七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术的效果

目的观察七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术的效果。方法选取2017-01—2018-06间在郑州二砂医院接受气管插管全麻下扁桃体切除术的86例患儿,依据不同麻醉用药分为2组,各43例。对照组应用丙泊酚,观察组采用七氟醚复合瑞芬太尼。比较2组麻醉前(T_0)、插管后5 min(T_1)、手术开始后5 min(T_2)及拔管时(T_3)患儿的平均动脉压(MAP)、HR(心率)、指氧饱和度(SpO_2)的水平,以及术后恢复自主呼吸时间、意识恢复时间、拔管时间和不良反应。结果 2组患儿T_0和T_3时点的MAP、HR和各时点SpO_2比较,差异均无统计学意义(P0.05)。观察组T_1～T_3时间点的MAP、HR波动幅度小于对照组,差异有统计学意义(P0.05)。观察组患儿术后恢复自主呼吸和意识时间及拔管时间均显著短于对照组,差异有统计学意义(P0.05)。2组患儿均无心律失常、呼吸抑制等不良反应。结论七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术,围术期易于控制麻醉深度,且血流动力学波动小,不良反应少,术后苏醒质量肯定。     

芬太尼或瑞芬太尼复合七氟醚诱导在无肌松条件下插管的应用

目的计算芬太尼或瑞芬太尼复合七氟醚诱导在无肌松条件下插管的半数有效量(ED50),比较抑制气管插管反应的效果。方法择期短小手术患者49例,ASAⅠ或Ⅱ级,年龄20～50岁。按照入室顺序随机分为芬太尼组(F组,n=23)和瑞芬太尼组(R组,n=26)。8%七氟醚肺活量诱导,眼睑反射消失后,维持呼气末七氟醚浓度(CETSev)为3%。按照改良Dixon序贯法调整芬太尼(剂量梯度为0.05μg/kg)或瑞芬太尼的剂量(剂量梯度为0.1μg/kg),静脉注射芬太尼或瑞芬太尼4min后气管插管。记录患者眼睑反射消失时间及气管插管反应。结果芬太尼ED50为1.30μg/kg(95%CI1.25～1.35μg/kg),瑞芬太尼ED50为0.47μg/kg(95%CI0.39～0.53μg/kg)。F组声带活动、呛咳和体动的发生率均明显高于R组(P<0.05)。结论无肌松条件下瑞芬太尼较芬太尼能更好地抑制气管插管反应。     

七氟醚与丙泊酚复合瑞芬太尼用于人工流产术的效果比较

目前用于人工流产术的麻醉是丙泊酚／芬太尼静脉注射,而丙泊酚注射时常发生疼痛。七氟醚对气道无刺激,血气分配系数低,苏醒快,具有镇静、镇痛和肌松作用．故可用于人工流产的麻醉。瑞芬太尼分布容积小,起效快,不影响术后的苏醒。本研究观察比较七氟醚与丙泊酚复合瑞芬太尼用于人工流产术的麻醉效果。     

探讨不同浓度七氟醚喉罩吸入联合瑞芬太尼静脉泵入用于新生儿的麻醉效果

目的比较不同浓度七氟醚喉罩吸入联合瑞芬太尼静脉泵入用于新生儿的麻醉效果。方法将99例接受择期手术治疗的新生儿随机分为3组,各33例。患儿术前均接受相同剂量的海俄辛、芬太尼和异丙酚诱导麻醉,待角膜反射完全消失后,给予不同浓度的七氟醚喉罩吸入联合瑞芬太尼静脉泵入维持麻醉,A、B、C 3组的七氟醚浓度分别为2.0%、1.5%、1.0%。比较3组麻醉效果。结果 3组患儿各时点HR、SpO_2、MAP的差异无统计学意义(P0.05)。B、C组患儿苏醒时间、PAED评分优于A组,B组患儿不良事件总发生率低于A、C组,差异均有统计学意义(P0.05)。结论不同浓度七氟醚喉罩吸入联合瑞芬太尼静脉泵入用于新生儿的麻醉效果相当,但1.5%浓度的七氟醚安全性最高。     

七氟醚复合瑞芬太尼在小儿唇腭裂手术中的应用

目的:观察七氟醚复合瑞芬太尼用于小儿唇腭裂手术的麻醉诱导、维持及苏醒的临床效果.方法:40例唇腭裂患者,ASA Ⅰ级,年龄6个月至12岁,随机分成两组(n=20):S组全凭吸入七氟醚麻醉,SR组七氟醚复合瑞芬太尼.观察两组患儿术中、术后血流动力学变化.记录诱导时间、自主呼吸恢复时间以及术后拔管时间,并观察有无术后躁动等.结果:SR组术中术后血流动力学变化小于S组(p＜0.05),SR组插管时间短于S组(p＜0.05).结论:七氟醚复合瑞芬太尼用于小儿唇腭裂手术较单纯使用七氟醚血流动力学更加平稳.     

