The influence of total intravenous anesthesia on perioperative fatigue in patients undergoing stent implantation for cerebrovascular stenosis

The influence of total intravenous anesthesia on perioperative fatigue in patients undergoing stent implantation for cerebrovascular stenosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The influence of total intravenous anesthesia on perioperative fatigue in patients undergoing stent implantation for cerebrovascular stenosis Xiaoxiao Zhang, Yang Bai, Youxuan Wu, Bei Wu, Haiyang Liu, Ruquan Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5350891/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : To explore the influence of total intravenous anesthesia on the occurrence of perioperative fatigue in patients with cerebrovascular stenosis who undergo elective stent implantation on an elective basis. Methods : Patients who underwent elective stent implantation for cerebrovascular stenosis in the Neuro-interventional Center of Beijing Tiantan Hospital, Capital Medical University were continuously included from November 2021 to March 2022. Demographic information, peripheral blood biomarkers, scale information, and information related to surgical anesthesia of the patients during the perioperative period were collected. Results : One day after the operation, more patients in the general anesthesia group were diagnosed with perioperative fatigue (14 (70%) vs. 4 (20%), P = 0.001) than in the local anesthesia group, and the severity was higher (7.0 ± 3.8 vs. 4.5 ± 2.9, P = 0.025). The proportion of patients with perioperative fatigue who received total intravenous anesthesia was higher than that in the non-fatigue group (6 (27.3) vs. 14 (77.8), P = 0.001), the decrease in norepinephrine levels was greater (0.05 (-0.03, 0.13) vs. -0.10 (-0.17, -0.04), P = 0.001), the decrease in serotonin levels was more obvious (-0.07 (-0.23, 0.22) vs. -0.19 (-0.30, -0.11), P = 0.035), while there was no significant statistical difference in dopamine levels. The levels of changed monoamine neurotransmitters one day and seven days after the operation were negatively correlated with the score of the Fatigue-14 Scale. Conclusion : The incidence of perioperative fatigue is relatively high. Total intravenous general anesthesia may increase the occurrence of perioperative fatigue. In addition, the levels of monoamine neurotransmitters, especially norepinephrine, may be related to the occurrence of perioperative fatigue. Perioperative fatigue Total intravenous anesthesia Biomarkers risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Fatigue is a complex subjective sensation, and patients may experience discomfort such as fatigue, exhaustion, and weakness. In the late 19th century, Felix first described fatigue symptoms [ 1 ]. Chronic fatigue syndrome occurs worldwide, with a prevalence rate of 0.2–0.4% among adults [ 1 ]. Fatigue is more common among people after diseases and surgeries [ 2 ]. And perioperative fatigue can lead to poor prognosis for patients [ 3 ]. Fatigue hinders postoperative recovery by affecting patients' active activities after surgery, thereby damaging muscle function and increasing the likelihood of severe complications (including pneumonia and deep vein thrombosis). Although fatigue and its related sequelae (often considered as complications of surgery) rarely pose a threat to life, their cumulative effects can significantly reduce the quality of life of patients, prolong hospital stays, and delay the time for patients to return to normal activities and work. Fatigue is one of the reasons for the increase in global social burdens and has become a disabling symptom affecting an individual's quality of life and productivity [ 4 ]. In recent years, an increasing number of anesthesiologists have begun to pay attention to the relationship between anesthetic drugs and perioperative fatigue. However, the conclusions of previous studies on the impact of general anesthetic drugs on perioperative fatigue have been inconsistent [ 5 – 12 ]. Propofol, as the most commonly used intravenous general anesthetic sedative drug in clinical practice at present, its influence on the occurrence of perioperative fatigue has great clinical significance. Therefore, this study designed a total intravenous anesthesia method with TCI infusion of propofol, aiming to explore the impact of propofol on the occurrence of perioperative fatigue. Fatigue was confused with mental and psychological diseases such as depression for a long time. It was not until recent years that it was gradually recognized as an independent disease state. However, it is undeniable that there are many similarities between them. As is known to all, the pathogenesis of depression is related to monoamine biological transmitters (dopamine, 5-hydroxytryptamine and norepinephrine) [ 13 , 14 ]. As a result, more and more clinicians have focused their research on these biological transmitters. The secondary outcome of this study is to explore the influencing factors of perioperative fatigue occurrence, with a focus on the study of the influence of monoamine biological transmitters on perioperative fatigue, thereby exploring the possible occurrence mechanism of perioperative fatigue. Methods 1.1 Patient Population Patients who underwent stent implantation for elective cerebrovascular stenosis in the Neurointerventional Center of Beijing Tiantan Hospital, Capital Medical University from November 2021 to March 2022 were continuously included. Inclusion criteria 1.Patients with cerebrovascular stenosis who are electively admitted, aged 18 - 80 years old; 2. After signing the informed consent, endovascular treatment under elective intervention was performed. Exclusion criteria 1. Primary school education or below / unable to cooperate with the scale examination / refused to sign the informed consent / poor compliance / difficult to complete the follow-up of patients; 2. Patients with alcohol or drug abuse; 3. Patients who have taken medications for mental and psychological diseases for a long time; 4. Patients with malignant tumors or severe organ dysfunction or an expected lifespan of less than 6 months; 5. Patients with new-onset stroke / previous stroke / other central nervous system diseases; 6. Patients with thyroid diseases / abnormal thyroxine levels / taking relevant medications; 7. Patients with previously diagnosed depression/M.I.N.I. depression scale indicating a depressive state and those with newly diagnosed depression state indicated by the postoperative M.I.N.I. depression scale; 8. Patients with previous cognitive dysfunction or a MOCA score less than 26 and a postoperative MOCA score less than 26; 9. Patients who have a state of fatigue or chronic fatigue syndrome before the operation. Based on the above inclusion and exclusion criteria, a total of 40 patients were included, including 20 in the general anesthesia group and 20 in the local anesthesia group. (Figur1) This study was approved by the Chinese Ethics Committee of Registering Clinical Trials (Reference number: ChiECRCT20210407). Written informed consent was obtained from all participants or family members. 1.2 Data collection 1.2.1 Clinical data collection All patients who met the inclusion criteria were selected for general anesthesia or local anesthesia based on the surgical requirements and patient conditions by professional neuro-interventional physicians who were unaware of the study groups. After the patient is admitted to the hospital, the preoperative medical records are obtained and the basic information of the patient (gender, age, smoking, drinking, previous disease history and medication history, etc.) is visited face-to-face. The location of vascular stenosis is identified before the operation (anterior and posterior circulation, intracranial and extracranial), the ASA classification is evaluated, and the perioperative laboratory tests (blood routine, C-reactive protein, blood biochemistry) are recorded. Serum biomarker detection (dopamine DA, neurotransmitter serotonin 5-HT and norepinephrine NE) and scale assessment: Fatigue Scale - 14, Fatigue Severity Scale (FSS), M.I.N.I. Depression Scale, Pittsburgh Sleep Questionnaire (PSQI), MOCA Cognitive Function Scale. The duration of the operation, the method and dosage of anesthesia, the types and quantities of stents were recorded during the operation. On the first day after the operation, the neurotransmitters 5-HT, DA and NE in the serum marker detection were recorded, and the fatigue, mood and sleep conditions were evaluated. On the 7th day after the operation, the patient's fatigue, mood, sleep, cognition, quality of life and other conditions were evaluated again using scales. The Fatigue Scale - 14, FSS, M.I.N.I., PSQI, MOCA, modified Rankin Scale (mRS) were assessed. Follow-up personnel: All visits were completed by neurology and anesthesiology personnel who had received relevant scale training. Among them, the author was responsible for preoperative visits, and two attending physicians conducted independent assessment and follow-up visits to complete the long-term visits. 1.2.2 Collection of peripheral blood biology information Detection of blood biomarkers: Peripheral venous blood of the patient was collected into red blood collection tubes, approximately 5 ml per tube, for the separation of serum. The whole blood samples collected in the serum separation tubes are placed at room temperature for 2 hours, then centrifuged at 1,000×g for 20 minutes, and the supernatant was taken to obtain the serum samples. Management of biological samples: Serum samples were stored in a -80°C refrigerator to avoid repeated freezing and thawing. Reagent kits from Beijing Bao Pai ke Biotechnology Co., Ltd. were purchased: 5-hydroxytryptamine (5-HT) detection kit (CEA808Ge 96T), dopamine (DA) detection kit (CEA851Ge 96T), and norepinephrine (NE) detection kit (CEA907Ge 96T). Serum cryopreserved specimens were transported by dry ice chain mail to the reagent kit manufacturer for post-processing. According to the detection instructions of the reagent kit, the steps of reagent preparation, sample addition, incubation, and washing were carried out in sequence. The level of the substance to be tested in the specimens was determined by using the competitive inhibition enzyme-linked immunosorbent assay. 