丙泊酚联合七氟烷麻醉对全麻下扁桃体切除术患儿苏醒期躁动的影响

目的观察丙泊酚联合七氟烷麻醉对全麻下扁桃体切除术患儿苏醒期躁动的影响。方法随机将行扁桃体切除术的94例患儿分为2组,各47例。对照组实施七氟烷麻醉,观察组采取丙泊酚联合七氟烷麻醉。观察2组麻醉苏醒时间、手术时间、不良反应、苏醒期躁动发生情况等。结果 (1)观察组Watcha评分、苏醒期躁动发生率低于对照组,差异有统计学意义(P0.05)。(2)2组麻醉苏醒时间、手术时间、不良反应发生率差异无统计学意义(P0.05)。结论丙泊酚联合七氟烷麻醉有助于提升全麻下扁桃体切除术患儿镇静效果,减少苏醒期躁动发生率,安全性较高。     

小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动的影响

目的 探讨全麻诱导前预防性应用小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动(EA)的影响.方法 选择2021年1—3月择期行扁桃体腺样体切除术的患儿97例,男48例,女49例,年龄3～12岁,体重15～50 kg,ASAⅠ或Ⅱ级.采用随机数字表法将患儿分为两组:艾司氯胺酮组(S组,n=49)和对照组(C组,n...     

右美托咪定对七氟醚麻醉扁桃体切除术患儿苏醒期躁动的影响

目的观察右美托咪定对七氟醚麻醉扁桃体切除术患儿苏醒期躁动的影响。方法选取2017-01-2018-09间在郑大二附院行七氟醚麻醉扁桃体切除术的40例患儿,随机分为2组,各20例。A组采用七氟醚复合芬太尼全麻。B组在A组基础上采用右美托咪定0.5μg/kg预处理,术中0.2~0.4μg/(kg·h)维持。记录患儿入室后(T0)、气管插管后(T1)、手术开始时(T2)、切扁桃体时(T3)、拔管后(T4)的MAP(平均动脉压)、HR(心率),以及手术时间、麻醉时间、苏醒时间、术后躁动评分。结果 A组T3时的MAP、HR与T0、T1、T2时相比,差异有统计学意义(P<0.05);B组T3时的MAP、HR与T1、T2时刻比较,差异无统计学意义(P>0.05)。2组手术时间、麻醉时间、苏醒时间,差异无统计学意义(P>0.05)。2组苏醒期躁动发生率,差异有统计学意义(P<0.05)。结论右美托咪定预处理可降低七氟醚麻醉扁桃体切除术患儿苏醒期躁动的发生率。     

曲马多不同静脉给药方案对小儿扁桃体切除术后躁动的影响

目的观察曲马多不同静脉给药方案对小儿扁桃体切除术后躁动的影响。方法择期扁桃体切除术患儿240例,年龄3~6岁,采用随机数字表法分为六组:A组诱导时给予曲马多2mg/kg,手术结束时给予生理盐水;B组诱导时给予生理盐水,手术结束时给予曲马多2mg/kg;C组诱导时给予曲马多1mg/kg,手术结束时给予生理盐水;D组诱导时给予生理盐水,手术结束时给予曲马多1mg/kg;E组诱导时给予曲马多1mg/kg,手术结束时给予曲马多1mg/kg;F组诱导时与手术结束时均给予生理盐水。记录拔管时间,清醒时间,清醒后10、20、30、40、50、60min的Ramsay镇静评分、躁动评分、FLACC评分及恶心呕吐发生率。结果清醒后10~50min B组镇静躁动评分、FLACC评分均明显低于其他五组(P0.05),而F组明显高于其他五组(P0.05)。清醒后10~40min B组Ramsay镇静评分明显高于其他五组(P0.05)。结论曲马多在小儿扁桃体切除术结束时以2mg/kg静脉注射可以在手术后1h内提供较好的镇静与镇痛,不增加手术后恶心呕吐的发生率,不影响拔管时间与清醒时间。     