七氟醚复合瑞芬太尼在小儿扁桃体手术中的应用

目的分析七氟醚复合瑞芬太尼在小儿扁桃体手术中的应用效果。方法将择期行扁桃体手术治疗的100例患儿随机分为2组,每组50例。观察组采用七氟醚复合瑞芬太尼麻醉,对照组给予丙泊酚复合瑞芬太尼麻醉。观察2组患儿麻醉前(T_0)、拔管后5 min(T_1)、手术开始后5 min(T_2)、插管后5 min(T_3)各时间点SBP、DBP、HR的变化和自主呼吸恢复时间、苏醒时间、气管拔管时间及不良反应发生率。结果 2组患儿T_0和T_3时间点SBP、DBP、HR比较,差异无统计学意义(P0.05)。观察组在T_1、T_2的HR、SBP与T_0、T_3比较,波动较小,差异无统计学意义(P0.05)。对照组T_1、T_2SBP、DBP、HR与T_0、T_3比较,波动较大,差异有统计学意义(P0.05)。观察组术后自主呼吸恢复时间、苏醒时间和气管拔管时间均显著短于对照组,差异有统计学意义(P0.05)。2组患儿均未出现呼吸抑制、心律失常、喉水肿等不良反应。结论小儿扁桃体手术中采用七氟醚复合瑞芬太尼麻醉,术中血流动力学平稳,麻醉恢复时间短,不良反应发生率无明显增加,安全性高。     

七氟醚-瑞芬太尼麻醉用于腹腔镜胆囊切除术患者的效果

目的 评价七氟醚-瑞芬太尼麻醉对腹腔镜胆囊切除术(LC)患者血流动力学、苏醒质量,以及认知功能的影响。方法 择期行LC的胆囊结石患者84例,性别不限,年龄33～61岁,BMI 19～24 kg/m²。ASAⅠ～Ⅱ级。采用随机数字表法分为七氟醚-瑞芬太尼组(S组)和丙泊酚-瑞芬太尼组(P组),每组42例。记录2组患者麻醉前(T₀)、麻醉后10 min(T₁)、手术进行时(T₂)、术毕时(T₃)的SpO₂、HR、 MAP血流动力学指标和患者的自主呼吸恢复时间、指令动作恢复时间、言语顺利应答时间、定向力恢复时间苏醒等质量指标。评价术后2 h、6 h、12 h、24 h的视觉模拟评分法(VAS)评分。统计呼吸抑制等不良反应发生率。结果 T₁、T₂、T₃时S组患者的SpO₂、HR、 MAP血流动力学指标稳定性均优于P组;术后自主呼吸恢复时间、指令动作恢复时间、言语顺利应答时间、拔...     

七氟醚复合舒芬太尼或雷米芬太尼静吸复合麻醉在先天性心脏病通道手术中的应用

目的观察七氟醚复合舒芬太尼或雷米芬太尼快通道麻醉在小儿先天性心脏病手术的应用。方法 60例先天性心脏病患者,男40例,女20例,年龄2～12岁,随机分为舒芬太尼组（SF组）、雷米芬太尼组（RF组）两组,每组30例。两组均用咪唑安定和维库溴铵诱导麻醉,SF组诱导用舒芬太尼1μg/kg,继之泵入舒芬太尼2～3μg/（kg·h）;RF组诱导用雷米芬太尼2μg/kg,继之泵入雷米芬太尼0.1～1μg/（kg·min）维持麻醉,两组均吸入七氟醚,间断静推维库溴铵。观察两组患者术前、术中、术后血流动力学变化,记录术后清醒时间、拔管时间、术后躁动情况。结果与T0比较,两组患者T4、T5HR明显增快（P〈0.05）,T1、T3、T4MAP下降（P〈0.05）;苏醒情况：SF组清醒时间、拔管时间较RF组长（P〈0.01）,RF组躁动发生率较SF组高（P〈0.05）。结论七氟醚复合舒芬太尼或雷米芬尼静吸复合麻醉均能为先天性心脏病手术提供安全、快捷的快通道麻醉。     

