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The aim of this observational study was to investigate the effects of catechol-O-methyltransferase (COMT) and ATP-binding cassette transporter B1 (ABCB1) gene polymorphisms on the postoperative analgesic effect of sufentanil in Chinese Han pediatric patients with fractures. A total of 185 pediatric patients who underwent fracture surgery were included. Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphisms of COMT and ABCB1 genes. Sufentanil was used for postoperative analgesia. The pain level of the patients was evaluated using the face, legs, activity, cry, and consolability scale before surgery, during awakening, at 2, 6, 12, and 24 hours after surgery. The postoperative Ramsay sedation score, sufentanil consumption, and incidence of adverse reactions were also recorded. Pediatric patients with different genotypes of ABCB1 and COMT showed no statistically significant differences in general data such as age, gender, weight, height, surgical duration, and American Society of Anesthesiologists classification (P > .05). There were no statistically significant differences in sedation scores after surgery between different genotypes of ABCB1 and COMT (P > .05). Among patients with CC genotype in ABCB1, the pain scores and total consumption of sufentanil at awakening, 2 and 6 hours after surgery were higher compared to TT and CT genotypes (P < .05), while there were no statistically significant differences between TT and CT genotypes (P > .05). Among patients with AA genotype in COMT, the pain scores and total consumption of sufentanil at awakening, 2, 6, 12, and 24 hours after surgery were higher compared to AG and GG genotypes (P < .05), while there were no statistically significant differences between AG and GG genotypes (P > .05). There were no statistically significant differences in adverse reactions between different genotypes of ABCB1 and COMT (P > .05). The polymorphisms of COMT gene rs4680 and ABCB1 gene rs1045642 are associated with the analgesic effect and consumption of sufentanil in pediatric patients after fracture surgery.

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Objective: There have been studies shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. We constructed an intervention strategy, based on the concept of co-design, for perioperative anxiety behavior in children's outpatient surgery and conducted a prospective randomized controlled research to confirm its effectiveness. Method: This research comprised a total of 100 kids who received surgery in our outpatient clinic between January 2019 and January 2020. According to the random number table approach, all kids were divided into observation as well as control categories, each of which had 50 instances.The behavioral intervention tactics included cognitive intervention before behavioral intervention and behavioral interventions in the environment. The observation cohort was offered behavioral intervention tactics before anesthesia, whereas the control category had surgery under standard anesthesia. The two categories' preoperative visit (T1) mean arterial pressure (MAP) & heart rates (HR) in the anesthesia preparation room (T2), during induction of anesthesia (T3) and 1 hour after surgery (T4) were compared, and the two groups' modified facial expression score (FLACC) at T1 and T4 was compared as well; At T3, the children' degree of cooperation and anxiety were evaluated with Induction Cooperation Scale (ICC) and modified Yale Perioperative Anxiety Scale (mYPAS). The satisfaction degree of the children's family with the surgery was collected 7d after the operation with a Satisfaction Rating Scale prepared by our hospital. Results: The MAP in the observation group was 58.49±6.35 at T1 time, which was not a significant diference from that of the control group (60.12±7.03). Also, the HR in the observation group was 100.27±12.38 at T1 time, with no difference from that in control group. MAP and HR at T2-T4 were remarkably higher in both groups than at T1 (P < .05); & During T2-T4, the group being observed appeared to have lower MAP & HR compared to the group acting as a control (P < .05). At T3, the observation category's ICC & mYPAS scores were significantly poorer than those of the control category (P < .05). On the seventh day following surgery, the satisfaction level of the observation category's family with the procedure was greater than that of the control category. (P < .05). Conclusion: The behavioral intervention strategy help children undergoing outpatient surgery maintain stable hemodynamic indicators during the perioperative period, reduce their anxiety and improve their cooperation for surgery. In future, the apply of the behavioral intervention strategy will effectively improve the satisfaction of children's family members with surgery.

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BACKGROUND: To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. METHODS: Children aged 3-7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators. RESULTS: The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05). CONCLUSION: Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management. TRIAL REGISTRATION: The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).

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Postoperative cognition impairment is a perishing complication in elderly patients undergone surgeries. Lithium is widely used in psychiatric patients for its role in neuronal protection, whereas whether or not it could attenuate surgery-associated postoperative cognition dysfunction used prophylactically is not well defined. After approval by the Institutional Animal Care and Use Committee, 48 male Sprague-Dawley rats aged 18months old were randomly divided into three groups with 16 each: i, no surgeries and drugs were given; ii, surgical procedures were performed only without drug delivery; iii, prophylactic 2mM/kg lithium chloride was given intraperitoneally once a day for seven days before surgeries. The change in spatial memory was assessed with Morris Water Maze (MWM), and the activation of PI3K/AKT/mTOR pathway was detected, and the levels of hippocampal glycogen synthase kinase-3ß (p-GSK-3ß) phosphorylation at serine 9 and interleukin-1ß (IL-1ß) were measured. The MWM detection showed that both swimming latency and distance were considerably prolonged by the surgeries, but these changes could be markedly shortened by prophylactic lithium administration. Meanwhile, the changes in the hippocampal PI3K cascades and p-GSK-3ß and IL-1ß expression displayed corresponding changes that were parallel to the alterations of spatial memory, and inhibition of PI3K and GSK-3ß suggested upstream PI3K activation leads to downstream change in p-GSK-3ß and IL-1ß. These results indicate, at least in part, that prophylactic lithium can alleviate surgery-associated impairment of the spatial memory in aged rats which is strongly associated with the reduced levels of hippocampal p-GSK-3ß and IL-1ß resulted from the activation of PI3K/AKT/mTORC2 pathway.

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