右美托咪定对扁桃体摘除术麻醉苏醒期躁动的影响

目的 评价右美托咪定对扁桃体摘除术患者麻醉苏醒期躁动的影响.方法 择期扁桃体摘除术患者60例,年龄12～20岁,体重35～65 kg,ASA Ⅰ或Ⅱ级,随机均分为两组.麻醉诱导后,右美托咪定组(D组)在10 min内静脉泵注右美托咪定1.0μg/kg(用生理盐水稀释至50 ml),然后以0.5μg,kg-1·h-1持续泵入至手术结束前20 min.对照组(C组)以同样方式泵注生理盐水.术中吸入异氟醚和静注丙泊酚维持麻醉.记录吸痰拔管时镇静躁动(SAS)评分及拔管后10 min的Ramsay镇静评分及VAS评分.结果 D组阿托品使用次数明显多于C组(P＜0.05).拔管时D组SAS评分明显低于C组,而Ramsay评分明显高于C组(P＜0.05).结论 右美托咪定可明显减少扁桃体摘除术患者麻醉苏醒期闻躁动的发生.     

抚触式护理在全麻苏醒期躁动患儿中的应用

目的 观察抚触式护理在全麻苏醒期躁动患儿中的应用效果.方法 将151例全麻苏醒期躁动患儿随机分为观察组(75例)和对照组(76例),观察组应用抚触式护理使患儿恢复平静,对照组常规护理,必要时应用约束带约束,比较两组效果.结果 两组患儿恢复平静和躁动所致不良反应发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 抚触式护理可以使全麻苏醒期躁动患儿安静,减少躁动所致不良反应的发生,保障患儿安全.     

盐酸达克罗宁胶浆在患儿扁桃体切除术中的应用

目的观察盐酸达克罗宁胶浆对患儿扁桃体切除术围术期血流动力学、术后疼痛及苏醒期躁动的影响。方法选择2017年1月至2018年2月全麻下择期行双侧扁桃体切除术患儿60例,男39例,女21例,年龄3～10岁,BMI 10～34 kg/m~2,ASAⅠ或Ⅱ级。随机分为3组:单次用药组(SD组)、重复用药组(RD组)和对照组(CG组),每组20例。SD组麻醉前15 min含服5 ml盐酸达克罗宁胶浆5 min;RD组麻醉前15 min含服5 ml盐酸达克罗宁胶浆5 min,术毕前扁桃体窝内均匀涂抹盐酸达克罗宁胶浆2 ml;CG组麻醉前15 min含服5 ml空白胶浆5 min,术毕前扁桃体窝内涂抹空白胶浆2 ml,所有患儿均采用气管插管全麻。记录麻醉诱导前(T_0)、插管即刻(T_1)、扁桃体剥离时(T_2)、入PACU 30 min(T_4)、入PACU 60 min(T_5)时HR、MAP;记录麻醉时间、手术时间、苏醒时间、拔管时间,记录患儿入PACU时(T_3)、入PACU 30 min(T_4)、入PACU 60 min(T_5)时FLACC和PAED评分;记录术后恶心呕吐、创面渗血、呼吸道梗阻、低氧血症等不良反应发生情况。结果与T_0时比较,T_1、T_2时SD组和RD组HR明显减慢、MAP明显降低(P0.05),T_4、T_5时SD组HR明显增快、RD组MAP明显降低(P0.05),T_1、T_4和T_5时CG组HR明显增快(P0.05)。T_1、T_2时SD组和RD组HR明显慢于CG组,且MAP明显低于CG组(P0.05);T_4、T_5时RD组HR明显慢于SD组和CG组,且MAP明显低于SD组和CG组(P0.05)。T_3、T_4和T_5时,RD组的FLACC、PAED评分明显低于SD和CG组(P0.05)。三组患儿术后恶心呕吐、创面渗血、呼吸道梗阻、低氧血症等不良反应差异无统计学意义。结论患儿扁桃体切除术麻醉前和术毕应用盐酸达克罗宁胶浆,不仅明显减少围术期血流动力学波动,还可有效缓解患儿术后疼痛,减少苏醒期躁动。     

