门诊患儿安全应用水合氯醛镇静的经验

通过改进门诊患儿应用水合氯醛口服镇静的管理,保障患儿用药安全。分析给予患儿水合氯醛镇静中存在的问题及原因,从而改进医疗制度和镇静流程,对患儿检查前镇静进行集中管理,并加强用药监护和评估,患儿镇静的满意率提高至97.8%,未发生严重不良事件,保障了患儿给予水合氯醛镇静的用药安全。     

Genotoxicity studies of glycidol fatty acid ester (glycidol linoleate) and glycidol

Glycidol fatty acid esters (GEs) are found in refined edible oils. Safety concerns have been alleged due to the possible release of glycidol (G), an animal carcinogen.     

Uso de hidrato de cloral a dosis única de 70 mg/kg como hipnótico en resonancia magnética nuclear. Estudio prospectivo de 3.132 casos

ObjectiveTo assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70 mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI).Material and methodsProspective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO₂, and incidence of complications such as respiratory depression (SatO₂ below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2 min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home.ResultsNo notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was < .05%.ConclusionsChloral hydrate at a dose of 70 mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.     

Chloral hydrate sedation for auditory brainstem response (ABR) testing in children: Safety and effectiveness

IntroductionThe auditory brainstem response (ABR) test is used to identify hearing loss and measure hearing thresholds of infants and children who cannot be tested using standard behavioral hearing testing methods. In order for the ABR to yield useful data, a child must be asleep throughout the duration of the test. In many centers, this is achieved through the use of a general anesthetic, with its inherent risks and costs. Since 2004, ABRs have been routinely conducted at BC Children's Hospital in an ambulatory care setting under oral chloral hydrate sedation, with monitoring by a specialist nurse. The aim of this retrospective study was to assess the effectiveness and safety of nurse-led sedation with chloral hydrate for ABR testing at our tertiary pediatric center.MethodsMedical and audiology records were reviewed for children aged 6 months to 17 years who underwent ABR testing from 2004 to 2012. We reviewed the dosage of drug used, condition of the child after chloral hydrate administration, adverse effects, audiological results, patients’ vital signs, and the effectiveness of the sedative in keeping the child asleep throughout the duration of the test. Frequency distributions were derived for adverse outcomes.Results725 ABR records encompassing 635 children (multiple ABR tests in some children) were reviewed. The average dose of chloral hydrate used was 52 mg/kg. The majority of sedated ABR's (80.8%) were completed without any incident. Significant events [apnea and/or bradycardia], minor complications [vomiting, hypoxemia, prolonged sedation, and/or tachypnea] and restlessness were noted in 3.4%, 6.2%, and 5.0% of the cases, respectively. The majority of these issues resolved without medical intervention, such as the need to provide supplementary oxygen. In 95.9% of ABRs, chloral hydrate was successful in sedating the child adequately to answer the audiological question.ConclusionsThis forms the largest study to date on oral sedation for ABR testing. Based on our results, the use of chloral hydrate in the presence of a sedation nurse was a safe and reliable method of performing ABR in infants and children. This may be of significant value to centres worldwide exploring alternatives to general anesthesia for ABR testing.     

Pharmacognostic studies of stem,roots and leaves of Malva parviflora L.

ObjectiveTo establish quality control parameters of a locally occurring medicinal plant, Malva parviflora which is utilized as folk medicine in Sialkot area in Pakistan.MethodsIn pharmacognostic studies different types of evaluations were carried out that focus on microscopic, macroscopic, fluorescence analysis and organoleptic evaluations.ResultsThe distinguishing characters of stem were the presence of parenchyma, cork cells, irregular shape calcium oxalate crystals, simple and compound starch granules and fusiform fibers with pits. Root microscopic characters were presence of simple and spherical starch granules with rounded or slit hilum, groups of lignified xylem fibers, reticulate vessels, and sieve tissues. Leaves microscopy indicated the presence of paracytic stomata, lignified fibers having pits, spiral and annular vessels, numerous sclereids while in fruit microscopy epicarp, thin walled cells endocarp, thin walled parenchyma and collenchyma of mesocarp and abundant thick walled endospermic cells containing aleurone grains and micro rosette crystals. Macroscopic study of leaves showed, 5-7 lobed reniform-shape, glabrous-surface, reticulate-venation in the leaves. Macroscopic features of roots showed type of root-taproot, surface-glabrous and stem was 1-10 dm tall simple to branched and may be prostrate or ascending. Similarly fruit was of schizocarp type.ConclusionsThis study provides the scientific data for the proper identification and establishment of standards for the use of Malva parviflora.     

水合氯醛口服用于口腔科患儿制动效果探讨

目的探讨口腔科检查及治疗前不同年龄患儿对6.5%水合氯醛口服给药制动效果。方法对232例口腔科检查及治疗患儿按年龄分为婴儿 (71例 )、幼儿 (82例 )、学龄前 (79例 )共三组 ,各组再随机分成观察组与对照组 ,观察组予口服水合氯醛 (120例 ) ,对照组予肌注苯巴比妥针 (112例 )。结果婴儿及幼儿组口服水合氯醛制动效果 :明显优于肌注苯巴比妥针 (P<0.01) ;学龄前组肌注苯巴比妥针明显优于口服水合氯醛 (P<0.01)。结论口腔科检查及治疗前患儿制动 ,婴幼儿宜选用水合氯醛口服 ,学龄前患儿宜选用肌注苯巴比妥针