Emergency department management of acute agitation in the reproductive age female and pregnancy

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

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.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

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.

Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients

BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.

Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.

Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

AIM To evaluate the safety and efficacy of agitation thrombolysis(AT) combined with catheter-directed thrombolysis(CDT) for the treatment of non-cirrhotic acute portal vein thrombosis(PVT). METHODS Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic(commonly known as TIP) or percutaneous transhepatic(commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.RESULTS AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre-and posttreatment(P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.CONCLUSION AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

BACKGROUND: Agitation occurs frequently among critically ill patients admitted to the intensive care unit(ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status.RESULTS: A total of 102 intubated patients were enrolled; of which 46(45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries(P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia(P<0.05). On multivariate analysis, use of propofol alone(OR=4.97; 95% CI=1.35–18.27), subarachnoid hemorrhage(OR=5.11; 95% CI=1.38–18.91) and ICP catheter insertion for severe head injury(OR=4.23; 95% CI=1.16–15.35) were independent predictors for agitation(P<0.01).CONCLUSION: Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

Effect of agitation speed on the morphology of Aspergillus niger HFD5A-1 hyphae and its pectinase production in submerged fermentation

AIM: To investigate the impact of agitation speed on pectinase production and morphological changing of Aspergillus niger(A. niger) HFD5A-1 in submerged fermentation. METHODS: A. niger HFM5A-1 was isolated from a rotted pomelo. The inoculum preparation was performed by adding 5.0 m L of sterile distilled water containing 0.1% Tween 80 to a sporulated culture. Cultivation was carried out with inoculated 1 × 107 spores/m L suspension and incubated at 30 ℃ with different agitation speed for 6 d. The samples were withdrawn after 6 d cultivation time and were assayed for pectinase activity and fungal growth determination. The culture broth was filtered through filter paper(Whatman No. 1, London) to separate the fungal mycelium. The cell-free culture filtrate containing the crude enzyme was then assayed for pectinase activity. The biomass was dried at 80 ℃ until constant weight. The fungal cell dry weight was then expressed as g/L. The 6 d old fungal mycelia were harvested from various agitation speed, 0, 50, 100, 150, 200 and 250 rpm. The morphological changing of samples was then viewed under the light microscope and scanning electron microscope.RESULTS: In the present study, agitation speed was found to influence pectinase production in a batch cultivation system. However, higher agitation speeds than the optimal speed(150 rpm) reduced pectinase production which due to shear forces and also collision among the suspended fungal cells in the cultivation medium. Enzyme activity increased with the increasing of agitation speed up to 150 rpm, where it achieved its maximal pectinase activity of 1.559 U/m L. There were significant different(Duncan, P < 0.05) of the pectinase production with the agitation speed at static, 50, 100, 200 and 250 rpm. At the static condition, a well growth mycelial mat was observed on the surface of the cultivation medium and sporulation occurred all over the fungal mycelial mat. However with the increased in agitation speed, the mycelial mat turned slowly to become a single circular pellet. Thus, it was found that agitation speed affected the morphological characteristics of the fungal hyphae/mycelia of A. niger HFD5A-1 by altering their external as well as internal cell structures.CONCLUSION: Exposure to higher shear stress with an increasing agitation speed could result in lower biomass yields as well as pectinase production by A. niger HFD5A-1.

Investigation on Eccentric Agitation in the Stirred Vessel Using 3D-Laser Doppler Velocimeter

The spatial structure of the velocity field in a stirred vessel with water has been measured and analyzed using the laser Doppler velocimeter technique, with the immersing depth and agitation speed of the impeller re-maining approximately constant. The experimental results were provided such as the mean velocity field, fluctuat-ing velocities, turbulent kinetic energy, Reynolds shear stress and time series of the velocity in the stirred tank. These results probably provided the valuable basis to further optimize and enlarge the stirred tank in the industrial process.

Application of High Shear Agitation for Desulfurization of Gasoline Using Ionic Liquids

The high shear agitation device was first adopted for gasoline desulfurization by ionic liquids. The effect of benzylimidazol fluoborate in desulfurization of gasoline and the influence of moisture on deuslfurization rate were investigated. The experimental results showed that the ionic liquid could effectively decrease the sulfur content of gasoline and the optimal conditions were as follows: The reaction could be carried out at room temperature, a volumetric ratio between oil and the liquid of 2:1, a volumetric ratio between water and ionic liquid of 0.04:1, a rotational speed of 5 krad/s, and a reaction time of 1 minute. The desulfurization rate of gasoline reached 53.6%, and the gasoline yield was up to 97.3%. The ionic liquid could be recycled for repeated use, and the use of high shear agitation for gasoline would have good prospects.