1.3 Standardized anesthesia methods All patients received standardized anesthesia during the operation, and the routine monitoring included 5-lead electrocardiogram, heart rate, non-invasive blood pressure, blood oxygen saturation, and end-tidal carbon dioxide. Before the surgical operation began in the angiography operating room, the patients were connected to the peripheral venous access. Patients under general anesthesia were induced and maintained using the TCI target-controlled infusion mode. The anesthesia machine used was the Avance CS 2 anesthesia machine of General Electric Healthcare Systems Trading and Development (Shanghai) Co., Ltd. Before induction, midazolam 0.03 mg/kg was intravenously injected. Anesthesia induction: Propofol (Liaoning Haisen Pharmaceutical Co., Ltd., Production batch number: 20230918). Plasma target-controlled concentration was set at 4 μg/ml, sufentanil (Human Fortune Pharmaceutical Group Co., Ltd., production batch number: 21B080211) 0.25 μg/kg, the induction time was set at 3 minutes. After the patient lost consciousness, rocuronium (Hainan Sida Pharmaceutical Co., Ltd., production batch number: 2306010A) 0.6 mg/kg was intravenously injected. After 90 seconds, laryngeal mask intubation was performed and the anesthesia machine was connected for assisted ventilation. Anesthesia maintenance: The plasma target-controlled concentration of propofol was 2.5 μg/ml, and the infusion rate of remifentanil (Human Fortune Pharmaceutical Group Co., Ltd., production batch number: 30A06061) was 0.1 μg/kg/min. Mechanical ventilation maintained normal levels of carbon dioxide (PaCO2 35-45 mmHg), SpO2 > 92%, PaO2 > 60 mmHg; blood pressure should be maintained within 20% of the basal level. If the blood pressure is too low, 6 mg of ephedrine can be given intravenously at a single dose. Body temperature was maintained above 35℃; blood glucose levels was maintained within 70-140 mg/dL. If the blood glucose concentration was less than 50 mg/dL, hypoglycemia treatment was initiated. 1.4 Definition of Fatigue This study adopted the Lynch case definition in 2007 [15]: Patients experience fatigue, lack of energy, and need to rest daily or almost daily. This fatigue makes it difficult to participate in daily activities (for inpatients, it may include treatment and may include the need to prematurely terminate activities due to fatigue). The Fatigue Severity Scale (FSS) was used for quantification: A total score lower than 36 was determined as no fatigue, and a total score of 36 or higher was determined as the existence of fatigue. The Fatigue-14 Scale was used to assess the severity of fatigue, and the higher the total score, the more severe the fatigue. 1.5 Statistical analysis The database was established and statistical analysis was conducted using SPSS 24.0. The normality distribution test was performed on the measurement data. If the data was normally distributed, it was expressed as x±S. If it did not conform to the normal distribution, it was expressed as the median and the range of the quartiles. The count data was expressed by the number of cases and percentages. The comparison between the two groups of measurement data that conformed to the normal distribution was conducted using the t-test, and the measurement data that did not conform to the normal distribution were tested using the rank sum test. The count data were tested using the chi-square test. P value < 0.05 was considered statistically significant. Results 2.1 The influence of total intravenous anesthesia on perioperative fatigue Among the 40 patients with cerebrovascular stenosis who underwent elective vascular stent implantation, 20 received total intravenous general anesthesia, and the other 20 received local anesthesia (see Table 1 ). The demographic statistics between the general anesthesia group and the local anesthesia group expressed no significant statistical difference in demographic information (name, gender, age, height, weight, BMI) and previous underlying diseases (hypertension, diabetes, coronary heart disease, heart failure, snoring). The hemoglobin content in the general anesthesia group was lower than that in the local anesthesia group, but neither was anemic (137.8 ± 15.8 vs. 151.2 ± 12.5, P = 0.005). Compared with the local anesthesia group, patients in the general anesthesia group had a higher PSQI scale score one day after the operation (12 (5.3, 15.8), p = 0.041). One day after the operation, more patients in the general anesthesia group were diagnosed with perioperative fatigue state than in the local anesthesia group (14 (70%) vs. 4 (20%), P = 0.001), and the severity was higher (7.0 ± 3.8 vs. 4.5 ± 2.9, P = 0.025). The results after a 7-day follow-up were similar (see Table 1 ). There was no statistical difference in prognosis between the general anesthesia group and the local anesthesia group. Table 1 Comparison of General Conditions between General Anesthesia Group and Local Anesthesia Group Patients General anesthesia group (n = 20) local anesthesia group (n = 20) P value Male 16(80.0) 19(95.0) 0.339 Age 60.4 ± 11.1 59.2 ± 8.4 0.690 Height (cm) 167.9 ± 7.8 169.9 ± 6.7 0.390 Weight (kg) 73.9 ± 13.6 77.1 ± 14.1 0.463 BMI (kg/m 2) 26.1 ± 3.5 26.7 ± 5.0 0.633 Hypertension 18(90.0) 15(75.0) 0.405 Diabetes 9(45.0) 10(50.0) 0.752 Heart failure 1(5.0) 0(0) 1.000 Atrial fibrillation 1(5.0) 2(10.0) 1.000 Coronary heart disease 2(10.0) 2(10.0) 1.000 Snoring 11(55.0) 10(50.0) 0.752 Smoking 9(45.0) 17(85.0) 0.008 Drinking alcohol 4(20.0) 13(65.0) 0.004 Number of supports 1(1,1) 1(1,1) 1.000 Surgery duration (min) 91.0 ± 34.3 80.1 ± 33.6 0.318 The stenosis is located in the posterior circulation 6(30.0) 13(65.0) 0.057 The stenosis is located within the cranium 9(45.0) 20(100.0) 0.000 Blood glucose (mmol/L) 6.1 ± 1.6 6.3 ± 2.6 0.805 Hemoglobin (g/L) 137.8 ± 15.8 151.2 ± 12.5 0.005 Sodium (mmol/L) 141.6 ± 1.5 141.6 ± 2.5 0.908 Potassium (mmol/L) 4.0 ± 0.4 4.1 ± 0.3 0.404 Calcium (mmol/L) 2.4 ± 0.1 2.4 ± 0.1 0.924 Chlorine (mmol/L) 104.1 ± 2.4 103.9 ± 2.8 0.818 Albumin (g/L) 42.8 ± 3.3 42.6 ± 3.7 0.935 MRS 0.5(0,1.75) 1(0,1.75) 0.663 One day after the operation, PSQI 12(5.3,15.8) 7.5(3.3,9.8) 0.041 Follow-up for 7 days, PSQI 11.0(4.0,14.0) 7.5(3.3,9.0) 0.075 Fatigue one day after surgery 14(70%) 4(20%) 0.001 Fatigue 7 days after surgery 14(70%) 1(5%) 0.000 The severity of fatigue one day after the operation 7.0 ± 3.8 4.5 ± 2.9 0.025 The severity of fatigue 7 days after the operation 6.8 ± 3.9 3.8 ± 3.0 0.010 BMI: Body Mass Index (BMI), also known as Body Mass Index, is a number obtained by dividing one's weight in kilograms by the square of one's height in meters. MRS: The MRS score, also known as the Improved Rankin Scale, is a scale used to evaluate the neurological recovery status of stroke patients. PSQI: The Pittsburgh Sleep Quality Index (PSQI) was compiled by Dr. Buysse and others, psychiatrists at the University of Pittsburgh, in 1989. This scale is suitable for evaluating sleep quality in patients with sleep disorders and mental disorders, as well as for assessing sleep quality in the general population. Figure 2 shows that the dosage of propofol in patients of the general anesthesia group is positively correlated with the Fatigue-14 Scale scores on the 1st and 7th days after surgery. The more the dosage of propofol, the higher the fatigue score and the more severe the fatigue severity. Figure 3 suggests that the dosage of propofol in patients of the general anesthesia group is negatively correlated with the changed monoamine neurotransmitters. The greater the dosage of propofol, the more the monoamine neurotransmitters decreased after surgery compared with those before surgery. 2.2 Risk factors of perioperative fatigue One day after the operation, 18 patients were diagnosed as being in a state of fatigue, and 15 patients still had fatigue seven days after the operation (see Table 2 ). On the first day after the operation, the proportion of perioperative fatigue patients who received total intravenous anesthesia was higher than that of non-fatigue patients (6 (27.3) vs. 14 (77.8), P = 0.001), the PSQI score was higher (5.2 ± 2.8 vs. 14.3 ± 2.4, P < 0.001), the level of norepinephrine decreased more (0.05 (-0.03, 0.13) vs. -0.10 (-0.17, -0.04), P = 0.001), the level of serotonin decreased more significantly (-0.07 (-0.23, 0.22) vs. -0.19 (-0.30, -0.11), P = 0.035), while there was no significant statistical difference in the level of dopamine. During the 7-day follow-up period after the operation, the results were similar to those on the first day after the operation (see Table 2 ). Table 2 Comparison of patients who experienced fatigue on postoperative day 1 and 7 compared to those who did not experience fatigue Fatigue one day after the operation P value Fatigue seven days after the operation P value No(n = 22 ) Yes (n = 18 ) No (n = 25 ) Yes (n = 15 ) Male 21(95.5) 14(77.8) 0.230 23(92.0) 12(80.0) 0.537 Age 59.5 ± 7.9 60.11 ± 11.8 0.846 59.2 ± 7.6 60.7 ± 12.7 0.659 Height (cm) 169.9 ± 6.5 167.6 ± 8.1 0.313 169.6 ± 7.0 167.7 ± 7.8 0.431 Weight (Kg) 77.5 ± 13.0 73.1 ± 14.7 0.321 76.3 ± 13.3 74.1 ± 14.9 0.639 BMI (kg/m 2 ) 26.9 ± 4.6 25.8 ± 3.8 0.467 26.5 ± 4.5 26.2 ± 3.9 0.833 Hypertension 17(77.3) 16(88.9) 0.587 20(80.0) 13(86.7) 0.914 Diabetics 10(45.5) 9(50.0) 0.775 11(44.0) 8(53.3) 0.567 Heart failure 0(0) 1(5.6) 0.919 0(0) 1(6.7) 0.794 Atrial fibrillation 1(4.5) 2(11.1) 0.856 2(8.0) 1(6.7) 1.000 Coronary heart disease 2(9.1) 2(11.1) 1.000 2(8.0) 2(8.0) 1.000 Snoring 9(40.9) 12(66.7) 0.105 11(44.0) 10(66.7) 0.16 Smoking 18(81.8) 8(44.4) 0.014 20(80.0) 6(40.0) 0.010 Drinking alcohol 13(59.1) 4(22.2) 0.019 15(60.0) 2(13.3) 0.004 General anesthesia 6(27.3) 14(77.8) 0.001 6(24.0) 14(93.3) 0.000 Number of supports 1(1,1) 1(1,1) 0.886 1(1,1) 1(1,1) 0.711 The stenosis is located in the posterior circulation 13(59.1) 16(88.9) 0.081 14(56.0) 15(100.0) 0.008 The stenosis is located within the cranium 9(40.9) 10(55.6) 0.545 9(36.0) 10(66.7) 0.120 Surgery duration (min) 78.0 ± 32.8 94.7 ± 34.0 0.125 78.7 ± 32.1 96.9 ± 35.0 0.100 Anesthesia duration (min) 80.0 ± 18.7 90.6 ± 36.5 0.514 80.0 ± 18.7 90.6 ± 36.5 0.514 Total dose of propofol (mg) 459.9 ± 92.4 561 ± 212.9 0.282 459.9 ± 92.4 561.2 ± 212.9 0.282 Total dose of remifentanil (ug) 228.4 ± 74.0 195.7 ± 121.2 0.551 228.4 ± 74.0 195.7 ± 121.2 0.551 Intraoperative use of ephedrine 1(4.5) 1(5.6) 1.000 1(4.0) 1(6.7) 1.000 Intraoperative BIS 46.5(43.7,48.0) 47.0(42.0,50.8) 0.804 46.5(43.7,48.0) 47.0(42.0,50.8) 0.804 Blood glucose (mmol/L) 6.1 ± 2.5 6.3 ± 1.7 0.795 6.2 ± 2.4 6.2 ± 1.7 0.960 Hemoglobin (g/L) 148.4 ± 14.4 139.7 ± 16.1 0.081 147.7 ± 13.9 139.1 ± 17.0 0.094 Sodium (mmol/L) 141.8 ± 2.1 141.4 ± 2.0 0.560 141.4 ± 2.4 141.9 ± 1.3 0.483 Potassium (mmol/L) 4.1 ± 0.4 4.1 ± 0.4 0.584 4.0 ± 0.4 4.2 ± 0.4 0.251 Calcium (mmol/L) 2.4 ± 0.1 2.4 ± 0.1 0.289 2.4 ± 0.1 2.4 ± 0.1 0.764 Chlorine (mmol/L) 104.1 ± 2.6 103.8 ± 2.6 0.782 104.1 ± 2.6 103.7 ± 2.6 0.662 Albumin (g/L) 42.4 ± 3.7 43.1 ± 3.0 0.519 42.6 ± 3.7 42.9 ± 3.0 0.756 MRS 1(0,2) 0.5(0,1.25) 0.579 1(0,1.5) 1(0,2) 0.976 One day after the operation, PSQI 5.2 ± 2.8 14.3 ± 2.4 0.000 6.2 ± 3.9 14.5 ± 2.5 0.000 Follow-up for 7 days, PSQI 4.8 ± 2.8 13.7 ± 3.4 0.000 5.9 ± 4.2 13.5 ± 3.6 0.000 DA(ld) (pg/ml) 0.01(-0.04,0.09) -0.03(-0.06,0.01) 0.115 0.00(-0.04,0.08) -0.04(-0.06,0.01) 0.135 5HT(ld) (ng/ml) -0.07(-0.23,0.22) -0.19(-0.30,-0.11) 0.035 -0.08(-0.21,0.17) -0.23(-0.30,-0.12) 0.022 NA(ld) (pg/ml) 0.05(-0.03,0.13) -0.10(-0.17,-0.04) 0.001 0.02(-0.05,0.13) -0.10(-0.19,-0.05) 0.003 DA(ld): Changes in dopamine levels are calculated by subtracting preoperative dopamine levels from postoperative dopamine levels. 5HT(ld): Changes in serotonin levels are calculated by subtracting preoperative serotonin levels from postoperative serotonin levels. NA(ld) : Changes in norepinephrine levels were calculated by subtracting preoperative norepinephrine levels from postoperative norepinephrine levels. Figure 4 shows that on the 1st and 7th days after the operation, the levels of changed monoamine biological neurotransmitters were negatively correlated with the scores of the Fatigue-14 Scale. The more the monoamine neurotransmitters decreased after the operation compared with those before the operation, the higher the fatigue score was, and the more severe the fatigue was. Discussion Fatigue is a complex subjective sensation, representing excessive and persistent mental and/or physical weakness or exhaustion. The state of fatigue often hinders patients' normal work and life and brings many adverse effects to them [ 1 ]. This study found that the incidence of perioperative fatigue was 45.0% on the first day after surgery and 37.5% on the seventh day after surgery, which is similar to the previous studies [ 16 ]. Perioperative fatigue is a very common clinical symptom. As scholars have attached more importance to it, research on fatigue has also increased. Previous studies suggest that postoperative fatigue may be caused by the response of endocrine metabolism to surgery [ 5 ]. Some studies believe that perioperative anxiety, depression, and sleep are not related to the fatigue state, while other studies have contrary opinions[ 17 – 19 ]. Thus, there are contradictory conclusions among previous studies on the risk factors of perioperative fatigue. In this study, after excluding the influence of depression and cognitive function changes on fatigue, we found that the perioperative fatigue state may be related to perioperative sleep disorders, but the causal relationship is not clear and needs to be further explored in the future. In recent years, an increasing number of anesthesiologists have begun to pay attention to the relationship between anesthetic drugs and perioperative fatigue. A secondary analysis of a randomized, open, multicenter study suggested that compared with general anesthesia, intraspinal anesthesia reduced the need for postoperative opioid drugs, significantly reducing the frequency and intensity of abdominal pain, drowsiness, and fatigue in patients [ 6 ]. In a study on the relationship between intraoperative infusion of low-dose ketamine and postoperative fatigue in patients undergoing laparoscopic total hysterectomy, Chen Yao et al. [ 7 ] believed that the use of low-dose ketamine could reduce the incidence of fatigue in patients undergoing gynecological laparoscopic surgery 3 days after surgery, and it had a good sedative and analgesic effect [ 8 ]. Some studies have shown that drugs such as opioids may cause fatigue, which is different from the residual sedative effect of anesthetic and analgesic drugs [ 9 – 10 ]. Shi et al. [ 11 ] found that breast cancer patients undergoing radical mastectomy under general anesthesia with dexmedetomidine had a lower score for the severity of perioperative fatigue. Propofol and desflurane are the two most widely used anesthetic drugs in modern times. It is generally believed that these drugs with rapid metabolic clearance do not cause fatigue. However, a study reported that compared with the application of desflurane, more patients using propofol had fatigue one week after laparoscopic cholecystectomy [ 12 ]. Another study indicated that the effects of propofol, thiopental sodium, and desflurane general anesthesia on fatigue after elective laparoscopic cholecystectomy were similar [ 5 ]. This study found that total intravenous anesthesia may increase the occurrence of perioperative fatigue, and this effect may persist until 7 days after surgery, which is similar to the results of previous studies. In the long term, as the follow-up time prolongs, the impact of anesthesia may gradually weaken, the number of patients in a fatigued state may decrease, and the severity of fatigue may decline. However, how long the fatigued state will last before fully returning to the preoperative normal state still needs further follow-up studies. The pathogenesis of fatigue is very complex and is not yet fully understood. Some researchers believe that fatigue susceptibility may be influenced by genetic factors [ 20 ]. Some studies have shown that fatigue is associated with increased activation of the immune system inflammation [ 2 , 21 , 22 ]. Fatigue has long been confused with mental and psychological disorders such as depression, and until recent years, it was gradually recognized as an independent disease state. However, it cannot be denied that there are many similarities between them. It is well known that the pathogenesis of depression is related to monoamine neurotransmitters (dopamine, serotonin, and norepinephrine), so more and more clinicians are focusing their research on these neurotransmitters [ 14 ]. Studies have shown that exercise can increase the release of several neurotransmitters in different brain regions. When the intracellular flow of dopamine in the prefrontal region and the anterior hypothalamus increases, interfering with body temperature regulation, the occurrence of fatigue can be controlled [ 13 ]. However, clinical studies have shown that the relationship among serotonin, dopamine and fatigue is contradictory. This study found that changes in the levels of perioperative monoamine neurotransmitters, especially changes of norepinephrine and serotonin, may be related to the occurrence of perioperative fatigue, providing theoretical support and research hypotheses for future studies of the relationships between neurotransmitters changes in cerebrospinal fluid and the functional nuclear magnetic resonance display. We believe that propofol may affect the central nervous system, causing activation or inhibition of related neural networks, thereby leading to a decrease in the levels of monoamine neurotransmitters and possibly causing the occurrence of perioperative fatigue. This discovery requires more randomized controlled trials in the future to verify. This study has several limitations, such as the single-center setting, which may not reflect the overall situation of the total population in China. The small sample size may lead to an increase risk of sampling bias, resulting in false positive or false negative results and affecting the reliability of the conclusion. Furthermore, the decision of whether to perform general anesthesia or local anesthesia is made by the surgeon based on factors such as the patient's cooperation level, the location of vascular stenosis, and the difficulty of the surgical operation. Randomization maynot be achieved, which may lead to a selection bias. Conclusion The incidence of perioperative fatigue is relatively high. Total intravenous general anesthesia may increase the occurrence of perioperative fatigue. In addition, the levels of monoamine neurotransmitters, especially norepinephrine, may be related to the occurrence of perioperative fatigue. Declarations Acknowledgement Authors thank all participated colleagues and patients. Disclosure statement No potential conflict of interest was reported by the