脑状态指数预测龋齿手术患儿全麻苏醒期躁动的可行性

目的分析围术期脑状态指数(CSI)与患儿全麻苏醒期躁动(EA)的相关性,并探讨CSI预测EA的可行性。方法选取择期行口腔龋齿治疗手术的患儿100例,男58例,女42例,年龄2～7岁,ASAⅠ或Ⅱ级,根据全麻苏醒期患儿有无躁动分为两组:躁动组(A组)和无躁动组(NA组)。所有患儿静脉麻醉诱导气管插管后使用多功能组合式监护仪(HXD-I)监测CSI,分别记录插管后(T_1)、手术开始20 min(T_2)、停麻醉药时(T_3)、拔管后(T_4)及唤醒时(T_5)的CSI,包括镇静指数(WLi)、镇痛指数(PTi)、皮层下兴奋指数(SCEi)、皮层兴奋指数(CEi)、谵妄指数(DELi)、遗忘指数(AMi)、焦虑指数(ANXi)和舒适指数(CFi)。绘制相关指数的ROC曲线,计算各指数ROC曲线下面积(AUC)。结果患儿发生EA 21例(21%)。T_1—T_5时两组WLi、PTi、DELi和AMi差异均无统计学意义。T_5时A组SCEi、CEi、ANXi和CFi明显大于NA组(P0.05)。SCEi、CEi、ANXi和CFi预测EA的AUC分别为0.765、0.768、0.712和0.717,敏感性分别为81%、100%、85.7%和61.9%,特异性分别为70.9%、44.3%、49.4%和77.2%。结论 SCEi、CEi、ANXi和CFi均可有效预测龋齿手术患儿全麻EA的发生,但SCEi的预测效能最高。     

经皮穴位电刺激对小儿扁桃体切除术后躁动的影响

目的 评价经皮穴位电刺激(TEAS)复合全麻对小儿扁桃体切除术后躁动及血流动力学的影响.方法 择期行扁桃体切除手术患儿60例,随机均分为经皮穴位电刺激组(T组)和对照组(C组),T组患儿予持续TEAS两侧合谷和内关穴位,两组麻醉诱导后全凭静脉维持麻醉,术后若患儿出现不能安慰的躁动,则静脉给予芬太尼0.5 μg/kg(T组)或1 μg/kg(C组).于入室时、插管时、拔管时、拔管后10 min以酶联免疫法测定两组患者血浆、肾上腺素(E)、去甲肾上腺素(NE)、β-内啡肽(β-EP)的变化.记录拔管时,拔管后5、10、15、30 min小儿麻醉后躁动(PAED)评分和疼痛评分(CHIPPS).结果 与入室时比较,插管时、拔管时、拔管后10 min两组患者E、NE均显著升高(P＜0.05),且C组显著高于T组(P＜0.05);T组插管时、拔管时、拔管后10 min时β-EP高于入室时和C组(P＜0.05);T组患者拔管后各时点PAED和CHIPPS均显著低于C组(P＜0.05).结论 TEAS可减少小儿扁桃体切除术后躁动的发生率.     

丙泊酚联合七氟烷对扁桃体切除术患儿苏醒期HR、MAP的影响

目的探讨丙泊酚联合七氟烷对扁桃体切除术患儿术后苏醒期HR、MAP的影响。方法随机将行扁桃体切除术的96例患儿分为2组,各48例。对照组行七氟烷麻醉诱导与维持,观察组实施七氟烷麻醉诱导、丙泊酚麻醉维持。比较2组的HR、MAP指标及术后恢复情况。结果麻醉诱导后2组HR、MAP水平均呈先上升后下降趋势,但观察组变化幅度小于对照组,差异有统计学意义(P0.05)。2组患儿苏醒时间、拔管时间相比,差异无统计学意义(P0.05);观察组苏醒期躁动持续时间短于对照组,差异有统计学意义(P0.05)。结论对扁桃体切除术患儿实施丙泊酚复合七氟烷麻醉,血流动力学稳定,有利于缓解术后苏醒期躁动,安全且可靠。     

