Background: Nasogastric tube inserted before laparoscopic cholecystectomy is a preoperative common preparation, which is an invasive procedure and exacerbates the patient’s anxiety level. This prospective, observational, cohort study aimed to explore the effects of preoperative anxiety level in patients with nasogastric tube inserted on the postoperative quality of recovery and pain undergoing laparoscopic cholecystectomy, and analyze the correlation between preoperative anxiety level and the postoperative quality of recovery. Method: Patients with STAI-S＞40 were excluded the day before surgery. After entering the operating room, patients were assessed anxiety level using the Anxiety - Visual Analog Scale. The quality of recovery was assessed using 15 - items quality of recovery on postoperative day 1 and 2. The pain was evaluated with the Numerical Rating Scale. 17 cases were excluded, and a total of 80 patients were enrolled in this study.Results: Compared with the group N, Anxiety Visual Analog Scale scores were higher in the group Y (with nasogastric tube inserted) after entering the operating room (P < 0.001), 15 - items quality of recovery scores on postoperative day 1 in the group Y was lower than group N (without nasogastric tube inserted) (P < 0.001). Pain intensity was higher in group Y at 2, 4, 8, 12, 24 and 48h after surgery than in Group N (P < 0.050). Anxiety Visual Analog Scale scores were significantly and negatively correlated with the 15- items quality of recovery scores (r = -0.91, P < 0.001). Compared with group N, group Y had longer time to get out of bed and postoperative first flatus time (P < 0.001). The AIS scores were higher on the night after surgery in group Y than in group (P < 0.001). Conclusion: In summary, nasogastric tube inserted increases preoperative anxiety level, which is associated with lower postoperative quality of recovery and higher pain intensity after surgery, and affects the patient's emergence time and postoperative sleep quality. We can implement intervention measures according to patients' conditions to relieve patients' preoperative anxiety level, improve the postoperative quality of recovery, improve patients' satisfaction and speed up recovery.Trial registration: This prospective, observational, cohort study selected patients who underwent laparoscopic cholecystectomy at Xuzhou Central Hospital from April 2022 to June 2022. The study was approved by the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20220318-024) and registered on Clinicaltrials.gov (10/04/2022, ChiCTR2200058548).

Background: Laparoscopic cholecystectomy (LC) is the most common intra-abdominal surgical procedure globally, which frequently leads to substantial postoperative pain. Opioids play a major role in pain management previously. Some studies found that esketamine could reduce pain and opioid consumption. However, the relationship between esketamine and the postoperative quality of recovery and pain is uncertain undergoing LC. Thestudy aimed to evaluate the effects of intraoperative intravenous esketamine infusion on the quality of recovery (QoR) and pain after laparoscopic cholecystectomy (LC). Patients and methods: A total of 152 patients were randomly divided into the control (0.9% saline), 0.2 mg (esketamine bolus 0.2 mg/kg, followed by 0.2 mg/kg/h) and 0.3 mg (esketamine bolus 0.3 mg/kg, followed by 0.3 mg/kg/h) groups. A bolus of 0.9% saline/esketamine was administered before endotracheal intubation, followed by continuous infusion until gallbladder removal. The primary outcomes were 40-item QoR (QoR-40) score on postoperative day 1 (POD-1) and pain (Numerical Rating Scale, NRS) score during rest and coughing at different time points. The secondary outcomes were hemodynamic parameters, propofol and remifentanil consumption, 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride, postoperative parameters, and adverse events. Results: The global QoR-40 score on POD-1 was lower in the control group than in the 0.2 and 0.3 mg groups. The NRS score during rest and coughing was lower in the 0.2 and 0.3 mg groups than in the control group at alltime points. Hemodynamic parameters were more stable in the esketamine groups. Propofol and remifentanil consumption was higher in the control group than in the esketamine groups. The 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride was lower in the esketamine groups. The extubation time was longer in the 0.3 mg group than in the control and 0.2 mg groups. The control group had more patients with oxygen saturation (SpO2) <95%. The incidence of postoperative vertigo, nystagmus and diplopia was higher in the 0.3 mg group than in the control and 0.2mg groups. Conclusions: Intravenous esketamine infusion improved the QoR on POD-1 after LC. It provided a good analgesic effect, reduced the 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride, and resulted in stable hemodynamic parameters. However, a higher esketamine dose prolonged the extubation time and increased the incidence of adverse events. Trial registration: This study was approved by the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20211209-051) and registered at ClinicalTrials.gov (19/12/2021, ChiCTR2100054508). This randomized triple-blind placebo-controlled trial was performed from December 2021 to August 2022. Written informed consent was obtained from all patients. The study was terminated after follow-up completion of the last study participant.

Background Children with preoperative anxiety are at risk of perioperative adverse events, such as reflux aspiration, prolonged induction time, wake agitation, and delirium. Identifying children at high risk of severe preoperative anxiety may help anesthesiologists intervene and manage them in advance. Aim The authors hypothesized that the risk of developing serious preoperative anxiety in children is predictable by variables related to basic information about the parent and child. We developed a clinical prediction model to identify patients vulnerable to severe preoperative anxiety among children aged 2–12 years. Methods We enrolled patients aged 2–12 years who underwent elective surgery under general anesthesia and divided them into derivation (n = 340, 70.8%) and validation (n = 140, 29.2%) groups. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale, and a high level of preoperative anxiety was defined as a score of >30. The following predictors were collected preoperatively: gender, age, weight, children's education level, only child, history of surgery, waiting time in the anesthesia waiting area, parental education level, parental anxiety, whether venous access had been established in the ward, and whether they had received anti‐anxiety interventions. A prediction model was built using binary logistic regression analysis; bootstrap was applied for internal validation, and external validation was performed using the validation datasets. Results The prediction model had good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.961 (95% CI = 0.943–0.979) and 0.896 (95% CI = 0.842–0.950) in the derivation and validation cohorts, respectively. The predictive variables included in the final clinical model were pharmacological intervention (OR = 0.008, 95% CI = 0.002–0.025), nonpharmacological intervention (OR = 0.342, 95% CI = 0.104–1.127), parental education level (OR = 0.211, 95% CI = 0.108–0.411), parental anxiety (OR = 6.15, 95% CI = 2.396–15.786), only child (OR = 2.417, 95% CI = 1.065–5.488), history of surgery (OR = 3.513, 95% CI = 1.137–10.860), and age (OR = 0.692, 95% CI = 0.500–0.957). Conclusions In this study, a clinical prediction model was developed and validated for the first time. The proposed clinical prediction model can help doctors identify children most likely to develop a high level of preoperative anxiety. Clinical Trial Registration Identifier ChiCTR2100054409 (https://www.chictr.org.cn/index.aspx).