{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:32:53Z","timestamp":1780356773717,"version":"3.54.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["No. 82371246"],"award-info":[{"award-number":["No. 82371246"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100018543","name":"Natural Science Foundation of Tibet Autonomous Region","doi-asserted-by":"crossref","award":["XZ202301ZR0004G"],"award-info":[{"award-number":["XZ202301ZR0004G"]}],"id":[{"id":"10.13039\/501100018543","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["High Altitude Medicine &amp; Biology"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:p>\n                    Tu, Ke, Lei Tian, Qi Zhu, Kailian Bai, Lin Li, Mengmei Fu, Mengxia Wang, Lei Zhang, Zhuo Zhan, Haoxi Li, Xiaojun Li, Ruofan Yi, Cheng Jiang, Hua Huang, and Mingming Zhang. Intraoperative opioid-free anesthesia with dexmedetomidine and esketamine versus conventional general anesthesia in laparoscopic cholecystectomy at 3,600 m: a randomized trial on hemodynamic stability and postoperative recovery.\n                    <jats:italic toggle=\"yes\">High Alt Med Biol.<\/jats:italic>\n                    27:8\u201316, 2026.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Opioid-free anesthesia (OFA) is gaining attention as an alternative to opioid-based techniques. However, its hemodynamic and clinical characteristics at high altitudes, where hypoxia and resource limitations prevail, remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this single-blind randomized trial, 48 patients undergoing laparoscopic cholecystectomy at 3,600 m were assigned to either a conventional general anesthesia (CGA) group (sevoflurane, sufentanil, remifentanil) or an OFA group (sevoflurane, dexmedetomidine, esketamine). The primary outcome was intraoperative mean arterial pressure (MAP); secondary outcomes included heart rate (HR), awakening time, sedation level, patient satisfaction, postoperative pain, postoperative nausea and vomiting (PONV), perioperative medication use, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared with CGA, the OFA group maintained higher intraoperative MAP, with significant differences after induction (OFA: 87.9 \u00b1 12.3 vs. CGA: 77.2 \u00b1 11.7 mmHg,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.005) and 10 minutes after incision (OFA: 83.5 \u00b1 14.9 vs. CGA: 72.5 \u00b1 9.8 mmHg,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.005). The CGA group exhibited a significant MAP decline at 10 minutes postincision (72.5 \u00b1 9.8 vs. baseline: 83.0 \u00b1 9.1 mmHg,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), whereas the OFA group showed a transient MAP increase after intubation (96.1 \u00b1 16.1 vs. baseline: 85.8 \u00b1 7.8 mmHg,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01). HR trends paralleled MAP changes. Awakening time was significantly longer with OFA (OFA: 20.4 \u00b1 7.5 min vs. CGA: 10.6 \u00b1 8.2 min,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), while pain scores at 6 and 12 hours were lower (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.005). Sedation, satisfaction, PONV, and medication use were comparable. No severe adverse events occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>At high altitudes, OFA with dexmedetomidine and esketamine exhibited distinct clinical characteristics compared with opioid-based anesthesia, maintaining blood pressure and postoperative analgesia but less effectively blunting intubation-induced pressor responses and prolonging awakening time. These factors should be weighed when selecting anesthesia strategies in resource-limited, high-altitude settings, particularly when managing large numbers of patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15578682251381135","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T06:14:42Z","timestamp":1758262482000},"page":"8-16","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Intraoperative Opioid-Free Anesthesia with Dexmedetomidine and Esketamine Versus Conventional General Anesthesia in Laparoscopic Cholecystectomy at 3,600 m: A Randomized Trial on Hemodynamic Stability and Postoperative Recovery"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7928-4559","authenticated-orcid":false,"given":"Ke","family":"Tu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailian","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengmei","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengxia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Zhan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoxi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruofan","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The 955th Hospital of Army, Chamdo, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi\u2019an, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Hospital of Xizang Military Command, Lhasa, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Human Anatomy, Histology and Embryology &amp; K.K. 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