Volume 102 ·  Issue 21 ·  2022

With the continuous update of anesthesia techniques, equipment and research field, the techniques and concepts of anesthesia in eye and ear-nose-throat (ENT) surgery are constantly optimized and developed. Eye and ENT anesthesia has its unique technical characteristics and problems. By reviewing related literature extensively and combining with our experience, this article analyzed and discussed the challenges of ENT anesthesia, such as difficult airway, airway hyperactivity, controlled hypotension and so on, as well as summarizing and evaluating the advantages and disadvantages of the techniques applied in ENT anesthesia.

The reality that most of ophthalmic surgeries are conducted under retrobulbar block or topic anesthesia performed by the ophthalmic surgeons themselves may affect the balance between quality and efficiency of ophthalmic anesthesia. The authors suggest that the key principle to perform ophthalmic anesthesia is to help the patients be well prepared preoperatively. In order to achieve this goal, we should make full use of the supraglottic airway device and awake sedation, improve ultrasound-guided regional block technique, strengthen cooperation with ophthalmic surgeons, thereby meeting the comfortable anesthesia requirements of ophthalmic surgery patients and adapting for the development trend of day surgery.

A shared airway during anesthesia refers to maintaining the airway and ventilation of the patient by the anesthesiologist as the surgeon performs the procedures in the same anatomic space. Due to the narrow airway space in shared airway surgery, the difficulty lies both in the exposure of surgery field and implementation of the optimized airway management strategy and maintaining the airway safety in clinical practice. In recent years, many new visualized airway management tools and supraglottic ventilation devices have been invented and verified in clinical settings. Especially, the development of tubeless supraglottic oxygenation and ventilation technique provides new insights into the airway management. This review intends to provide a reference for future innovations in airway management tools and ventilation techniques by summarizing previous airway management strategies of shared airway surgery to benefit more patients.

To compare the anesthetic effects of mivacurium and cisatracurium besylate in laser laryngeal microsurgery, and to provide clinical evidence and reference for further optimization of muscle relaxation application.

From October 2021 to January 2022, fifty-six patients of Beijing Tongren Hospital, Capital Medical University, scheduled for laser laryngeal microsurgery with general anesthesia, were enrolled. These patients, aged 18-65 years old, 25 males and 31 females, were divided into two groups (n=28) by random number table method. Cisatracurium besylate group (group C): cisatracurium besylate was injected at 0.1 mg/kg. Normal saline was continuously infused during operation. Mivacurium group (group M):Mivacurium was injected at 0.25 mg/kg and continuously infused at 0.3 mg·kg^-1·h^-1 during operation.The intubation time, the extubation time, recovery index, Cooper′s score, Cormack-Lehane grade, surgical condition grade, postoperative residual neuromuscular block and allergic related adverse events were compared between the two groups.

The intubation time and the extubation time of group M were (3.7±1.1) and (16.2±5.0) min, which were statistically significant shorter than those of group C (4.9±0.7) and (26.4±8.6) min (all P<0.05). The recovery indexes of the patients in group M and group C were (4.5±3.4) and (6.2±5.0) min. The Cooper′s scores of the two groups were both 9(9, 9). The Cormack-Lehane grades of the two groups were all grade Ⅰ. The number of cases with good/excellent surgical condition grades in group M and group C were 5/23 and 0/28. There were no significant differences in recovery index, Cooper′s score, Cormack-Lehane grades and surgical condition grades between the two groups (all P>0.05). The TOF ratio of group M in the post anesthesia care unit (PACU) was (95.7±2.6) %, which was significantly higher than (92.9±3.9) % of group C(P=0.015). There were no significant differences in MAP and HR between the two groups at different time points (all P>0.05). The incidence of skin flushing in group M and group C was 10.7% (3/28) and 0, and the difference was not statistically significant (P=0.074). There were no cases of severe hypotension, significantly elevated airway pressure or airway spasm in both groups.

In laser laryngeal microsurgery, compared with cisatracurium besylate, mivacurium has shorter intubation time and extubation time, stable hemodynamics, no significant increase in allergic related adverse events. mivacurium is safe and effective.

To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression.

This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (n=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery.