七氟醚全凭吸入麻醉在婴儿唇裂整复术中的应用

目的 探讨七氟醚全凭吸入麻醉在婴儿唇裂整复术中应用的可行性和安全性.方法 60例ASA Ⅰ级唇裂婴儿随机均分为七氟醚全凭吸入麻醉组(S组)和丙泊酚-芬太尼静脉麻醉组(P组).记录患儿入室后、气管插管时、手术切皮时、手术开始后30 min的HR、MAP;记录拔管时间、改良Aldrete评分达9分所需时间、单位时间维库溴铵用量、苏醒期躁动及术后恶心呕吐情况.结果 P组气管插管时HR明显快于入室后及S组(P＜0.01);S组拔管时间和改良Aldrete评分到9分的时间均明显短于P组(P＜0.01);S组苏醒期躁动例数多于P组(P＜0.05);两组患儿均无苏醒期呕吐;S组患儿的维库溴铵用量显著小于P组(P＜0.01).结论 七氟醚全凭吸入麻醉维持平稳,苏醒迅速完全,可安全用于婴儿唇裂整复手术,其不足是苏醒期躁动发生率高.     

七氟醚麻醉下瑞芬太尼抑制小儿切皮反应的血浆靶浓度

目的 确定七氟醚麻醉下瑞芬太尼抑制小儿切皮时躯体和心血管反应的血浆靶浓度.方法 择期全麻手术小儿75例,年龄2～5岁,ASA Ⅰ级,随机均分为五组,七氟醚吸入诱导后,采用Minto药代动力学模型靶控输注瑞芬太尼,血浆靶浓度分别为1、2、3、4、5 ng/ml(R1～R5组),维持呼气末七氟醚浓度稳定在1.5%,15 min后开始切皮.切皮即刻,小儿发生体动为躯体反应阳性;MAP或HR较切皮前升高或增快＞15%为心血管反应阳性.Probit法计算瑞芬太尼抑制50%和95%患儿切皮即刻躯体和心血管反应的有效血浆靶浓度(Cp50和CP95).结果 五组瑞芬太尼抑制切皮时躯体反应有效构成比分别为0/15、5/15、12/15、15/15、15/15;抑制心血管反应有效构成比分别为0/15、2/15、8/15、13/15、14/15.结论 在1.5%七氟醚麻醉下,瑞芬太尼抑制2～5岁小儿切皮时躯体反应的Cp50及其95%可信区间为2.29(1.92～2.59)ng/ml,Cp95及其95%可信区间为3.53(3.02～5.03)ng/ml;抑制心血管反应的Cp50及其95%可信区间为2.89(2.46～3.29)ng/ml,Cp95及其95%可信区间为4.99(4.19～7.18)ng/ml.     

米库氯铵与顺苯磺酸阿曲库铵在婴幼儿唇腭裂手术中的应用比较

目的观察和比较米库氯铵和顺苯磺酸阿曲库铵用于婴幼儿唇腭裂手术中的肌松效应和安全性。方法 2012年9月至2013年9月择期行唇腭裂手术治疗的患儿60例,年龄6个月至3岁,随机分为两组,每组30例。两组均给予咪达唑仑0.1mg/kg、丙泊酚2mg/kg、瑞芬太尼1μg/kg及米库氯铵0.2mg/kg(M组)或顺苯磺酸阿曲库铵0.15mg/kg(C组)行麻醉诱导后气管插管。采用TOF-Guard加速度肌松监测仪连续监测尺神经四个成串刺激(TOF)。观察并记录肌松起效时间、临床作用时间和恢复指数,进行插管评级并观察不良反应情况。结果两组的插管条件评级差异无统计学意义。M组肌松起效时间、肌松临床作用时间以及恢复指数明显短于C组(P0.05);M组不良反应发生率明显低于C组(P0.05)。结论米库氯铵用于婴幼儿唇腭裂手术时起效快、肌松效应时间短,恢复较快。     