authors. Human Ethics and Consent to Participate declarations ： This experiment has been approved by the Chinese Ethics Committee of Registering Clinical Trials. Reference number: ChiECRCT20210407. Clinical trial number: This study is registered with the Chinese Clinical Trial Registry. Registration number: ChiCTR21000498999 (http://www.chictr.org.cn/). Reg Date: 2021-08-10. Funding Declaration: No Funding. Author Contributions ZhangXiaoxiao, data collection, conceptual research, statistical analysis, result interpretation and manuscript writing; BaiYang, data collection; WuYouxuan, statistical analysis; WuBei, English proofreading; LiuHaiyang and HanRuquan, conception and revision of the manuscript. References Penner IK, Paul F. Fatigue as a symptom or comorbidity of neurological diseases[J]. Nat Rev Neurol, 2017, 13(11): 662-675. DOI:10.1038/nrneurol.2017.117. Lee CH, Giuliani F. The role of inflammation in depression and fatigue[J/OL]. Front Immunol, 2019, 10: 1696. DOI:10.3389/fimmu.2019.01696. Van Cutsem J, Marcora S, De Pauw K, et al. The effects of mental fatigue on physical performance: a systematic review[J]. Sports Med, 2017, 47(8): 1569-1588.DOI:10.1007/s40279-016-0672-0. Lee CH, Giuliani F. The role of inflammation in depression and fatigue[J/OL]. Front Immunol, 2019, 10: 1696. DOI:10.3389/fimmu.2019.01696. Christensen T, Kehlet H. Postoperative fatigue[J]. World J Surg, 1993, 17(2): 220-225.DOI:10.1007/BF01658930. Wodlin NB, Nilsson L, Arestedt K, et al. Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting[J]. Acta Obstet Gynecol Scand, 2011, 90(4): 369-379. DOI:10.1111/j.1600-0412.2010.01059.x. 陈耀, 赵紫健, 许琦琦, 等. 术中输注小剂量氯胺酮对腹腔镜全子宫切除术患者术后疲劳的影响[J]. 国际麻醉学与复苏杂志, 2020, 41(5): 479-483.DOI:10.3760/cma.j.cn.321761-20190523-00033. Zlott DA, Byrne M. Mechanisms by which pharmacologic agents may contribute to fatigue[J]. PM R, 2010, 2(5): 451-455. DOI:10.1016/j.pmrj.2010.04.018. Korttila KT. Post-anaesthetic psychomotor and cognitive function[J]. Eur J Anaesthesiol Suppl, 1995, 10: 43-46. Lichtor JL, Alessi R, Lane BS. Sleep tendency as a measure of recovery after drugs used for ambulatory surgery[J]. Anesthesiology, 2002, 96(4): 878-883.DOI:10.1097/00000542-200204000-00015. Shi C, Jin J, Pan Q, et al. Intraoperative use of dexmedetomidine promotes postoperative sleep and recovery following radical mastectomy under general anesthesia[J]. Oncotarget, 2017, 8(45): 79397-79403. DOI:10.18632/oncotarget.18157. Raeder JC, Mjåland O, Aasbø V, et al. Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy[J]. Acta Anaesthesiol Scand, 1998, 42(1): 106-110.DOI:10.1111/j.1399-6576.1998.tb05089.x. Meeusen R, Roelands B. Fatigue: Is it all neurochemistry?[J]. Eur J Sport Sci, 2018, 18(1): 37-46. DOI:10.1080/17461391.2017.1296890. Cordeiro L, Rabelo P, Moraes MM, et al. Physical exercise-induced fatigue: the role of serotonergic and dopaminergic systems[J/OL]. Braz J Med Biol Res, 2017, 50(12): e6432.DOI:10.1590/1414-431X20176432. Lynch J, Mead G, Greig C, Young A, Lewis S, Sharpe M. Fatigue after stroke: the development and evaluation of a case definition. J Psychosom Res (2007) 63(5):539-44. Epub 2007/11/06. doi: 10.1016/j.jpsychores.2007.08.004. PubMed PMID: 17980228. Nostdahl T, Fredheim OM, Bernklev T, et al. A randomised controlled trial of propofol vs. thiopentone and desflurane for fatigue after laparoscopic cholecystectomy[J]. Anaesthesia, 2017, 72(7): 864-869. DOI:10.1111/anae.13909. Xu XY, Lu JL, Xu Q, et al. Risk factors and the utility of three different kinds of prediction models for postoperative fatigue after gastrointestinal tumor surgery[J]. Support Care Cancer, 2021, 29(1): 203-211. DOI:10.1007/s00520-020-05483-0. Schei S, Solheim O, Jakola AS, et al. Perioperative fatigue in patients with diffuse glioma[J]. J Neurooncol, 2020, 147(1): 97-107. DOI:10.1007/s11060-020-03403-0. Hugoy T, Lerdal A, Rustoen T, et al. Predicting postoperative fatigue in surgically treated lung cancer patients in Norway: a longitudinal 5-month follow-up study[J/OL]. BMJ Open, 2019, 9(9): e028192. DOI:10.1136/bmjopen-2018-028192. Wang T, Yin J, Miller AH, et al. A systematic review of the association between fatigue and genetic polymorphisms[J]. Brain Behav Immun, 2017, 62: 230-244. DOI:10.1016/j.bbi.2017.01.007. Wu JM, Yang HT, Ho TW, et al. Association between interleukin-6 levels and perioperative fatigue in gastric adenocarcinoma patients[J/OL]. J Clin Med, 2019, 8(4): 543. DOI:10.3390/jcm8040543. Zielinski MR, Systrom DM, Rose NR. Fatigue, sleep, and autoimmune and related disorders[J/OL]. Front Immunol, 2019, 10: 1827. DOI:10.3389/fimmu.2019.01827 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5350891","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":375225190,"identity":"812a7fd1-0321-412e-97f6-0639f3faba0f","order_by":0,"name":"Xiaoxiao Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIie2QoQ7CMBCGr2lyMwV9ivEIJRgep6iZ4avIEpKqBT0FbzHdGdR4AgwJL4CsgdAJNCcR96kT9+X++wEE4V95elpgcYh8Q3XjZj03F8dX9Cz47YnqJW+97GoLBqkKUAMk3zNCtTkPGdoFuEbVjjdGqOlrS1lRR6dVYCioVQPOUoXaWJ5ipivRkUPkKpS7VU2kVTDoBtYvU2P69d6X5fkx3JNnKJkifafI2hcEQRB+8wEesTMbSOICLgAAAABJRU5ErkJggg==","orcid":"","institution":"Capital Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xiaoxiao","middleName":"","lastName":"Zhang","suffix":""},{"id":375225191,"identity":"c79fb69f-2a82-4f7b-b858-518841adb2ab","order_by":1,"name":"Yang Bai","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Bai","suffix":""},{"id":375225192,"identity":"b177336c-337e-46e4-a038-859d26620b35","order_by":2,"name":"Youxuan Wu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Youxuan","middleName":"","lastName":"Wu","suffix":""},{"id":375225193,"identity":"7570a35d-b9f6-481d-aec1-f21f435972c1","order_by":3,"name":"Bei Wu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bei","middleName":"","lastName":"Wu","suffix":""},{"id":375225194,"identity":"5aed6a33-c8b6-4113-891e-6e89ef23b9fb","order_by":4,"name":"Haiyang Liu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Haiyang","middleName":"","lastName":"Liu","suffix":""},{"id":375225195,"identity":"6c42c65e-119a-4fe9-af03-ac83bf1cd796","order_by":5,"name":"Ruquan Han","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ruquan","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2024-10-29 04:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5350891/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5350891/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70296899,"identity":"839d434c-12f0-419a-a2c3-127579e06cff","added_by":"auto","created_at":"2024-12-02 00:42:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":112352,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart showing patient enrollment\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5350891/v1/e5fbb19689a0b65221d1caa2.png"},{"id":70296903,"identity":"1c1f2905-55c5-460a-9c9b-09e3b5445697","added_by":"auto","created_at":"2024-12-02 00:42:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":134790,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot and trend line of the dosage of propofol and the Fatigue Scale-14 (FS-14) score one day and seven days after surgery in the general anesthesia group\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5350891/v1/efb0904116f9423c5ffbc052.png"},{"id":70296901,"identity":"e1a0d591-8e12-4972-af36-69ad66c113b4","added_by":"auto","created_at":"2024-12-02 00:42:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":207954,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot and trend line of the relationship between the dosage and changes of propofol and norepinephrine/5-hydroxytryptamine/dopamine in patients of the general anesthesia group\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5350891/v1/e632d59c72ff93902d8ebd71.png"},{"id":70297268,"identity":"9ef77953-e99e-4b68-a236-667566da5b84","added_by":"auto","created_at":"2024-12-02 00:50:12","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":358030,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot and trend line of the changing norepinephrine/5-hydroxytryptamine/dopamine relationship of the patients and the Fatigue Scale-14 (FS-14) scores on the first and seventh days after surgery\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5350891/v1/3489dc7c25f1761ded7c5d2e.png"},{"id":87547625,"identity":"4b0cab6b-9ec7-415a-818e-8e5cd7276dce","added_by":"auto","created_at":"2025-07-25 05:32:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1553692,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5350891/v1/04d22e3a-35fe-40f1-888f-459fa658fb46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe influence of total intravenous anesthesia on perioperative fatigue in patients undergoing stent implantation for cerebrovascular stenosis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFatigue is a complex subjective sensation, and patients may experience discomfort such as fatigue, exhaustion, and weakness. In the late 19th century, Felix first described fatigue symptoms [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Chronic fatigue syndrome occurs worldwide, with a prevalence rate of 0.2\u0026ndash;0.4% among adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Fatigue is more common among people after diseases and surgeries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. And perioperative fatigue can lead to poor prognosis for patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Fatigue hinders postoperative recovery by affecting patients' active activities after surgery, thereby damaging muscle function and increasing the likelihood of severe complications (including pneumonia and deep vein thrombosis). Although fatigue and its related sequelae (often considered as complications of surgery) rarely pose a threat to life, their cumulative effects can significantly reduce the quality of life of patients, prolong hospital stays, and delay the time for patients to return to normal activities and work. Fatigue is one of the reasons for the increase in global social burdens and has become a disabling symptom affecting an individual's quality of life and productivity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, an increasing number of anesthesiologists have begun to pay attention to the relationship between anesthetic drugs and perioperative fatigue. However, the conclusions of previous studies on the impact of general anesthetic drugs on perioperative fatigue have been inconsistent [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Propofol, as the most commonly used intravenous general anesthetic sedative drug in clinical practice at present, its influence on the occurrence of perioperative fatigue has great clinical significance. Therefore, this study designed a total intravenous anesthesia method with TCI infusion of propofol, aiming to explore the impact of propofol on the occurrence of perioperative fatigue.