术中肢体被动活动对全麻患者恢复期的影响

目的探讨被动活动全麻恢复期患者下肢对缓解术中躁动及其他不良情况的效果。方法将全麻开腹手术患者随机分为观察组和对照组各30例，观察组根据手术拔管时间在全麻开始2h、3h、4h、手术结束前由巡回护士为患者做一系列下肢被动活动，对照组患者则不做任何被动活动。观察两组患者恢复期的拔管时间、清醒时间及躁动情况。结果两组拔管时间比较，差异无显著性意义（P〉0．05）；观察组完全清醒时间较对照组显著提前（P〈0．05），躁动发生率显著低于对照组（P〈0．01）。结论术中采取下肢被动活动，有利于减轻患者恢复期躁动，使患者感觉舒适。     

全麻术后患者麻醉恢复期并发症的临床评估及护理对策

目的了解全麻术后患者麻醉恢复期并发症的发生情况并分析其原因,为临床准确评估患者病情并及时进行针对性护理提供参考。方法对麻醉恢复室接收的5060例全麻术后患者进行病情评估、记录,并根据年龄将患者分为小儿组、成人组及老年组,统计麻醉恢复期常见并发症的发生情况及各年龄组并发症的发生情况。结果麻醉恢复期患者发生各种并发症1297例(25.63%),其中循环系并发症548例(10.83%),呼吸系并发症490例(9.68%),神经系统并发症192例(3.80%)。不同年龄患者麻醉恢复期并发症发生率比较,差异有统计学意义(P0.01),成人组发生率显著低于少儿组及老年组,老年组苏醒时间较成人组及少儿组长(P0.05,P0.01)。结论麻醉恢复期并发症以呼吸、循环系统异常较常见,婴幼儿及老年患者术后并发症的发生率较高,宜适当延长在麻醉恢复室的留观时间。应制定个性化的麻醉和复苏方案,以减少患者麻醉恢复期并发症。     

15°头高斜坡侧卧位气管拔管对肥胖患者全麻恢复期呼吸功能的影响

目的评价15°头高斜坡侧卧位气管拔管对肥胖患者全麻恢复期呼吸功能的影响。方法选择全麻手术患者120例,男62例,女58例,年龄18～65岁,BMI≥28 kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法分为四组,每组30例:平卧位组(C组)、15°头高斜坡仰卧位组(S组)、15°头高斜坡左侧卧位组(L组)和15°头高斜坡右侧卧位(R组)。所有患者均在全麻下完成手术。术毕C组采用平卧位,S组采用15°头高斜坡仰卧位,L组采用15°头高斜坡左侧卧位,R组采用15°头高斜坡右侧卧位。记录入室时(T_0)、拔管后1 min(T_1)、5 min(T_2)、30 min(T_3)、2 h(T_4)的SpO_2、PaO_2、MAP和HR;记录拔管时间和出室时间;记录咳嗽、咽痛、喉痉挛和舌后坠等不良反应的发生情况。结果与T_0时比较,T_1—T_4时四组SpO_2明显降低(P0.05),T_1—T_2时四组MAP明显升高,HR明显增快(P0.05)。与C组比较,T_1—T_4时S组、L组、R组SpO_2、PaO_2明显升高(P0.05),T_1—T_2时四组MAP明显降低,HR明显减慢(P0.05),拔管时间和出室时间明显缩短(P0.05),L组、R组咳嗽、舌后坠发生率明显降低(P0.05)。与S组比较,T_1—T_4时L组、R组SpO_2、PaO_2明显升高(P0.05),拔管时间和出室时间明显缩短(P0.05),咳嗽、舌后坠发生率明显降低(P0.05)。四组咽痛发生率差异无统计学意义。结论 15°头高斜坡侧卧位气管拔管可改善肥胖患者全麻恢复期的氧储备,促进呼吸功能的恢复。     

骨科患者全麻术后急性精神障碍的观察及护理

目的 探讨骨科患者全麻术后急性精神障碍的早期表现和护理方法.方法 对52例骨科全麻术后急性精神障碍患者做到早发现、早干预,对重症患者辅以药物治疗.结果 均于发病后2周内恢复正常,出院随访半年无复发.结论 对骨科全麻术后患者密切观察其临床表现,可早期发现其急性精神障碍,及时处理,有利患者早期康复.     

Effect of Passive Smoke Exposure on General Anesthesia for Pediatric Dental Patients

