Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial | 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 Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial Liu Minqiang, Ma Mingfei, Hong Fengzhu, Li Yang, Guo Shanshan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4733014/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Sep, 2024 Read the published version in BMC Anesthesiology → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Opioid-reduced multimodal analgesia has been clinically used for years to reduce perioperative complications related to opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Methods: Surgical patients (n=151) with palmar hyperhidrosis were randomly divided into a control group (Group C, 73 patients) and a weak opioid group (Group W, 78 patients). All patients were administered general anesthesia using a laryngeal mask. In Group C, the patients were anesthetized with propofol, fentanyl, and cisatracurium, and mechanical ventilation was used during the operation. In Group W, the patients received propofol, dezocine, and dexmedetomidine (DEX), and spontaneous breathing was maintained during surgery. Perioperative complications related to opioids include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness; vital signs, blood gas index, visual analog scale (VAS) score, and other adverse events; patient satisfaction between groups were also recorded. Results : Perioperative complications related to opioids were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction ( P > 0.05). Conclusions: In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages. Trial registration Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021. Dezocine Dexmedetomidine Intercostal nerve block Sympathectomy Figures Figure 1 Background Opioids have played a crucial role in surgical procedures for years because of their strong analgesic effects; however, their use can also lead to adverse reactions such as dose-dependent inhibition of respiratory and circulatory function, scratching, nausea, vomiting, and drowsiness [ 1 ] . In the last few decades, anesthesiologists have attempted to reduce opioid consumption in order to reduce surgical complications. Opioid-reduced anesthesia is a technique developed based on perioperative multimodal pain management that uses few or no opioid drugs [ 2 ] . The main components of opioid-reduced anesthesia include sedatives, N-methyl-D-aspartate receptor antagonists, anti-inflammatory drugs, α2 receptor agonists, and local anesthetics, combined with spinal anesthesia or peripheral nerve block when necessary, to partially or completely replace opioid drugs with the goal of minimizing the use of opioids and reducing the adverse reactions caused by them [3~5] . With the continuous promotion of enhanced recovery after surgery (ERAS), the combination of weak opioids (such as dezocine and butorphanol), α2-adrenal agonists, non-steroidal anti-inflammatory drugs (NSAIDs), or nerve block techniques has been used to achieve multi-mode anesthesia and proved to be safe and effective [6~9] . Thoracoscopic sympathectomy is an important treatment for palmar hyperhidrosis and has the advantages of precise results, minimal trauma, and fast postoperative recovery [ 10 , 11 ] . To test the efficacy of opioid-reduced anesthesia, we aimed to investigate the clinical effects of dezocine combined with dexmedetomidine (DEX) and intercostal nerve block on the possibility that this anesthesia strategy can achieve similar analgesic effects but with fewer adverse reactions when compare to strong opioids. Materials and methods Study design This study was registered in the Chinese Clinical Trial Register ( http://www.chictr.org.cn ; registration number: ChiCTR2100055005, on December 30, 2021). Ethical approval (Number: 2022-025-02) for this study (Research Ethics Committee) was provided by the Ethical Committee of Shenzhen Third People's Hospital, Shenzhen, Guangdong, China (Chairman Zhang Guoliang), on 24 March 2022). Written informed consent about this research protocol was obtained from all eligible patients. Patient recruitment Between May 2022 and March 2023, patients who received general anesthesia with a laryngeal mask were recruited. The inclusion criteria were patients diagnosed with palmar hyperhidrosis, who underwent elective single/bilateral endoscopic thoracic sympathectomy, aged 18–60 years, and American Society of Anesthesiologists (ASA) class I or II. The exclusion criteria were as follows: body mass index (BMI) > 30 kg/m 2 ; breastfeeding or pregnancy; a history of thoracic surgery or a second thoracic sympathetic nerve resection; important organ system dysfunction; spontaneous bleeding or coagulation dysfunction; a history of chronic pain; a history of upper airway infection in the last 2 weeks; abuse of opioid or non-steroidal anti-inflammatory drugs; known hypersensitivity or allergy to non-steroidal drugs, alcohol, and local anesthetics; and concomitant mental illness or cognitive impairment. Patients who had serious surgical complications switched to thoracotomy or changed the anesthesia method were also excluded. Sample size calculation This study was a non-inferiority-designed clinical trial, assuming that patients in the two groups experienced similar analgesic effects. The sample size was estimated using PASS software version 23.0, and the combined standard deviation of the two groups was determined based on the pretrial results σ = 0.5, non-inferiority threshold δ = 0.2. With α = 0.025 (one side), inspection efficiency (1- β)= 0.9, the minimum sample required for each group was 68 cases. Considering that 20% of the patients may have been lost during the study, total 164 patients were recruited. Randomization The patients were divided into two groups based on computer-generated random numbers. If the number was odd, the patients were assigned to the strong opioid group (control group, Group C); if the number was even, the patients were assigned to the weak opioid group (Group W). Blinding design One anesthesiologist who was aware of the patient grouping administered clinical anesthesia according to standard procedures, and another anesthesiologist who was blinded to the grouping was responsible for data recording. Anesthesia protocol All patients fasted for 10 h; however, a 200 mL carbohydrate drink was administered orally 2 h before surgery. After the patient entered the operating room, electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO 2 ), bispectral index (BIS), and pain index (PI) were recorded. Upper limb venous access was established, and lactate sodium Ringer's solution was continuously infused at a rate of 4–8 mL/kg/h; mask oxygen was administered at a rate of 2 L/min. In group C, a targeted infusion of propofol 3–6 µg/mL, fentanyl 4 µg/kg, and cisatracurium 0.15 mg/kg was intravenously injected for general anesthesia induction. Laryngeal mask intubation was performed when BIS ≤ 60 and PI ≤ 50. The anesthesia maintenance was achieved through a targeted propofol infusion at 3–6 µg/mL and an intravenous remifentanil infusion at 0.1 µg/kg/min. During the operation, mechanical ventilation was used with 100% oxygen inhalation, a tidal volume of 5–6 mL/kg, and a respiratory rate of 14–20 beats/min. The end-tidal carbon dioxide partial pressure (P ET CO 2 ) was maintained between 35 and 45 mmHg, while the BIS was maintained, as much as possible, between 40–60, and the PI between 30–50. When the HR and MAP were 20% higher than the baseline, anesthesia was deepened. If necessary, an intravenous injection of 10–20 mg of urapidil or 0.5 mg/kg of esmolol should be administered. When the HR and MAP were 20% lower than the baseline values, anesthesia was appropriately reduced. If necessary, atropine (0.5 mg) or ephedrine (5–15 mg) should be administered. Flurbiprofen (50 mg) was injected before the skin incision. During intrathoracic surgery, mechanical ventilation was temporarily paused, a 2 L/min of oxygen was provided through the inhalation end of the threaded tube, and the expiratory end was released from the anesthesia machine to assist in lung collapse on the surgical side. When SPO 2 < 90%, low-tidal volume ventilation was assisted; if necessary, mechanical ventilation was restored. Before closing the pleural cavity, manual breathing was used to fully inflate the lungs. Ondansetron (4 mg) was administered, and general anesthesia was discontinued. In Group W, DEX 1 µg/kg was intravenously pumped 15 min before anesthesia. The general anesthesia induction was an infusion of propofol 3–6 µg/mL and a dezosin 5 mg intravenous injection. Laryngeal mask intubation was performed with a BIS of 60 and a PI of 50. The anesthesia was maintained by intravenous propofol of 3–6 µg/mL and DEX 0.3–0.5 µg/kg/h; spontaneous breathing was maintained during the surgery. If necessary, intermittent auxiliary ventilation would be performed. Before surgery, flurbiprofen (50 mg) was injected, and the surgeon performed an intercostal nerve block with 0.33% ropivacaine and 1% lidocaine 10 mL/side. DEX was discontinued after the completion of the first-side sympathetic nerve transection. If the surgical procedure was unilateral, DEX was discontinued at the beginning of the surgery. Manually controlled breathing was performed before the thoracic cavity was closed. Spontaneous breathing continued after sufficient lung expansion, and P ET CO 2 was < 45 mmHg. The other treatments were the same as those used in Group C. Laryngeal mask removal Withdrawal of the laryngeal mask complied with the following principles: responding to calls in a normal voice, recovery of coughing and swallowing reflex, regular autonomous breathing rhythm, tidal volume over 5 mL/kg, the respiratory rate between 12–20 times/min, SPO 2 > 95% when air was inhaled for more than 5 min, and hemodynamic stability. Complete awakening standard Using the patient's directional recovery as the standard for complete recovery, directional force recovery, the ability to complete directed movements accurately, the ability to identify time and place, muscle tone recovery, lying flat, and looking up can last for more than 10 s. Discharge criteria The discharge time was evaluated by a thoracic surgeon based on the patient's recovery situation: respiratory and circulatory function stable, the incision shown no signs of bleeding or infection, visual analog scale (VAS) ≤ 3, the patient can eat normally and move around autonomously. Data collection Perioperative complications related to opioids, including hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness, were observed. HR, MAP, SPO 2 , BIS, PI, and venous blood gas indices, including oxygen partial pressure (PO 2 ), partial pressure of carbon dioxide (PCO 2 ), base excess (BE), hydrogen carbonate (HCO 3 − ), blood glucose (BG), and lactate levels of patients before anesthesia (T 1 ), immediately after skin incision (T 2 ), at the end of surgery (T 3 ), and leaving the operating room (T 4 ), were recorded. VAS score was observed immediately after awakening (P 1 ), exit from the operating room (P 2 ), 2 h after surgery (P 3 ), 6 h following the operation (P 4 ), discharge (P 5 ), and 24 h postoperatively (P 6 ). Other adverse events related to anesthesia, such as surgery interruption, change in anesthesia method, postoperative cognitive dysfunction (POCD), anaphylaxis, patient demographics, propofol dose, laryngeal mask removal time, directional recovery time, and postoperative hospital stay, were recorded. Patient satisfaction with anesthesia (divided into very satisfied, satisfied, basically satisfied, and dissatisfied) was assessed when leaving the facility. Outcomes The primary outcome was perioperative complications associated with opioid use. The secondary outcomes were BIS, PI, vital signs, blood gas index, and VAS scores. The other outcomes included propofol concentration, postoperative recovery, other adverse events, and patient satisfaction. Statistical analyses Statistical analyses were performed using the SPSS 19.0 statistical package. Data are presented as means ± standard deviation (x̄ ± s) or median (interquartile range [IQR]), and qualitative data was displayed as numbers and percentages (n [%]). Quantitative data such as weight, height, BMI, operation time, propofol dosage, laryngeal mask removal time, directional recovery time, and postoperative hospital stay between the groups were analyzed using the independent sample t-test or Mann–Whitney U test . The VAS, HR, MAP, SPO 2 , BIS, PI, and blood gas indices were assessed using repeated-measures ANOVA . Categorical data such as sex, surgery type, and perioperative complications were compared using the chi-square test or Fisher’s exact test. P < 0.05 was considered statistically significant. Results One hundred sixty four patients were initially recruited in this study; 13 patients (7.9%) whose basic parameters did not meet the inclusion criteria were excluded, including 3 patients (1.8%) with a BMI greater than 30 kg/m 2 , 3 (1.8%) with a history of thoracic surgery, 4 (2.4%) in Group C, 1 (0.6%) in Group W who did not receive the assigned intervention, and 2 (1.2%) in Group C who developed pneumothorax after surgery and underwent closed pleural drainage. Finally, 151 patients (92.1%) were analyzed, including 73 in Group C and 78 in Group W (Fig. 1 ). Demographic profile There were no statistically significant differences in sex, age, weight, height, BMI, surgery type, or operation time between the groups ( P > 0.05) (Table 1 ). Table 1 Demographics between the two groups Item Group C Group W F/χ 2 P Gender (Male/Female), n (%) 32/41 (43.8/56.2) 29/49 (37.2/62.8) 0.694 0.405 Age (year), (x̄ ± s) 26 ± 5 25 ± 4 2.502 0.133 Height (cm), (x̄ ± s) 165 ± 7 164 ± 8 1.487 0.233 Weight (kg), (x̄ ± s) 57 ± 11 56 ± 10 2.609 0.501 BMI (kg/m 2 ), (x̄ ± s) 21 ± 3 21 ± 2 3.171 0.985 Surgery (Single/Double), n (%) 44/29 (60.3/39.7) 39/39 (50.0/50.0) 1.612 0.204 Operation time (min), (x̄ ± s) 24 ± 13 22 ± 10 1.806 0.484 BMI, body mass index. Perioperative complications related to opioids None of the patients experienced hypoxemia, vomiting, urine retention, or itching. There were no significant differences in the incidence of hypotension, bradycardia, hypertension, tachycardia, nausea, or dizziness, and the total number of patients with complications was similar between the groups ( P > 0.05) (Table 2 ). Table 2 Occurrence of perioperative adverse reactions related to opioids Item Group C Group W χ 2 P Hypotension, n (%) 47 (64.4) 44 (56.4) 1.003 0.317 Bradycardia, n (%) 27 (37.0) 28 (36.0) 0.019 0.889 Hypertension, n (%) 3 (4.1) 5 (6.4) 0.403 0.526 Tachycardia, n (%) 6 (8.2) 8 (10.3) 0.187 0.666 Nausea, n (%) 6 (8.2) 2 (2.6) 2.494 0.114 Dizziness, n (%) 1 (1.4) 4 (5.1) 1.789 0.181 Total cases, n (%) 50 (68.5) 57 (73.1) 0.384 0.536 Other adverse reactions related to anesthesia All patients successfully underwent surgical treatment, and there were no cases of surgical interruption, change in the anesthesia method, POCD, or anaphylaxis. Changes in perioperative sedation and analgesia index The BIS and PI values declined sharply after general anesthesia induction and then gradually increased to near the pre-anesthesia level when leaving the operating room but were still lower than the baseline. Compared with T 1 , there was a statistically significant difference in BIS and PI between T 2 and T 4 in both groups ( P 0.05) (Table 3 ). Table 3 Comparison of BIS and PI between the two groups Item Time point Group C Group W F P BIS, (x̄ ± s) T 1 96 ± 2 96 ± 4 3.673 0.890 T 2 47 ± 7 ## 46 ± 8 ## 0.015 0.227 T 3 57 ± 10 ## 56 ± 12 ## 0.518 0.438 T 4 91 ± 6 ## 91 ± 5 ## 0.849 0.681 F 1060.708 866.573 P < 0.001 < 0.001 PI, (x̄ ± s) T 1 75 ± 12 73 ± 9 0.333 0.369 T 2 35 ± 10 ## 36 ± 11 ## 0.830 0.487 T 3 37 ± 10 ## 38 ± 11 ## 0.632 0.608 T 4 56 ± 14 ## 55 ± 13 ## 0.123 0.714 F 312.529 254.487 P < 0.001 < 0.001 Compared with group T 1 , # P < 0.05, ## P < 0.01; BIS, bispectral index; PI, pain index. Variety of perioperative respiratory and circulatory indicators HR and MAP declined markedly after anesthesia and increased slowly as the operation progressed, whereas the changes in SPO 2 were relatively small. Compared with T 1 , HR and MAP were lower at T 2 , T 3 , and T 4 in both groups ( P < 0.01), whereas SPO 2 in Group C was relatively higher at T 2 ( P 0.05) (Table 4 ). Table 4 Comparison of HR, MAP, and SPO 2 between the two groups Item Time point Group C Group W F P HR (beat/min) , T 1 77 ± 12 73 ± 12 0.972 0.059 (x̄ ± s) T 2 64 ± 11 ## 65 ± 11 ## 0.002 0.930 T 3 68 ± 11 ## 66 ± 10 ## 0.629 0.096 T 4 72 ± 11 ## 67 ± 10 ## 0.738 0.011 F 25.872 17.885 P < 0.001 < 0.001 MAP (mmHg) , T 1 90 ± 11 88 ± 11 0.277 0.287 (x̄ ± s) T 2 73 ± 8 ## 75 ± 11 ## 1.167 0.216 T 3 76 ± 11 ## 73 ± 11 ## 0.008 0.101 T 4 83 ± 10 ## 79 ± 10 ## 0.010 0.009 F 68.537 47.708 P < 0.001 < 0.001 SPO 2 (%), T 1 98.8 ± 1.3 98.8 ± 1.3 0.226 0.890 (x̄ ± s) T 2 99.2 ± 1.0 # 99.1 ± 1.3 0.623 0.452 T 3 99.0 ± 1.0 99.1 ± 1.0 0.547 0.340 T 4 98.6 ± 2.6 98.9 ± 1.2 1.176 0.308 F 2.718 1.368 P 0.046 0.253 Compared with group T 1 , # P < 0.05, ## P < 0.01; HR, heart rate; MAP, mean arterial pressure; SPO 2 , pulse oxygen saturation. Changes in perioperative blood gas analysis Following anesthesia, PH, PCO 2 , BE, HCO 3 − , BG and lactate showed mild fluctuations, and PO 2 was significantly increased in these two groups. In both Groups C and W, PH was relatively higher at T 2 but lower at T 3 and T 4 ; PCO 2 decreased at T 2 but increased at T 3 and T 4 ; PO 2 increased sharply from T 2 to T 4 ; BE, HCO 3 − and BG increased marginally at T 3 and T 4 compared with T 1 ( P < 0.05). Furthermore, the lactate levels at T 4 were higher than those at T 1 in Group C ( P 0.05) (Table 5 ). Table 5 Comparison of perioperative blood gas index between the two groups Item Time point Group C Group W F/ Z P PH, (x̄ ± s) T 1 7.37 ± 0.03 7.38 ± 0.02 0.506 0.063 T 2 7.38 ± 0.03 ## 7.39 ± 0.03 ## 0.026 0.529 T 3 7.33 ± 0.03 ## 7.32 ± 0.04 ## 0.323 0.126 T 4 7.35 ± 0.03 ## 7.34 ± 0.02 ## 0.093 0.224 F 67.729 133.667 P < 0.001 < 0.001 PCO 2 (mmHg), T 1 42 ± 4 42 ± 4 0.142 0.904 (x̄ ± s) T 2 39 ± 4 ## 39 ± 4 ## 0.750 0.670 T 3 48 ± 7 ## 49 ± 8 ## 0.000 0.203 T 4 45 ± 6 ## 46 ± 5 ## 0.053 0.192 F 56.607 92.771 P < 0.001 < 0.001 PO 2 (mmHg), T 1 48 ± 12 48 ± 8 6.581 0.926 (x̄ ± s) T 2 277 ± 85 ## 278 ± 89 ## 0.015 0.960 T 3 209 ± 88 ## 207 ± 88 ## 0.118 0.904 T 4 122 ± 65 ## 112 ± 45 ## 7.378 0.274 F 262.066 300.559 P < 0.001 < 0.001 BE (mmol/L) , T 1 0 (-1, 1) 0 (-1, 1) -0.245 0.806 M (IQR) T 2 0 (-1, 1) 0 (-1, 1) -0.571 0.568 T 3 1 (0, 2) ## 2 (0, 3) ## -0.691 0.489 T 4 1 (1, 2) ## 2 (1, 3) ## -1.095 0.274 F 19.796 29.200 P < 0.001 < 0.001 HCO 3 − (mmol/L), T 1 25 ± 2 24 ± 2 0.005 0.484 (x̄ ± s) T 2 24 ± 2 24 ± 2 ## 2.649 0.102 T 3 26 ± 2 ## 27 ± 2 ## 2.821 0.181 T 4 26 ± 2 ## 26 ± 2 ## 12.384 0.156 F 41.504 67.930 P < 0.001 < 0.001 BG (mmol/L), T 1 5.1 ± 0.8 5.2 ± 0.7 0.762 0.699 (x̄ ± s) T 2 5.2 ± 0.8 5.3 ± 0.5 7.429 0.797 T 3 5.4 ± 1.1 ## 5.4 ± 0.6 # 3.670 0.984 T 4 5.4 ± 1.0 ## 5.4 ± 0.6 # 4.182 0.984 F 8.014 6.290 P < 0.001 < 0.001 Lactate (mmol/L), T 1 1.1 ± 0.4 1.1 ± 0.4 0.094 0.538 (x̄ ± s) T 2 1.2 ± 0.4 1.1 ± 0.4 0.046 0.112 T 3 1.2 ± 0.4 1.1 ± 0.4 0.001 0.124 T 4 1.3 ± 0.4 # 1.2 ± 0.3 0.737 0.057 F 4.407 0.806 P 0.005 0.492 Compared with group T 1 , # P < 0.05, ## P < 0.01; BE, base excess; BG, Blood glucose; HCO 3 − , hydrogen carbonate; PCO 2 , partial pressure of carbon dioxide; PO 2 , oxygen partial pressure. Postoperative VAS Compared with P 1 , the VAS scores at P 2 to P 6 in Group C and from P 3 to P 6 in Group W showed an evident increase ( P < 0.01) but were not significantly different between Groups C and W ( P < 0.05) (Table 6 ). Table 6 Comparison of postoperative VAS scores between the two groups Item Time point Group C Group W Z P VAS, M (IQR) P 1 0 (0, 0) 0 (0, 0) -1.805 0.071 P 2 1 (0, 1) ## 0 (0, 0) -4.839 < 0.001 P 3 1 (1, 2) ## 1 (1, 1) ## -3.600 < 0.001 P 4 1 (1, 2) ## 1 (1, 2) ## -0.512 0.609 P 5 1 (1, 2) ## 1 (1, 2) ## -0.221 0.825 P 6 1 (0, 1) ## 1 (0, 1) ## -1.024 0.306 F 91.075 166.054 P < 0.001 < 0.001 Compared with group T 1 , # P < 0.05, ## P < 0.01; VAS, visual analog scale. Dosage of propofol and postoperative recovery time There were no statistically significant differences in the dosage of propofol, postoperative directional recovery time, or hospital stay between the two groups ( P > 0.05). Compared with group C, the laryngeal mask removal time was prolonged in group W ( P < 0.05) (Table 7 ). Table 7 Propofol dose and postoperative recovery time between the two groups Item Group C Group W F P Propofol dose ( mg ), (x̄ ± s) 298 ± 80 302 ± 88 0.139 0.772 Laryngeal mask removal time ( min ), (x̄ ± s) 8 ± 6 10 ± 6 0.125 0.024 Directional recovery time ( min ), (x̄ ± s) 13 ± 7 13 ± 7 0.120 0.978 Postoperative hospital stay (min), (x̄ ± s) 5 ± 1 5 ± 2 2.775 0.102 Patient satisfaction There were no cases of basic satisfaction or dissatisfaction in either group, and the proportion of those who were very satisfied or satisfied was similar between the groups ( P < 0.05) (Table 8 ). Table 8 Comparison of patients’ satisfaction between two groups Item Group C Group W χ 2 P Very satisfied, n (%) 64 (87.7) 71 (91.0) 0.448 0.503 Satisfied, n (%) 9 (12.3) 7 (9.0) Basically satisfied, n (%) 0 (0) 0 (0) Dissatisfied, n (%) 0 (0) 0 (0) Discussion To reduce perioperative complications caused by anesthesia procedures and relieve the incidence of side effects related to anesthesia drugs, opioid-reduced combined with non-intubation and nerve block anesthesia techniques have gradually been promoted and have achieved good results in thoracic surgeries in recent years [ 12 , 13 ] . In the present study, we combined multiple methods to monitor opioid-reduced anesthesia in patients with palmar hyperhidrosis who underwent thoracoscopic sympathectomy. Dezocine, an