\u003c/p\u003e \u003cp\u003eFatigue was confused with mental and psychological diseases such as depression for a long time. It was not until recent years that it was gradually recognized as an independent disease state. However, it is undeniable that there are many similarities between them. As is known to all, the pathogenesis of depression is related to monoamine biological transmitters (dopamine, 5-hydroxytryptamine and norepinephrine) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As a result, more and more clinicians have focused their research on these biological transmitters. The secondary outcome of this study is to explore the influencing factors of perioperative fatigue occurrence, with a focus on the study of the influence of monoamine biological transmitters on perioperative fatigue, thereby exploring the possible occurrence mechanism of perioperative fatigue.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1.1 Patient Population\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who underwent stent implantation for elective cerebrovascular stenosis in the Neurointerventional Center of Beijing Tiantan Hospital, Capital Medical University from November 2021 to March 2022 were continuously included.\u003c/p\u003e\n\u003cp\u003eInclusion criteria\u003c/p\u003e\n\u003cp\u003e1.Patients with cerebrovascular stenosis who are electively admitted, aged 18 - 80 years old;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. After signing the informed consent, endovascular treatment under elective intervention was performed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criteria\u003c/p\u003e\n\u003cp\u003e1. Primary school education or below / unable to cooperate with the scale examination / refused to sign the informed consent / poor compliance / difficult to complete the follow-up of patients;\u003c/p\u003e\n\u003cp\u003e2. Patients with alcohol or drug abuse;\u003c/p\u003e\n\u003cp\u003e3. Patients who have taken medications for mental and psychological diseases for a long time;\u003c/p\u003e\n\u003cp\u003e4. Patients with malignant tumors or severe organ dysfunction or an expected lifespan of less than 6 months;\u003c/p\u003e\n\u003cp\u003e5. Patients with new-onset stroke / previous stroke / other central nervous system diseases;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6. Patients with thyroid diseases / abnormal thyroxine levels / taking relevant medications;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. Patients with previously diagnosed depression/M.I.N.I. depression scale indicating a depressive state and those with newly diagnosed depression state indicated by the postoperative M.I.N.I. depression scale;\u003c/p\u003e\n\u003cp\u003e8. Patients with previous cognitive dysfunction or a MOCA score less than 26 and a postoperative MOCA score less than 26;\u003c/p\u003e\n\u003cp\u003e9. Patients who have a state of fatigue or chronic fatigue syndrome before the operation.\u003c/p\u003e\n\u003cp\u003eBased on the above inclusion and exclusion criteria, a total of 40 patients were included, including 20 in the general anesthesia group and 20 in the local anesthesia group. (Figur1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Chinese Ethics Committee of Registering Clinical Trials (Reference number: ChiECRCT20210407). Written informed consent was obtained from all participants or family members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1.2 Data collection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1.2.1 Clinical data collection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients who met the inclusion criteria were selected for general anesthesia or local anesthesia based on the surgical requirements and patient conditions by professional neuro-interventional physicians who were unaware of the study groups.\u003c/p\u003e\n\u003cp\u003eAfter the patient is admitted to the hospital, the preoperative medical records are obtained and the basic information of the patient (gender, age, smoking, drinking, previous disease history and medication history, etc.) is visited face-to-face. The location of vascular stenosis is identified before the operation (anterior and posterior circulation, intracranial and extracranial), the ASA classification is evaluated, and the perioperative laboratory tests (blood routine, C-reactive protein, blood biochemistry) are recorded. Serum biomarker detection (dopamine DA, neurotransmitter serotonin 5-HT and norepinephrine NE) and scale assessment: Fatigue Scale - 14, Fatigue Severity Scale (FSS), M.I.N.I. Depression Scale, Pittsburgh Sleep Questionnaire (PSQI), MOCA Cognitive Function Scale.\u003c/p\u003e\n\u003cp\u003eThe duration of the operation, the method and dosage of anesthesia, the types and quantities of stents were recorded during the operation.\u003c/p\u003e\n\u003cp\u003eOn the first day after the operation, the neurotransmitters 5-HT, DA and NE in the serum marker detection were recorded, and the fatigue, mood and sleep conditions were evaluated.\u003c/p\u003e\n\u003cp\u003eOn the 7th day after the operation, the patient's fatigue, mood, sleep, cognition, quality of life and other conditions were evaluated again using scales. The Fatigue Scale - 14, FSS, M.I.N.I., PSQI, MOCA, modified Rankin Scale (mRS) were assessed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollow-up personnel: All visits were completed by neurology and anesthesiology personnel who had received relevant scale training. Among them, the author was responsible for preoperative visits, and two attending physicians conducted independent assessment and follow-up visits to complete the long-term visits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1.2.2 Collection of peripheral blood biology information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetection of blood biomarkers: Peripheral venous blood of the patient was collected into red blood collection tubes, approximately 5 ml per tube, for the separation of serum. The whole blood samples collected in the serum separation tubes are placed at room temperature for 2 hours, then centrifuged at 1,000×g for 20 minutes, and the supernatant was taken to obtain the serum samples.\u003c/p\u003e\n\u003cp\u003eManagement of biological samples: Serum samples were stored in a -80°C refrigerator to avoid repeated freezing and thawing. Reagent kits from Beijing Bao Pai ke Biotechnology Co., Ltd. were purchased: 5-hydroxytryptamine (5-HT) detection kit (CEA808Ge 96T), dopamine (DA) detection kit (CEA851Ge 96T), and norepinephrine (NE) detection kit (CEA907Ge 96T). Serum cryopreserved specimens were transported by dry ice chain mail to the reagent kit manufacturer for post-processing. According to the detection instructions of the reagent kit, the steps of reagent preparation, sample addition, incubation, and washing were carried out in sequence. The level of the substance to be tested in the specimens was determined by using the competitive inhibition enzyme-linked immunosorbent assay.\u003c/p\u003e\n\u003cp\u003e1.3 Standardized anesthesia methods\u003c/p\u003e\n\u003cp\u003eAll patients received standardized anesthesia during the operation, and the routine monitoring included 5-lead electrocardiogram, heart rate, non-invasive blood pressure, blood oxygen saturation, and end-tidal carbon dioxide. Before the surgical operation began in the angiography operating room, the patients were connected to the peripheral venous access.\u003c/p\u003e\n\u003cp\u003ePatients under general anesthesia were induced and maintained using the TCI target-controlled infusion mode. The anesthesia machine used was the Avance CS\u003csup\u003e2\u003c/sup\u003e anesthesia machine of General Electric Healthcare Systems Trading and Development (Shanghai) Co., Ltd.\u003c/p\u003e\n\u003cp\u003eBefore induction, midazolam 0.03 mg/kg was intravenously injected.\u003c/p\u003e\n\u003cp\u003eAnesthesia induction: Propofol (Liaoning Haisen Pharmaceutical Co., Ltd., Production batch number: 20230918). \u0026nbsp;Plasma\u003c/p\u003e\n\u003cp\u003etarget-controlled concentration was set at 4 μg/ml, sufentanil (Human Fortune Pharmaceutical Group Co., Ltd., production batch number: 21B080211) 0.25 μg/kg, the induction time was set at 3 minutes. After the patient lost consciousness, rocuronium (Hainan Sida Pharmaceutical Co., Ltd., production batch number: 2306010A) 0.6 mg/kg was intravenously injected. After 90 seconds, laryngeal mask intubation was performed and the anesthesia machine was connected for assisted ventilation.