The NRS pain scores [M(Q₁, Q₃)] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(P=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (P=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all P>0.05). There were no obvious complications of medial canthus peribulbar block in group PB.

NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.

To investigate the effects of high-flow nasal oxygen (HFNO) combined with early extubation on the incidence of respiratory adverse events (RAE) during emergence from general anesthesia in children undergoing adenoid-tonsillectomy.

From December 2021 to January 2022, 40 pediatric patients [21 males, 19 females, with a median age of 4 (4, 5) years] undergoing tonsillectomy and/or adenoidectomy in Eye & ENT Hospital of Fudan University were randomly divided into two groups: HFNO-assisted early extubation group (Group H, n=20) and conventional extubation group (Group C, n=20) by using a random number table. After entering the post-anesthesia care unit (PACU), the patients in group H received humidified and heated oxygen (flow rate: 25 L/min) through a nasal cannula until their consciousness regained. After patient′s spontaneous breathing resumed for 10 min, the oral endotracheal tube was removed. Patients in group C did not receive HFNO. The oral endotracheal tube was removed after the patient′s spontaneous breathing resumed for at least 10 min with signs of tube intolerance, or 20 min without signs of tube intolerance. During the PACU stay, the incidence of RAE, the incidence of cough, the application rate of intensive care strategy, the time to extubation, the duration of PACU stay, and vital signs at spontaneous breathing resuming and extubation in each group were recorded.

In Group H, the total incidence of RAE [30% (6/20) vs 65% (13/20), P=0.027], the incidence of cough [10% (2/10) vs 45% (9/20), P=0.031] and the application rate of intensive care strategy [20% (4/20) vs 55% (11/20), P=0.048] during PACU stay was significantly lower, compared with those of Group C. Likewise, the time to extubation was significantly shorter [(33.4±4.5) min vs (42.7±5.3) min, P<0.001]. However, there was no statistically significant difference in the duration of PACU stay, the vital signs at the time of spontaneous breathing resuming and extubation between the two groups (P>0.05), except that the end-tidal carbon dioxide partial pressure (P_ETCO₂) at the time of extubation in group H was significantly higher than group C [(52.9±9.4) mmHg vs (48.9±3.1) mmHg (1 mmHg=0.133 kPa), P<0.001].

HFNO combined with early extubation can significantly reduce the incidence of RAE in children undergoing adenoid-tonsillectomy during the emergence from general anesthesia.

To observe the effects of topical anesthesia with 1% tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery.

From October 2021 to December 2021, 92 patients (46 males and 46 females) in Beijing Tongren Hospital, with a median age [M (Q₁, Q₃)] of 51 (42, 57) years who scheduled for microlaryngosurgery under general anesthesia, were divided into two groups (n=46 in each group) using the random number table method. Group T received topical anesthesia with 1% tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction, with 0.5 ml at each position, while the control group (group C) received equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of patients entering the operating room (baseline), after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation. The recovery profiles, including time to recover breathing, time to open eyes, time to extubation and adverse reactions were evaluated during recovery period.

The MAP of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation were (99.4±12.9), (78.5±8.8), (79.2±10.2), (100.6±17.0), (101.9±14.7), (100.8±13.9), (97.4±12.1), (107.3±16.8) mmHg (1 mmH=0.133 kPa), respectively, while in group C were (99.5±11.6), (80.9±12.8), (90.5±16.0), (109.5±20.4), (108.0±18.9), (103.7±15.5), (100.1±13.3), (114.2±17.3) mmHg, respectively. The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T (P<0.05).The HR of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation was (71.3±10.6), (66.0±10.1), (69.5±11.4), (61.3±14.2), (69.8±9.8), (71.0±10.6), (70.6±11.0), (78.8±11.6) bmp, respectively, while in group C were (73.1±10.9), (67.8±9.9), (79.5±12.9), (57.1±18.1), (69.2±12.8), (71.4±11.7), (70.7±11.5), (85.3±13.0) bmp, respectively. The two critical time points of HR after intubation and after extubation in group C were significantly higher than that of group T (P<0.05). The time to recover breathing in the two groups was (11.8±3.5) min and (11.3±4.6) min, respectively. The time to open eyes was (12.0±3.3) min and (11.5±5.0) min, respectively. The time to extubation was (13.2±3.7) min and (12.6±4.9) min, respectively. There were no statistically significant difference in time to recovery between the two groups (P>0.05). Likewise, there were no toxic reactions to local anesthetics, respiratory depression, hypoxemia, laryngospasm and cough occurred in either group.

