ObjectiveThis study aimed to investigate, using clinical serum metabolomics, the effects of general anesthesia combined with transversus abdominis plane block (TAPB) on systemic metabolism in patients undergoing radical gastrectomy compared with general anesthesia alone.MethodsFifty-six patients undergoing laparoscopic-assisted radical gastrectomy for gastric cancer were assigned to a general anesthesia-only group (control group, 30 patients) and a general anesthesia combined with TAPB group (treatment group, 26 patients). Clinical serum metabolomics analyses were performed to investigate alterations in systemic metabolism between the control and treatment groups.ResultsKyoto Encyclopedia of Genes and Genomes analysis revealed that the top differential metabolic pathways between the treatment and control groups were choline metabolism in cancer, glycerophospholipid metabolism, adenosine triphosphate-binding cassette transporters, and protein digestion and absorption. In this study, altered choline metabolism in cancer and glycerophospholipid metabolism shared the same five metabolites, including 1-stearoyl-2-arachidonyl-sn-glycero-3-phosphocholine, 1-stearoyl-2-oleoyl-sn-glycerol 3-phosphocholine, phosphocholine, 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (PC (16:0/16:0)), and glycerophosphocholine. The levels of these metabolites were decreased with TAPB. General anesthesia combined with TAPB reduced choline and glycerophospholipid metabolism and may serve as a potential indicator. In addition, DL-proline, lysine, DL-glutamic acid, and glutamic acid were shared with adenosine triphosphate-binding cassette transporters and protein digestion and absorption. Their decreased levels in TAPB contributed to the beneficial effects of anesthesia.ConclusionsGeneral anesthesia combined with TAPB treatment reduced sufentanil dose and pain scores (numeric rating scale and visual analog scale) on postoperative days 1 and 3 compared with the control during laparoscopic-assisted radical gastrectomy. Furthermore, majority of the top differential metabolites were associated with indicators of anesthesia management and may have contributed to the beneficial effects of combined anesthesia. These metabolites included prostaglandins and sucrose, which may have contributed to the effects of anesthesia, including TAPB.

We report a 32-year-old primigravida with no prior symptoms, normal baseline ECG, and no family history of sudden death who developed ventricular fibrillation (VF) shortly after uncomplicated vaginal delivery. She received epidural ropivacaine and sufentanil during labor. Post-resuscitation ECG demonstrated coved ST-segment elevation with T-wave inversion in V1-V2, consistent with spontaneous type 1 Brugada syndrome (BrS) pattern. Echocardiography excluded structural heart disease; coronary CT angiography excluded coronary artery disease. Laboratory investigations revealed borderline hypokalemia (3.5 mmol/L) and mild hypomagnesemia (0.75 mmol/L). Clinical whole-exome sequencing revealed no pathogenic or likely pathogenic variants in established arrhythmia-associated genes. The ECG normalized two days later. An implantable cardioverter-defibrillator was implanted. This case illustrates multifactorial unmasking of latent BrS-involving ropivacaine-mediated sodium channel blockade, postpartum autonomic instability, bradycardia, and electrolyte imbalance in a genotype-negative asymptomatic woman, highlighting the importance of recognizing concealed channelopathies in peripartum cardiac arrest.