\u003c/p\u003e\n\u003cp\u003eAnesthesia maintenance: The plasma target-controlled concentration of propofol was 2.5 μg/ml, and the infusion rate of remifentanil (Human Fortune Pharmaceutical Group Co., Ltd., production batch number: 30A06061) was 0.1 μg/kg/min.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMechanical ventilation maintained normal levels of carbon dioxide (PaCO2 35-45 mmHg), SpO2 \u0026gt; 92%, PaO2 \u0026gt; 60 mmHg; blood pressure should be maintained within 20% of the basal level. If the blood pressure is too low, 6 mg of ephedrine can be given intravenously at a single dose. Body temperature was maintained above 35℃; blood glucose levels was maintained within 70-140 mg/dL. If the blood glucose concentration was less than 50 mg/dL, hypoglycemia treatment was initiated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.4 \u0026nbsp;Definition of Fatigue\u003c/p\u003e\n\u003cp\u003eThis study adopted the Lynch case definition in 2007 [15]: Patients experience fatigue, lack of energy, and need to rest daily or almost daily. This fatigue makes it difficult to participate in daily activities (for inpatients, it may include treatment and may include the need to prematurely terminate activities due to fatigue).\u003c/p\u003e\n\u003cp\u003eThe Fatigue Severity Scale (FSS) was used for quantification: A total score lower than 36 was determined as no fatigue, and a total score of 36 or higher was determined as the existence of fatigue. The Fatigue-14 Scale was used to assess the severity of fatigue, and the higher the total score, the more severe the fatigue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1.5 Statistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe database was established and statistical analysis was conducted using SPSS 24.0. The normality distribution test was performed on the measurement data. If the data was normally distributed, it was expressed as x±S. If it did not conform to the normal distribution, it was expressed as the median and the range of the quartiles. The count data was expressed by the number of cases and percentages. The comparison between the two groups of measurement data that conformed to the normal distribution was conducted using the t-test, and the measurement data that did not conform to the normal distribution were tested using the rank sum test. The count data were tested using the chi-square test. P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1 The influence of total intravenous anesthesia on perioperative fatigue\u003c/p\u003e \u003cp\u003eAmong the 40 patients with cerebrovascular stenosis who underwent elective vascular stent implantation, 20 received total intravenous general anesthesia, and the other 20 received local anesthesia (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The demographic statistics between the general anesthesia group and the local anesthesia group expressed no significant statistical difference in demographic information (name, gender, age, height, weight, BMI) and previous underlying diseases (hypertension, diabetes, coronary heart disease, heart failure, snoring). The hemoglobin content in the general anesthesia group was lower than that in the local anesthesia group, but neither was anemic (137.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8 vs. 151.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5, P\u0026thinsp;=\u0026thinsp;0.005). Compared with the local anesthesia group, patients in the general anesthesia group had a higher PSQI scale score one day after the operation (12 (5.3, 15.8), p\u0026thinsp;=\u0026thinsp;0.041). One day after the operation, more patients in the general anesthesia group were diagnosed with perioperative fatigue state than in the local anesthesia group (14 (70%) vs. 4 (20%), P\u0026thinsp;=\u0026thinsp;0.001), and the severity was higher (7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 vs. 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9, P\u0026thinsp;=\u0026thinsp;0.025). The results after a 7-day follow-up were similar (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was no statistical difference in prognosis between the general anesthesia group and the local anesthesia group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of General Conditions between General Anesthesia Group and Local Anesthesia Group Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral anesthesia group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003elocal anesthesia group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of supports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.0\u0026thinsp;\u0026plusmn;\u0026thinsp;34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.1\u0026thinsp;\u0026plusmn;\u0026thinsp;33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe stenosis is located in the posterior circulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe stenosis is located within the cranium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood glucose (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChlorine (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5(0,1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0,1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne day after the operation, PSQI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(5.3,15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5(3.3,9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up for 7 days, PSQI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.0(4.0,14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5(3.3,9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue one day after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue 7 days after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe severity of fatigue one day after the operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe severity of fatigue 7 days after the operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI: Body Mass Index (BMI), also known as Body Mass Index, is a number obtained by dividing one's weight in kilograms by the square of one's height in meters. MRS: The MRS score, also known as the Improved Rankin Scale, is a scale used to evaluate the neurological recovery status of stroke patients. PSQI: The Pittsburgh Sleep Quality Index (PSQI) was compiled by Dr. Buysse and others, psychiatrists at the University of Pittsburgh, in 1989. This scale is suitable for evaluating sleep quality in patients with sleep disorders and mental disorders, as well as for assessing sleep quality in the general population.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the dosage of propofol in patients of the general anesthesia group is positively correlated with the Fatigue-14 Scale scores on the 1st and 7th days after surgery. The more the dosage of propofol, the higher the fatigue score and the more severe the fatigue severity. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e suggests that the dosage of propofol in patients of the general anesthesia group is negatively correlated with the changed monoamine neurotransmitters. The greater the dosage of propofol, the more the monoamine neurotransmitters decreased after surgery compared with those before surgery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e2.2 Risk factors of perioperative fatigue\u003c/p\u003e \u003cp\u003eOne day after the operation, 18 patients were diagnosed as being in a state of fatigue, and 15 patients still had fatigue seven days after the operation (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). On the first day after the operation, the proportion of perioperative fatigue patients who received total intravenous anesthesia was higher than that of non-fatigue patients (6 (27.3) vs. 14 (77.8), P\u0026thinsp;=\u0026thinsp;0.001), the PSQI score was higher (5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 vs. 14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the level of norepinephrine decreased more (0.05 (-0.03, 0.13) vs. -0.10 (-0.17, -0.04), P\u0026thinsp;=\u0026thinsp;0.001), the level of serotonin decreased more significantly (-0.07 (-0.23, 0.22) vs. -0.19 (-0.30, -0.11), P\u0026thinsp;=\u0026thinsp;0.035), while there was no significant statistical difference in the level of dopamine. During the 7-day follow-up period after the operation, the results were similar to those on the first day after the operation (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patients who experienced fatigue on postoperative day 1 and 7 compared to those who did not experience fatigue\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFatigue one day after the operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFatigue seven days after the operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;22 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;18 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;25 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;15 )\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23(92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e169.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e167.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (Kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14(93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of supports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe stenosis is located in the posterior circulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe stenosis is located within the cranium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.7\u0026thinsp;\u0026plusmn;\u0026thinsp;32.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.9\u0026thinsp;\u0026plusmn;\u0026thinsp;35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.6\u0026thinsp;\u0026plusmn;\u0026thinsp;36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.6\u0026thinsp;\u0026plusmn;\u0026thinsp;36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dose of propofol (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e459.9\u0026thinsp;\u0026plusmn;\u0026thinsp;92.