Topical anesthesia with 1% tetracaine can effectively reduce the hemodynamic changes without influencing patient′s recovery, and does not increase the incidence of adverse reactions.

To explore the risk factors of anxiety during anesthesia induction in children undergoing eye and ear-nose-throat (ENT) surgeries.

The clinical data of 930 children who underwent eye and ENT surgeries in the Eye & ENT Hospital of Fudan University from January to December 2019 were collected. The outcome variable was the degree of anxiety during anesthesia induction. Demographic information about the children and their family members, anxiety scores and the usage of preoperative sedative drugs were collected as the exposure factors. The risk factors of anxiety during anesthesia induction were determined by logistic regression analysis.

A total of 930 children were included in the study, of which 56(6.0%) cases developed anxiety during the induction period. Univariate logistic regression analysis showed that age (OR=0.72, 95%CI:0.61-0.86, P<0.001), anxiety grading of children by medical evaluation method (mild as the reference, moderate OR=5.42, 95%CI:2.92-10.07, P<0.001; severe OR=7.53, 95%CI: 2.54-22.29, P<0.001), Modified Yale Preoperative Anxiety Scale (mYPAS) score at arrival in the preoperative waiting room (OR=1.05, 95%CI:1.02-1.07, P<0.001) and sedation score (OR=0.48, 95%CI: 0.30-0.76, P<0.001) were risk factors for the development of anxiety during the induction period. Multivariate logistic regression analysis revealed that anxiety grading of children by medical evaluation method was a risk factor for affecting anxiety in the induction period (mild as the reference, moderate OR=4.08, 95%CI:1.81-9.18, P<0.01; severe OR=4.95, 95%CI:1.26-19.44, P=0.022).

Anxiety grading of children by medical evaluation method is an essential risk factor for predicting anxiety during induction period.

To evaluate the effect of gender factor on the effective dose of oxycodone for inhibiting responses to laryngeal mask airway (LMA) insertion in elderly patients undergoing ophthalmic surgery.

From June to October 2021, 56 elderly patients, including 26 females and 30 males, aged from 65 to 80 (72±5) years, with a body mass index (BMI) of 18.5-24.9 kg/m² and American Society of Anesthesiologists (ASA) physical status of Ⅰ or Ⅱ, who underwent elective ophthalmic surgery requiring LMA insertion in the Beijing Tongren Hospital affiliated to Capital Medical University were selected. Patients were divided into two groups according to gender: elderly female group and elderly male group. The modified Dixon sequential method was used. Oxycodone 0.10 mg/kg was injected intravenously in the first patient. Etomidate 0.2 mg/kg and cisatracurium 0.1 mg/kg were administrated 5 min later. After 3 min, the laryngeal mask was placed when the bispectral index (BIS) ≤60. The positive response to LMA insertion was defined as an increase in the maximum mean arterial pressure or the maximum heart rate>20% of the baseline value within 2 min after insertion. When the response to LMA insertion was positive, the dose of oxycodone was increased in the next patient, otherwise the dose was decreased, and the ratio of adjacent dose was 1.1. This process was repeated until the 7th turning point occurred. The half-maximal effective doses (ED₅₀) and 95% confidence intervals (CI) of oxycodone for inhibiting laryngeal mask insertion were calculated and compared between the two groups. Meanwhile, the adverse reactions during anesthesia induction were observed.

All 26 patients in the elderly female group completed the test, but one patient in the elderly male group withdrew due to poor alignment of laryngeal mask, and finally 29 patients completed the study. There were 13 cases and 14 cases who had positive response to LMA insertion in the elderly female and male groups, respectively. The ED₅₀ (95%CI) of oxycodone for inhibiting laryngeal mask insertion in the elderly male group was 0.096 (0.083-0.112) mg/kg, which was higher than that in the elderly female group [0.081 (0.073-0.098) mg/kg, P=0.008]. No adverse reactions such as choking cough, muscle tremor, hypoxemia, nausea, vomiting, reflux and aspiration occurred in 55 patients, except that one patient in the elderly female group had transient hypotension after induction, which improved after symptomatic treatment.

