The purpose of this paper is to explore the safe and effective dose of dexmedetomidin for the prevention of agitation and delirium during the awakening period for children undergoing general anesthesia. Samples of 989...The purpose of this paper is to explore the safe and effective dose of dexmedetomidin for the prevention of agitation and delirium during the awakening period for children undergoing general anesthesia. Samples of 989 cases are collected from children with comprehensive treatment of dental caries, and were randomly divided into four groups. Group A, group B and group C were intravenously at constant speed （60 mL/h）, 0.5 and 0.25 infusion with 1 μg/kg dexmedetomidine. Group D （control group） was intravenously saline at the same speed. The score of 5-point scale and the incidence of ED （emergency delirium） and EA （emergence agitation） in four groups were compared. Comparison of four groups of CHIPPS （children and infants postoperative pain） score, the amount of operation time and record seven halothane （TO）, time to stop cover drug withdrawal of laryngeal anesthesia （TM）, eye opening time （TE）, independent records of children at the time of ICU stay after anesthesia （TP）. Results show that there was no significant difference between the four groups （p 〉 0.05）, among which the TM in B, C groups was significantly higher than that in A, D groups （p 〈 0.05）. Group C was significantly higher than group B （p 〈 0.05）. There was no significant difference in TE and TP between the A, B, D groups （p 〉 0. 05）. TE in group C was significantly higher than that in groups A, D （p 〉 0. 05）. The TP of group C was significantly higher than that of groups A, D （p 〈 0.05）, but there was no significant difference between the B, C groups （p 〉 0.05）. The incidence rates of EA and ED in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C and group C （p 〉 0.05）. The CHIPPS score and sevoflurane dosage in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C （p 〉 0.05）. Conclusion： the dose of dexmetomidine 0.5 μg/kg in children with general anesthesia can prevent restlessness and delirium after operation.展开更多
Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral pals...Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.展开更多
<b>Objective:</b> The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guid...<b>Objective:</b> The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. <b>Methods:</b> Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO<sub>2</sub> of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. <b>Results:</b> The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH<sub>2</sub>O. <b>Conclusion:</b> For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.展开更多
Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term ...Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term postoperative complications. Recently, video distraction intervention has been evaluated for its anxiolytic effects in preoperative children. Aim: The aim of this integrative review was to demonstrate the varying methodological approaches utilized to evaluate the effectiveness of a video distraction intervention in reducing preoperative anxiety in children undergoing day case surgery. Methods: A total of 8 articles, meeting the inclusion criteria, were evaluated and included. Findings: The eight studies investigating the effect of video distraction on children preoperative anxiety concluded that video distraction was significant in controlling children preoperative anxiety. Four of the eight studies (50%), investigated video distraction effectiveness against pharmacological comparisons and demonstrated superior or equal anxiolytic effect of video distraction on different points along the surgical continuum. Three of the eight studies compared video distraction against parental presences and video distraction showed superior anxiolytic effect. Three of the eight studies evaluated the effect of video distraction on anesthesia induction compliance and emergence delirium. A significant effect on anesthesia induction was demonstrated while non-significant effect on emergence delirium was documented. Conclusion: Video distraction is a safe, time and cost effective non pharmacological anxiolytic intervention. It can be provided by nurses to control children high level of anxiety before surgery and during anesthesia induction.展开更多
Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in amb...Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.展开更多
文摘The purpose of this paper is to explore the safe and effective dose of dexmedetomidin for the prevention of agitation and delirium during the awakening period for children undergoing general anesthesia. Samples of 989 cases are collected from children with comprehensive treatment of dental caries, and were randomly divided into four groups. Group A, group B and group C were intravenously at constant speed （60 mL/h）, 0.5 and 0.25 infusion with 1 μg/kg dexmedetomidine. Group D （control group） was intravenously saline at the same speed. The score of 5-point scale and the incidence of ED （emergency delirium） and EA （emergence agitation） in four groups were compared. Comparison of four groups of CHIPPS （children and infants postoperative pain） score, the amount of operation time and record seven halothane （TO）, time to stop cover drug withdrawal of laryngeal anesthesia （TM）, eye opening time （TE）, independent records of children at the time of ICU stay after anesthesia （TP）. Results show that there was no significant difference between the four groups （p 〉 0.05）, among which the TM in B, C groups was significantly higher than that in A, D groups （p 〈 0.05）. Group C was significantly higher than group B （p 〈 0.05）. There was no significant difference in TE and TP between the A, B, D groups （p 〉 0. 05）. TE in group C was significantly higher than that in groups A, D （p 〉 0. 05）. The TP of group C was significantly higher than that of groups A, D （p 〈 0.05）, but there was no significant difference between the B, C groups （p 〉 0.05）. The incidence rates of EA and ED in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C and group C （p 〉 0.05）. The CHIPPS score and sevoflurane dosage in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C （p 〉 0.05）. Conclusion： the dose of dexmetomidine 0.5 μg/kg in children with general anesthesia can prevent restlessness and delirium after operation.
文摘Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.
文摘<b>Objective:</b> The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. <b>Methods:</b> Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO<sub>2</sub> of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. <b>Results:</b> The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH<sub>2</sub>O. <b>Conclusion:</b> For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.
文摘Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term postoperative complications. Recently, video distraction intervention has been evaluated for its anxiolytic effects in preoperative children. Aim: The aim of this integrative review was to demonstrate the varying methodological approaches utilized to evaluate the effectiveness of a video distraction intervention in reducing preoperative anxiety in children undergoing day case surgery. Methods: A total of 8 articles, meeting the inclusion criteria, were evaluated and included. Findings: The eight studies investigating the effect of video distraction on children preoperative anxiety concluded that video distraction was significant in controlling children preoperative anxiety. Four of the eight studies (50%), investigated video distraction effectiveness against pharmacological comparisons and demonstrated superior or equal anxiolytic effect of video distraction on different points along the surgical continuum. Three of the eight studies compared video distraction against parental presences and video distraction showed superior anxiolytic effect. Three of the eight studies evaluated the effect of video distraction on anesthesia induction compliance and emergence delirium. A significant effect on anesthesia induction was demonstrated while non-significant effect on emergence delirium was documented. Conclusion: Video distraction is a safe, time and cost effective non pharmacological anxiolytic intervention. It can be provided by nurses to control children high level of anxiety before surgery and during anesthesia induction.
文摘Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.