The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months–12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child''s risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events—coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts (P = .03). If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (−) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post–general anesthesia respiratory morbidity in children being treated for early childhood caries.Key Words: Passive smoke exposure, Dental cariesEnvironmental tobacco smoke (ETS) is defined as the gaseous by-product of burning tobacco products and is also referred to as “passive” or “secondhand” smoke. It has been further defined as 15% mainstream smoke and 85% sidestream smoke from a smoldering cigarette.¹ It is estimated that there are upwards of 4000 chemical compounds (some of which are carcinogenic and/or toxic) within ETS. In a developing airway, there may be significant airway remodeling (reduced maximal expiratory flow and forced expiratory volume) as well as marked increase in airway irritation.¹Previous research has detailed negative health consequences of ETS to include increased likelihood of respiratory infections, middle ear infections, asthma onset and severity, sudden infant death syndrome, and even dental caries.^2–5 Jones and Bhattacharyya (2006) demonstrated that children who are exposed to ETS at home are more likely to experience adverse respiratory events while under or recovering from general anesthesia (GA) for a wide variety of procedures.⁶ However, another study in 2006 noted that although healthy children with a positive history of ETS did have lower preoperative peak expiratory flow rate, their recovery from anesthesia was unaffected.⁷ To the authors'' knowledge, no study has examined ETS exposure exclusively in patients receiving general anesthesia for dental procedures. General anesthesia is gaining increasing popularity as a modality to treat early childhood caries. In 2005, Eaton et al commented on the shift of general anesthesia from one of the least acceptable modalities of treatment for dental disease to the third most desirable behind tell-show-do and nitrous oxide.¹² Currently, 31 of 50 states have legislation that lists criteria for dentistry for children under GA, and in many instances, there are age-based criteria.^9,10 The primary aim of this study was to evaluate the likelihood for post–GA respiratory morbidity in a pediatric dental population with parent-reported ETS.     

全麻术中发生过敏性休克一例

一、临床资料 患者男性，37岁，身高175cm，体重87kg，因“睡眠呼吸暂停综合症”拟在全麻下行“经鼻内窥镜鼻中隔矫正＋双扁桃体切除＋腭咽成型术”。患者既往高血压1年余，血压最高195／140mmHg，规律服北京降压0号和倍他乐克，平日血压控制可，一般130／90mmHg左右。无外伤手术史，无药物过敏史，家族史无特殊。辅助检查未见明显异常。     

Avoiding Patient Injury During General Anesthesia

Attention to detail when preparing a dental patient for rehabilitation utilizing general anesthesia will prevent a variety of positional and traumatic injuries. The dentist and anesthesiologist must anticipate potential hazards to the unconscious patient.     

右美托咪啶对老年患者全麻术后早期认知功能的影响

目的:观察右美托咪啶对老年患者七氟烷全麻术后早期认知功能的影响。方法:择期开腹手术老年患者60例,随机分为D组(七氟烷复合右美托咪啶)和C组(七氟烷复合生理盐水),记录术前(T0)、术后5min(T1)、拔管前15min(T2)、拔管后30min(T3)、平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2),记录患者从停止吸入药到自主呼吸的恢复时间(T4)、呼之睁眼时间(T5)、拔管时间(T6)和定向力恢复时间(T7)及手术前1d和手术后第1d两组患者简易智力状态检查法(MMSE)测试评分,计算POCD发生率。结果:两组在T0比较,D组MAP无变化、HR下降,两组在T2、T3比较,D组MAP和HR降低(P<0.05);两组在T0比较,手术后第1dC组MMSE下降(P<0.01),D组POCD发生率(17%)低于C组(47%)。结论:七氟烷复合右美托咪啶麻醉有利于患者术后恢复期血流动力学稳定,降低老年患者术后早期认知功能障碍的发生率。     

Postoperative Pain in Children After Dentistry Under General Anesthesia

The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4–6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents'' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rho_s correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.Key Words: Postoperative pain, Assessment, Anesthetic, ChildrenPain is defined as an unpleasant “subjective experience that is the product of both emotional and sensory components interrelated with the context of culture and environment.”¹ It is a concrete experience and an abstract concept.² Pain results from actual or potential tissue damage, but the perception of pain is modified by physiological mechanisms in the complex human nervous system.Current clinical practices show that health care providers and parents tend to underestimate children''s pain when compared with children''s self-reports.³ This incongruity results from the inability of young children to fully understand, verbalize, and express their experiences^4–6 in conjunction with adults being unable to adequately detect and identify signs of pain in the pediatric population. Given that pain in children is inherently difficult to assess, pain may be unrecognized or undiagnosed resulting in a mistaken belief that infants and children suffer less than adults or do not feel pain.⁷ The International Association for the Study of Pain acknowledges that the “inability to communicate verbally does not negate the possibility that an individual is experiencing pain and (is) in need of appropriate pain management.”⁸Dental extractions of primary teeth have been, and very often still are, carried out without any pain relief medication in the belief that children do not experience significant amounts of pain.⁹ Studies conducted to describe dentists'' knowledge of and attitudes towards procedural pain in children have revealed that dentists downplay procedural pain.^10–12 Pain is likely the most significant morbidity associated with dental extractions.^13–15 However, for unknown reasons, the impact of these studies has been slow to permeate into clinical knowledge and translate into clinical intervention.Postoperative pain is often a new experience for young children. The complexity of interpreting and verbalizing pain may be convoluted further by unfamiliar postoperative sensations from general anesthesia (GA), surgical site discomfort, and disorientation. The recovery period after surgery may require formal assessments of pain in this population.Our literature review identified 6 publications that studied morbidity following pediatric dental rehabilitation under GA^{1,9,13,15–23} and 4 studies that focused on postoperative pain as their primary outcome.^15,19,22,23 While collective interpretation of these previous studies was difficult with the variability in age, demographics, and implemented pain assessment tools, postoperative pain remained the most common and long-lasting morbidity after pediatric dental rehabilitation.^13,14,16 In the study by Atan et al,¹³ postoperative pain was reported in 74% of children aged 6 to 16 years following dental treatment under intubated GA. Of the morbidity measures reported, pain had the longest duration in comparison to sleepiness, weakness, and nausea. Farsi et al¹⁸ determined that the prevalence of postoperative pain was 47.8% at 36 hours and 16.7% at 72 hours. The pilot study by Fung et al¹⁵ found that 57.5% of 40 children who had 1 or more extractions under GA had postoperative pain immediately after treatment. In the study by O''Donnell et al,⁹ none of the 70 patients in the no-analgesia group reported “no pain” and 100% scored mild to high pain; 18.6% scored moderate pain and 81.4% scored moderate-to-high pain. All children receiving no analgesia experienced some level of pain following extractions of primary teeth under GA.The variability in the current literature, the variability in clinicians'' perceptions of children''s postoperative pain, and the variability in home recovery practices prompted this study. The objectives of this study were to determine the prevalence, severity, and duration of postoperative pain after pediatric dental rehabilitation under GA using reliable and valid pain assessment tools in the clinic and at home.     