opioid κ receptor partial agonist with weak inhibitory effects on cardiovascular function and low incidence of drowsiness, nausea, vomiting, etc. has been widely applied for the treatment of acute pain for years [ 14 ] . The trauma of sympathectomy was minimal, and the pain caused by this surgery was mild; thus, the application of dezocine could meet the requirements of intraoperative analgesia. DEX, a selective α2-adrenal receptor agonist that could activate corresponding receptors in the brain and spinal dorsal horn producing sedative and analgesic effects, has been widely used in perioperative adjuvant analgesic treatment [ 15 ] . In this study, patients in Group W received an infusion of DEX before anesthesia to reduce the excitability of the sympathetic nervous system, and there were no cases of tachycardia during the operation. Furthermore, to implement the ERAS concept, all patients in this study were orally administered carbohydrate-containing beverages 2 h before surgery. As a result, the perioperative blood volume was sufficient, and there was no significant difference in the incidence of bradycardia and hypotension between groups. The HR, MAP, and incidence of adverse reactions were similar between groups, suggesting that the use of DEX in this surgery was safe. Flurbiprofen, a classic NSAID with strong anti-inflammatory and analgesic effects, plays an important role in the development of multimodal analgesia during surgery [ 16 ] . We used this medication in both groups, and the postoperative pain experienced by the patients was low. This result confirmed the rationality of the above drug combinations. Analgesia and sedation are important indicators during anesthesia, and PI and BIS are reliable indicators of intraoperative analgesia and sedation [ 17 , 18 ] . The VAS score is a common tool for evaluating pain intensity; typically, a VAS score of less than 4 signifies slight pain [ 19 , 20 ] . We combined the PI and BIS to guide the dose of sedatives and analgesics during surgery, and various VAS scores were used to assess postoperative pain. An intercostal nerve block is a common regional block method that can effectively alleviate pain caused by the incision and thoracic drainage tube, reduce the dosage of analgesic drugs, and promote rapid postoperative recovery of patients during thoracic surgery [ 21 ] . To improve the intraoperative analgesic effect, we combined intercostal nerve block in patients in Group W. The results showed that the VAS, PI, and BIS values were similar between the groups and were maintained at clinically appropriate levels, suggesting that analgesia via the combination of multiple analgesics and nerve block was effective. In this study, the incidence of perioperative complications was important in assessing the effect of the opioid-reduced anesthesia strategy. The results showed that patients in the two groups did not show significant differences in opioid-related adverse reactions. This indicates that the use of opioid-reduced anesthesia during thoracoscopic sympathectomy is safe and feasible. During spontaneous breathing, preserving general anesthesia, hypoxemia, and hypercapnia are the major challenges faced by anesthesiologists [ 22 ] . In this study, patients in both groups were treated with laryngeal mask intubation to relieve upper respiratory tract obstruction after repeated preliminary tests to avoid hypoxia caused by upper respiratory obstruction. Auxiliary ventilation was administered when necessary. In addition, during single-lung ventilation, oxygen was supplied to all patients through the inhalation end of the threaded tube to ensure oxygen supply. The exhalation end of the threaded tube was detached from the anesthesia machine, which aided in the emission of carbon dioxide while performing lung collapse on the surgical side. Before surgery was completed, manual breathing was used to fully inflate the lungs to avoid postoperative atelectasis. In Group W, some patients experienced insufficient tidal volume and elevated transient carbon dioxide levels during surgery. In this situation, excessive ventilation was performed via manually assisted breathing after the completion of sympathectomy to keep P ET CO 2 near normal levels as much as possible before the end of surgery. Blood gas analysis showed that the partial pressures of oxygen and carbon dioxide were at a healthy level when the patients exited the operating room. These results are consistent with those of Li et al. [ 23 ] , who reported that short-term mild hypercapnia during thoracic surgery did not affect patient prognosis. In addition, none of the patients experienced complications, such as hypoxemia, heart failure, or delayed awakening during the perioperative period, and the dosage of propofol was similar between the groups; therefore, the postoperative recovery time was not extended. Finally, all patients were either very satisfied or satisfied with the anesthesia. These results confirm that implementing an anesthetic strategy without muscle relaxation during thoracoscopic sympathectomy is safe. However, the anesthesia scheme in Group W was relatively complex and did not reduce the incidence of perioperative complications. Therefore, the use of opioid-reduced anesthesia in this surgery has no clinical advantages. This study had some limitations. First, to improve patient comfort, all patients underwent peripheral venous puncture and catheterization, and blood gas analysis samples were obtained from the venous indwelling needle during the perioperative period. For subjects who had apparent anxiety before anesthesia, oxygen inhalation began immediately after the patient’s admission, which might have an impact on the blood gas index results of patients. Second, this was a single-center, single-blind trial, and funds supported by our institution had a 2-year cycle; after completing the preliminary preparation, subjects were recruited within 10 months. A multicenter, large sample, and longer research are necessary to enhance the reliability and finality of this study. In summary, during minimally invasive surgery, such as thoracoscopic sympathectomy, the strategy of opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages. Abbreviations ASA American Society of Anesthesiologists BE Base excess BG Blood glucose BIS Bispectral index BMI Body mass index DEX Dexmedetomidine ECG Electrocardiogram ERAS Enhanced recovery after surgery HCO 3 − Hydrogen carbonate HR Heart rate IQR Interquartile range MAP Mean arterial pressure NSAIDs Non-steroidal anti-inflammatory drugs PCO 2 Partial pressure of carbon dioxide P ET CO 2 End tidal carbon dioxide partial pressure PI Pain index PO 2 Oxygen partial pressure POCD Postoperative cognitive dysfunction SPO 2 Pulse oxygen saturation VAS Visual analog scale Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of Shenzhen third People's Hospital (No.29 Bulan Road, Longgang district, Shenzhen, Guangdong, China, approval number: 2022-025-02, date: 2012-3-24). Written informed consent was obtained and documented for all participants. Consent for publication Not applicable. Availability of data and material This study was recorded on ResMan Research Manager: http://www.medresman.org.cn/uc/projectsh/projectedit.aspx?proj=5899 Competing interests All authors declared no competing interests in this work. Funding This study was supported by funds from Top Three Medical and Health Projects of Shenzhen (Professor Chen Jingyu's lung transplantation and minimally invasive thoracic surgery team, SZSM202311034), and the hospital clinical projects of Shenzhen Third People's Hospital (G2022043). Authors' contributions Liu Minqiang, Ma Mingfei, and Wu Qiang conceived and designed this study. Hong Fengzhu, Li Yang, Guo Shanshan, and Shi Qinlang collected the data. Liu Minqiang and Hong Fengzhu conducted the statistical analyses. Liu Minqiang and Ma Mingfei drafted the manuscript. He Renliang, Li Zepeng, and Wu Qiang revised the manuscript. Li Zepeng and Wu Qiang assume direct responsibility for the manuscript. All authors have approved the final submission. Acknowledgements We would like to thank Editage for the language editing of the manuscript. References Altawili AA, Altawili MA, Alzarar AH, Abdulrahim NM, Alquraish HH, Alahmari MA, Basyouni MH, Almohaya YA, Alhabshan WMS, Alshahrani AMA, Alamrad JFA, Aljumaah AS, Alsalman MA, Alhafith AA. Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review. Cureus. 2024 Jan 1;16(1):e51475. doi: 10.7759/cureus.51475. PMID: 38298287; PMCID: PMC10830133. Evrard E, Motamed C, Pagès A, Bordenave L. Opioid Reduced Anesthesia in Major Oncologic Cervicofacial Surgery: A Retrospective Study. J Clin Med. 2023 Jan 23;12(3):904. doi: 10.3390/jcm12030904. PMID: 36769551; PMCID: PMC9917718. Zhu T, Zhao X, Sun M, An Y, Kong W, Ji F, Wang G. Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study. BMC Anesthesiol. 2022 Nov 16;22(1):354. doi: 10.1186/s12871-022-01889-x. PMID: 36384481; PMCID: PMC9667678. Sun XJ, Feng TC, Wang YM, Wang F, Zhao JB, Liu X, Li FL. The effect of the enhanced recovery after surgery protocol and the reduced use of opioids on postoperative outcomes in elderly patients with colorectal cancer. Eur Rev Med Pharmacol Sci. 2023 Oct;27(20):10053-10060. doi: 10.26355/eurrev_202310_34185. PMID: 37916375. Zhang Z, Li C, Xu L, Sun X, Lin X, Wei P, Li J. Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis. Front Pharmacol. 2024 Jan 4;14:1330250. doi: 10.3389/fphar.2023.1330250. PMID: 38239201; PMCID: PMC10794765. Ding J, Zhu M, Lv H, Zhang J, Chen W. Application Effect of Dexmedetomidine and Dezocine in Patients Undergoing Lung Cancer Surgery under General Anesthesia and Analysis of Their Roles in Recovery Time and Cognitive Function. Comput Math Methods Med. 2022 Jun 30;2022:9889534. doi: 10.1155/2022/9889534. PMID: 35813440; PMCID: PMC9262508. Maidanskaia EG, Mirra A, Marchionatti E, Levionnois OL, Spadavecchia C. Antinociceptive, Sedative and Excitatory Effects of Intravenous Butorphanol Administered Alone or in Combination with Detomidine in Calves: A Prospective, Randomized, Blinded Cross-Over Study. Animals (Basel). 2023 Jun 9;13(12):1943. doi: 10.3390/ani13121943. PMID: 37370454; PMCID: PMC10295376. Zong S, Du J, Chen Y, Tao H. Application effect of dexmedetomidine combined with flurbiprofen axetil and flurbiprofen axetil monotherapy in radical operation of lung cancer and evaluation of the immune function. J BUON. 2021 Jul-Aug;26(4):1432-1439. PMID: 34565001. Zhou Y, Yuan P, Xing Q, Jin W, Shi C. Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial. BMC Anesthesiol. 2024 Jan 4;24(1):14. doi: 10.1186/s12871-023-02386-5. PMID: 38172686; PMCID: PMC10765788. Pei G, Meng S, Yang Y, Wang X, Liu Q, Wang S, Huang Y. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res. 2023 Apr;33(2):111-120. doi: 10.1007/s10286-023-00932-2. Epub 2023 Apr 5. PMID: 37017809; PMCID: PMC10182923. Huang Y, Liu Y, Zou W, Mao N, Tang J, Jiang L, Zou G, Yang L, Yu B, Wei G. Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis. Front Surg. 2023 Feb 24;10:1144299. doi: 10.3389/fsurg.2023.1144299. PMID: 36911618; PMCID: PMC9998541. Albayrak E, Gündüz E, Titiz T, Özen Küçükçetin I. The effects of erector spinae plane block (ESPB) on surgery-related stress response in thoracic surgery. Acta Chir Belg. 2023 Dec 19:1-7. doi: 10.1080/00015458.2023.2297532. Epub ahead of print. PMID: 38112523. Zheng YF, Jiang YS, Liu HT, Chen FZ, Shao AZ, Zhu JF, Ma XD, Chen YF, Lin ZJ, He LP, Sun CX. Thoracic paravertebral nerve block combined laryngeal mask airway with preservation of spontaneous breathing can accelerate postoperative recovery. Eur Rev Med Pharmacol Sci. 2023 Nov;27(22):10875-10883. doi: 10.26355/eurrev_202311_34455. PMID: 38039017. Chen Y, Lu Y, Xiang X, Fu L, Liu Y, Li C, Sun J. Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study. Front Pharmacol. 2023 Jul 10;14:1150045. doi: 10.3389/fphar.2023.1150045. PMID: 37492093; PMCID: PMC10364117. Verret M, Le JBP, Lalu MM, McIsaac DI, Nicholls S, Turgeon AF, Hutton B, Zivkovic F, Graham M, Le M, Geist A, Berube M, Gilron I, Poulin P, Daudt H, Martel G, McVicar J, Moloo H, Fergusson DA. Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol. BMJ Open. 2024 Feb 1;14(2):e080012. doi: 10.1136/bmjopen-2023-080012. PMID: 38307526. Xiao J, Zhao C, Zhu J, Lin Q, Shen J, Liu J, Cai H, Wu X. Analgesia with reduced incidence of adverse reactions using flurbiprofen axetil in combination with half standard-dose opioids in primary total knee arthroplasty. Int J Clin Pharmacol Ther. 2023 Jun;61(6):239-245. doi: 10.5414/CP204319. PMID: 36971319. Stefanini M, Cagnazzi E, Calza S, Latronico N, Rasulo FA. Feasibility of the pupillary pain index as a guide for depth of analgesia during opioid-sparing anesthesia with continuous infusion of dexmedetomidine. J Anesth Analg Crit Care. 2023 Aug 14;3(1):27. doi: 10.1186/s44158-023-00112-8. PMID: 37580838; PMCID: PMC10424415. Vide S, Castro A, Antunes P, Lima D, Larson M, Gambús P, Amorim P. Pharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index. J Clin Monit Comput. 2020 Apr;34(2):319-324. doi: 10.1007/s10877-019-00323-x. Epub 2019 May 22. PMID: 31119519. Liu ZF, Qiu ZY, Zhang Y, Fu J, Ma XW. Correlation of diclofenac sodium sustained-release capsules in conjunction with function training and VAS score after ankle fracture surgery. Eur Rev Med Pharmacol Sci. 2023 Nov;27(22):10852-10859. doi: 10.26355/eurrev_202311_34452. PMID: 38039014. Caniklioğlu M, Özkaya M. The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain. Cureus. 2021 Jul 13;13(7):e16377. doi: 10.7759/cureus.16377. PMID: 34408932; PMCID: PMC8362862. Wang T, Wang X, Yu Z, Li M. Programmed Intermittent Bolus for Erector Spinae Plane Block Versus Intercostal Nerve Block With Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery: A Randomized Controlled Noninferiority Trial. Clin J Pain. 2024 Feb 1;40(2):99-104. doi: 10.1097/AJP.0000000000001174. PMID: 37975501; PMCID: PMC10779491. Huang Y, Bo Y, Li Y, Zhao Y, Li X, Chen D, Deng N, Liu J, Li J, Zhu M, Liu R, Peng J, Jin H. The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery: a randomized trial. J Thorac Dis. 2022 Oct;14(10):4012-4030. doi: 10.21037/jtd-22-1165. PMID: 36389295; PMCID: PMC9641321. Li XL, He XB, Wan L, Liu CQ, Cui Y. Comparison of tracheal intubation with controlled ventilation and laryngeal mask airway with spontaneous ventilation for thoracoscopic bullectomy. Medicine (Baltimore). 2020 Apr;99(16):e19704. doi: 10.1097/MD.0000000000019704. PMID: 32311952; PMCID: PMC7440194. Additional Declarations No competing interests reported. Supplementary Files CONSORT2010checklist.doc Cite Share Download PDF Status: Published Journal Publication published 12 Sep, 2024 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 24 Jul, 2024 Reviewers agreed at journal 23 Jul, 2024 Reviews received at journal 22 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviews received at journal 18 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviewers invited by journal 18 Jul, 2024 Editor assigned by journal 16 Jul, 2024 Submission checks completed at journal 15 Jul, 2024 First submitted to journal 12 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4733014","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331140033,"identity":"560dc34c-6d84-4c9c-b8f3-07ea6106adc6","order_by":0,"name":"Liu Minqiang","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liu","middleName":"","lastName":"Minqiang","suffix":""},{"id":331140034,"identity":"1b42e390-be6c-48a8-9add-4d5cab207c24","order_by":1,"name":"Ma Mingfei","email":"","orcid":"","institution":"the Fourth People's Hospital of Longgang District","correspondingAuthor":false,"prefix":"","firstName":"Ma","middleName":"","lastName":"Mingfei","suffix":""},{"id":331140035,"identity":"8fb4321e-7003-4302-907f-9c2d636e9716","order_by":2,"name":"Hong Fengzhu","email":"","orcid":"","institution":"the Fourth People's Hospital of Longgang District","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Fengzhu","suffix":""},{"id":331140036,"identity":"08f6abbe-d4b2-49d0-9893-65f2554a198b","order_by":3,"name":"Li Yang","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Yang","suffix":""},{"id":331140037,"identity":"d823e523-77fc-4d8c-81dd-95165e45e3ae","order_by":4,"name":"Guo Shanshan","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guo","middleName":"","lastName":"Shanshan","suffix":""},{"id":331140038,"identity":"c08b1eb0-703b-4487-b7ab-5c220a056d33","order_by":5,"name":"Shi Qinlang","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shi","middleName":"","lastName":"Qinlang","suffix":""},{"id":331140039,"identity":"4c817d62-f0db-4948-a04f-29c3688fecbf","order_by":6,"name":"He Renliang","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"Renliang","suffix":""},{"id":331140040,"identity":"45e052d2-ead6-40b5-9aab-f8eecc62149d","order_by":7,"name":"Li Zepeng","email":"","orcid":"","institution":"the Fourth People's Hospital of Longgang District","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zepeng","suffix":""},{"id":331140041,"identity":"b53daf55-6094-443c-8c6d-f9fcfcb00a93","order_by":8,"name":"Wu Qiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIie3QMUvDQBTA8QtCslz3c6j9CpHCdciQr5Kj0FtS6ehQy0nhskT8JA4iBMcrD+Jy0jVju2RSqKNQxTsbnBLr6HB/eHAk+fHCIeRy/dOUmTOEvGvVPPDNnBwlQ0PEN8F/ITYmGnuchNX4Xr0/XvG7DMyWPcRxsKw36DJiInhW7WQyW93op2mhmVCeBJbjchQizZnAF0kboVUaqp4sp4WyRECCSeoTawXBYRdZfciS0/X28GN48GLI5+8EenKe0MpsQT54OcGGiG4S63oGfanOi8psYZKzXE8oSUo+lDhtJafZ+OHtVS4GdM23m90+ioMMarKbR/3bQLcSe2lm4HD8uSF78Du+b8ii+7XL5XK5vgCc7Wu4dr8s5wAAAABJRU5ErkJggg==","orcid":"","institution":"National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wu","middleName":"","lastName":"Qiang","suffix":""}],"badges":[],"createdAt":"2024-07-13 02:00:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4733014/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4733014/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12871-024-02711-6","type":"published","date":"2024-09-12T15:57:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62064605,"identity":"445f051a-3756-41ee-9034-05d0384bd27a","added_by":"auto","created_at":"2024-08-09 00:33:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37488,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram of the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4733014/v1/d8943462a595d9c04649be9d.png"},{"id":64619499,"identity":"284afc04-5761-427e-b49d-129c9d6ddc39","added_by":"auto","created_at":"2024-09-16 16:15:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145857,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4733014/v1/ceff4df5-5c7c-42c8-ac25-7656f1432b75.pdf"},{"id":62064606,"identity":"8810a65e-3915-4c2d-ae2b-dc9bd7cf931f","added_by":"auto","created_at":"2024-08-09 00:33:34","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":206848,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2010checklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-4733014/v1/edb3b39b685c07b71a8b66e0.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eOpioids have played a crucial role in surgical procedures for years because of their strong analgesic effects; however, their use can also lead to adverse reactions such as dose-dependent inhibition of respiratory and circulatory function, scratching, nausea, vomiting, and drowsiness \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In the last few decades, anesthesiologists have attempted to reduce opioid consumption in order to reduce surgical complications. Opioid-reduced anesthesia is a technique developed based on perioperative multimodal pain management that uses few or no opioid drugs \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The main components of opioid-reduced anesthesia include sedatives, N-methyl-D-aspartate receptor antagonists, anti-inflammatory drugs, α2 receptor agonists, and local anesthetics, combined with spinal anesthesia or peripheral nerve block when necessary, to partially or completely replace opioid drugs with the goal of minimizing the use of opioids and reducing the adverse reactions caused by them \u003csup\u003e[3~5]\u003c/sup\u003e. With the continuous promotion of enhanced recovery after surgery (ERAS), the combination of weak opioids (such as dezocine and butorphanol), α2-adrenal agonists, non-steroidal anti-inflammatory drugs (NSAIDs), or nerve block techniques has been used to achieve multi-mode anesthesia and proved to be safe and effective \u003csup\u003e[6~9]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThoracoscopic sympathectomy is an important treatment for palmar hyperhidrosis and has the advantages of precise results, minimal trauma, and fast postoperative recovery \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. To test the efficacy of opioid-reduced anesthesia, we aimed to investigate the clinical effects of dezocine combined with dexmedetomidine (DEX) and intercostal nerve block on the possibility that this anesthesia strategy can achieve similar analgesic effects but with fewer adverse reactions when compare to strong opioids.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study was registered in the Chinese Clinical Trial Register (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.chictr.org.cn\u003c/span\u003e\u003cspan address=\"http://www.chictr.org.