The ED₅₀ of oxycodone for inhibiting laryngeal mask insertion reaction in ophthalmic surgery is different in patients with different genders, which is 0.096 (0.083-0.112) mg/kg in the elderly male group and 0.081 (0.073-0.098) mg/kg in the elderly female group.

To investigate the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery, and to provide a basis for further improvement of the medical quality of ophthalmic ambulatory surgery.

The data of the appointment for ophthalmic ambulatory surgeries from December 1, 2020 to November 30, 2021, including the patient′s general condition, disease diagnosis, proposed surgical arrangement, anesthesia method and the completion of the surgeries, were collected through the electronic medical record management system in Beijing Tongren Hospital, Capital Medical University. The total number and incidence of cancelled surgeries registered in the surgical center were analyzed, the incidence of cancelled surgeries of different ages, sexes, subspecialty surgical types, anesthesia methods, patient sources were analyzed, and the reasons for surgical cancellation were further analyzed.

A total of 10, 595 non-cataract ophthalmic day surgeries were applied, of which 827 were temporarily cancelled on the day of surgery, with a cancellation rate of 7.8%. The difference in the same-day surgery cancellation rate at different ages was statistically significant (P<0.001), of which the surgery cancellation rate in toddler and infants was the lowest, which was 2.1% (23/1 110) and 3.4% (2/59), respectively, while the surgery cancellation rate was the highest in elderly patients over 75 years old, at 10.4% (48/462). There was a statistically significant difference in surgical cancellation rates among different sub-specialties (P<0.001), with the lowest surgical cancellation rate in the tumor sub-specialty at 4.5% (33/732), while the corneal sub-specialty had the highest surgical cancellation rate at 14.3% (40/280), followed by the plastic sub-specialty with 11.8% (153/1 297). There were no statistically significant differences in the rate of surgical cancellation between different sexes, anesthesia methods or patients′ home address (all P>0.05). The most common reason for same-day surgery cancellation was the absence of the patient on the day of surgery (49.7%, 479/827), followed by changes in the patient′s general condition (18.4%, 152/827), and inadequate preoperative preparation (6.0%, 50/827). 64.3% (532/827) of the same-day surgical cancellations were considered to have been avoided by enhancing preoperative communication, consultation and management.

The same-day cancellation rate of ambulatory surgery in non-cataract ophthalmology is 7.8%, of which the cancellation rate in elderly patients and in less invasive surgery are higher. The absence of the patient on the same day and the change of the patient′s condition are the main reasons for the cancellation of surgery on the same day, and most of them are avoidable.

To explore the effect of the combination of posterior circulation embolization and micro-resection on the risk and prognosis in patients with brain arteriovenous malformations (bAVMs) supplied by posterior circulation in a one-stop hybrid operation setting.

Patients with bAVMs supplied by posterior circulation who received surgical treatment in Beijing Tiantan Hospital, Capital Medical University, were enrolled from January 2016 to December 2019 from a prospective, multicentral cohort (NCT03209804). The patients were divided into the posterior circulation embolization group and the non-posterior circulation embolization group. Propensity score matching (PSM) (1∶1) was performed according to the baseline information, the morphology of bAVMs, vascular architecture, and Spetzler-Martin grade of brain lesions. The primary endpoint was the deterioration of neurological function. The secondary endpoints were perioperative complications. The differences in surgical risk and clinical prognosis between the two groups were compared.

