BackgroundFibreoptic bronchoscopy is an important used to evaluate and manage paediatric patients with respiratory disease.This study aimed to compare the effect of two different anaesthesia methods, propofol combined with remifentanil and propofol combined with sevoflurane, on children undergoing fibreoptic bronchoscopy (FOB).Method:Sixty children were enrolled and randomly divided into two groups. In the remifentanil group (Group R), the patients were induced with 4 mg•kg− 1 propofol + 4 µg•kg− 1 remifentanil (slow intravenous injection) and maintained with 0.3–0.5 µg•kg− 1•min− 1 remifentanil. In the sevoflurane group (Group S), the patients were induced with 2 mg•kg− 1 propofol and 8% sevoflurane and maintained with 4–6 vol% sevoflurane. Heart rate (HR), mean blood pressure (MBP) and pulse oxygen saturation (SpO2) were monitored and recorded at four time points: baseline (T0), when the bronchoscope reached glottis (T1), the time of lavage (T2), and the time of brush biopsy (T3). Waking time and the satisfaction score of physicians were recorded, and emergence agitation (EA) was evaluated in the postanesthesia care unit (PACU). Finally, any supplementary medicine or adverse events were also recorded.ResultsCompared with group S, the waking time was significantly shorter and the incidence of EA was significantly lower in Group R. During bronchoscopy, significant differences in MAP or HR were not observed between the two groups at T0. Compared with group S, the HR of group R was significantly decreased at T1, T2 and T3, and MAP was significantly decreased at T1, but the fluctuation range was within 20% of the baseline. A significant difference in SpO2 was not observed between the two groups at any time point. No significant differences in the operation time of FOB, the incidence of complications, such as moving, hypoxemia, bronchospasm, and bucking, or the level of satisfaction were observed between the two groups.ConclusionsTotal intravenous anaesthesia using propofol plus remifentanil in children undergoing fibreoptic bronchoscopy potentially reduces the waking time and decreases the incidence of EA to improve the work efficiency and turnover rate of the outpatient operating room.Trial registrationRegistered at the China Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR1900026098).

Background Postoperative delirium (POD) is a sign of deterioration in the homeostasis and physical status of the patient. However, there have been no reports regarding the relationship between the decrease of regional cerebral oxygen saturation (rSctO2) reading during surgery and the POD in hip replacement in the elder. This study aims to investigate this correlation and the incidence of POD.Methods We performed a retrospective study of 4834 patients who underwent hip arthroplasties between 2015 and 2019 at our hospital. Data were collected as part of routine patient care. The patients’ cognitive performance was evaluated by using the Manual of Mental Disorders (DSM-IV-TR 4th edition) criteria. Patients found to be delirious after surgery served as the delirium group, other patients who did not develop delirium after surgery regarded as the no-delirium group. The various factors including the decline of rSctO2 reading intraoperatively were assessed using Multivariable logistic regression models. Odds ratio (OR) and 95% confidence intervals (CI) are reported.Results POD was found in 27 patients (n=351); the incidence of POD was 7.7%; all of them were in their 70’s or 80’s. Lab data and rSctO2 reading before surgery were no significantly difference between the delirium group and the no-delirium group. Patients who displayed the decline of rSctO2 reading intraoperatively were at higher risk for POD (compared with no-delirium patients: OR2.169 CI 1.663-2.829 p=0.000) and gender (compared with no-delirium patients: OR 0.163 CI 0.029-0.909 p=0.039) was at a higher risk. Twenty-four patients recovered from POD gradually. One patient had persistent and severe cognitive dysfunction after surgery, two patients died of complications either acute pulmonary embolism 4 days after surgery or acute stroke 21 days after surgery respectively.Conclusions The incidence of POD was 7.7%. This study shows that the decline of rSctO2 reading during hip replacement surgery in the elder is associated with increased probability for the POD.