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; registration number: ChiCTR2100055005, on December 30, 2021). Ethical approval (Number: 2022-025-02) for this study (Research Ethics Committee) was provided by the Ethical Committee of Shenzhen Third People's Hospital, Shenzhen, Guangdong, China (Chairman Zhang Guoliang), on 24 March 2022). Written informed consent about this research protocol was obtained from all eligible patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatient recruitment\u003c/h2\u003e \u003cp\u003eBetween May 2022 and March 2023, patients who received general anesthesia with a laryngeal mask were recruited. The inclusion criteria were patients diagnosed with palmar hyperhidrosis, who underwent elective single/bilateral endoscopic thoracic sympathectomy, aged 18\u0026ndash;60 years, and American Society of Anesthesiologists (ASA) class I or II. The exclusion criteria were as follows: body mass index (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e; breastfeeding or pregnancy; a history of thoracic surgery or a second thoracic sympathetic nerve resection; important organ system dysfunction; spontaneous bleeding or coagulation dysfunction; a history of chronic pain; a history of upper airway infection in the last 2 weeks; abuse of opioid or non-steroidal anti-inflammatory drugs; known hypersensitivity or allergy to non-steroidal drugs, alcohol, and local anesthetics; and concomitant mental illness or cognitive impairment. Patients who had serious surgical complications switched to thoracotomy or changed the anesthesia method were also excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation\u003c/h2\u003e \u003cp\u003eThis study was a non-inferiority-designed clinical trial, assuming that patients in the two groups experienced similar analgesic effects. The sample size was estimated using PASS software version 23.0, and the combined standard deviation of the two groups was determined based on the pretrial results σ\u0026thinsp;=\u0026thinsp;0.5, non-inferiority threshold δ\u0026thinsp;=\u0026thinsp;0.2. With α\u0026thinsp;=\u0026thinsp;0.025 (one side), inspection efficiency (1- β)= 0.9, the minimum sample required for each group was 68 cases. Considering that 20% of the patients may have been lost during the study, total 164 patients were recruited.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRandomization\u003c/h2\u003e \u003cp\u003eThe patients were divided into two groups based on computer-generated random numbers. If the number was odd, the patients were assigned to the strong opioid group (control group, Group C); if the number was even, the patients were assigned to the weak opioid group (Group W).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eBlinding design\u003c/h2\u003e \u003cp\u003eOne anesthesiologist who was aware of the patient grouping administered clinical anesthesia according to standard procedures, and another anesthesiologist who was blinded to the grouping was responsible for data recording.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnesthesia protocol\u003c/h2\u003e \u003cp\u003eAll patients fasted for 10 h; however, a 200 mL carbohydrate drink was administered orally 2 h before surgery. After the patient entered the operating room, electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO\u003csub\u003e2\u003c/sub\u003e), bispectral index (BIS), and pain index (PI) were recorded. Upper limb venous access was established, and lactate sodium Ringer's solution was continuously infused at a rate of 4\u0026ndash;8 mL/kg/h; mask oxygen was administered at a rate of 2 L/min.\u003c/p\u003e \u003cp\u003eIn group C, a targeted infusion of propofol 3\u0026ndash;6 \u0026micro;g/mL, fentanyl 4 \u0026micro;g/kg, and cisatracurium 0.15 mg/kg was intravenously injected for general anesthesia induction. Laryngeal mask intubation was performed when BIS\u0026thinsp;\u0026le;\u0026thinsp;60 and PI\u0026thinsp;\u0026le;\u0026thinsp;50. The anesthesia maintenance was achieved through a targeted propofol infusion at 3\u0026ndash;6 \u0026micro;g/mL and an intravenous remifentanil infusion at 0.1 \u0026micro;g/kg/min. During the operation, mechanical ventilation was used with 100% oxygen inhalation, a tidal volume of 5\u0026ndash;6 mL/kg, and a respiratory rate of 14\u0026ndash;20 beats/min. The end-tidal carbon dioxide partial pressure (P\u003csub\u003eET\u003c/sub\u003eCO\u003csub\u003e2\u003c/sub\u003e) was maintained between 35 and 45 mmHg, while the BIS was maintained, as much as possible, between 40\u0026ndash;60, and the PI between 30\u0026ndash;50. When the HR and MAP were 20% higher than the baseline, anesthesia was deepened. If necessary, an intravenous injection of 10\u0026ndash;20 mg of urapidil or 0.5 mg/kg of esmolol should be administered. When the HR and MAP were 20% lower than the baseline values, anesthesia was appropriately reduced. If necessary, atropine (0.5 mg) or ephedrine (5\u0026ndash;15 mg) should be administered. Flurbiprofen (50 mg) was injected before the skin incision. During intrathoracic surgery, mechanical ventilation was temporarily paused, a 2 L/min of oxygen was provided through the inhalation end of the threaded tube, and the expiratory end was released from the anesthesia machine to assist in lung collapse on the surgical side. When SPO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;90%, low-tidal volume ventilation was assisted; if necessary, mechanical ventilation was restored. Before closing the pleural cavity, manual breathing was used to fully inflate the lungs. Ondansetron (4 mg) was administered, and general anesthesia was discontinued.\u003c/p\u003e \u003cp\u003eIn Group W, DEX 1 \u0026micro;g/kg was intravenously pumped 15 min before anesthesia. The general anesthesia induction was an infusion of propofol 3\u0026ndash;6 \u0026micro;g/mL and a dezosin 5 mg intravenous injection. Laryngeal mask intubation was performed with a BIS of 60 and a PI of 50. The anesthesia was maintained by intravenous propofol of 3\u0026ndash;6 \u0026micro;g/mL and DEX 0.3\u0026ndash;0.5 \u0026micro;g/kg/h; spontaneous breathing was maintained during the surgery. If necessary, intermittent auxiliary ventilation would be performed. Before surgery, flurbiprofen (50 mg) was injected, and the surgeon performed an intercostal nerve block with 0.33% ropivacaine and 1% lidocaine 10 mL/side. DEX was discontinued after the completion of the first-side sympathetic nerve transection. If the surgical procedure was unilateral, DEX was discontinued at the beginning of the surgery. Manually controlled breathing was performed before the thoracic cavity was closed. Spontaneous breathing continued after sufficient lung expansion, and P\u003csub\u003eET\u003c/sub\u003eCO\u003csub\u003e2\u003c/sub\u003e was \u0026lt;\u0026thinsp;45 mmHg. The other treatments were the same as those used in Group C.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLaryngeal mask removal\u003c/h2\u003e \u003cp\u003eWithdrawal of the laryngeal mask complied with the following principles: responding to calls in a normal voice, recovery of coughing and swallowing reflex, regular autonomous breathing rhythm, tidal volume over 5 mL/kg, the respiratory rate between 12\u0026ndash;20 times/min, SPO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;95% when air was inhaled for more than 5 min, and hemodynamic stability.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eComplete awakening standard\u003c/h2\u003e \u003cp\u003eUsing the patient's directional recovery as the standard for complete recovery, directional force recovery, the ability to complete directed movements accurately, the ability to identify time and place, muscle tone recovery, lying flat, and looking up can last for more than 10 s.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDischarge criteria\u003c/h2\u003e \u003cp\u003eThe discharge time was evaluated by a thoracic surgeon based on the patient's recovery situation: respiratory and circulatory function stable, the incision shown no signs of bleeding or infection, visual analog scale (VAS)\u0026thinsp;\u0026le;\u0026thinsp;3, the patient can eat normally and move around autonomously.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003ePerioperative complications related to opioids, including hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness, were observed. HR, MAP, SPO\u003csub\u003e2\u003c/sub\u003e, BIS, PI, and venous blood gas indices, including oxygen partial pressure (PO\u003csub\u003e2\u003c/sub\u003e), partial pressure of carbon dioxide (PCO\u003csub\u003e2\u003c/sub\u003e), base excess (BE), hydrogen carbonate (HCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e), blood glucose (BG), and lactate levels of patients before anesthesia (T\u003csub\u003e1\u003c/sub\u003e), immediately after skin incision (T\u003csub\u003e2\u003c/sub\u003e), at the end of surgery (T\u003csub\u003e3\u003c/sub\u003e), and leaving the operating room (T\u003csub\u003e4\u003c/sub\u003e), were recorded. VAS score was observed immediately after awakening (P\u003csub\u003e1\u003c/sub\u003e), exit from the operating room (P\u003csub\u003e2\u003c/sub\u003e), 2 h after surgery (P\u003csub\u003e3\u003c/sub\u003e), 6 h following the operation (P\u003csub\u003e4\u003c/sub\u003e), discharge (P\u003csub\u003e5\u003c/sub\u003e), and 24 h postoperatively (P\u003csub\u003e6\u003c/sub\u003e). Other adverse events related to anesthesia, such as surgery interruption, change in anesthesia method, postoperative cognitive dysfunction (POCD), anaphylaxis, patient demographics, propofol dose, laryngeal mask removal time, directional recovery time, and postoperative hospital stay, were recorded. Patient satisfaction with anesthesia (divided into very satisfied, satisfied, basically satisfied, and dissatisfied) was assessed when leaving the facility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome was perioperative complications associated with opioid use. The secondary outcomes were BIS, PI, vital signs, blood gas index, and VAS scores. The other outcomes included propofol concentration, postoperative recovery, other adverse events, and patient satisfaction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using the SPSS 19.0 statistical package. Data are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s) or median (interquartile range [IQR]), and qualitative data was displayed as numbers and percentages (n [%]). Quantitative data such as weight, height, BMI, operation time, propofol dosage, laryngeal mask removal time, directional recovery time, and postoperative hospital stay between the groups were analyzed using the independent sample \u003cem\u003et-test\u003c/em\u003e or Mann\u0026ndash;Whitney \u003cem\u003eU test\u003c/em\u003e. The VAS, HR, MAP, SPO\u003csub\u003e2\u003c/sub\u003e, BIS, PI, and blood gas indices were assessed using repeated-measures \u003cem\u003eANOVA\u003c/em\u003e. Categorical data such as sex, surgery type, and perioperative complications were compared using the \u003cem\u003echi-square\u003c/em\u003e test or \u003cem\u003eFisher\u0026rsquo;s exact\u003c/em\u003e test. