Objective To investigate the effect of dexmedetomidine on agitation during recovery from sevoflurane anesthesia in children. Methods Three hundred ASA Ⅰ or Ⅱ children, aged 4-7 yr, weighing 16-30kg, scheduled for elective ear-nose-throat operation under general anesthesia, were randomly divided into 2 groups ( n = 150 each) : control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine 0.5 μg/kg in 20 ml was infused intravenously over 10 min before anesthesia induction in group D, while equal volume of normal Saline was infused in group C. Anesthesia was induced with inhalation of 8 % sevoflurane 5 min after the end of administration . The children were tracheal incubated and mechanically ventilated. Anesthesia was maintained with inhalation of 2 % -3 % sevoflurane. BIS was maintained at 40-60 during operation. The recovery time and agitation within 2 h after operation were recorded. Results There was no significant difference in the recovery time between the two groups ( P > 0.05) . The incidence of agitation was significantly lower in group D than in group C ( P <0.05 ) . Conclusion Dexmedetomidine can reduce the occurrence of agitation during recovery from sevoflurane anesthesia in children.

ObjectiveTo compare the efficacy of laryngeal tube-suction airway (LTSA) and SLIPA laryngeal mask airway (SLIPA) in obese patients undergoing laparoscopic cholecystectomy.MethodsSixty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index ＞ 30 kg/m2,undergoing laparoscopic cholecystectomy,were randomly into 2 groups ( n =30 each):group LTSA ( group Ⅰ ) and group SLI PA ( group Ⅱ ).Anesthesia was induced with target-controlled infusion (TCI) of propofol with the target plasma concentration (Cp) of 3-5 μg/ml and remifentanil (target Cp =4-6 ng/ml ).Rocuronium 0.6 mg/kg was injected intravenously as soon as the patients lost consciousness.LTSA and PLMA were inserted when BIS value was 50-60.HR,mean arterial pressure (MAP),SpO2,peak airway pressure(Ppeak) and PETCO2 were monitored during operation.Fiberoptic bronchoscopy was performed and the placement was scored.The placement time,the rate of successful placement at first attempt,airway sealing pressure,the failure of airway management and side effects were recorded.ResultsThere was no significant difference in HR,MAP,the fiberoptic bronchoscopy scores,the airway sealing pressure,and the incidence of side effects between the two groups.The placement time was significantly shorter in group Ⅰ than in group Ⅱ (P ＜ 0.05).The rate of successful placement at first attempt was more than 90％ and no failure was found in airway management in both groups.The SpO2,Ppeak,and PET CO2 were within the normal range during operation in both groups.ConclusionBoth LTSA and SLIPA can be safely and effectively used in obese patients undergoing laparoscopic cholecystectomy,however,LTSA placement is more easier.

Objective To compare the efficacy of anesthesia with dexmedetomidinc and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer. Methods Forty ASA Ⅱ male patients, aged 35-62 yr, weighing 45-70 kg, scheduled for percutaneous microwave coagulation therapy,were randomly divided into 2 groups ( n = 20 each): midasolam group ( group Ⅰ ) and dexmedetomidine group ( group Ⅱ ). A loading dose of midazolam 40 μg/kg ( in normal saline 20 ml) was given intravenously over 10 min,followed by midasolam infusion at 40 μg·kg-1 ·h-1 in group Ⅰ . A loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml ) was given intravenously over 10 min, followed by dexmedetomidine infusion at 0.5 loading dose of sufentanil 0.2 μg/kg was given, and then patient-controlled intravenous anesthesia with sufentsnil (background infusion 0.1 μg·kg-1 ·h-1 , bolus dose 0.1 μg/kg, lockout interval 3 min) was used. The operation was started 2 min after administration of the loading dose of sufentanil. Bradycardia, tachycardia, hypotension, hypertensinn and respiratory depression were recorded. The number of attempts and successfully delivered doses was also recorded. Results There was no significant difference in the incidence of bradycardia, tachycardia, hypotension and hypertension between the two groups ( P ＞ 0 .05). The incidence of respiratory depression was significantly lower, and the number of attempts and successfully delivered doses was smaller in group Ⅱ than in group Ⅰ ( P ＜ 0.05). Conclusion The efficacy of anesthesia with dexmedetomidine and sufentanil is better than that of anesthesia with midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.

