围术期小儿应激反应因素与调控

目的 小儿围术期应激反应的典型表现是神经内分泌系统、免疫系统和代谢系统的变化.术前焦虑、紧张等心理因素以及麻醉、手术创伤均可影响小儿围术期应激反应,而且应激反应的剧烈程度与围术期并发症的发生率密切相关.目的 通过综述比较,确定更能有效降低小儿围术期应激反应的麻醉药物、麻醉方法和术后镇痛方式.内容 综述小儿围术期应激反应...     

围术期应激反应及其调控的若干问题

围术期应激反应包括神经系统、内分泌系统、代谢及免疫系统功能的变化,它将影响外科疾病的预后和转归,处理不当可能会导致严重的后果.因此,围术期应激反应已日益引起人们的重视.现就围术期应激反应的机制及调控方法的若干问题进行简要概述.     

非麻醉措施对围术期应激反应的调控

非麻醉措施对围术期应激反应的调控徐道妙＊谭秀娟＊＊湖南医科大学湘雅医院麻醉科，邮政编码：４１０００７应激（ｓｔｒｅｓｓ）的研究在整个人类健康与疾病领域里占有显著的位置。随着病理生理学的发展，应激反应的概念逐步发展成为“机体受到强烈刺激而发生的以交感神...     

围麻醉期应激反应及其调控

围麻醉期应激反应可改变机体的内分泌、代谢及免疫功能,影响外科疾病的转归和患者的预后。如何调控围麻醉期应激反应的程度,已成为人们关注的热点,但其处理措施尚不完善。本文就麻醉药、麻醉方法及非麻醉性药物对应激反应的调控作一简单介绍。     

不同镇痛方法对开胸手术围术期应激反应的影响

开胸手术可以产生严重的术后疼痛,并使呼吸运动、咳嗽、排痰功能受到影响,增加术后并发症,可能延长卧床时间及住院时间。因此开胸手术的术后镇痛在减轻上述不利影响方面具有重要作用。目前在临床上存在多种不同的开胸术后镇痛方法,硬膜外镇痛及冷冻镇痛术由于其镇痛效果好、副作用少而在临床较广泛应用。本研究选择开胸行食管癌根治术及肺叶切除术的患者探讨上述两种镇痛方法对术中及术后应激反应的影响。     

术后镇痛对机体应激反应的调控

围术期应激反应包括神经、内分泌、代谢及免疫功能的变化，影响手术病人的预后和转归。术后镇痛对机体应激反应的调控作用日益受到重视。现就应激机制、应激评估指标及术后镇痛方法对机体应激反应的影响等作一简要概述。     

围术期低体温

术中低体温(<36℃)并非罕见,有报道显示,轻度低温发生率为50％～70％。低体温在某些时候对机体可能是有益的(低灌注时的器官保护),但多数情况下,将产生不良影响。现将在临床遇到术中低体温的典型病例报告如下。 病例报告 1.术中低温后心跳停止 例1.男,52岁,身高165 cm,体重60 kg,ASA Ⅲ级,因患     

小儿喉部疾患围术期麻醉管理

背景 小儿喉部疾患病因复杂,常伴有不同程度的喉梗阻,围术期麻醉管理复杂.目的 通过查阅大量文献,对小儿喉部疾患围术期麻醉管理进行综述.内容 主要从小儿喉部疾患的病因、手术方式、麻醉方法和通气方式进行综述. 趋向 临床上根据不同的病因和手术方式选择不同的通气方式和麻醉方法,保证患儿的安全.     

布比卡因在新生儿硬外麻醉围术期的应用研究

目的:通过对不同浓度布比卡因在新生儿硬膜外麻醉围术期的药效学观察,选出适合于新生儿麻醉的最佳浓度。方法:72例ASAⅠ~Ⅱ级行幽门环肌切开术的患儿随机双盲分为四组:Ⅰ组0.67％利多卡因组;Ⅱ组0.175％布比卡因组;Ⅲ组0.25％布比卡因组;Ⅳ组0.30％布比卡因组。四组均按0.75ml·kg-1给药,观察各组用药前后平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)以及起效时间、阻滞部位肌肉松驰程度及术后8h患儿的精神反应。结果:各组间血压、心率、呼吸变化无显著性差异,Ⅲ、Ⅳ组术中肌肉松驰程度优于Ⅰ、Ⅱ组,Ⅱ、Ⅲ、Ⅳ组术后镇痛镇静及精神反应优于Ⅰ组,Ⅲ、Ⅳ组间无显著性差异。结论:0.25％布比卡因混合液可以较好地提供新生儿腹部手术的麻醉和术后镇痛。     

围麻醉期应激反应及其调控

围麻醉期应激反应可改变机体的内分泌，代谢及免疫功能，影响外科疾病的转归和患者的预后，如何调控围麻醉期应激反应的程度，已成为人们关注的特点，但其处理措施尚不完善，本文就麻醉药，麻醉方法及其麻醉性药物对应激反应的调控作出一简单介绍。     

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Opioids have long held a prominent role in the management of perioperative pain in adults and children. Published reports concerning the appropriate, and inappropriate, use of these medications in pediatric patients have appeared in various publications over the last 50 years. For this document, the Society for Pediatric Anesthesia appointed a taskforce to evaluate the available literature and formulate recommendations with respect to the most salient aspects of perioperative opioid administration in children. The recommendations are graded based on the strength of the available evidence, with consensus of the experts applied for those issues where evidence is not available. The goal of the recommendations was to address the most important issues concerning opioid administration to children after surgery, including appropriate assessment of pain, monitoring of patients on opioid therapy, opioid dosing considerations, side effects of opioid treatment, strategies for opioid delivery, and assessment of analgesic efficacy. Regular updates are planned with a re‐release of guidelines every 2 years.     