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOne hundred sixty four patients were initially recruited in this study; 13 patients (7.9%) whose basic parameters did not meet the inclusion criteria were excluded, including 3 patients (1.8%) with a BMI greater than 30 kg/m\u003csup\u003e2\u003c/sup\u003e, 3 (1.8%) with a history of thoracic surgery, 4 (2.4%) in Group C, 1 (0.6%) in Group W who did not receive the assigned intervention, and 2 (1.2%) in Group C who developed pneumothorax after surgery and underwent closed pleural drainage. Finally, 151 patients (92.1%) were analyzed, including 73 in Group C and 78 in Group W (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDemographic profile\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences in sex, age, weight, height, BMI, surgery type, or operation time between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eDemographics between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eF/χ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32/41 (43.8/56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29/49 (37.2/62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.501\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), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery (Single/Double), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44/29 (60.3/39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39/39 (50.0/50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI, body mass index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative complications related to opioids\u003c/h2\u003e \u003cp\u003eNone of the patients experienced hypoxemia, vomiting, urine retention, or itching. There were no significant differences in the incidence of hypotension, bradycardia, hypertension, tachycardia, nausea, or dizziness, and the total number of patients with complications was similar between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (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\u003eOccurrence of perioperative adverse reactions related to opioids\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypotension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBradycardia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cases, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOther adverse reactions related to anesthesia\u003c/h2\u003e \u003cp\u003eAll patients successfully underwent surgical treatment, and there were no cases of surgical interruption, change in the anesthesia method, POCD, or anaphylaxis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eChanges in perioperative sedation and analgesia index\u003c/h2\u003e \u003cp\u003eThe BIS and PI values declined sharply after general anesthesia induction and then gradually increased to near the pre-anesthesia level when leaving the operating room but were still lower than the baseline. Compared with T\u003csub\u003e1\u003c/sub\u003e, there was a statistically significant difference in BIS and PI between T\u003csub\u003e2\u003c/sub\u003e and T\u003csub\u003e4\u003c/sub\u003e in both groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); however, there was no significant difference in the comparison of the above indicators between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of BIS and PI between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIS, (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1060.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e866.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI, (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e254.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCompared with group T\u003csub\u003e1\u003c/sub\u003e, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e##\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBIS, bispectral index; PI, pain index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eVariety of perioperative respiratory and circulatory indicators\u003c/h2\u003e \u003cp\u003eHR and MAP declined markedly after anesthesia and increased slowly as the operation progressed, whereas the changes in SPO\u003csub\u003e2\u003c/sub\u003e were relatively small. Compared with T\u003csub\u003e1\u003c/sub\u003e, HR and MAP were lower at T\u003csub\u003e2\u003c/sub\u003e, T\u003csub\u003e3\u003c/sub\u003e, and T\u003csub\u003e4\u003c/sub\u003e in both groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), whereas SPO\u003csub\u003e2\u003c/sub\u003e in Group C was relatively higher at T\u003csub\u003e2\u003c/sub\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there were no significant differences in HR, MAP, or SPO\u003csub\u003e2\u003c/sub\u003e between Groups C and W (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of HR, MAP, and SPO\u003csub\u003e2\u003c/sub\u003e between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (beat/min) ,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP (mmHg) ,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPO\u003csub\u003e2\u003c/sub\u003e (%),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCompared with group T\u003csub\u003e1\u003c/sub\u003e, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e##\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHR, heart rate; MAP, mean arterial pressure; SPO\u003csub\u003e2\u003c/sub\u003e, pulse oxygen saturation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eChanges in perioperative blood gas analysis\u003c/h2\u003e \u003cp\u003eFollowing anesthesia, PH, PCO\u003csub\u003e2\u003c/sub\u003e, BE, HCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e, BG and lactate showed mild fluctuations, and PO\u003csub\u003e2\u003c/sub\u003e was significantly increased in these two groups. In both Groups C and W, PH was relatively higher at T\u003csub\u003e2\u003c/sub\u003e but lower at T\u003csub\u003e3\u003c/sub\u003e and T\u003csub\u003e4\u003c/sub\u003e; PCO\u003csub\u003e2\u003c/sub\u003e decreased at T\u003csub\u003e2\u003c/sub\u003e but increased at T\u003csub\u003e3\u003c/sub\u003e and T\u003csub\u003e4\u003c/sub\u003e; PO\u003csub\u003e2\u003c/sub\u003e increased sharply from T\u003csub\u003e2\u003c/sub\u003e to T\u003csub\u003e4\u003c/sub\u003e; BE, HCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e and BG increased marginally at T\u003csub\u003e3\u003c/sub\u003e and T\u003csub\u003e4\u003c/sub\u003e compared with T\u003csub\u003e1\u003c/sub\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, the lactate levels at T\u003csub\u003e4\u003c/sub\u003e were higher than those at T\u003csub\u003e1\u003c/sub\u003e in Group C (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nevertheless, there was no significant difference in blood gas index between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of perioperative blood gas index between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF/ Z\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH, (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO\u003csub\u003e2\u003c/sub\u003e (mmHg),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePO\u003csub\u003e2\u003c/sub\u003e (mmHg),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277\u0026thinsp;\u0026plusmn;\u0026thinsp;85\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e278\u0026thinsp;\u0026plusmn;\u0026thinsp;89\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209\u0026thinsp;\u0026plusmn;\u0026thinsp;88\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e207\u0026thinsp;\u0026plusmn;\u0026thinsp;88\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u0026thinsp;\u0026plusmn;\u0026thinsp;65\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u0026thinsp;\u0026plusmn;\u0026thinsp;45\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBE (mmol/L) ,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (-1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (-1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (-1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (-1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0, 3) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1, 3) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e (mmol/L),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBG (mmol/L),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactate (mmol/L),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCompared with group T\u003csub\u003e1\u003c/sub\u003e, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e##\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBE, base excess; BG, Blood glucose; HCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e, hydrogen carbonate;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePCO\u003csub\u003e2\u003c/sub\u003e, partial pressure of carbon dioxide; PO\u003csub\u003e2\u003c/sub\u003e, oxygen partial pressure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative VAS\u003c/h2\u003e \u003cp\u003eCompared with P\u003csub\u003e1\u003c/sub\u003e, the VAS scores at P\u003csub\u003e2\u003c/sub\u003e to P\u003csub\u003e6\u003c/sub\u003e in Group C and from P\u003csub\u003e3\u003c/sub\u003e to P\u003csub\u003e6\u003c/sub\u003e in Group W showed an evident increase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) but were not significantly different between Groups C and W (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of postoperative VAS scores between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS, M (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0, 1) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-4.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1, 1) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e5\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1, 2) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003csub\u003e6\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0, 1) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0, 1) \u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCompared with group T\u003csub\u003e1\u003c/sub\u003e, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e##\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eVAS, visual analog scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eDosage of propofol and postoperative recovery time\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences in the dosage of propofol, postoperative directional recovery time, or hospital stay between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Compared with group C, the laryngeal mask removal time was prolonged in group W (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePropofol dose and postoperative recovery time between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol dose ( mg ), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e298\u0026thinsp;\u0026plusmn;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e302\u0026thinsp;\u0026plusmn;\u0026thinsp;88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaryngeal mask removal time ( min ), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirectional recovery time ( min ), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay (min), (x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ePatient satisfaction\u003c/h2\u003e \u003cp\u003eThere were no cases of basic satisfaction or dissatisfaction in either group, and the proportion of those who were very satisfied or satisfied was similar between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patients\u0026rsquo; satisfaction between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery satisfied, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasically satisfied, n (%)\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\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDissatisfied, n (%)\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\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo reduce perioperative complications caused by anesthesia procedures and relieve the incidence of side effects related to anesthesia drugs, opioid-reduced combined with non-intubation and nerve block anesthesia techniques have gradually been promoted and have achieved good results in thoracic surgeries in recent years \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. In the present study, we combined multiple methods to monitor opioid-reduced anesthesia in patients with palmar hyperhidrosis who underwent thoracoscopic sympathectomy.