Background Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring. Methods A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded. Results SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly. Conclusions SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients studied had normal neurological examination findings, hence, these results may not be applicable to patients with preexisting deficits. Trial registration The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR2100045504 (18/04/2021).

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BackgroundPostoperative pneumonia is a preventable complication associated with adverse outcomes, that greatly aggravates the medical expenses of patients. The goal of our study is to identify risk factors and outcomes of postoperative pneumonia.MethodsA matched 1:1 case-control study, including adult patients who underwent surgery between January 2020 and June 2020, was conducted in the Second Affiliated Hospital of Kunming Medical University in China. Cases included all patients developing postoperative pneumonia within 30 days after surgery, defined using consensus criteria. Controls were selected randomly from the matched eligible population.ResultsOut of 17,190 surgical patients, 264 (1.54%) experienced postoperative pneumonia. Increased age, chronic obstructive pulmonary disease, emergency surgery, postoperative reduced albumin, prolonged ventilation, and longer duration of bed rest were identified as significant risk factors independently associated with postoperative pneumonia. Regarding prognostic implications, postoperative pneumonia was associated with longer length of hospital stay, higher ICU occupancy rate, higher unplanned re-operation rate, and higher in-hospital mortality rate. Postoperative pneumonia was most commonly caused by Gram-negative pathogens, and multidrug resistant bacteria accounted for approximately 16.99% of cases.ConclusionsPostoperative pneumonia is associated with severe clinical outcomes. We identified six independent risk factors that can aid in risk stratification and management of patients at risk of postoperative pneumonia, and the distribution of causative pathogens can also help in the implementation of effective interventions.Clinical Trial Registrationwww.chictr.org.cn, identifier: chiCTR2100045986.

IntroductionA giant abdominal tumor with a large hiatal hernia remains a rare disease with few studies regarding its implications in anesthesia. A large hiatal hernia may compress the heart and cause arrhythmia and even cardiac arrest, which greatly increases the risks and challenges of anesthesia management.Case descriptionWe present a case in which a patient with a giant abdominal desmoid tumor and large hiatal hernia experienced a critical situation during anesthesia and surgery.ConclusionsIt is a great challenge for anesthesiologists to manage a patient's respiratory system and circulation. Careful perioperative management and optimized multidisciplinary teams are the key factors in the successful management of this rare condition. In addition, awake endotracheal intubation, ventilation preserving spontaneous breathing and target-directed fluid therapy play an essential role in anesthesia management.