Thoracoscopic wedge resection of the upper lobe of the left lung achieved by a new approach of laryngeal mask general anesthesia with preservation of spontaneous breathing: A case report.

INTRODUCTION: General laryngeal mask anesthesia with the preservation of spontaneous breathing has accelerated the advancement of the enhanced recovery after surgery concept in thoracoscopic surgery. However, the need for increased doses of anesthetic drugs to reduce laryngeal mask airway (LMA) stimulation poses challenges due to the increased risk of hypotension, respiratory depression, susceptibility to hypoxemia, and carbon dioxide retention, particularly in the lateral position. PATIENT CONCERNS: During the perioperative period, reducing the dose of anesthetic drugs while simultaneously improving LMA tolerance and preventing circulatory and respiratory depression poses a challenge. DIAGNOSES: The patient was diagnosed with a nodule in the upper lobe of the left lung. INTERVENTIONS: In this case, we chose remimazolam sedation, which mildly inhibits circulatory respiration, and used mucosal surface anesthesia in the pharynx. This approach improved the patient's tolerance to LMA, reduced the dose of anesthetic drugs, and facilitated the successful thoracoscopic wedge resection of the upper lobe of the left lung with preservation of spontaneous respiration. OUTCOMES: During 2 weeks follow-up, the patient recovered satisfactorily and did not report any discomfort. CONCLUSION: We used pharyngeal mucosal surface anesthesia and thoracic paravertebral nerve block in combination with remimazolam sedation to provide precise analgesia, moderate sedation, and successful LMA general anesthesia with preservation of spontaneous respiration in patients undergoing thoracoscopic pulmonary wedge resection.

Successful use of remimazolam combined with remifentanil for painless gastroscopy in a patient with morbid obesity: a case report.

Backgroud: In recent years, as the number of people with obesity has surged, the number of morbidly obese patients has also grown. The pathophysiological changes in morbid obesity can lead to combined lung diseases, which may result in hypoventilation, hypoxemia, acute upper airway obstruction, acute respiratory distress syndrome, and sleep apnea syndrome, posing serious challenges to anesthesia management. Here, we describe a case of the administration of remimazolam combined with remifentanil in a patient with morbid obesity undergoing gastroscopy. This has rarely been reported in clinical practice, and we present our management experience here with the aim of providing a reference for clinical work. Case presentation: We report the case of a 32-year-old male hypertensive patient with a height of 180 cm, weight of 145 kg, and body mass index of 44.8 kg/m2. The patient's main complaint was intermittent hunger pain for more than 1 year, and duodenal polyps were found. Considering the patient's morbid obesity and the combination of sleep apnea syndrome and hypertension, we administered remimazolam along with remifentanil to ensure perioperative safety. Conclusion: The procedure lasted 30 min, and the anesthesia was satisfactory with no complications. Remimazolam combined with remifentanil intravenous anesthesia is safe for short gastroscopy in patients with morbidly obesity. The administration of a small dose of split-titration delivery facilitates the maintenance of stable vital signs.

Microsphere Assisted Super-resolution Optical Imaging of Plasmonic Interaction between Gold Nanoparticles.

Conventional far-field microscopy cannot directly resolve the sub-diffraction spatial distribution of localized surface plasmons in metal nanostructures. Using BaTiO3 microspheres as far-field superlenses by collecting the near-field signal, we can map the origin of enhanced two-photon photoluminescence signal from the gap region of gold nanosphere dimers and gold nanorod dimers beyond the diffraction limit, on a conventional far-field microscope. As the angle θ between dimer's structural axis and laser polarisation changes, photoluminescence intensity varies with a cos4θ function, which agrees quantitatively with numerical simulations. An optical resolution of about λ/7 (λ: two-photon luminescence central wavelength) is demonstrated at dimer's gap region.