围术期镇痛对术后炎症反应的影响

手术创伤后局部组织损伤产生炎症介质,包括PGs,细胞因子等,它们释放人血产生全身炎症反应,炎症介质还可产生疼痛或痛觉增敏。围术期镇痛应该采用多种药物、方法的多模式镇痛,其中局麻药硬膜外镇痛具有较重要的作用,结合阿片类镇痛药、NSAIDs、超前镇痛等,通过抑制交感活化及炎症介质产生等机制对减轻术后炎症反应,促进术后恢复及结局改善具有重要意义。     

The effect of perioperative and postoperative caudal block on pain control in children

Ten paediatric patients (ASA status 1) who had bilateral club foot deformities and underwent bilateral posterior medio-lateral release within a two week interval (one foot operated each time) were assigned to one of two groups in a double-blind manner. Group one received caudal bupivicaine (0.25%) 2 mg·kg⁻¹ before the surgical incision, followed by caudal normal saline infused at the same volume after the surgical incision. Group two received caudal saline before surgical incision followed by caudal bupivicaine (0.25%) infused 15 min after the surgical incision. No additional analgesic was used before or during the operation. Patients were selected in a manner that allowed each patient to be assigned to either group one or two during the first or second surgical episodes. Anaesthesia was induced with halothane and maintained with nitrous oxide and isoflurane. The anaesthesiologist following the patient for postoperative pain control and analgesic requirement was blinded to the regional technique. Postoperative pain was rated on a paediatric pain scale. Children received a morphine suppository at the appropriate dose related to the body weight for postoperative pain control. There was no significant difference in the cumulative postoperative analgesic requirements within the first 48 h, nor in the time to the first postoperative analgesic administration between the two groups.     

Ketamine for perioperative pain management in children: a meta-analysis of published studies

Introduction: Balanced analgesia, using both opioid and nonopioids agents, has become the standard care for postoperative pain management. Ketamine, a compound with analgesic and antihyperalgesic properties, has been shown to decrease postoperative pain and opioid requirements in adults. The goal of the present meta‐analysis was to investigate postoperative analgesic properties of ketamine in pediatric patients. Material and methods: A comprehensive literature search was conducted to identify clinical trials that used ketamine as a perioperative analgesic compound in children and infants. Outcomes measured were postoperative analgesic consumption, pain intensity and duration of sensory block (when ketamine was used by caudal route) during the postoperative care unit (PACU) stay and the early postoperative period (6–24 h after leaving the operative room). The data from each trial were combined to calculate the pooled odds ratios or standard mean differences and their 95% confidence intervals. Results: Thirty‐five randomized, blinded controlled studies were retrieved from the literature. Systemic ketamine was effective in decreasing PACU pain intensity and analgesic requirement but failed to influence early (6–24 h) pain intensity and analgesic requirement. Ketamine administered locally during tonsillectomy, decreased PACU and early (6–24 h) pain intensity and PACU analgesic requirements. Used as an adjuvant for caudal analgesia, ketamine increased the duration of sensory block and PACU analgesic requirement without impacting PACU pain intensity. Ketamine failed to exhibit a postoperative opioid‐sparing effect. Conclusions: This meta‐analysis found that administration of ketamine was associated with decreased PACU postoperative pain intensity and nonopioid analgesic requirement. However, ketamine failed to exhibit a postoperative opioid‐sparing effect.     

Anesthesia and perioperative medical management of children with spinal muscular atrophy

Objective:  To describe the perioperative medical care, anesthetic considerations, and the risk of postanesthetic respiratory failure in patients with pediatric spinal muscular atrophy (SMA).
Methods:  There is a retrospective chart review carried out at an urban, tertiary care pediatric hospital. All patients with ICD-9 codes corresponding to SMA diagnoses were identified, and records screened for anesthetic and perioperative medical management. Medical records were reviewed for demographic, clinical, and outcome data.
Main results:  Twenty-five children with SMA (10 type I, 8 type II, 7 type III) accounted for 56 general and regional anesthetic cases. Twenty-one (38%) cases had preexisting ventilator dependence. Total intravenous anesthesia with nitrous oxide was provided in 14 (25%) cases, balanced anesthesia with inhalational agents and epidural or systemic opioids were used in 41 (84%) cases, and one infant received a spinal anesthesia. Intraoperative and postoperative complications occurred in 2 (4%) and 2 (4%) cases respectively. One case required an unplanned postanesthetic intensive care unit admission, and there were two late deaths with redirection of care.
Conclusions:  Perioperative care can be provided for children with SMA safely and effectively with total intravenous or inhaled anesthetics along with the judicious use of opioids to improve patient comfort without increased morbidity. Further prospective studies of standardized anesthetic and perioperative respiratory medical management in this population are required to minimize the decompensation of tenuous preoperative respiratory function.     

围手术期镇痛在骨关节手术中的新进展

骨关节手术术后疼痛十分常见,不仅病人痛苦,而且因患者肢体活动不足,引起关节肌肉功能废用、组织慢性水肿、软组织萎缩、局部骨质疏松、关节僵硬,是导致生活质量丧失的永久性损害.因此,术后镇痛对骨关节术后其功能恢复至关重要.现就对骨关节围术期疼痛的评估、各种常用的非药物治疗和药物治疗方式的疗效、不良反应及目前国内外新进展进行综述,以期对骨关节术后疼痛临床处理有一定的指导意义.