Outcome variables
delirium, postoperative delirium, sinus bradycardia, hypoxia, hypotension, TG
DISORDERS, ADVERSE EVENTS, SINUS BRADYCARDIA, HYPOXIA, SECONDARY, BLOOD, RESIDUAL
The primary outcomes were anesthesia induction time and time until the patient was fully alert post-operatively. Induction time was defined as the time from when the participant became unresponsive to painful stimulation (namely the squeezing of his/her trapezius) after the start of anesthesia administration. Time to fully alert was defined as the time from the stopping of anesthetic dosing to the patient accurately stating his/her date of birth [Key secondary endpoints included: anesthesia success rate, defined as the absence of (1) intraoperative awakening or recall, (2) the need for rescue sedative medication and (3) body movement; LMA insertion time; the BIS values; the number of patients with BIS values > 60 or < 40 during anesthesia maintenance; % time BIS > 60 during anesthesia maintenance, defined as the percentage of time with BIS values > 60 in the whole anesthesia maintenance period; the recovery time including the time to eye opening, time to LMA extraction and time to the third consecutive Aldrete score ≥ 9 in the post-anesthesia care unit (PACU); postoperative delirium. Time to the third consecutive Aldrete score ≥ 9 was defined as the period from LMA extraction to the measurement of the third consecutive Aldrete score ≥ 9. Postoperative delirium was assessed prior to PACU discharge using the Diagnostic and Statistical Manual of Mental Disorders. After stopping the anesthetic, the dosages of opioids and vasoactive drugs were also recorded. Patients were under monitoring in PACU 60 min after flumazenil administration or 60 min after entering PACU to assess the recovery profiles, especially the sedation status after flumazenil administration. Recovery profiles were assessed based on the scores of the following assessments: modified observer’s alertness/sedation scale (MOAA/S) before the surgery and 60 min after flumazenil administration or 60 min after entering PACU; Aldrete score 60 min after entering PACU; mini-mental state examination (MMSE) before the surgery, in PACU and on 1 day after surgery (POD1); visual analogue scale (VAS) before the surgery, in PACU and on POD1; the post-operative quality of recovery scale (PostopQRS) before the surgery, on POD1 and 14 days after surgery (POD14); a telephone interview to evaluate cognitive status on POD14. Residual cognitive effects (more than 7 days) following ambulatory anesthesia in middle-aged patients have been previously reported [Blood samples were drawn before anesthesia induction and at PACU discharge to measure inflammatory factors and biomarkers relevant to cognitive and lipid profiles, such as neuropeptide Y (NPY), interleukin (IL)-8, IL-1β, IL-10, triglyceride (TG) and very low density lipoprotein (VLDL) levels. The above factors were measured using enzyme-linked immunosorbent assay kits obtained from XLPCC (Shanghai, China) according to the manufacturer’s instructions. In order to explore whether RT had the similar effect to propofol in terms of inflammatory factors activation and Th17/Treg cell balance [Drug-related adverse events (AEs) including hypotension, sinus bradycardia and hypoxia (defined as SpO