\u003c/p\u003e \u003cp\u003eDezocine, an opioid κ receptor partial agonist with weak inhibitory effects on cardiovascular function and low incidence of drowsiness, nausea, vomiting, etc. has been widely applied for the treatment of acute pain for years \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. The trauma of sympathectomy was minimal, and the pain caused by this surgery was mild; thus, the application of dezocine could meet the requirements of intraoperative analgesia. DEX, a selective α2-adrenal receptor agonist that could activate corresponding receptors in the brain and spinal dorsal horn producing sedative and analgesic effects, has been widely used in perioperative adjuvant analgesic treatment \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In this study, patients in Group W received an infusion of DEX before anesthesia to reduce the excitability of the sympathetic nervous system, and there were no cases of tachycardia during the operation. Furthermore, to implement the ERAS concept, all patients in this study were orally administered carbohydrate-containing beverages 2 h before surgery. As a result, the perioperative blood volume was sufficient, and there was no significant difference in the incidence of bradycardia and hypotension between groups. The HR, MAP, and incidence of adverse reactions were similar between groups, suggesting that the use of DEX in this surgery was safe. Flurbiprofen, a classic NSAID with strong anti-inflammatory and analgesic effects, plays an important role in the development of multimodal analgesia during surgery \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. We used this medication in both groups, and the postoperative pain experienced by the patients was low. This result confirmed the rationality of the above drug combinations.\u003c/p\u003e \u003cp\u003eAnalgesia and sedation are important indicators during anesthesia, and PI and BIS are reliable indicators of intraoperative analgesia and sedation \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. The VAS score is a common tool for evaluating pain intensity; typically, a VAS score of less than 4 signifies slight pain \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. We combined the PI and BIS to guide the dose of sedatives and analgesics during surgery, and various VAS scores were used to assess postoperative pain. An intercostal nerve block is a common regional block method that can effectively alleviate pain caused by the incision and thoracic drainage tube, reduce the dosage of analgesic drugs, and promote rapid postoperative recovery of patients during thoracic surgery \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. To improve the intraoperative analgesic effect, we combined intercostal nerve block in patients in Group W. The results showed that the VAS, PI, and BIS values were similar between the groups and were maintained at clinically appropriate levels, suggesting that analgesia via the combination of multiple analgesics and nerve block was effective.\u003c/p\u003e \u003cp\u003eIn this study, the incidence of perioperative complications was important in assessing the effect of the opioid-reduced anesthesia strategy. The results showed that patients in the two groups did not show significant differences in opioid-related adverse reactions. This indicates that the use of opioid-reduced anesthesia during thoracoscopic sympathectomy is safe and feasible.\u003c/p\u003e \u003cp\u003eDuring spontaneous breathing, preserving general anesthesia, hypoxemia, and hypercapnia are the major challenges faced by anesthesiologists \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In this study, patients in both groups were treated with laryngeal mask intubation to relieve upper respiratory tract obstruction after repeated preliminary tests to avoid hypoxia caused by upper respiratory obstruction. Auxiliary ventilation was administered when necessary. In addition, during single-lung ventilation, oxygen was supplied to all patients through the inhalation end of the threaded tube to ensure oxygen supply. The exhalation end of the threaded tube was detached from the anesthesia machine, which aided in the emission of carbon dioxide while performing lung collapse on the surgical side. Before surgery was completed, manual breathing was used to fully inflate the lungs to avoid postoperative atelectasis. In Group W, some patients experienced insufficient tidal volume and elevated transient carbon dioxide levels during surgery. In this situation, excessive ventilation was performed via manually assisted breathing after the completion of sympathectomy to keep P\u003csub\u003eET\u003c/sub\u003eCO\u003csub\u003e2\u003c/sub\u003e near normal levels as much as possible before the end of surgery. Blood gas analysis showed that the partial pressures of oxygen and carbon dioxide were at a healthy level when the patients exited the operating room. These results are consistent with those of Li et al. \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, who reported that short-term mild hypercapnia during thoracic surgery did not affect patient prognosis. In addition, none of the patients experienced complications, such as hypoxemia, heart failure, or delayed awakening during the perioperative period, and the dosage of propofol was similar between the groups; therefore, the postoperative recovery time was not extended. Finally, all patients were either very satisfied or satisfied with the anesthesia. These results confirm that implementing an anesthetic strategy without muscle relaxation during thoracoscopic sympathectomy is safe. However, the anesthesia scheme in Group W was relatively complex and did not reduce the incidence of perioperative complications. Therefore, the use of opioid-reduced anesthesia in this surgery has no clinical advantages.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, to improve patient comfort, all patients underwent peripheral venous puncture and catheterization, and blood gas analysis samples were obtained from the venous indwelling needle during the perioperative period. For subjects who had apparent anxiety before anesthesia, oxygen inhalation began immediately after the patient\u0026rsquo;s admission, which might have an impact on the blood gas index results of patients. Second, this was a single-center, single-blind trial, and funds supported by our institution had a 2-year cycle; after completing the preliminary preparation, subjects were recruited within 10 months. A multicenter, large sample, and longer research are necessary to enhance the reliability and finality of this study.\u003c/p\u003e \u003cp\u003eIn summary, during minimally invasive surgery, such as thoracoscopic sympathectomy, the strategy of opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBE\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBase excess\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBIS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBispectral index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDEX\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDexmedetomidine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eECG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectrocardiogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eERAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnhanced recovery after surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHCO\u003c/b\u003e\u003csub\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sub\u003e\u003csup\u003e\u003cb\u003e\u0026minus;\u003c/b\u003e\u003c/sup\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHydrogen carbonate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMAP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMean arterial pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNSAIDs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-steroidal anti-inflammatory drugs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePCO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePartial pressure of carbon dioxide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eP\u003c/b\u003e\u003csub\u003e\u003cb\u003eET\u003c/b\u003e\u003c/sub\u003e\u003cb\u003eCO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnd tidal carbon dioxide partial pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePain index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOxygen partial pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePOCD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostoperative cognitive dysfunction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSPO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulse oxygen saturation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eVAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analog scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of Shenzhen third People's Hospital (No.29 Bulan Road, Longgang district, Shenzhen, Guangdong, China, approval number:\u0026nbsp;2022-025-02, date: 2012-3-24). Written informed consent was obtained and documented for all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was recorded on ResMan Research Manager:\u003c/p\u003e\n\u003cp\u003ehttp://www.medresman.org.cn/uc/projectsh/projectedit.aspx?proj=5899\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declared no competing interests in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by funds from Top Three Medical and Health Projects of Shenzhen (Professor Chen Jingyu's lung transplantation and minimally invasive thoracic surgery team, SZSM202311034), and the hospital clinical projects of Shenzhen Third People's Hospital (G2022043).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiu Minqiang, Ma Mingfei, and Wu Qiang conceived and designed this study. Hong Fengzhu, Li Yang, Guo Shanshan, and Shi Qinlang collected the data. Liu Minqiang and Hong Fengzhu conducted the statistical analyses. Liu Minqiang and Ma Mingfei drafted the manuscript. He Renliang,\u0026nbsp;Li Zepeng,\u0026nbsp;and Wu Qiang revised the manuscript.