右美托咪定用于小儿唇腭裂手术麻醉的临床观察

目的 探讨右美托咪定用于小儿唇腭裂手术麻醉中的临床效果,为小儿唇腭裂手术麻醉安全用药提供依据.方法 先天性唇腭裂修复术患儿40例,随机分为右美托咪定组(D组)和对照组(C组).两组患儿均采用紧闭面罩8％七氟烷吸入麻醉诱导,D组同时静脉泵注右美托咪定1 μg/kg,C组给予同等容量生理盐水,均于10 min给完.两组患儿均采用气管插管静吸复合全身麻醉方法,术中维持C组采用异丙酚-七氟烷复合麻醉;D组采用右美托咪定-异丙酚-七氟烷复合麻醉,观察并记录不同时点患儿心率、平均动脉压、脉搏血氧饱和度、呼气末二氧化碳分压并进行躁动评分,记录两组呼吸抑制及躁动发生率.结果 两组患儿的手术时间、麻醉时间及苏醒时间差异无统计学意义(P＞0.05).D组患儿在气管插管即刻(T2)、术中20 min(T3)、术毕(T4)及拔管(T5)时平均动脉压和心率均明显低于C组(P＜0.05).D组躁动发生率为11.1％,明显低于C组36.4％(P＜0.05).D组无一例发生呼吸抑制.结论 右美托咪定用于小儿唇腭裂修复术安全有效,术中血流动力学平稳,术后恢复期安静、舒适,能够减少围术期并发症的发生.     

Early postoperative complications in primary cleft lip and palate surgery

We studied the occurrence of early complications of cleft lip and palate surgery by the retrospective study of 132 consecutive cases (160 procedures) operated between three and six months of age. Three children presented with major complications within the immediate postoperative period. All were treated successfully. A local complication directly related to the operation occurred in 7.5% of the cases within the first six postoperative days. In 17%, a general complication not directly related to the operation was observed. The majority of these general complications were cross infections during the hospital stay. These observations led us to reduce the hospital stay to one day for cleft lip and five days for cleft palate and cleft lip and palate operations without compromise to safety but with a reduction of the morbidity and hence the treatment costs and of the child-family disturbance.     

Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

Aim:

The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria.

Setting and Design:

A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria.

Material and Methods:

One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery.

Results:

There were 52 females and 48 males with a mean age of 64.4 ± 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45%) followed by unilateral cleft lip (28%). Cleft palate repair was the most common procedure (45%) followed by unilateral cleft lip repair (41%). The mean estimated blood loss was 95.8 ± 144.9 ml (range, 2-800ml). Ten (10%) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 ± 135.4ml (range, 35-500ml). Six (60%) of those transfused had a preoperative PCV of < 30%. Only 4.9% of patients who had unilateral cleft lip surgery were transfused as compared with 50% for CLP surgery, 11% for CP surgery, and 10% for bilateral cleft lip surgery.

Conclusions:

The frequency of blood transfusion in cleft lip and palate surgery was 10% with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A "type and screen" policy is advocated for cleft lip and palate surgery.     

Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery

STUDY OBJECTIVE: To compare the recovery characteristics of two widely used anesthetic techniques: remifentanyl-propofol and sevoflurane-fentanyl in a standardized ambulatory population.DESIGN: Randomized, single-blinded study. SETTING: University-affiliated medical center. PATIENTS: 50 ASA physical status I and II patients undergoing elective ambulatory otorhinolaryngeal surgery. INTERVENTIONS: Patients were randomized two groups to receive total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-fentanyl (SF group). TIVA patients received induction with propofol 1.5 mg/kg intravenously (IV) and remifentanil 0.5 microg/kg IV. The anesthesia was continued with a continuous infusion of propofol 100 microg/kg/min and remifentanil 0.0625-0.25 microg/kg/min. The SF group received, at induction, fentanyl 2 microg/kg followed by propofol 1.5 mg/kg IV. Maintenance was obtained with 1 to 1.5 minimum alveolar concentration of sevoflurane and bolus of fentanyl 1 microg/kg IV as needed. MEASUREMENTS AND MAIN RESULTS: Early recovery times (eye opening, response to commands, extubation, orientation, operating room stay after surgery, and Aldrete score > or =9) and patient satisfaction were similar between the two groups. Postanesthetic discharge scoring system (PADSS) > or = 9 was significantly shorter for the TIVA group (135.9 +/- 51 vs. 103 +/- 32 min) (p < 0.01) but this difference was not associated with a shorter postanesthesia care unit (PACU) length of stay. CONCLUSION: Early recovery times are comparable between total intravenous anesthesia and sevoflurane-based anesthesia. Even though patients in the TIVA group achieved home readiness criteria in a significantly shorter time, this technique does not shorten PACU length of stay, which depends instead on multiple nonmedical and administrative issues.     

Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants

BACKGROUND: Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. METHODS: In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. RESULTS: In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. CONCLUSIONS: A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.