Currently, there is a lack of knowledge regarding Aeromonas caviae meningitis. We report the first case of super-refractory status epilepticus (SRSE) in a woman with Aeromonas caviae meningitis. The case report demonstrates that this condition can lead to severe SRSE. Effective treatment for epilepsy is crucial for improving the prognosis for similar patients. According to Gomes et al.\'s consensus protocol for SRSE, using a combination of up to one anesthetic drug and three non-anesthetic anti-epileptic drugs may be helpful and important in managing SRSE that is caused by Aeromonas caviae meningitis.

OBJECTIVE: Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia.
METHODS: This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed.
RESULTS: Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level.
CONCLUSIONS: Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia.
BACKGROUND: Clinicaltrials.gov (ChiCTR2100051809).

BACKGROUND: The operating room is a demanding and time-constrained setting, in comparison to primary care settings, where perioperative medication administration is more complicated and there is a high risk that the patient will experience a medication error. Without consulting the pharmacist or seeking assistance from other staff members, anesthesia clinicians prepare, deliver, and monitor strong anesthetic drugs. The purpose of this study was to determine the Incidence and root causes of medication errors by anesthetists in Amhara region, Ethiopia.
METHODS: A multi-center cross sectional web-based survey study was conducted from October 1 to November 30, 2022, across eight referral and teaching hospitals of Amhara region. A self-administered semi structured questionnaire was distributed using survey planet. Data analysis was conducted using SPSS version 20. Descriptive statistics were computed and binary logistic regression was used for data analysis. A p-value < 0.05 was considered statistically significant.
RESULTS: The study included 108 anesthetists in total, yielding a response rate of 42.35%. Out of 104 anesthetists, Majority of participants (82.7%) were male. During their clinical practice, more than half (64.4%) of participants experienced atleast one drug administration error. 39 (37.50%) of the respondents revealed that they experienced more medication errors while on night shifts. Anesthetists who did not always double-check their anesthetic drugs before administration had a 3.51 higher risk of developing MAEs compared to those who always double-check anesthetic drugs before administration (AOR = 3.51; 95% CI: 1.34, 9.19). Additionally, participants who administer medications that have been prepared by someone else are about five times more likely to experience MAEs than participants who prepare their own anesthetic medications prior to administration (AOR = 4.95; 95% CI: 1.54, 15.95).
CONCLUSIONS: The study found a considerable rate of errors in the administration of anaesthetic drugs. The failure to always double-check medications before administration and the use of drugs prepared by another anaesthetist were identified to be underlying root causes for drug administration errors.

Malignant tumors are the second leading cause of death worldwide. This is a public health concern that negatively impacts human health and poses a threat to the safety of life. Although there are several treatment approaches for malignant tumors, surgical resection remains the primary and direct treatment for malignant solid tumors. Anesthesia is an integral part of the operation process. Different anesthesia techniques and drugs have different effects on the operation and the postoperative prognosis. Propofol is an intravenous anesthetic that is commonly used in surgery. A substantial number of studies have shown that propofol participates in the pathophysiological process related to malignant tumors and affects the occurrence and development of malignant tumors, including anti-tumor effect, pro-tumor effect, and regulation of drug resistance. Propofol can also reshape the tumor microenvironment, including anti-angiogenesis, regulation of immunity, reduction of inflammation and remodeling of the extracellular matrix. Furthermore, most clinical studies have also indicated that propofol may contribute to a better postoperative outcome in some malignant tumor surgeries. Therefore, the author reviewed the chemical properties, pharmacokinetics, clinical application and limitations, mechanism of influencing the biological characteristics of malignant tumors and reshaping the tumor microenvironment, studies of propofol in animal tumor models and its relationship with postoperative prognosis of propofol in combination with the relevant literature in recent years, to lay a foundation for further study on the correlation between propofol and malignant tumor and provide theoretical guidance for the selection of anesthetics in malignant tumor surgery.

In this approach, tensiometry and UV-visible techniques are used to determine the effect of cationic gemini and conventional surfactants on tetracaine hydrochloride (TCH), an anesthetic drug. We have estimated micellar, interfacial, and energetic constraints. To gain a deep understanding of their mixed association behavior, the outputs were examined using different theoretical models. The critical micelle concentration for single and mixed amphiphiles was estimated. The cmc values of mixed amphiphiles were found between the individual amphiphiles due to strong attractive interaction (synergism) between the components after mixing. The non-ideal behavior of mixtures was confirmed by the larger values of ideal cmc than the experimental cmc values. The negative values of interaction parameter (β) and values of activity coefficients less than unity indicate strong synergistic interaction between drug and surfactant. The stability of the mixed systems is demonstrated by the negative Gibbs free energy of micellization and excess free energy of micellization. In contrast to a single chain surfactant, a double chain surfactant (gemini) exhibits better interactions with the drug. Spectral measurements (UV-visible spectra) were used to monitor the binding of the drug with surfactant (conventional as well as gemini). Studying these mixed aggregates could help to optimize their compositions and find synergistic properties between TCH monomers and surfactants.

