麻醉前应用长托宁对高血压患者血压的影响

目的：观察长托宁作麻醉前用药对高血压患者血压的影响。方法：择期手术高血压和正常血压患者各60例．随机平均分为实验（A）组、高血压对照（B）组、药物对照（C）组和空白对照（D）组；A组再分为A1（术前3天连续使用降压药，n=12）和A2（术前3天内未用降压药，n=18）两个亚组。全组患者年龄（59．34±9．83）岁，体重（64．61±10．29）kg，男71例，女49例。入手术室后测定Bp、HR和SpO2做为基础值（T^0）。A、C组静注长托宁0．5mg。记录此后5、10、20和30min（T^5、T^10、T^20、T^30）的Bp、HR和SpO2。结果：各时点HR和SpO2组间及组内无统计学差异。A组T^10SBP、DBP和T^20SBP均低于基础值（P〈0．05）；B组T^10SBP高于A组同时点值（P〈0．05）。A组MAP基础值与给药后20min内最低值之间的差值（17．60±9．00mmHg）同基础值呈正相关（γ=0．581，P=0．002）。结论：成人高血压患者麻醉前静注0．5mg长托宁，具有持续20min以上的降压作用，特别是对血压较高或术前未用降压药物治疗的患者效果更为明显。     

Using Telemedicine for Pediatric Preanesthesia Evaluation: A Pilot Project

PurposeThe purpose of the study was to implement using telemedicine for pediatric preanesthesia evaluation and to evaluate patient and provider satisfaction.DesignThis is a nonrandomized prospective evidence-based practice project.MethodsPediatric patients were nonrandomly recruited to receive preanesthesia evaluation by telemedicine. Patients, parents, and providers completed a 5-point Likert scale satisfaction survey after the encounter.FindingsOverall satisfaction with using telemedicine was very high for both patients, parents, and providers, with an overall mean Likert scale score of 4.63 for patients and parents, and 4.67 for providers.ConclusionsThis project provides evidence in support of using telemedicine in the setting of pediatric preanesthesia evaluation. Using telemedicine has the potential to improve patient outcomes by improving the patient-provider relationship and increasing access to care.     

Maternal heart rate variability just before surgery significantly correlated with emergence behavior of children undergoing general anesthesia

BACKGROUND: Emergence agitation in pediatric anesthesia is associated with preanesthesia child anxiety, which is strongly influenced by maternal mental conditions. Mental stress affects the autonomic nervous system, thereby influencing heart rate variability (HRV). The present study tested the correlations between preanesthesia maternal HRV and perioperative child behavior. METHODS: A total of 27 pairs of mothers and children were analyzed in the present study. Maternal HRV was recorded from the night before the child's surgery to arrival to the operation room and thereafter recorded data were analyzed. The children underwent minor plastic surgery under general anesthesia, and induction and emergence behavior were assessed. RESULTS: Quality of mask induction did not correlate with the ratio of low-frequency (LF) components to high-frequency (HF) components (LF/HF ratio) of preanesthesia maternal HRV either obtained during 21:00-06:00 (stage I) or 06:00-08:00 (stage II). Scores of the child's emergence behavior did not correlate with the LF/HF ratio of maternal HRV of stage I; however, the LF/HF ratio of maternal HRV of stage II significantly correlated with emergence behavior. CONCLUSIONS: Two-hour maternal HRV just before surgery significantly correlated with emergence behavior of children undergoing general anesthesia.     

长托宁用于小儿增殖体切除术麻醉前给药的临床观察

[目的]观察小儿增殖体手术前应用长托宁或阿托品对于心率、血压、体温以及分泌物量的影响.[方法]选择择期行增殖体切除术病人30例,ASA Ⅰ～Ⅱ级,随机分为A组(长托宁组)和B组(阿托品组).麻醉开始前30min给予长托宁或阿托品0.02 mg/kg肌肉注射.麻醉诱导采用静脉诱导,记录给药前、麻醉前及拔管后患者的血压、心率及体温.记录患者麻醉前后的口干情况,采用客观的VAS评分,对拔管时气道及口腔分泌物多少进行定量的分析.[结果]两组各时段血压和体温无明显变化,B组用药后心率(101.5±5.8)bpm,明显比A组(94.3±6.4)bpm升高.A组拔管时分泌物(5.4±2.2)mL,明显少于B组(9.7±2.6)mL.A组(1.5±0.2)mL术后3 h分泌物明显低于B组(4.4±2.1)mL(P＜0.05,P＜0.01).术后第2日随访,两组患儿均无尿潴留、肠麻痹.[结论]小儿增殖体切除术前使用长托宁可更有效更持久的抑制腺体分泌,与阿托品相比优势明显.长托宁(0.02 mg/kg肌注)是小儿增殖体切除术理想的术前用药.