瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿扁桃体手术中的应用

目的 探讨瑞芬太尼复合丙泊酚全凭静脉麻醉用于小儿扁桃体手术的临床疗效和安全性.方法 将择期行扁桃体切除术的患儿50例按随机数字表分为瑞芬太尼组(R组)和芬太尼组(F组),每组25例.麻醉诱导:R组予瑞芬太尼1μg·kg(-1)(稀释后缓慢注射),F组用芬太尼3μg·kg(-1),其他用药均相同,为咪达唑仑0.1mg·kg(-1),丙泊酚2mg·kg(-1),阿曲库钱0.5mg·kg(-1);麻醉诱导后:R组持续输注瑞芬太尼、丙泊酚;F组持续吸人异氟醚维持麻醉.记录2组诱导前(T0)、诱导后(T1)、插管时(T2)、手术开始后5 min(T3)、拔管时(T4)的MAP,HR,记录2组自主呼吸恢复时间、拔管时间、再入睡率等.结果 2组T0,T1的MAP和HR差异无统计学意义(P>0.05);R组T2,T3,T4的MAP,HR均低于F组(均P<0.05);R组苏醒时间、拔管时间、再入睡率均少于F组(均P<0.05).结论 瑞芬太尼复合丙泊酚全凭静脉麻醉用于小儿扁桃体手术较芬太尼、丙泊酚、异氟醚静吸麻醉围术期血流动力学更稳定,术后苏醒迅速.     

Cholecystectomy,gallstones, tonsillectomy,and pancreatic cancer risk: a population-based case-control study in minnesota

Background:

Associations between medical conditions and pancreatic cancer risk are controversial and are thus evaluated in a study conducted during 1994–1998 in Minnesota.

Methods:

Cases (n=215) were ascertained from hospitals in the metropolitan area of the Twin Cities and the Mayo Clinic. Controls (n=676) were randomly selected from the general population and frequency matched to cases by age and sex. The history of medical conditions was gathered with a questionnaire during in-person interviews. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression.

Results:

After adjustment for confounders, subjects who had cholecystectomy or gallstones experienced a significantly higher risk of pancreatic cancer than those who did not (OR (95% CI): 2.11 (1.32–3.35) for cholecystectomy and 1.97 (1.23–3.12) for gallstones), whereas opposite results were observed for tonsillectomy (0.67 (0.48–0.94)). Increased risk associated with cholecystectomy was the greatest when it occurred ⩽2 years before the cancer diagnosis (5.93 (2.36–15.7)) but remained statistically significant when that interval was ⩾20 years (2.27 (1.16–4.32)).

Conclusions:

Cholecystectomy, gallstones, and tonsillectomy were associated with an altered risk of pancreatic cancer. Our study suggests that cholecystectomy increased risk but reverse causality may partially account for high risk associated with recent cholecystectomy.     

喉友口腔喷剂在扁桃体切除术后的临床观察

目的 观察喉友口腔喷剂在扁桃体切除术后的临床疗效.方法 2004年9月～2006年3月于我院因慢性扁桃体炎或扁桃体肥大而住院行双侧扁桃体切除术患者40例,随机平均分成治疗组与对照组,治疗组予喉友口腔喷剂治疗,对照组予硼砂液漱口,比较两组病人术后不同时间疼痛变化、进食、术后12 h伪膜完成情况及平均创面痊愈时间,数据作统计学分析.结果 治疗组比对照组有明显的统计学意义(p＜0.05).结论 扁桃体术后应用喉友口腔喷剂喷涂创面,可有效改善术后症状,促进恢复.     