Objective To evaluate the efficacy of thracheal extubation-insertion of the nasopharyngeal airway for preventing the response to extubation under anesthesia in patients with hypertension. Methods Eighty ASA Ⅱ or Ⅲ patients with hypertension, scheduled for laparoscopic cholecystectomy under general anesthesia were randomly allocated into 2 groups with 40 patients in each group: tracheal tube group (group Ⅰ ) and tracheal tube-nasopharyngeal airway group (group Ⅱ). Anesthesia was induced with midazolam 0.05 mg/kg, sufentanil 0.4 μg/kg, cisatracurium besylate 0.15 mg/kg and propofol 2 mg/kg. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with TCI of propofol (target plasma concentration 3-4 μg/L) and sufentanil (target plasma concentration 0.2-0.4 μg/L). BIS was maintained at 40-50. Target plasma concentrations of propofol and sufentanil were adjusted to 1 μg/L and 0.1 ng/L respectively after operation and the infusion was stopped after recovery of breathing. In group Ⅱ, extubation was performed, and then the nasopharyngeal airway was inserted and oxygen was inhaled by mask, and the airway was removed after recovery of consciousness. In group Ⅰ , extubation was performed after recovery of cousciousness. The SP, DP, HR and SpO_2 were recorded immediately before anesthesia induction (T_0), immediately and 2 min after insertion of the nasopharyngeal airway (T_(1,2)), and immediately and 2 rain after removal of the tube or airway (T_(3,4)). The maximal value of SP (SP_(max)), DP (DP_(max)) and HR (HR_(max)) were also recorded during extubation. The differences in SP (△SP), DP (△DP) and HR (△HR) before and after extubation were calculated. The plasma concentrations of AD and NE were determined. The coughing and restlessness were observed. Results The SP, DP, HR and plasma concentrations of AD and NE were significantly higher at T_(3,4) in group Ⅰ and the SP, DP at T_(1,3,4) and HR at T_(2,3) were significantly lower in group Ⅱ than those at T_0 (P<0.05). The SP, DP, HR and plasma concentrations of AD and NE were significantly lower at T_(2-4) in group Ⅱ than in group Ⅰ (P<0.05). The SP_(max), DP_(max), HR_(max), △SP, ADP and △HR were significantly lower in group Ⅱ than in group Ⅰ (P<0.05). The incidence of coughing and restlessness was obviously lower in group Ⅱ than in group Ⅰ (P<0.05). Conclusion Thracheal extubation-insertion of the nasopharyngeal airway under anesthesia can effectively prevent the patients' response to extubation during emergence from anesthesia.

Objective To compare the anesthetic efficacy of dexmedetomidine and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer.Methods Forty ASA Ⅱ male patients (aged 35-62 years and weighing 45-70 kg) scheduled for percutaneous microwave coagulation therapy were randomly divided into two groups (n =20 each):midazolam group (group Ⅰ) and dexmedetomidine group (group Ⅱ).A loading dose of midazolam 40 μg/kg (in normal saline 20 ml) was given intravenously over 10 minutes,followed by midazolam infusion at 40 μg·kg-1 · h-1 in group Ⅰ.And a loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml) was given intravenously over 10 minutes,followed by dexmedetomidine at 0.5 μg· kg-1 · h-1 in group Ⅱ.At 5 minutes after administration of the loading dose of midazolam or dexmedetomidine,a loading dose of sufentanil 0.2 μg/kg was given,and then patient-controlled intravenous anesthesia (PCIA) with sufentanil (with the background infusion of 0.1 μg·kg-1 · h-1,bolus dose of 0.1 μg/kg and lockout interval of 3 minutes) was used.The operation was started 2 minutes after administration of the loading dose of sufentanil.The incidences of bradycardia,tachycardia,hypotension,hypertension and respiratory depression were recorded.The total attempts and effective pressing times of PCIA were also recorded.Results There was no significant difference in the incidences of bradycardia,tachycardia,hypotension,and hypertension between the two groups (P ＞ 0.05).The incidence of respiratory depression was significantly lower,and the total attempts and effective pressing times were smaller in group Ⅱ than in group Ⅰ (P ＜ 0.05).Conclusion The anesthetic efficacy of dexmedetomidine and sufentanil is better than that of midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.

Objective Through utilizing the existing human resources and establishing stratified management modes based on the responsibility of the leader of nursing teamwork to reduce nursing de-fects and nursing disputes, and improve the quality of emergency care. Methods Nurses in the depart-ment of emergency were stratified, and the stratified management modes based on the responsibility of the leader of nursing teamwork was implemented. Then the results underwent analysis and feedback through assessment. Results Quality of care, the satisfaction degree of patients, doctors and the relevant depart-ments before and after the implementation had statistical significance by χ2 test. The cases of nursing de-fects reduced from 5 in 2005 to 1 in 2007 and nursing disputes reduced from 5 in 2005 to 0 in 2007.The intact rate of first aid materials increased from 98% in 2005 to 100% in 2007. Conclusions The strati-fied management modes can ensure that the quality of emergency care implemented in every hour and link, and can reduce the nursing defects and disputes, increase patient satisfaction degree and improve quality of care. So the stratified management modes are worthy of clinical reference in emergency department.