Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study.

BACKGROUND: The collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (IVC-CI) to assess the patient's blood volume. METHODS: A total of 188 elderly patients aged between 65 and 85 years were recruited for gastrointestinal surgery under general anesthesia. Ultrasound measurements AXV and IVC were performed before induction of general anesthesia. Patients were grouped in accordance to the hypotension after induction. ROC curves were used to analyze the predictive value of ultrasound measurements of AXV and IVC for hypotension after induction of anesthesia. Pearson linear correlation was used to assess the correlation of ultrasound measurements and decrease in mean arterial blood pressure (MAP). RESULTS: The maximum diameter of AXV(dAXVmax) and the maximum diameter of IVC (dIVCmax) were not related to the percentage decrease in MAP; the collapsibility of AXV (AXV-CI) and IVC-CI were positively correlated with MAP changes (correlation coefficients:0.475, 0.577, respectively, p < 0.001). The areas under the curve (AUC) was 0.824 (0.759-0.889) for AXV-CI, and 0.874 (0.820-0.928) for IVC-CI. The optimal threshold for AXV-CI was 31.25% (sensitivity 71.7%, specificity 90.1%), while for IVC-CI was 36.60% (sensitivity 85.9%, specificity 79.0%). Hypotension and down-regulation of MAP during induction can be accurately predicted by AXV-Cl after correction for confounding variables. CONCLUSION: Infraclavicular axillary vein diameter has no significant correlation with postanesthesia hypotension, whereas AXV-CI may predict postanesthesia hypotension during gastrointestinal surgery of the elderly. TRIAL REGISTRATION: This study was registered in the Clinical Trial Registry of China on 05/06/2022 (ChiCTR2200060596).

Ultrasound-Guided Thoracic Paravertebral Nerve Block on Postoperative Pain, Quality of Life, and Recovery in Patients with Non-Small-Cell Lung Cancer.

OBJECTIVES: Our study will investigate the effect of ultrasound-guided thoracic paravertebral block (UG-TPVB) on postoperative pain, quality of life, and enhanced recovery in patients with non-small-cell lung cancer (NSCLC) undergoing lobectomy surgery. METHODS: Our study included 100 patients aged 52 to 75 years who underwent lobectomy surgery with pathological diagnosis of NSCLC. Patients received ultrasound-guided thoracic paravertebral block or general anesthesia with tracheal intubation. Patients' pain score was recorded on a numeric rating scale (NRS) 24 hours post operation. The total postoperative dosage of tramadol hydrochloride, length of hospitalization, quality of life (QoL), and inflammation levels were recorded. RESULTS: Compared with patients who received general anesthesia with tracheal intubation, patients in the UG-TPVB group had lower postoperative NRS scores at 24 h (1.8 vs. 3.5, P = 0.035); the average 24 h postoperative NRS score of the UG-TPVB group is lower than that of the general anesthesia with tracheal intubation (4.6 vs. 5.3, P = 0.012), thus receiving less dosage of tramadol hydrochloride (221 ± 45 vs. 250 ± 38 mg, P < 0.01). Patients in the UG-TPVB group had better EORTC QLQ-C30 scores compared with patients in the general anesthesia with tracheal intubation group. The difference of length of hospitalization, hs-CRP, and IL-6 between two groups did not reach statistical difference (length of hospitalization 6.2 vs. 6.9 days, P = 0.055; hs-CRP: 7.1 ± 1.9 vs. 10.4 ± 6.6, P = 0.095; and IL-6: 71.3 ± 7.2 vs. 68.9 ± 8.7, P = 0.529). Discussion. NSCLC patients undergoing lobectomy surgery who received UG-TPVB had less postoperative pain, used less dosage of tramadol hydrochloride, and had better QoL.

Matrix metalloproteinase-9 -1562 C/T polymorphism is associated with the risk of sepsis in a Chinese population: A retrospective study.