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e561\u0026thinsp;\u0026plusmn;\u0026thinsp;212.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e459.9\u0026thinsp;\u0026plusmn;\u0026thinsp;92.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e561.2\u0026thinsp;\u0026plusmn;\u0026thinsp;212.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dose of remifentanil (ug)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e228.4\u0026thinsp;\u0026plusmn;\u0026thinsp;74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195.7\u0026thinsp;\u0026plusmn;\u0026thinsp;121.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e228.4\u0026thinsp;\u0026plusmn;\u0026thinsp;74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e195.7\u0026thinsp;\u0026plusmn;\u0026thinsp;121.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative use of ephedrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative BIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.5(43.7,48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.0(42.0,50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.5(43.7,48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.0(42.0,50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood glucose (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e141.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChlorine (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5(0,1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0,1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(0,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne day after the operation, PSQI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up for 7 days, PSQI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDA(ld) (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01(-0.04,0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.03(-0.06,0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00(-0.04,0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.04(-0.06,0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5HT(ld) (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.07(-0.23,0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.19(-0.30,-0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.08(-0.21,0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.23(-0.30,-0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA(ld) (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.05(-0.03,0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.10(-0.17,-0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02(-0.05,0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.10(-0.19,-0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eDA(ld): Changes in dopamine levels are calculated by subtracting preoperative dopamine levels from postoperative dopamine levels. 5HT(ld): Changes in serotonin levels are calculated by subtracting preoperative serotonin levels from postoperative serotonin levels. NA(ld) : Changes in norepinephrine levels were calculated by subtracting preoperative norepinephrine levels from postoperative norepinephrine levels.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that on the 1st and 7th days after the operation, the levels of changed monoamine biological neurotransmitters were negatively correlated with the scores of the Fatigue-14 Scale. The more the monoamine neurotransmitters decreased after the operation compared with those before the operation, the higher the fatigue score was, and the more severe the fatigue was.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFatigue is a complex subjective sensation, representing excessive and persistent mental and/or physical weakness or exhaustion. The state of fatigue often hinders patients' normal work and life and brings many adverse effects to them [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This study found that the incidence of perioperative fatigue was 45.0% on the first day after surgery and 37.5% on the seventh day after surgery, which is similar to the previous studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePerioperative fatigue is a very common clinical symptom. As scholars have attached more importance to it, research on fatigue has also increased. Previous studies suggest that postoperative fatigue may be caused by the response of endocrine metabolism to surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Some studies believe that perioperative anxiety, depression, and sleep are not related to the fatigue state, while other studies have contrary opinions[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Thus, there are contradictory conclusions among previous studies on the risk factors of perioperative fatigue. In this study, after excluding the influence of depression and cognitive function changes on fatigue, we found that the perioperative fatigue state may be related to perioperative sleep disorders, but the causal relationship is not clear and needs to be further explored in the future.\u003c/p\u003e \u003cp\u003eIn recent years, an increasing number of anesthesiologists have begun to pay attention to the relationship between anesthetic drugs and perioperative fatigue. A secondary analysis of a randomized, open, multicenter study suggested that compared with general anesthesia, intraspinal anesthesia reduced the need for postoperative opioid drugs, significantly reducing the frequency and intensity of abdominal pain, drowsiness, and fatigue in patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In a study on the relationship between intraoperative infusion of low-dose ketamine and postoperative fatigue in patients undergoing laparoscopic total hysterectomy, Chen Yao et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] believed that the use of low-dose ketamine could reduce the incidence of fatigue in patients undergoing gynecological laparoscopic surgery 3 days after surgery, and it had a good sedative and analgesic effect [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some studies have shown that drugs such as opioids may cause fatigue, which is different from the residual sedative effect of anesthetic and analgesic drugs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Shi et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] found that breast cancer patients undergoing radical mastectomy under general anesthesia with dexmedetomidine had a lower score for the severity of perioperative fatigue. Propofol and desflurane are the two most widely used anesthetic drugs in modern times. It is generally believed that these drugs with rapid metabolic clearance do not cause fatigue. However, a study reported that compared with the application of desflurane, more patients using propofol had fatigue one week after laparoscopic cholecystectomy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another study indicated that the effects of propofol, thiopental sodium, and desflurane general anesthesia on fatigue after elective laparoscopic cholecystectomy were similar [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This study found that total intravenous anesthesia may increase the occurrence of perioperative fatigue, and this effect may persist until 7 days after surgery, which is similar to the results of previous studies. In the long term, as the follow-up time prolongs, the impact of anesthesia may gradually weaken, the number of patients in a fatigued state may decrease, and the severity of fatigue may decline. However, how long the fatigued state will last before fully returning to the preoperative normal state still needs further follow-up studies.\u003c/p\u003e \u003cp\u003eThe pathogenesis of fatigue is very complex and is not yet fully understood. Some researchers believe that fatigue susceptibility may be influenced by genetic factors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Some studies have shown that fatigue is associated with increased activation of the immune system inflammation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Fatigue has long been confused with mental and psychological disorders such as depression, and until recent years, it was gradually recognized as an independent disease state. However, it cannot be denied that there are many similarities between them. It is well known that the pathogenesis of depression is related to monoamine neurotransmitters (dopamine, serotonin, and norepinephrine), so more and more clinicians are focusing their research on these neurotransmitters [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have shown that exercise can increase the release of several neurotransmitters in different brain regions. When the intracellular flow of dopamine in the prefrontal region and the anterior hypothalamus increases, interfering with body temperature regulation, the occurrence of fatigue can be controlled [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, clinical studies have shown that the relationship among serotonin, dopamine and fatigue is contradictory. This study found that changes in the levels of perioperative monoamine neurotransmitters, especially changes of norepinephrine and serotonin, may be related to the occurrence of perioperative fatigue, providing theoretical support and research hypotheses for future studies of the relationships between neurotransmitters changes in cerebrospinal fluid and the functional nuclear magnetic resonance display. We believe that propofol may affect the central nervous system, causing activation or inhibition of related neural networks, thereby leading to a decrease in the levels of monoamine neurotransmitters and possibly causing the occurrence of perioperative fatigue. This discovery requires more randomized controlled trials in the future to verify.