Oral ondansetron decreases vomiting after tonsillectomy in children

Vomiting is a common, unpleasant aftermath of tonsillectomy in children. Intraoperative intravenous ondansetron (OND) reduces vomiting after this operation. Our doubleblind, placebocontrolled, randomized investigation studied the effect of the oral form of OND on vomiting after outpatient tonsillectomy in children. We studied 233 healthy children age 2–14 yr undergoing elective tonsillectomy. Subjects were given placebo (PLAC) or OND 0.1 mg · kg^?1 rounded off to the nearest 2 mg one hr before surgery. Anaesthesia was induced with either propofol or halothane/N₂O. Vecuronium 0.1 mg · kg^?1 was administered at the discretion of the anaesthetist. Anaesthesia was maintained with halothane/N₂O, 50 μg · kg^?1 midazolam iv and 1–1.5 mg · kg^?1 codeine im. At the end of surgery, residual neuromuscular blockade was reversed with neostigmine and atropine. All episodes of inhospital emesis were recorded by nursing staff. Rescue antiemetics in the hospital were 1 mg · kg^?1 dimenhydrinate ivfor vomiting × 2 and 50 μg · kg^?1 droperidol iv for vomiting × 4. Parents kept a diary of emesis after discharge. Postoperative pain was treated with morphine, codeine and/or acetaminophen. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. Oral OND (n = 109) reduced postoperative emesis from 54% to 39%, P < 0.05. This effect was most dramatic inhospital, where 10% of the OND-patients and 30% of the PLAC-group vomited, P < 0.05. The OND-subjects required fewer rescue antiemetics, 7% vs 17%, P < 0.05. In conclusion, oral ondansetron decreased the incidence of vomiting after outpatient tonsillectomy in children.     

Local bupivacaine–epinephrine infiltration combined with general anesthesia for adult tonsillectomy

Conclusion. Use of a solution of bupivacaine (5 mg/ml)–epinephrine (5 µg/ml) (BE) is beneficial in reducing intraoperative bleeding and decreasing the operation time in adult (adeno)tonsillectomy patients. Objective. Pain and intra- and postoperative bleeding are problems associated with tonsillectomy/adenotonsillectomy. In order to make tonsillectomy/adenotonsillectomy better suited to outpatient surgery, solutions to these problems should be found. One possibility may be the combination of local and general anesthesia. The aim of this study was to find out if such a combination is beneficial in tonsillectomy/adenotonsillectomy. Material and methods. We performed a prospective, randomized, double-blind, controlled study on 64 adult (adeno)tonsillectomy patients to investigate the possible benefits of infiltrating the peritonsillar space with a BE solution. Results. In the recovery room, the BE group experienced less pain than a control group infiltrated with saline; subsequently there was no significant difference between the groups concerning pain. The average volume of intraoperative bleeding and the operation time were significantly smaller in the BE group. Postoperative bleeding from the tonsillar fossae occurred in 19% (6/31) of the patients in the BE group and in 18% (6/33) in the saline group.     

Post-operative pain control after tonsillectomy: dexametasone vs tramadol

Conclusion: Tramadol was found to be more effective than dexamethasone in post-operative pain control, with long-lasting relief of pain.

Objective: This study aimed to compare the effects of pre-operative local injections of tramadol and dexamethasone on post-operative pain, nausea and vomiting in patients who underwent tonsillectomy.

Design: Sixty patients between 3–13 years of age who were planned for tonsillectomy were included in the study. Patients were divided into three groups. Group 1 was the control group. Patients in Group 2 received 0.3?mg/kg Dexamethasone and Group 3 received 0.1?mg/kg Tramadol injection to the peritonsillary space just before the operation. Patients were evaluated for nausea, vomiting, and pain.

Results: When the control and the dexamethasone groups were compared; there were statistically significant differences in pain scores at post-operative 15 and 30?min, whereas there was no statistically significant difference in pain scores at other hours. When the control and tramadol groups were compared, there was a statistically significant difference in pain scores at all intervals. When tramadol and dexamethasone groups were compared, there was no statistically significant difference in pain scores at post-operative 15 and 30?min, 1 and 2?h, whereas there was a statistically significant difference in pain scores at post-operative 6 and 24?h.