Matrix metalloproteinase-9 (MMP-9) has been shown to participate in the pathogenesis of sepsis. In this study, we recruited 312 sepsis patients and 413 controls to explore the relationship between sepsis risk and the MMP-9 -1562 C/T polymorphism in Han Chinese. The PCR restriction fragment length polymorphism method was used for genotyping. Our data indicated that the MMP-9 -1562 C/T polymorphism was related with the risk of sepsis (CT vs. CC: P = 0.033, odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.03-2.05; TT+CT vs. CC: P = 0.019, OR = 1.49, 95% CI 1.07-2.07). Stratified analyses demonstrated that this effect was more evident in smokers, drinkers, females and overweight individuals. Furthermore, cross-over analyses suggested that the combined effect of smoking and CT genotype of -1562 C/T polymorphism contributed to the risk of sepsis. In addition, MMP-9 serum levels were significantly lower in sepsis patients than in controls. The MMP-9 -1562 C/T polymorphism was significantly associated with decreased MMP-9 serum levels. Lastly, we observed that this polymorphism was connected to the mortality of sepsis. In conclusion, the interaction between the MMP-9 -1562 C/T polymorphism and smoking correlated with the risk of sepsis in Han Chinese. This polymorphism may serve as a diagnostic marker for sepsis patients.

P2RX7 Gene rs1718125 Polymorphism is Related with Postoperative Pain and Fentanyl Intake in Esophageal Cancer Patients.

BACKGROUND: Prevention and control of postoperative pains are essential, which affects the prognosis and life quality of patients. Fentanyl is a widely used opioid drug for pre-, intra- and postoperative analgesia. Identifying a patient's genotype before surgery may help to control the fentanyl dose in the perioperative period. PATIENTS AND METHODS: This study enrolling 645 esophageal cancer (EC) patients was aimed to investigate the associations of P2RX7 gene rs1718125 polymorphism with fentanyl intake and postoperative pains in a Chinese Han population. Genotyping was accomplished by direct sequencing and polymerase chain reaction. RESULTS: The GA/AA genotype carriers showed lower visual analog scale scores at postoperative 0, 6 and 24 h, but not at 48 h, compared with the GG genotype. The fentanyl consumption of GG genotype was remarkably more relative to the GA/AA genotype at 6 and 24 h after treatment. CONCLUSION: P2RX7 rs1718125 polymorphism is connected to the postoperative pains and fentanyl use for EC patients.

CHRM3 rs2165870 Polymorphism Correlates with Postoperative Nausea and Vomiting Incidence and the Efficacy of Ondansetron in a Chinese Han Population.

BACKGROUND: Previous GWAS studies have shown that there is a relationship between M3 muscarinic acetylcholine receptor (CHRM3) rs2165870 polymorphism and postoperative nausea and vomiting (PONV) incidence. However, no Chinese studies have addressed this issue. METHODS: To explore the relationship between CHRM3 rs2165870 polymorphism and PONV incidence in a Chinese Han population, we enrolled 512 patients receiving elective surgery in this study. CHRM3 rs2165870 polymorphism was genotyped using PCR-RFLP method. RESULTS: We found that AA genotype or A allele of CHRM3 rs2165870 polymorphism elevated the risk of PONV (AA versus GG; OR, 2.88; 95% CI, 1.51-5.47; P = 0.001; A versus G; OR, 1.39; 95% CI, 1.07-1.81; P = 0.013). In addition, CHRM3 rs2165870 polymorphism was related to the risk of PONV among the males, smokers, and those individuals with Apfel Score 3-4 or ASA classification 2-3. Last, we assessed the effects of CHRM3 rs2165870 polymorphism on the treatment efficacy of ondansetron for PONV. Data uncovered that 103 of 209 patients (49.3%) showed response to ondansetron treatment for PONV. The PONV incidence was significantly higher in AA genotype carriers compared with GG genotype carriers during the first 2 h after surgery, but not from 2 to 24 h after surgery. CONCLUSION: To sum up, this study reveals that CHRM3 rs2165870 polymorphism is related to the incidence of PONV and treatment effects of ondansetron for preventing PONV in this Chinese Han population.