\u003c/p\u003e \u003cp\u003eThis study has several limitations, such as the single-center setting, which may not reflect the overall situation of the total population in China. The small sample size may lead to an increase risk of sampling bias, resulting in false positive or false negative results and affecting the reliability of the conclusion. Furthermore, the decision of whether to perform general anesthesia or local anesthesia is made by the surgeon based on factors such as the patient's cooperation level, the location of vascular stenosis, and the difficulty of the surgical operation. Randomization maynot be achieved, which may lead to a selection bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe incidence of perioperative fatigue is relatively high. Total intravenous general anesthesia may increase the occurrence of perioperative fatigue. In addition, the levels of monoamine neurotransmitters, especially norepinephrine, may be related to the occurrence of perioperative fatigue.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors thank all participated colleagues and patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDisclosure statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis experiment has been approved by the Chinese Ethics Committee of Registering Clinical Trials. Reference number: ChiECRCT20210407.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e This study is registered with the Chinese Clinical Trial Registry. Registration number: ChiCTR21000498999 (http://www.chictr.org.cn/). Reg Date: 2021-08-10.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eNo Funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhangXiaoxiao, data collection, conceptual research, statistical analysis, result interpretation and manuscript writing;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBaiYang, data collection;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWuYouxuan, statistical analysis;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWuBei, English proofreading;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLiuHaiyang and HanRuquan, conception and revision of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePenner IK, Paul F. Fatigue as a symptom or comorbidity of neurological diseases[J]. Nat Rev Neurol, 2017, 13(11): 662-675. DOI:10.1038/nrneurol.2017.117.\u003c/li\u003e\n\u003cli\u003eLee CH, Giuliani F. The role of inflammation in depression and fatigue[J/OL]. Front Immunol, 2019, 10: 1696. DOI:10.3389/fimmu.2019.01696.\u003c/li\u003e\n\u003cli\u003eVan Cutsem J, Marcora S, De Pauw K, et al. The effects of mental fatigue on physical performance: a systematic review[J]. Sports Med, 2017, 47(8): 1569-1588.DOI:10.1007/s40279-016-0672-0.\u003c/li\u003e\n\u003cli\u003eLee CH, Giuliani F. The role of inflammation in depression and fatigue[J/OL]. Front Immunol, 2019, 10: 1696. DOI:10.3389/fimmu.2019.01696.\u003c/li\u003e\n\u003cli\u003eChristensen T, Kehlet H. Postoperative fatigue[J]. World J Surg, 1993, 17(2): 220-225.DOI:10.1007/BF01658930.\u003c/li\u003e\n\u003cli\u003eWodlin NB, Nilsson L, Arestedt K, et al. Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting[J]. Acta Obstet Gynecol Scand, 2011, 90(4): 369-379. DOI:10.1111/j.1600-0412.2010.01059.x.\u003c/li\u003e\n\u003cli\u003e陈耀, 赵紫健, 许琦琦, 等. 术中输注小剂量氯胺酮对腹腔镜全子宫切除术患者术后疲劳的影响[J]. 国际麻醉学与复苏杂志, 2020, 41(5): 479-483.DOI:10.3760/cma.j.cn.321761-20190523-00033.\u003c/li\u003e\n\u003cli\u003eZlott DA, Byrne M. Mechanisms by which pharmacologic agents may contribute to fatigue[J]. PM R, 2010, 2(5): 451-455. DOI:10.1016/j.pmrj.2010.04.018.\u003c/li\u003e\n\u003cli\u003eKorttila KT. Post-anaesthetic psychomotor and cognitive function[J]. Eur J Anaesthesiol Suppl, 1995, 10: 43-46.\u003c/li\u003e\n\u003cli\u003eLichtor JL, Alessi R, Lane BS. Sleep tendency as a measure of recovery after drugs used for ambulatory surgery[J]. Anesthesiology, 2002, 96(4): 878-883.DOI:10.1097/00000542-200204000-00015.\u003c/li\u003e\n\u003cli\u003eShi C, Jin J, Pan Q, et al. Intraoperative use of dexmedetomidine promotes postoperative sleep and recovery following radical mastectomy under general anesthesia[J]. Oncotarget, 2017, 8(45): 79397-79403. DOI:10.18632/oncotarget.18157.\u003c/li\u003e\n\u003cli\u003eRaeder JC, Mj\u0026aring;land O, Aasb\u0026oslash; V, et al. Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy[J]. Acta Anaesthesiol Scand, 1998, 42(1): 106-110.DOI:10.1111/j.1399-6576.1998.tb05089.x.\u003c/li\u003e\n\u003cli\u003eMeeusen R, Roelands B. Fatigue: Is it all neurochemistry?[J]. Eur J Sport Sci, 2018, 18(1): 37-46. DOI:10.1080/17461391.2017.1296890.\u003c/li\u003e\n\u003cli\u003eCordeiro L, Rabelo P, Moraes MM, et al. Physical exercise-induced fatigue: the role of serotonergic and dopaminergic systems[J/OL]. Braz J Med Biol Res, 2017, 50(12): e6432.DOI:10.1590/1414-431X20176432.\u003c/li\u003e\n\u003cli\u003eLynch J, Mead G, Greig C, Young A, Lewis S, Sharpe M. Fatigue after stroke: the development and evaluation of a case definition. J Psychosom Res (2007) 63(5):539-44. Epub 2007/11/06. doi: 10.1016/j.jpsychores.2007.08.004. PubMed PMID: 17980228.\u003c/li\u003e\n\u003cli\u003eNostdahl T, Fredheim OM, Bernklev T, et al. A randomised controlled trial of propofol vs. thiopentone and desflurane for fatigue after laparoscopic cholecystectomy[J]. Anaesthesia, 2017, 72(7): 864-869. DOI:10.1111/anae.13909.\u003c/li\u003e\n\u003cli\u003eXu XY, Lu JL, Xu Q, et al. Risk factors and the utility of three different kinds of prediction models for postoperative fatigue after gastrointestinal tumor surgery[J]. Support Care Cancer, 2021, 29(1): 203-211. DOI:10.1007/s00520-020-05483-0.\u003c/li\u003e\n\u003cli\u003eSchei S, Solheim O, Jakola AS, et al. Perioperative fatigue in patients with diffuse glioma[J]. J Neurooncol, 2020, 147(1): 97-107. DOI:10.1007/s11060-020-03403-0.\u003c/li\u003e\n\u003cli\u003eHugoy T, Lerdal A, Rustoen T, et al. Predicting postoperative fatigue in surgically treated lung cancer patients in Norway: a longitudinal 5-month follow-up study[J/OL]. BMJ Open, 2019, 9(9): e028192. DOI:10.1136/bmjopen-2018-028192.\u003c/li\u003e\n\u003cli\u003eWang T, Yin J, Miller AH, et al. A systematic review of the association between fatigue and genetic polymorphisms[J]. Brain Behav Immun, 2017, 62: 230-244. DOI:10.1016/j.bbi.2017.01.007.\u003c/li\u003e\n\u003cli\u003eWu JM, Yang HT, Ho TW, et al. Association between interleukin-6 levels and perioperative fatigue in gastric adenocarcinoma patients[J/OL]. J Clin Med, 2019, 8(4): 543. DOI:10.3390/jcm8040543.\u003c/li\u003e\n\u003cli\u003eZielinski MR, Systrom DM, Rose NR. Fatigue, sleep, and autoimmune and related disorders[J/OL]. Front Immunol, 2019, 10: 1827. DOI:10.3389/fimmu.2019.01827\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Perioperative fatigue, Total intravenous anesthesia, Biomarkers risk factors","lastPublishedDoi":"10.21203/rs.3.rs-5350891/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5350891/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To explore the influence of total intravenous anesthesia on the occurrence of perioperative fatigue in patients with cerebrovascular stenosis who undergo elective stent implantation on an elective basis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Patients who underwent elective stent implantation for cerebrovascular stenosis in the Neuro-interventional Center of Beijing Tiantan Hospital, Capital Medical University were continuously included from November 2021 to March 2022. Demographic information, peripheral blood biomarkers, scale information, and information related to surgical anesthesia of the patients during the perioperative period were collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: One day after the operation, more patients in the general anesthesia group were diagnosed with perioperative fatigue (14 (70%) vs. 4 (20%), P = 0.001) than in the local anesthesia group, and the severity was higher (7.0 ± 3.8 vs. 4.5 ± 2.9, P = 0.025). The proportion of patients with perioperative fatigue who received total intravenous anesthesia was higher than that in the non-fatigue group (6 (27.3) vs. 14 (77.8), P = 0.001), the decrease in norepinephrine levels was greater (0.05 (-0.03, 0.13) vs. -0.10 (-0.17, -0.04), P = 0.001), the decrease in serotonin levels was more obvious (-0.07 (-0.23, 0.22) vs. -0.19 (-0.30, -0.11), P = 0.035), while there was no significant statistical difference in dopamine levels. The levels of changed monoamine neurotransmitters one day and seven days after the operation were negatively correlated with the score of the Fatigue-14 Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The incidence of perioperative fatigue is relatively high. Total intravenous general anesthesia may increase the occurrence of perioperative fatigue. In addition, the levels of monoamine neurotransmitters, especially norepinephrine, may be related to the occurrence of perioperative fatigue.\u003c/p\u003e","manuscriptTitle":"The influence of total intravenous anesthesia on perioperative fatigue in patients undergoing stent implantation for cerebrovascular stenosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 00:42:07","doi":"10.21203/rs.3.rs-5350891/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"771f6a70-0798-4046-bf47-dc5de0c4b696","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-25T05:24:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 00:42:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5350891","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5350891","identity":"rs-5350891","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}