全麻术后苏醒延迟一例报告

女性患者，21岁，41千克，因下腹部反复疼痛不适二个月入院。CT提示骶前腹膜后包块。手术拟行“骶前腹膜后包块切除术”。患者既往体健，未诉其它特殊病史，实验室资料未见明显异常。     

硬膜外与全麻用于全髋置换术围手术期出血量的比较

本文以同一原发病的男性40例且由同一术者施术的全髋置换术(THR)为对象,应用硬膜外麻醉(E组)和气管内插管全身麻醉(G组)对其围术期的血液出入进行对照比较.两组平均手术时间均为120min,出血量和手术时间呈正相相关(P<0.01).术中出血量两组间无明显差别,围术期总出血量E组为1630±80ml,G组为1380±62ml,以E组明显居多,故此主张THR以选用全麻施术为宜.     

Ventilation via Cut Nasotracheal Tube During General Anesthesia

Many patients with disabilities need recurrent dental treatment under general anesthesia because of high caries prevalence and the nature of dental treatment. We evaluated the use of a nasal device as a possible substitute for flexible laryngeal mask airway to reduce the risk of unexpected failure accompanying intubation; we succeeded in ventilating the lungs with a cut nasotracheal tube (CNT) with its tip placed in the pharynx. We hypothesized that this technique would be useful during dental treatment under general anesthesia and investigated its usefulness as part of a minimally invasive technique. A prospective study was designed using general anesthesia in 37 dental patients with disabilities such as intellectual impairment, autism, and cerebral palsy. CNT ventilation was compared with mask ventilation with the patient in 3 positions: the neck in flexion, horizontal position, and in extension. The effect of mouth gags was also recorded during CNT ventilation. The percentages of cases with effective ventilation were similar for the 2 techniques in the neck extension and horizontal positions (89.2–97.3%). However, CNT ventilation was significantly more effective than mask ventilation in the neck flexion position (94.6 vs 45.9%; P < .0001). Mouth gags slightly reduced the rate of effective ventilation in the neck flexion position. Most dental treatments involving minor oral surgeries were performed using mouth gags during CNT ventilation. CNT ventilation was shown to be superior to mask ventilation and is useful during dental treatment under general anesthesia.Key Words: General anesthesia, Cut nasotracheal tube.People with oral diseases often need to visit the dental office several times during a single treatment period because of the nature of dental treatment, which may include laboratory work such as the manufacture of crowns and inlays. People with disabilities such as cerebral palsy, intellectual disability, and autism may not be able to cooperate with dental staff satisfactorily.¹ They may need repeated dental treatment under general anesthesia, as they are more prone to dental caries and other oral diseases. Although there is a low rate of unexpected anesthetic-related failures, such as “inability to intubate or ventilate” or injuries to oral tissues, complications may occur during general anesthesia in these patients.^2–7 Therefore, for these patients it is preferable to adopt a method of general anesthesia that is as minimally invasive as possible. We prefer to use laryngeal mask airways only for cavity preparation, wherein it is not necessary to administer muscle relaxants and perform laryngoscopy. Dental treatment can be performed using a flexible laryngeal mask airway (FLMA)⁸; however, its flexible tube sometimes interferes with dental procedures that need to be performed with precision, particularly those involving proper occlusion of the teeth. It is difficult to master the technique of using FLMA as a nasal airway.⁹We evaluated a nasal device as a possible substitute for the FLMA and hypothesized that effective ventilation would be possible with a nasotracheal tube with an inflated cuff inserted to a position very close to the epiglottis. We investigated the effectiveness of ventilation using a cut nasotracheal tube (CNT) placed in the pharynx to evaluate the usefulness of this new method in dental treatment under general anesthesia (Figure).Open in a separate windowFigure 1.A cut tube and a normal tube.