Five hundred and forty-five patients were enrolled in the cohort, and 38.3% met the included criteria (n=209 cases), with 42 cases in the posterior circulation embolization group and 167 cases in the non-posterior circulation embolization group. Depending on whether the patients were posterior circulation embolized, 39 patients in the posterior circulation embolization group and 39 patients in the non-posterior circulation embolization group were finally included after performing PSM. There were 50 males and 28 females, aged 5-58 (30±13) years. The exacerbation rate of neurological dysfunction in the posterior circulation embolization group was higher than that in the non-posterior circulation embolization group three months after surgery, however there was no statistically significant difference between the two groups [15.4% (6/39) vs 2.6% (1/39), P=0.107]. The intraoperative blood loss in the embolization group was significantly less than that in the non-embolization group [650 (500, 1 500) ml vs 1 200 (800, 2 000) ml, P=0.002]. There was no significant difference in microsurgery time between the two groups [437 (374, 521) min vs 424 (359, 601) min, P=0.865]. Likewise, there were no statistically significant differences in the incidence of postoperative complications and aggravation of neurological dysfunction, including postoperative bAVMs residual [5.1%(2/39) vs 7.7%(3/39), P=1.000], hemorrhagic complications [5.1%(2/39) vs 0(0), P=0.494], postoperative ischemic complications [10.3%(4/39) vs 5.1%(2/39), P=0.675], neurological dysfunction at discharge (17.9% vs 15.4%, P=0.755), and one-year neurological dysfunction [5.1%(2/39) vs 2.6%(1/39), P=1.000].

Posterior circulation embolization of bAVMs in a one-stop hybrid operation can effectively reduce intraoperative bleeding and surgical risk. Embolization of the feeding artery has no significant impact on the perioperative complications and neurological outcomes.

Lumbar ligamentum flavum cyst combined with lumbar instability complicated with acute foot ptosis is extremely rare in domestic and foreign literature reports. This article introduces a case of lumbar ligamentum flavum cyst complicated with acute foot ptosis. The patient was admitted to hospital with the main complaint of "numbness and weakness of right lower limb for 2 weeks". Imaging examination showed lumbar instability combined with lumbar ligamentum flavum cyst. After resection, decompression and fusion of lumbar ligamentum flavum cyst, the foot ptosis was significantly improved after operation. It is suggested that patients with lumbar ligamentum flavum cyst complicated with acute dyskinesia should undergo early surgical treatment.

This paper reports a case of huge mesenteric epithelioid hemangioendothelioma invading the jejunum. The clinical manifestation of the patient was abdominal pain and distension without obvious inducement for 1 month. Imaging examination showed a huge cystic-solid mass in the abdominal cavity, accompanied by calcified components and messy separation, and the enhancement was mild uneven enhancement, which was misdiagnosed as liposarcoma. The patient was discharged after symptomatic anti-infection, surgery, drainage and other treatments. The patient was diagnosed as mesenteric epithelioid hemangioendothelioma by postoperative pathology. There was no recurrence or obvious complication after 8 years of follow-up.

The core pathological changes of Parkinson's disease (PD) are substantia nigra lesions, which are mainly characterized by degenerative changes of dopaminergic neurons in substantia nigra bodies and iron deposition lesions. In recent years, it has been found that the structure and lesions of substantia nigra can be displayed by using neuromelanin sequence, magnetic sensitivity sequence, quantitative magnetic susceptibility technique, diffusion tensor imaging, etc. On high-resolution substantia nigra MRI, neuromelanin-sensitive sequences and magnetic-sensitive sequences can be used as imaging markers for PD patients, distinguishing PD patients from healthy people, and are also valuable for the identification of PD prodromal phase, which can be used for early PD diagnosis. However, in the differential diagnosis of PD and PD superposition syndrome, the sensitivity and specificity of substantia nigra MRI are not high. Comprehensive consideration of the changes of substantia nigra and other regions such as midbrain and putamen in MRI is an important direction to improve the differential rate of PD and PD superposition syndrome. High-field intensity MRI, such as 7.0T MRI, can more clearly observe the structure of substantia nigra and distinguish substantia nigra bodies. In the future, further research on the relationship between substantia nigra structure and the course, classification and treatment of PD patients on high-field intensity MRI will help doctors to early diagnosis and standardized management of PD patients.

A total of 565 patients undergoing gastroscopy under intravenous anesthesia were selected for the study and randomly assigned to receive nasal mask oxygen (n=283) and the conventional nasal tube oxygen administration group (n=282）。 The primary outcome measure was the incidence of hypoxemia, and secondary outcome measures included the incidence of severe hypoxemia, duration of hypoxemia, minimum oxygen saturation, proportion requiring emergency airway treatment, time to surgery, time to recovery, satisfaction of anesthesiologists and gastrointestinal endoscopists, and other adverse events (including cough, hiccups, nausea and vomiting, reflux, aspiration, and laryngospasm).