曲马多减轻患儿扁桃体切除术术后疼痛和减少术后躁动的效果

目的观察曲马多不同给药方案对患儿扁桃体切除术后48h内疼痛和躁动的影响。方法择期扁桃体切除术患儿212例,男136例,女76例,年龄3~6岁,ASAⅠ或Ⅱ级,采用随机数字表法分为七组:A组(n=31),曲马多2mg/kg+0.2mg·kg-1·h-1泵注;B组(n=29),曲马多2mg/kg+0.1mg·kg-1·h-1泵注;C组(n=32),曲马多1mg/kg+0.2mg·kg-1·h-1泵注;D组(n=29),曲马多1mg/kg+0.1mg·kg-1·h-1泵注;E组(n=29),生理盐水10ml+曲马多0.2mg·kg-1·h-1泵注;F组(n=31),生理盐水10ml+曲马多0.1mg·kg-1·h-1泵注;以上所有持续静脉注射药物均为2ml/h;N组(n=31),生理盐水10ml+生理盐水2ml/h泵注。各组手术结束时刻均采用1ml 1%的利多卡因于双侧扁桃体窝内局部注射。记录拔管时间,清醒时间,以及清醒后10、30、60、120min的Ramsay评分,术后10、30、60、120min和4、8、24、32、48h的FLACC镇痛评分,以及4、8、12、24、32、40、48h的PCIA每时间段自控按压次数,呕吐发生次数,及以上各时间段的曲马多用量。结果七组患儿的拔管时间、清醒时间、呕吐发生率差异无统计学意义。A、B、C组在清醒后30min,D、E组在60min,而F、N组在90min后达到镇静满意(Ramsay评分2~4分)。A、B组在术后10min之后FLACC评分降低至4分以下,C组则在术后10、30min FLACC评分高于A、B组,D、E组在术后10、30、60、120min及4h疼痛评分高于A、B组,而F组在术后10、30、60、120min及4、8、24h疼痛评分始终高于A、B、C、D组,术后8、24、32、48h疼痛评分始终高于E组。N组术后10、30、60、120min及4、8、24、32、48h疼痛评分始终高于A、B、C、D、E组,术后4、8、24、32、48h疼痛评分始终高于F组(P0.05)。曲马多用量各时间段内,B组患儿均低于其他各组(P0.05),A组患儿在12h内低于C、D、E、F组,12h后高于D、F组(P0.05)。C、D组在8h内均低于E、F两组(P0.05),F组在8~12h高于E组,但12h后低于E组(P0.05)。结论曲马多2mg/kg+0.1mg·kg-1·h-1泵注在较短时间内达到比较良好的镇痛效果,并且术后躁动发生更少,不影响拔管时间与苏醒时间,是3~6岁患儿扁桃体切除术后48h内比较理想的镇痛方式。     

Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia

BACKGROUND AND OBJECTIVE: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 microg kg(-1) was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. METHODS: One hundred and twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg(-1). After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 microg kg(-1) during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. RESULTS: The time to tracheal extubation was significantly shorter in Groups 3 (5.2+/-1.7 min) and (6.4+/-2.1 min) than in Groups 1 (8.1+/-2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8+/-1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0+/-3.9 min) than in Groups 1 (13.8+/-4.9 min) (P = 0.017) and 2 (14.9+/-4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05). CONCLUSIONS: After midazolam premedication and intravenous induction of anaesthesia with thiopental administration of intravenous fentanyl 2.5 microg kg(-1) did not provide any clinically significant benefit on emer gence agitation in children who receive sevoflurane or desflurane anaesthesia.     

Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy

ObjectiveTo assess the efficacy and safety of ketofol administration in controlling emergence agitation (EA) after sevoflurane-based anesthesia in children undergoing adenoidectomy or adenotonsillectomy.Subjects and methodsThis double-blinded randomized study involved 90 children (3–6 years) scheduled for elective adenotonsillectomy or adenoidectomy. They were randomly assigned to receive 10 ml of normal saline (control group, C) or, 1 mg/kg propofol in 10 ml saline (group P) or ketofol as 1 mg/kg propofol and 0.25 mg/kg ketamine in 10 ml saline (group K) 10 min before the end of surgery. In PACU, sedation, behavior, pain and severity of EA were assessed using modified Aldrete score, Aono’s scale, Objective Pain Score (OPS) and Pediatric Anesthesia Emergence Delirium (PAED) scale, respectively.ResultsIn ketofol group, OPS was significantly lower compared to propofol and control groups. Recovery criteria were in favor of ketofol and propofol groups including longer time to eye opening (p < 0.001) and time to Aldrete score ⩾ 9 (p = 0.001). Time to discharge from PACU was comparable in the three groups (p = 0.079). EA was significantly more frequent in the control group (p < 0.001), but comparable in ketofol and propofol groups. PAED score was significantly higher in control group compared to ketofol and propofol groups. Ketofol and propofol preserved hemodynamic stability.ConclusionKetofol provides a promising new option for controlling emergence agitation with adequate postoperative sedative and analgesic effect, good recovery criteria and hemodynamic stability compared to propofol and control groups in children undergoing adenoidectomy or adenotonsillectomy.     

芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学

目的 探讨芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学.方法 择期拟行鼻内镜下增殖体刮除术的息儿26例,年龄5～8岁,体重15～30 kg,ASA Ⅰ或Ⅱ级.麻醉诱导:吸入8%七氟醚(氧流量6 L/min),静脉注射瑞芬太尼1 μg/kg(经30 s注射完),气管插管后行机械通气,随后静脉注射芬太尼抑制麻醉恢复期间患儿躁动,采用改良的序贯法确定静脉注射芬太尼的剂量.第1例患儿静脉注射芬太尼的剂量为4μg/kg,相邻剂量差值为0.5μg/kg,以患儿苏醒后易激惹且难以安慰作为判断躁动发生的标准.麻醉维持:吸人2%七氟醚(氧流量1 L/min),静脉输注瑞芬太尼0.2μg·kg-1·min-1.术毕停用七氟醚和瑞芬太尼,带气管导管回麻醉恢复室,待患儿苏醒.记录术后4h内患儿躁动、恶心、呕吐、呼吸抑制等的发生情况及苏醒时间.计算芬太尼抑制50%、95%患儿七氟醚复合瑞芬太尼麻醉恢复期间躁动的剂量(ED50、ED95)及其95%可信区间.结果 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50及其95%可信区间为3.01(2.52～3.40)μg/kg,En95及其95%可信区间为3.81(3.41～6.22)μg/kg.术后4h内未发生明显恶心、呕吐及呼吸抑制.苏醒时间(11.3±2.6)min.结论 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50为3.01μg/kg,ED95为3.81μg/kg.     

芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学

Oblective To define the median effective dose (ED50) and 95%effective dose of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanil anesthesia in children.Methods Twenty six ASA ⅠorⅡchildren aged 5-8 yr weighing 15-30 kg undergoing adenoidectomy under general anesthesia were studied.The patients were unpremedicated.Anesthesia was induced with inhalation of 8%sevoflurane (fresh gas flow=6 L/min)and iv remifentanil 1μg/kg.The patients were mechanically ventilated after tracheal intubation.Fentanyl was injected iv to inhibit emergence agitation.The dose of fentanyl was determined by using modified Dixon's upand-down method (increment or decrement of 0.5μg/kg).The initial dose of fentanyl was 4 μg/kg.Anesthesia Sevoflurane inhalation and remifentanil infusion were terminated at the end of operation.The patients were transferred to the PACU.No alteration in the ventilatory settings was made.Stimulation of the patients was avoided during emergence.The emergence time and the occurrence of agitation,nausea and vomiting and respiratory depression within 4h after operation were recorded.ED50,ED95 and 95%confidence interval (CI) of fentanyl for inhibition of emergence agitation were calculated.Results ED50 was 3.01μg/kg (95%CI 2.52-3.40μg/kg) and ED95 3.81μg/kg(95%CI 3.41-6.22μg/kg).No nsusea and vomiting and respiratory depression occurred within 4h after operation.The emergence time was (11.3±2.6) min.Conclusion The ED50 and ED95 of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanyl anesthesia were 3.01 and 3.81μg/kg respectively in children.