Effects of geometrical and physical factors on light particles dispersion by agitation characteristic curve

In this study,the effects of geometrical and physical factors on light particles dispersion in stirred tank were investigated by agitation characteristic curve.The experiments and CFD simulations with discrete phase model(DPM)and volume of fluid model(VOF)were conducted in this paper.Five factors,which include four geometrical factors(submergence,impeller-to-tank ratio,number of impeller blades and baffling mode)and a physical factor(liquid viscosity)were considered.For each factor,the power consumption curve and agitation characteristic curve were drawn to compare the power consumption and mixing results in the stirred tank.Characteristics of the agitation characteristic curves were compared with the previous published literatures and theories.It is found that the agitation characteristic curves reflect the tendency of power consumption and particles distribution well in stirred tank.The good agreement indicates the applicability of the agitation characteristic curves for the study of light particles distribution in stirred tank.

CFD investigation of the agitation in the desupersaturation during the wet-process phosphoric acid(WPPA)process

Desupersaturation is a complex cooling operation that involves hydrodynamic,thermal and mechanical phenomena.This process requires continuous agitation to avoid fouling problems and sludge deposition.The current work aims to investigate the well mixedness in the desupersaturation tank for optimal performance.For this purpose,a multi-fluid CFD study was conducted based on the Euler–Euler modeling approach,considering a multiphase flow involving a liquid phase(phosphoric acid)and a poly-dispersed solid phase,i.e.a sludge with three different sizes where each size is considered as a separate phase.First,the hydrodynamic behavior of the flow within the agitated desupersaturator is analyzed through the investigation of the velocity fields as well as the power and pumping numbers,to determine both the agitator capacity to pump the flow and its power consumption during the operation.Then,in order to assess the mixture homogeneity,we evaluated the solid suspension in the desupersaturation reactor following conventional methods and two new proposed methodologies:the first approach is to evaluate the suspension quality in the mixing system by compartment and the second consists on the assessment of the uniform convergence of the solid concentration.Furthermore,we calculated the time required to achieve a full suspension at different solid concentrations.On other hand,we conducted a detailed analysis of the solid distribution dependency on the impeller rotational speed at different solid volume fraction,which allows a good understanding of the parameters controlling the homogenization in the desupersaturator.

Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia

TimeslipsTM is a group storytelling program that encourages creative expression among dementia patients without the pressure to recall the past. Analysis of the literature was conducted to determine the nine most relevant agitation and anxiety scales most appropriate for use with Timeslips in nursing home patients with dementia, who experience agitation and anxiety. Qualitative assessment of the nine scales was conducted to identify six criteria to determine the most pertinent characteristics for implementation of Timeslips within this patient population: 1) validity/reliability, 2) observation period, 3) training required, 4) time to administer, 5) most appropriate administrator and 6) accessibility/cost. Utilizing these six criteria, quantitative assessment was conducted using the Analytical Hierarchical Process (AHP) to identify that the Overt Agitation Severity Scale (OASS) was optimal. IRB approvals have been attained to investigate use of the OASS with Timeslips in the nursing home setting for patients with dementia, who experience agitation and anxiety.

Dexmedetomidine versus Ketamine for the Prevention of Emergence Agitation in Pediatric: A Prospective, Randomized, and Controlled Clinical Trial

Background: This study compares the effect of dexmedetomidine versus Ketamine for the prevention of emergence agitation in children undergoing general anaesthesia. Method: 75 Children are randomly allocated into three groups. Group C: Were assigned to receive normal saline. Group K: Were assigned to receive Ketamine 0.25 mg/kg. Group D: assigned to receive 0.25 ug /kg of dexmedetomidine, before the end of surgery. Results: There was no statistically significant difference in demographic data and intraoperative parameters between the three groups. But as regards to time to discharge, there was a significant difference between group C, group K and group D (group C = 39.96 ± 2.84, group K = 37.28 ± 3.80, group D = 35.08 ± 3.36 and P value = 0.0002). FLACC scale was low after extubation, before leaving the operating room and on arrival to PACU (small FLACC scale in group K, D than group C). PAED scoreless in Group K and Group D than Group C (postoperative, at 10 minutes, 20 min, 30 min). Conclusion: Ketamine and dexmedetomidine reduced the incidence and severity of emergence delirium effectively when compared to normal saline, and the effects of dexmedetomidine being much superior to Ketamine.

