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
BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often ...BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.展开更多
Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare...Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.展开更多
目的观察右美托咪定术前滴鼻对父母陪伴麻醉诱导(Parent presence at the induction of anesthesia,PPIA)患儿术前焦虑水平及苏醒期躁动水平的影响。方法选择中国医科大学附属盛京医院2018年1月至2019年4月择期行腺样体或伴有扁桃体切...目的观察右美托咪定术前滴鼻对父母陪伴麻醉诱导(Parent presence at the induction of anesthesia,PPIA)患儿术前焦虑水平及苏醒期躁动水平的影响。方法选择中国医科大学附属盛京医院2018年1月至2019年4月择期行腺样体或伴有扁桃体切除术患儿120例,按随机数字表法分成NS组、D1组和D2组,每组40例。在麻醉诱导前30 min,三组患儿分别经鼻滴入0.5 ml生理盐水(NS组)、1.0μg/kg右美托咪定(D1组)、2.0μg/kg右美托咪定(D2组),30 min后,在父母陪伴下患儿吸入8%七氟烷,睫毛反射消失后转运至手术室。于术前1 d访视时(T_(0))、进入术前等候室时(T_(1))及麻醉诱导开始时(T_(2))用简化的改良耶鲁围手术期焦虑量表(Modified Yale Preoperative Anxiety Scale,mYPAS-SF)评分,麻醉诱导期间利用麻醉诱导期合作度评分量表(Induction compliance checklist,ICC)评分,苏醒时应用小儿麻醉苏醒期躁动评分量表(Pediatric anesthesia emergence delirium scale,PAED)评分。结果T_(2)时,D1组、D2组患儿的mYPAS-SF评分低于NS组(F=2.831,F=4.311,P<0.05),D1组、D2组患儿的ICC评分均低于NS组(F=2.543,F=4.983;P<0.05);D2组的ICC评分低于D1组,差异有统计学意义(F=2.439,P<0.05),D2组的PAED评分低于D1组和NS组(F=4.382,F=3.182,P<0.05)。结论经鼻应用右美托咪定2.0μg/kg可明显减轻父母陪伴麻醉诱导患儿麻醉诱导期的焦虑水平,提高患儿麻醉诱导依从性,缓解患儿苏醒期躁动。展开更多
目的探讨术前经口腔颊黏膜给予单剂量右美托咪啶对七氟醚吸入全麻下行扁桃体(伴或不伴腺样体)射频消融术患儿苏醒期躁动发生率的影响。方法选取90例拟在全麻下行择期扁桃体(伴或不伴腺样体)射频消融术的患儿,随机数字表法分为3组:DEX-...目的探讨术前经口腔颊黏膜给予单剂量右美托咪啶对七氟醚吸入全麻下行扁桃体(伴或不伴腺样体)射频消融术患儿苏醒期躁动发生率的影响。方法选取90例拟在全麻下行择期扁桃体(伴或不伴腺样体)射频消融术的患儿,随机数字表法分为3组:DEX-Ⅰ组、DEX-Ⅱ组和对照组,各30例。DEX-Ⅰ组和DEX-Ⅱ组分别于术前30min经口腔颊黏膜一次性给予右美托咪啶1μg/kg和2μg/kg,对照组于同一时间点以相同方式给与等量生理盐水。记录患儿术前Ramsay评分,术中的平均动脉压、心率和血氧饱和度,拔管时间,入麻醉后监护室(PACU)后5、10、15、30、45和60 min时的Watcha激动评分和改良OPS疼痛评分(Watcha激动评分≥3分视为发生术后躁动),并记录围术期不良事件的发生情况。结果3组Ramsay镇静评分、手术时长和拔管时间差异无统计学意义。DEX-Ⅰ与DEX-Ⅱ组在入PACU后5、10、15和60 min 4个时间点Watcha激动评分均低于对照组,该2组4个时点评分差异均无统计学意义。入PACU后5、10、15和30 min时DEX-Ⅰ与DEX-Ⅱ组术后改良OPS评分均低于对照组,该2组间上述4个时点评分差异无统计学意义。与对照组相比,DEX-Ⅰ与DEX-Ⅱ组术中心率和平均动脉压明显降低,但在正常临床范围内。3组患儿围术期均未见不良事件的发生。结论术前经口腔颊黏膜一次性给予1~2μg/kg右美托咪啶可以有效降低全麻患儿术后苏醒期躁动的发生率。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BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.
文摘Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.
文摘目的探讨术前经口腔颊黏膜给予单剂量右美托咪啶对七氟醚吸入全麻下行扁桃体(伴或不伴腺样体)射频消融术患儿苏醒期躁动发生率的影响。方法选取90例拟在全麻下行择期扁桃体(伴或不伴腺样体)射频消融术的患儿,随机数字表法分为3组:DEX-Ⅰ组、DEX-Ⅱ组和对照组,各30例。DEX-Ⅰ组和DEX-Ⅱ组分别于术前30min经口腔颊黏膜一次性给予右美托咪啶1μg/kg和2μg/kg,对照组于同一时间点以相同方式给与等量生理盐水。记录患儿术前Ramsay评分,术中的平均动脉压、心率和血氧饱和度,拔管时间,入麻醉后监护室(PACU)后5、10、15、30、45和60 min时的Watcha激动评分和改良OPS疼痛评分(Watcha激动评分≥3分视为发生术后躁动),并记录围术期不良事件的发生情况。结果3组Ramsay镇静评分、手术时长和拔管时间差异无统计学意义。DEX-Ⅰ与DEX-Ⅱ组在入PACU后5、10、15和60 min 4个时间点Watcha激动评分均低于对照组,该2组4个时点评分差异均无统计学意义。入PACU后5、10、15和30 min时DEX-Ⅰ与DEX-Ⅱ组术后改良OPS评分均低于对照组,该2组间上述4个时点评分差异无统计学意义。与对照组相比,DEX-Ⅰ与DEX-Ⅱ组术中心率和平均动脉压明显降低,但在正常临床范围内。3组患儿围术期均未见不良事件的发生。结论术前经口腔颊黏膜一次性给予1~2μg/kg右美托咪啶可以有效降低全麻患儿术后苏醒期躁动的发生率。