\u0026nbsp;Li Zepeng\u0026nbsp;and Wu Qiang assume direct responsibility for the manuscript. All authors have approved the final submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage for the language editing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAltawili AA, Altawili MA, Alzarar AH, Abdulrahim NM, Alquraish HH, Alahmari MA, Basyouni MH, Almohaya YA, Alhabshan WMS, Alshahrani AMA, Alamrad JFA, Aljumaah AS, Alsalman MA, Alhafith AA. Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review. Cureus. 2024 Jan 1;16(1):e51475. doi: 10.7759/cureus.51475. PMID: 38298287; PMCID: PMC10830133.\u003c/li\u003e\n \u003cli\u003eEvrard E, Motamed C, Pag\u0026egrave;s A, Bordenave L. Opioid Reduced Anesthesia in Major Oncologic Cervicofacial Surgery: A Retrospective Study. J Clin Med. 2023 Jan 23;12(3):904. doi: 10.3390/jcm12030904. PMID: 36769551; PMCID: PMC9917718.\u003c/li\u003e\n \u003cli\u003eZhu T, Zhao X, Sun M, An Y, Kong W, Ji F, Wang G. Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study. BMC Anesthesiol. 2022 Nov 16;22(1):354. doi: 10.1186/s12871-022-01889-x. PMID: 36384481; PMCID: PMC9667678.\u003c/li\u003e\n \u003cli\u003eSun XJ, Feng TC, Wang YM, Wang F, Zhao JB, Liu X, Li FL. The effect of the enhanced recovery after surgery protocol and the reduced use of opioids on postoperative outcomes in elderly patients with colorectal cancer. Eur Rev Med Pharmacol Sci. 2023 Oct;27(20):10053-10060. doi: 10.26355/eurrev_202310_34185. PMID: 37916375.\u003c/li\u003e\n \u003cli\u003eZhang Z, Li C, Xu L, Sun X, Lin X, Wei P, Li J. Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis. Front Pharmacol. 2024 Jan 4;14:1330250. doi: 10.3389/fphar.2023.1330250. PMID: 38239201; PMCID: PMC10794765.\u003c/li\u003e\n \u003cli\u003eDing J, Zhu M, Lv H, Zhang J, Chen W. Application Effect of Dexmedetomidine and Dezocine in Patients Undergoing Lung Cancer Surgery under General Anesthesia and Analysis of Their Roles in Recovery Time and Cognitive Function. Comput Math Methods Med. 2022 Jun 30;2022:9889534. doi: 10.1155/2022/9889534. PMID: 35813440; PMCID: PMC9262508.\u003c/li\u003e\n \u003cli\u003eMaidanskaia EG, Mirra A, Marchionatti E, Levionnois OL, Spadavecchia C. Antinociceptive, Sedative and Excitatory Effects of Intravenous Butorphanol Administered Alone or in Combination with Detomidine in Calves: A Prospective, Randomized, Blinded Cross-Over Study. Animals (Basel). 2023 Jun 9;13(12):1943. doi: 10.3390/ani13121943. PMID: 37370454; PMCID: PMC10295376.\u003c/li\u003e\n \u003cli\u003eZong S, Du J, Chen Y, Tao H. Application effect of dexmedetomidine combined with flurbiprofen axetil and flurbiprofen axetil monotherapy in radical operation of lung cancer and evaluation of the immune function. J BUON. 2021 Jul-Aug;26(4):1432-1439. PMID: 34565001.\u003c/li\u003e\n \u003cli\u003eZhou Y, Yuan P, Xing Q, Jin W, Shi C. Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial. BMC Anesthesiol. 2024 Jan 4;24(1):14. doi: 10.1186/s12871-023-02386-5. PMID: 38172686; PMCID: PMC10765788.\u003c/li\u003e\n \u003cli\u003ePei G, Meng S, Yang Y, Wang X, Liu Q, Wang S, Huang Y. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res. 2023 Apr;33(2):111-120. doi: 10.1007/s10286-023-00932-2. Epub 2023 Apr 5. PMID: 37017809; PMCID: PMC10182923.\u003c/li\u003e\n \u003cli\u003eHuang Y, Liu Y, Zou W, Mao N, Tang J, Jiang L, Zou G, Yang L, Yu B, Wei G. Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis. Front Surg. 2023 Feb 24;10:1144299. doi: 10.3389/fsurg.2023.1144299. PMID: 36911618; PMCID: PMC9998541.\u003c/li\u003e\n \u003cli\u003eAlbayrak E, G\u0026uuml;nd\u0026uuml;z E, Titiz T, \u0026Ouml;zen K\u0026uuml;\u0026ccedil;\u0026uuml;k\u0026ccedil;etin I. The effects of erector spinae plane block (ESPB) on surgery-related stress response in thoracic surgery. Acta Chir Belg. 2023 Dec 19:1-7. doi: 10.1080/00015458.2023.2297532. Epub ahead of print. PMID: 38112523.\u003c/li\u003e\n \u003cli\u003eZheng YF, Jiang YS, Liu HT, Chen FZ, Shao AZ, Zhu JF, Ma XD, Chen YF, Lin ZJ, He LP, Sun CX. Thoracic paravertebral nerve block combined laryngeal mask airway with preservation of spontaneous breathing can accelerate postoperative recovery. Eur Rev Med Pharmacol Sci. 2023 Nov;27(22):10875-10883. doi: 10.26355/eurrev_202311_34455. PMID: 38039017.\u003c/li\u003e\n \u003cli\u003eChen Y, Lu Y, Xiang X, Fu L, Liu Y, Li C, Sun J. Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study. Front Pharmacol. 2023 Jul 10;14:1150045. doi: 10.3389/fphar.2023.1150045. PMID: 37492093; PMCID: PMC10364117.\u003c/li\u003e\n \u003cli\u003eVerret M, Le JBP, Lalu MM, McIsaac DI, Nicholls S, Turgeon AF, Hutton B, Zivkovic F, Graham M, Le M, Geist A, Berube M, Gilron I, Poulin P, Daudt H, Martel G, McVicar J, Moloo H, Fergusson DA. Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol. BMJ Open. 2024 Feb 1;14(2):e080012. doi: 10.1136/bmjopen-2023-080012. PMID: 38307526.\u003c/li\u003e\n \u003cli\u003eXiao J, Zhao C, Zhu J, Lin Q, Shen J, Liu J, Cai H, Wu X. Analgesia with reduced incidence of adverse reactions using flurbiprofen axetil in combination with half standard-dose opioids in primary total knee arthroplasty. Int J Clin Pharmacol Ther. 2023 Jun;61(6):239-245. doi: 10.5414/CP204319. PMID: 36971319.\u003c/li\u003e\n \u003cli\u003eStefanini M, Cagnazzi E, Calza S, Latronico N, Rasulo FA. Feasibility of the pupillary pain index as a guide for depth of analgesia during opioid-sparing anesthesia with continuous infusion of dexmedetomidine. J Anesth Analg Crit Care. 2023 Aug 14;3(1):27. doi: 10.1186/s44158-023-00112-8. PMID: 37580838; PMCID: PMC10424415.\u003c/li\u003e\n \u003cli\u003eVide S, Castro A, Antunes P, Lima D, Larson M, Gamb\u0026uacute;s P, Amorim P. Pharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index. J Clin Monit Comput. 2020 Apr;34(2):319-324. doi: 10.1007/s10877-019-00323-x. Epub 2019 May 22. PMID: 31119519.\u003c/li\u003e\n \u003cli\u003eLiu ZF, Qiu ZY, Zhang Y, Fu J, Ma XW. Correlation of diclofenac sodium sustained-release capsules in conjunction with function training and VAS score after ankle fracture surgery. Eur Rev Med Pharmacol Sci. 2023 Nov;27(22):10852-10859. doi: 10.26355/eurrev_202311_34452. PMID: 38039014.\u003c/li\u003e\n \u003cli\u003eCaniklioğlu M, \u0026Ouml;zkaya M. The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain. Cureus. 2021 Jul 13;13(7):e16377. doi: 10.7759/cureus.16377. PMID: 34408932; PMCID: PMC8362862.\u003c/li\u003e\n \u003cli\u003eWang T, Wang X, Yu Z, Li M. Programmed Intermittent Bolus for Erector Spinae Plane Block Versus Intercostal Nerve Block With Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery: A Randomized Controlled Noninferiority Trial. Clin J Pain. 2024 Feb 1;40(2):99-104. doi: 10.1097/AJP.0000000000001174. PMID: 37975501; PMCID: PMC10779491.\u003c/li\u003e\n \u003cli\u003eHuang Y, Bo Y, Li Y, Zhao Y, Li X, Chen D, Deng N, Liu J, Li J, Zhu M, Liu R, Peng J, Jin H. The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery: a randomized trial. J Thorac Dis. 2022 Oct;14(10):4012-4030. doi: 10.21037/jtd-22-1165. PMID: 36389295; PMCID: PMC9641321.\u003c/li\u003e\n \u003cli\u003eLi XL, He XB, Wan L, Liu CQ, Cui Y. Comparison of tracheal intubation with controlled ventilation and laryngeal mask airway with spontaneous ventilation for thoracoscopic bullectomy. Medicine (Baltimore). 2020 Apr;99(16):e19704. doi: 10.1097/MD.0000000000019704. PMID: 32311952; PMCID: PMC7440194.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dezocine, Dexmedetomidine, Intercostal nerve block, Sympathectomy","lastPublishedDoi":"10.21203/rs.3.rs-4733014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4733014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eOpioid-reduced multimodal analgesia has been clinically used for years to reduce perioperative complications related to opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eSurgical patients (n=151) with palmar hyperhidrosis were randomly divided into a control group (Group C, 73 patients) and a weak opioid group (Group W, 78 patients). All patients were administered general anesthesia using a laryngeal mask. In Group C, the patients were anesthetized with propofol, fentanyl, and cisatracurium, and mechanical ventilation was used during the operation. In Group W, the patients received propofol, dezocine, and dexmedetomidine (DEX), and spontaneous breathing was maintained during surgery. Perioperative complications related to opioids include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness; vital signs, blood gas index, visual analog scale (VAS) score, and other adverse events; patient satisfaction between groups were also recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Perioperative complications related to opioids were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction (\u003cem\u003eP \u003c/em\u003e\u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIn minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.\u003c/p\u003e","manuscriptTitle":"Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 00:33:30","doi":"10.21203/rs.3.rs-4733014/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-24T09:32:31+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"106098342839291662485390902276656885272","date":"2024-07-23T22:28:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-23T00:32:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195609768465202209999966323952381100162","date":"2024-07-22T03:20:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266289541758765720029571285224941421769","date":"2024-07-19T03:34:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-19T03:06:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339188966481898925657266284951820180147","date":"2024-07-19T01:18:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311185730413950013614252038220599878081","date":"2024-07-18T18:33:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-18T14:16:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-16T20:01:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-15T11:40:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2024-07-13T01:58:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb478142-99ad-46b1-a3b9-6939b561fce5","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:08:52+00:00","versionOfRecord":{"articleIdentity":"rs-4733014","link":"https://doi.org/10.1186/s12871-024-02711-6","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2024-09-12 15:57:53","publishedOnDateReadable":"September 12th, 2024"},"versionCreatedAt":"2024-08-09 00:33:30","video":"","vorDoi":"10.1186/s12871-024-02711-6","vorDoiUrl":"https://doi.org/10.1186/s12871-024-02711-6","workflowStages":[]},"version":"v1","identity":"rs-4733014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4733014","identity":"rs-4733014","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}