OBJECTIVE: To evaluate the effect of anesthetic drugs on the expression of circadian gene Clock and Bmal1 in the brain of New Zealand rabbits, and to explore their change pattern.
METHODS: A total of 90 New Zealand rabbits were randomly divided into 5 groups (n=18 in each group): A normal saline group (1 mL/h saline, group S), a propofol group [600 µg/(kg·min-1) propofol, 1 mL/h, group P], a 10% lipid group (1 mL/h lipid, group F), a dexmedetomidine group [1 µg/(kg·min-1) dexmedetomidine, 1 mL/h, group D), a sevoflurane (SEV) group (2.5% SEV, SEV group). Inhaled and intravenous anesthetic drugs were stopped after 24 h. Experimental animals were killed at 0, 24, and 72 h after anesthesia, and their brain tissues were isolated. Western blotting was performed to measure the Clock and Bmal1 protein expression in the brain of rabbits.
RESULTS: At 0 and 24 h after anesthesia, compared with the group S, the levels of Clock and Bmal1 proteins were decreased significantly in the group P, the group D, and the group SEV (all P<0.05). At 72 h after anesthesia, compared with the group S, the levels of Clock and Bmal1 proteins showed no significant changes in the group P, the group D, and the SEV group (all P>0.05). Compared with the group S, the levels of Clock and Bmal1 proteins at all time points showed no significant changes in the group F (all P>0.05).
CONCLUSIONS: Anesthetic SEV, propofol, and dexmedetomidine can inhibit the expression of clock gene Clock and Bmal1 protein in the brain fissues of the New Zealand rabbits, and the suppression effect continues for at least 24 h after anesthesia, whereas the suppression decreases significantly at 72 h after anesthesia.
目的: 观察麻醉药物对新西兰兔钟基因Clock和Bmal1表达的影响，并探讨其变化规律。方法: 将90只新西兰兔随机分为生理盐水组(S组，1 mL/h)、丙泊酚组[P组，600 µg/(kg·min-1)，1 mL/h]、10%的脂肪乳组(F组， 1 mL/h)、右美托咪定组[D组，1 µg/(kg·min-1)，1 mL/h]、七氟烷(sevoflurane，SEV)组(吸入2.5% SEV，SEV组)，每组18只。24 h后停止吸入或静脉滴注麻醉药。5组试验动物分别在停止麻醉后0、24和72 h处死，分离脑组织。采用蛋白质印迹法测定新西兰兔Clock和Bmal1蛋白的表达水平。结果: 麻醉后0和24 h，与S组比较，SEV组、P组和D组中Clock和Bmal1蛋白表达水平均明显下调(均P<0.05)。麻醉后72 h，与S组比较，SEV组、P组和D组中Clock和Bmal1蛋白表达水平均无明显变化(均P>0.05)。与S组比较，F组中各时间点的Clock和Bmal1蛋白表达水平均无明显变化(均P>0.05)。结论: 麻醉药物SEV、丙泊酚和右美托咪定可抑制新西兰兔脑组织中Clock和Bmal1蛋白的表达，这种抑制作用一直持续至麻醉后24 h，而在麻醉后72 h该抑制作用明显减弱。.

UNASSIGNED: Benson\'s relaxation (BR) technique is a suitable non-pharmacological approach to reduce preoperative anxiety (PA).
UNASSIGNED: This study aimed to investigate the effect of BR therapy on PA and the induction and maintenance dose of propofol during cataract surgery (CS).
UNASSIGNED: Seventy-two patients were randomly divided into two experiments or BR and control groups. The Amsterdam and Spielberger State-Trait Anxiety inventory (STAI) scores were used to assess PA directly two days and a half-hour before the CS. The control group did not receive any preoperation intervention or relaxation. Benson\'s relaxation method was performed three times, each time for 20 minutes, including two days before surgery, a night before surgery, and an hour before the surgery in the presence of a researcher by an audio file. The induction and maintenance dose of anesthetic drug was recorded and compared between the two groups.
UNASSIGNED: The mean propofol consumption was significantly reduced during the induction of anesthesia in the intervention group compared to the control group (0.99 ± 0.29 versus 1.29 ± 0.49; P = 0.005) as well as the maintenance of anesthesia (84.66 ± 17.98 versus 108.33 ± 34.38, P = 0.001). The results of the post-intervention Amsterdam anxiety score showed a significant decrease in the intervention group compared to the control group (P = 0.032, F = 9.61, Eta2 = 0.12). The control group showed a higher Spielberger state score compared to the intervention group as well as the Spielberger trait (P < 0.001, F = 14.78, Eta2 = 0.18).
UNASSIGNED: The BR method effectively reduces the level of PA in patients undergoing CS. Moreover, it reduces the need for anesthetic drug, propofol, during surgery.