A multicenter, open-label, rater-blinded randomized controlled trial compared high-flow nasal tube oxygen therapy (HFNO) at 70 L/min and 50% oxygen concentration with conventional oxygen therapy (6 L/min with nasal tube or mask, or 5 L/min with nasopharyngeal airway) on the incidence of hypoxia in digestive endoscopic deep sedation in moderate and high-risk patients. From March to September 2019, a total of 380 patients with combined sleep apnea, obesity, hypertension, diabetes, heart disease, age>60 years, or American Society of Anesthesiologists (ASA)>Class I digestive endoscopy were enrolled in the study. Patients were randomly assigned to the HFNO group (n=191) and standard oxygen therapy group (n=188）。 The primary outcome measure was oxygen saturation (SpO₂) ≤92% incidence. HFNO Group SpO₂The incidence of ≤92% was 9.4% (18/191), significantly lower than 33.5% (63/188) in the standard oxygen therapy group. Lowest SpO between groups₂The median of the difference was 2%. In the HFNO group compared with the standard oxygen therapy group, SpO₂≤90% [5.8% (11/191) vs 22.9% (43/188)], SpO₂The incidence of events ≤85% [3.1% (6/191) vs. 9.6% (18/188)], requiring manual airway opening [11.1% (21/191) vs. 32.4% (61/188)], and requiring increased oxygen flow [7.9% (15/191) vs. 23.4% (44/188)] was significantly lower than in the standard oxygen therapy group. It is suggested that HFNO can reduce the risk of hypoxia in patients with intermediate and high risk during digestive endoscopic deep sedation.

In recent years, the efficacy of high-flow nasal catheter oxygen therapy (HFNO) for oxygenation maintenance in normal populations has been widely recognized, but its use in obese populations has not been fully validated. A recent randomized controlled trial compared the effects of 70 L/min HFNO versus 15 L/min closed mask (FM) administration of 100% oxygen on asphyxia time after general anesthesia and neuromuscular block in morbidly obese patients. A total of 80 patients aged 18 to 65 years with a body mass index (BMI)>40 kg/m were enrolled in the study between October 2018 and September 2019²of patients undergoing bariatric surgery, randomly assigned to the HFNO group (n=41) and the FM group (n=39）。 Anesthesia was induced after pre-oxygenation in 45° half-sitting position, and rocuronium was given to start asphyxia and oxygenation. The oropharyngeal airway and mandibular lifting manipulation were used to maintain the patency of the upper airway, and the observation was performed for 18 minutes. The primary study endpoint was the time to asphyxia when oxygen saturation decreased to 92%. Asphyxia time in the HFNO and FM groups [M（Q₁，Q₃)] 18 (18, 18), 18 (4, 18) min, respectively. Oxygen saturation decreased to 92% within 18 min in 5 (12%) patients in the HFNO group and 15 (38%) patients in the FM group.

A deep neuromuscular block may be beneficial for surgical space conditions during laparoscopic surgery. However, intraoperative deep neuromuscular block inevitably increases the risk of residual muscle relaxants after surgery, prolonging the extubation time and stay in the anesthesia recovery room (PACU). The effect of moderate neuromuscular block combined with transversal ventral block (TAPB) on surgical space conditions during laparoscopic surgery has not been reported. The study explored whether the above combination is similar to the surgical spatial conditions of deep neuromuscular block while being more conducive to patient recovery.

Tracheectomy and reconstruction are the most effective treatments for tracheal stenosis. The difficulty is that surgeons and anesthesiologists need to operate and maintain ventilation in the same airway of the patient. It is a challenge for anesthesiologists to ensure patient ventilation safety and surgical field satisfaction. High-flow oxygen has begun to be used to prolong apnea time, and this study aimed to evaluate the effectiveness of apnea conditions with high-flow oxygen as the only means of gas exchange during tracheal anastomosis reconstruction.