We aimed to investigate whether the cardioprotection of sevoflurane against ischemia/reperfusion (IR) injury is via inhibiting endoplasmic reticulum stress (ERS). The rat in vivo model of myocardial IR injury was induced by ligation of the left anterior descending (LAD) coronary artery. Sevoflurane significantly ameliorated the reduced cardiac function, increased infarct size and elevated troponin I level and lactate dehydrogenase (LDH) activity in plasma induced by IR injury. Sevoflurane suppressed the I/R-induced myocardial apoptosis. The increased protein levels of glucose-regulated protein 78 and C/EBP homologous protein after myocardial I/R were significantly reduced by sevoflurane. The protein levels of phosphorylated protein kinase RNA-like endoplasmic reticulum kinase (PERK), phosphorylated eukaryotic initiation factor 2 (eIF2α) and activating transcription factor 4 (ATF4) were significantly increased in rats with I/R and attenuated by sevoflurane treatment. The phosphorylation of Akt was further activated by sevoflurane. The cardioprotection of sevoflurane could be blocked by wortmannin, a PI3K/Akt inhibitor. Our results suggest that the cardioprotection of sevoflurane against IR injury might be mediated by suppressing PERK/eIF2a/ATF4/CHOP signaling via activating the Akt pathway, which helps in understanding the novel mechanism of the cardioprotection of sevoflurane.

Background: Preschool children with obstructive sleep apnea-hypopnea syndrome (OSAHS) experience a potentially lethal sleep disorder disease. Early surgical resection of OSAHS is critical for children’s growth and development. Tonsil adenoidectomy is an essential treatment technique for OSAHS. However, laryngeal trauma caused by surgery leads to agitation due to pain during recovery, accompanied by other symptoms such as unstable vital signs and postoperative anxiety. Little research has been done on the treatment and care of postoperative agitation and respiratory complications in children with OSAHS. Therefore, exploring a better-personalized care method is essential for reducing the incidence of respiratory complications during anesthesia recovery in children with OSAHS and the smooth recovery of the child. Objectives: The study aimed to investigate the respiratory complications and agitation of childhood OSAHS in the anesthesia recovery period after surgery and suitable nursing care methods. Methods: A total of 200 children with OSAHS were randomly divided into the routine care group (Group A, n = 100) and the personalized nursing group (Group B, n = 100). Personalized nursing included postoperative bleeding care, psychological care, infusion care, and pain care. Patients’ demographic and clinical data were collected. A CO2 laser-assisted modified uvulopalatopharyngoplasty (UPPP) was performed after the induction of general anesthesia. Children were extubated and transferred to the recovery room after the surgery. The nurses closely monitored the children’s agitation, oxygen saturation, and spontaneous breathing every 15 min within one hour in the recovery room. The respiratory frequency and amplitude, ECG changes, blood pressure, hospitalization time, and economic costs were recorded. Results: The incidences of agitation and respiratory obstruction were significantly lower in Group B than in Group A in the recovery room (P < 0.05). Blood pressure and heart rates were significantly higher, and oxygen saturation was lower in Group A at 15 min, 30 min, and 45 min (all P < 0.05), but the difference disappeared 60 min after surgery (P > 0.05). The hospitalization time and expenses of Group B were significantly lower than those of Group A (P < 0.05). Conclusions: Personalized nursing care during postoperative anesthesia recovery can reduce the incidence of agitation and respiratory obstruction, lower blood pressure and heart rate, and accelerate postoperative recovery in children with OSAHS. Our study discovered a suitable nursing method for OSAHS children after general anesthesia to improve patients’ recovery and reduce economic costs.

Background: Perioperative Antibiotic Prophylaxis is the use of antibiotics before a surgical procedure to reduce the incidence of post-operative surgical site infections (SSI). SSIs are associated with prolonged in-patient hospital stays, longer antibiotic courses and increased cost to the health service. Appropriate use of prophylaxis is important to avoid antimicrobials resistance.The objective of this study is to assess the appropriateness of perioperative antibiotic prophylaxis. Indication, antibiotic choice, dose, dosing interval, redosing, and timing of first administration and duration of prophylaxis were compared against the National Antibiotic Guideline (NAG) 2014 or local guidelines.Methods and materials: A cross sectional study was performed using prospective data gathered from five government hospitals in Selangor using the Plan-Do-Study-Act (PDSA) cycles. Interventions were conducted between Cycles 1 and 2 by pharmacists in each hospital according to the results of Cycle 1.Results: A total of 150 patients were recruited in Cycle 1 and only 120 patients recruited in Cycle 2 as one of the hospital needed to withdraw as it underwent renovation at the operation theatre. In Cycle 1, 89.3% of patients received antibiotic prophylaxis, while 3.3% did not receive antibiotic prophylaxis, and 7.3% had incomplete documentation and were excluded from further analysis. Improvement was seen in Cycle 2 with no case of incomplete documentation and only 2.5% patients did not receive antibiotic prophylaxis. Compliance to guideline increased in Cycle 2 after intervention (53% versus 41%). The most frequently encountered categories of non-compliance in Cycle 2 were the duration of prophylaxis (100%), timing of antibiotic administration (7.3%), choice of antibiotic (3.6%) and re-dosing of antibiotic for prolonged surgery (3.6%). Conclusion:This study revealed that compliance of the perioperative antibiotics to guidelines can be improved with routine interventions. Furthermore, each hospital should develop a formal strategy, including a local guideline for antimicrobial prophylaxis in surgical procedures.