The effect of individualized music on agitation for home-dwelling persons with dementia

Purpose: The purpose of this study was to test the effect of individualized music on agitation for homedwelling patients with dementia. Method: One group pre-post test was used for research design and a total of 26 subjects participated in this study. Individualized music intervention was subjects’ listening to their preferred music for 30 minutes prior to peak agitation time twice a week for a total of four sessions. The subject’s agitation levels were measured for three different points: thirty minutes prior to listening to music, 30 minutes while listening to the music, and after listening to the music throughout the 4 sessions. To measure the agitation level, the modified CohenMansfield Agitation Inventory was used. A Paired ttest was used for data analysis. Results: Most subjects were female (73.1%), Caucasian (92.4%), Protestant (50%), and independent activity (53.8%). The mean of the subjects’ MMSE scores was 8.08 (8.17). The most favorite music types included country/western music (31.0%), religious music (26.9%), and big band (26.9%). Agitation level decreased while listening to the music compared to the baseline (t = 3.70, p < .001). Conclusion: The findings of this study would provide meaningful data to develop an individualized music intervention protocol to control agitation for homedwelling patients with dementia.

Rheological investigations of the improved fine scheelite flotation spiked with agitation medium

The fine scheelite flotation using garnet and glass beads as agitation medium was investigated through slurry rheology and froth property analysis. The apparent viscosity of fine scheelite, calcite and quartz(-20 μm) slurry were measured and the corresponding scheelite flotation behaviours, froth water recovery and froth height were studied. It was found that calcite slurry could aggregate into network structures and exhibit much higher apparent viscosity at the vicinity of pH 8.5–9.0 than scheelite and quartz(scheelite, calcite, and quartz slurry at 20.34, 38.66, and 14.58 mPa·s, respectively). Agitation medium containing garnet and glass beads could reduce the slurry apparent viscosity by effectively dispersing the calcite network structures in flotation slurry, and improve the fine scheelite flotation selectivity. As the apparent viscosity was reduced, the froth water recovery decreased from 24.33% to 6.37% and initial froth height of the flotation froth decreased from 69.6 to 8.7 mm, and finally results in increase in separation efficiency from 23.10% to 31.96%. The results could be potentially used in flotation of fine minerals by applying agitation medium to improve the process selectivity.

Genetic transformation of Platymonas (Tetraselmis) subcordiformis (Prasinophyceae, Chlorophyta) using particle bombardment and glass-bead agitation

Platymonas (Tetraselmis) subcordiformis is a unicellular marine green alga. It was found to be very sensitive to the herbicide Basta through a sensitivity test indicating it could be employed as a selective agent. The bar gene is a practicable and selectable marker gene. The vector containing the expression cassette of the bar gene was transferred to P. subcordiformis by both particle bombardment and glass-bead agitation and transformants were then selected using Basta. Finally, Southern blotting analysis indicated that the bar gene had been successfully integrated into the nuclear genome of P. subcordiformis using both of the transgenic techniques, with the transformation efficiency of the glass-bead method being slightly higher than that of particle bombardment. This is the first report on stable transformation of P. subcordiformis, and will improve fundamental research and enlarge application of this alga.

Reduced emergence agitation with proparacaine hydrochloride eye drops after general anaesthesia for paediatric strabismus surgery

Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabismus surgery were randomly assigned to receive 1-2 drops of isotonic saline(n=129)or proparacaine hydrochloride(n=129)after surgery.The incidence and degree of emergence agitation were recorded and compared between groups.Results:A significantly lower occurrence of emergence agitation was observed with proparacaine hydrochloride drops compared to isotonic saline(12.4% vs.31.8%;p<0.05).Conclusion:Proparacaine hydrochloride eye drops reduce the incidence of emergence agitation after general anaesthesia for paediatric strabismus surgery.

Comparative Study and Safe Dose Analysis of Dexmedetomidine in the Prevention of Emergence Agitation and Emergency Delirium in Children Undergoing General Anesthesia

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.

Nickel extraction from low grade laterite by agitation leaching at atmospheric pressure

This research work deals with the extraction of nickel from a low grade nickel laterite ore, taken from a deposit located in southwestern of Iran, through agitation leaching at atmospheric pressure. The assaying and mineralogical studies carried out on the nickel laterite sample, showed the 0.88% Ni, and principally consisted of oxide and silicate crystalline phases i.e. dolomite, quartz, magnetite, and goethite. Among numerous factors affecting such process, four major parameters i.e. temperature, agitator speed(r/min), leaching agents and their concentration were considered in a two-level full factorial experimental design. The agitation leach tests showed that the ore could be leached at atmospheric pressure with sulfuric acid while citric acid was almost unpromising. Analysis of variance(ANOVA) using DX7 software was employed to identify effective parameters. Sulfuric acid concentration and temperature were the most effective parameters on Ni extraction. Furthermore, the factorial models for experiment responses were developed. The results showed 83% Ni extraction after 4 h leaching, under optimized conditions i.e.temperature at 95 ℃, acid concentration at 5 N and agitator speed at 1000 r/min. This study revealed that factorial experimental design can be implemented to identify effective parameters on the agitation leaching process of nickel laterite.