Examining the impact of permissibility hypercapnia on postoperative delirium among elderly patients undergoing thoracoscopic-laparoscopic esophagectomy: A single-center investigative study.

OBJECTIVE: This study explores how permissive hypercapnia, a key aspect of lung protective ventilation, impacts postoperative delirium in elderly patients following thoracic surgery. METHODS: A single-center trial at The Second Hospital of Anhui Medical University involved 136 elderly patients undergoing thoracoscopic esophageal cancer resection. Randomly assigned to maintain PaCO2 35-45 mmHg (group N) or 46-55 mmHg (group H). Primary outcome: postoperative delirium (POD) incidence 1-3 days post-surgery. Secondary endpoints included monitoring rSO2, cardiovascular parameters (MAP, HR), pH, OI, and respiratory parameters (VT, RR, Cdyn, PIP) at specific time points. Perioperative tests assessed CRP/ALB ratio (CAR) and systemic inflammatory index (SII). VAS scores were documented for three postoperative days. RESULTS: Postoperatively, group H showed significantly lower POD incidence than group N (7.4% vs. 19.1%, P = 0.043). Group H exhibited higher PaCO2 and rSO2 during surgery (P < 0.05). Patients in group H maintained better cardiovascular stability with higher blood pressure and lower heart rate on T2-4 (P < 0.05). Respiratory parameters were more stable in group H with lower TV, RR, and PIP, and higher Cdyn during OLV (P < 0.05). Group H had lower pH and OI at T2-4 (P < 0.05). CRP and CAR levels rose less in group H on the first day and one week later (P < 0.05). CONCLUSIONS: Maintaining PaCO2 at 46-55 mmHg reduces POD incidence, possibly by enhancing rSO2 levels and stabilizing intraoperative respiration/circulation.

The complete chloroplast genome of Dianella ensifolia (Asphodelaceae).

Dianella ensifolia (L.) Redouté 1802 is a plant known for its significant medicinal values. In this study, we presented its chloroplast genome. The length of the chloroplast genome was found to be 156,571 bp, with a GC content of 37.86%. It consisted of a large single-copy (LSC) of 85,318 bp and a small single-copy (SSC) of 18,307 bp, a pair of inverted repeats (IRs) of 26,473 bp each that separated the LSC and SSC regions. The chloroplast genome of D. ensifolia consisted of 114 unique genes, including 80 protein-coding genes, four rRNA genes, and 30 tRNA genes. Through phylogenetic analysis, we identified a close relationship between D. ensifolia and D. nigra. This newly sequenced chloroplast genome not only enhances our understanding of the genome of Dianella, but also provides valuable insights for the evolutionary study of the family Asphodelaceae.

Opioid-sparing effect of modified intercostal nerve block during single-port thoracoscopic lobectomy: Retraction: A randomised controlled trial.

BACKGROUND: Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. OBJECTIVE: This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. DESIGN: This was a randomised controlled study. SETTING: The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. PATIENTS: Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. INTERVENTION: Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 µg kg-1 remifentanil, it was then infused at 0.2 to 0.5 µg kg-1 min-1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. MAIN OUTCOME MEASURES: The primary outcome was intra-operative remifentanil consumption. RESULTS: Median [IQR] remifentanil consumption was reduced in the MINB group [0 µg (0 to 0 µg)] compared with the CGA group [1650.0 µg (870.0 to 1892.5 µg)]. The median difference was 1650.0 µg (95%CI 1200.0 to 1770.0 µg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). CONCLUSION: We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. TRIAL REGISTRATION: http://www.chictr.org.cn, ChiCTR2000029337.