A method is described for sensitive and selective fluorometric determination of morphine. It is based on the effect of morphine on quenching of the fluorescence of fluorescein by gold nanoparticles (AuNPs) via surface energy transfer. When fluorescein is added to solutions of colloidal AuNPs, its fluorescence becomes quenched due to nanometal surface energy transfer (NSET) because the absorption of AuNPs strongly overlaps the emission spectrum of fluorescein. In the presence of morphine, which contains both a tertiary nitrogen ring atom and a phenolic hydroxy group, it will coordinate to the AuNPs, and this causes recovery of fluorescence. The presence of a tertiary nitrogen ring atom and a phenolic hydroxy group (both required for the effect to occur) in morphine make the probe highly selective and sensitive for morphine. A paper strip assay also was developed by utilizing this detection scheme. The turn-on fluorescent probe was successfully applied to the determination of morphine in spiked serum and urine samples. The method has a 53 pM limit of detection. The paper strip was applied to the determination of morphine in sweat, urine and other biological fluids. It is perceived to be useful for early detection of drug abuse by adolescent. Graphical abstract Schematic of the mechanism of fluorescence turn on detection of morphine using Au NPs (gold nanoparticles) acting asquencher of the fluorescence of fluorescein.

OBJECTIVE: In contrast to propofol, volatile agents are often considered harmful to maintain anesthesia due to increasing brain volume and potential deleterious effects. Patients for cranioplasty, including patients with large bone defects, could be susceptible for intraoperative complications but have not properly been investigated so far. The aim of the present study was to evaluate brain swelling, intraoperative conditions, surgical course, and postoperative complication rates of propofol-based vs. volatile-based anesthesia.
METHODS: In this monocentric, retrospective, and observational study, we collected demographic, clinical, and outcome data of patients undergoing cranioplasty between December 2010 and September 2014. According to the hypnotic drug used, patients were assigned to either a propofol or a volatile group. The primary outcome parameter was brain swelling. For comparison of the groups, univariate analysis was performed using Chi-square and Mann-Whitney-U test.
RESULTS: One hundred and one patients were identified in the period. Twenty-three patients were excluded due to cerebrospinal fluid diversion. Baseline characteristics and preoperative conditions did not vary between the groups except a higher body mass index and positive end-expiratory pressure (PEEP) in the propofol group. The choice of anesthesia (volatile or intravenous) influence neither the intraoperative local conditions nor postoperative complication rate. No significant risk factor for impaired bone flap placement was identified.
CONCLUSIONS: In a well-defined cohort, the choice of the anesthetic agent does not influence the degree of intraoperative brain swelling, bone flap fit, and postoperative course.

Near-infrared (NIR) responsive nanoparticles are of great interest in the biomedical field as antennas for photothermal therapy and also as triggers for on-demand drug delivery. The present work reports the preparation of hollow gold nanoparticles (HGNPs) with plasmonic absorption in the NIR region covalently bound to a thermoresponsive polymeric shell that can be used as an on-demand drug delivery system for the release of analgesic drugs. The photothermal heating induced by the nanoparticles is able to produce the collapse of the polymeric shell thus generating the release of the local anesthetic bupivacaine in a spatiotemporally controlled way. Those HGNPs contain a 10 wt.% of polymer and present excellent reversible heating under NIR light excitation. Bupivacaine released at physiological temperature (37 °C) showed a pseudo-zero order release that could be spatiotemporally modified on-demand after applying several pulses of light/temperature above and below the lower critical solution temperature (LCST) of the polymeric shell. Furthermore, the nanomaterials obtained did not displayed detrimental effects on four mammalian cell lines at doses up to 0.2 mg/mL. From the results obtained it can be concluded than this type of hybrid thermoresponsive nanoparticle can be used as an externally activated on-demand drug delivery system.