neonatal sevoflurane exposure leads to aberrant activation of GSK3β during the critical period. This promotes Arc degradation, thereby disrupting its synaptic localization. This leads to microglial dysfunction in terms of synaptic engulfment. In adolescence, this disruption leads to excessive microglial phagocytosis and significant synaptic loss, ultimately resulting in cognitive deficits. Graphical elements: GSK3β, green circles; Arc, orange circles; phosphorylation site, pale yellow circle containing the letter "P"; C1q, yellow umbrella shapes.

Background: Prophylactic antiemetics are routinely used in gastrointestinal surgery. This study investigated whether granisetron pretreatment alters norepinephrine requirements for preventing post-induction hypotension in elderly patients. Methods: In this randomized double-blind trial, 64 patients (60– 74 years) undergoing laparoscopic gastrointestinal resection received intravenous granisetron (3 mg) or saline placebo before induction. The 50% effective dose (ED₅₀) of norepinephrine to prevent hypotension (> 20% decrease in mean arterial pressure) within 30 min post-induction was determined using the up-down sequential method, with probit regression as confirmatory analysis. Results: Baseline characteristics were comparable between the two groups. The up-down sequential analysis revealed that the ED₅₀ of norepinephrine was significantly lower in the granisetron group (0.037 μg/kg/min [95% CI 0.031– 0.040 μg/kg/min]) than in the control group (0.049 μg/kg/min [95% CI 0.043– 0.052 μg/kg/min]) (P < 0.001) representing an approximate 24% reduction. This finding was supported by probit regression analysis, which estimated ED₅₀ values of 0.040 μg/kg/min [95% CI 0.033– 0.051 μg/kg/min] and 0.052 μg/kg/min [95% CI 0.045– 0.064 μg/kg/min] for the granisetron and control groups, respectively. No significant difference was observed in the incidence of postoperative nausea and vomiting between the two groups. Conclusion: Granisetron pretreatment significantly reduces the ED₅₀ of norepinephrine required to prevent post-induction hypotension in elderly patients by approximately 24% indicating a pharmacodynamic interaction consistent with enhanced vasopressor efficacy. These findings indicate that pre-induction antiemetic administration may represent a potentially favorable timing strategy.

Hypoxemia occurs in people living with obesity undergoing gastroscopy under intravenous anesthesia. Preventing hypoxia in people living with obesity with appropriate anesthetics is therefore important. This study aims to compare the safety and efficacy of ciprofol versus propofol, both combined with sufentanil, for sedation during gastroscopy in people living with obesity. This prospective, randomized, controlled trial was conducted at the Endoscopic Center of Hangzhou Red Cross Hospital. Between August 2023 and August 2024, 652 patients were assessed for eligibility. Subsequently, Patients aged 18-65 years, classified as American Society of Anesthesiologists II, with a body mass index (BMI) between 30 and 40 kg/m², were enrolled. Participants were randomly assigned to receive either ciprofol or propofol, both combined with sufentanil, during their gastroscopy. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300074217). The primary outcome, hypoxemia, occurred in 34.3% of propofol patients vs 19.1% with ciprofol (absolute difference 15.2%; 95% CI 4.9--29.9%). For secondary outcomes, the propofol group experienced significantly more apnea episodes (17.9% vs 5.9%; absolute difference 12%; 95% CI 1.3% to 22.8%) and lower minimum SpO₂ values (90 [80 to 95] vs 93 [90 to 97]; absolute difference --3; 95% CI --8 to 1). Endoscopist satisfaction was higher with ciprofol (4 [3 to 5] vs 5 [4 to 5]; absolute difference --1; 95% CI --1 to 0), and injection pain was significantly more frequent in the propofol group (26.9% vs 1.5%; absolute difference 25.4%; 95% CI 14.4% to 36.4%). Ciprofol combined with sufentanil for gastroscopy sedation in people living with obesity, results in lower incidences of hypoxemia and injection pain, shorter apnea duration, and higher endoscopist satisfaction compared to propofol. Chinese Clinical Trial Registry: ChiCTR2300074217; 2023/08/01.