Objective To investigate the effect of combined general anesthesia with localanesthetic infiltration on heart rate variability and hemodynamics in laparoscopic cholecystectomy.Methods By simple randomization 70 patients undergoing laparoscopic cholecystectomy were assignedto two groups,68 patients completed the study(34 in each group).Group GA was given generalanesthesia.Group GL was given general anesthesia combined with local anesthetic.Iow-frectuency(LF),high-frequency(HF),LF/HF,Lfnu(LF/TP×100%),Hfnu(HF/TP×100%)and totalpower(TP),were recorded at the time points of baseline(T_0),skin incision(T_1),skin closure(T_2)and 1 h(T_3),3 h(T_4)after surgery.MAP and HR were recorded at the points of baseline,skinincision,skin closure and 1,3 h after surgery.Results Compared with the baseline,there was anincrease in MAP and HR at T_1,T_3,T_4(P<0.05)in group GA. Heart rate variability changesshowed that in group GA Lfnu,LF/HF increased significantly at T_1-T_4(P<0.05)and in group GLLF/HF increased significantly at T_1,T_2(P<0.05),and TP in group GA and group GL decreasedsignificantly at T_1,T_2(P<0.05).Conclusion Our results support that combined general anesthesiawith local anesthetic infiltration has lass influence on hemodynamics and automomic nerve,and can bean useful analgesic adjuvanct for patients undergoing laparoscopic cholecystectomy.

Objective To observe the effect of Nalmefene on postoperative recovery on neonates by laparoscopic pyloromyotomy. Methods Elective laparoscopic pyloromyotomy for 60 neonates under general anestheisa, aged 15 ~ 28 days, ASA Ⅱ~Ⅲ , were randomly divided into two groups: Nalmefene group (M group) and Naloxone group (L group), 30 cases in each. Nalmefene 0.25 μg/kg and Naloxone 1.00 μg/kg were respectively administrated in M group and L group when the procedures finished. Parameters SpO2, MAP, HR and RR were measured and analyzed statistically at different times: end of surgery before drugs were used (T0), 10 min after administration (T1), 30 mins after extubation (T2) and 2 h after extubation (T3). Meanwhile observing spontaneous breathing recovery time, extubation time, residence time at PACU and adverse events 24 s after surgery. Results There were no actual differences in the value of MAP, HR and SpO2 at T0, T1, T2 and T3 times in the two groups (P > 0.05). However, the values of RR was significant faster at T1, T2 and T3 times than that at T0 in both groups (P < 0.05), compared with L group, the value of RR at T1 was much faster in M group (P < 0.05). The times of extubation and residence at PACU have significant differences in M group than that in L group (P < 0.05). The adverse events in both groups have no differences. Conclusion Nalmefene can facilitate the recovery at laparoscopic pyloromyotomy on neonates. Compared with naloxone, it can reduce the extubation time, and promote the early rehabilitation.

Objective To observe the impact of Dezocine used before end of operation on postoperative recovery and safety effect on postoperative pain in children receiving laparoscopic appendectomy. Methods 60 ASAⅠ ~ Ⅱcases of aged 4~10 yr, underwent laparoscopic appendectomy, were randomly divided into 3 groups: Dezocine group (D group), Fentanyl group (F group) and control group (normal saline group), 20 cases in each group. Remifentanil combined with Propofol and Sevoflurane was given for conducting endotracheal intubation general anesthesia. At 30 min before the end of operation, D group was given Dezocine 0.10 mg/kg, while F group fentanyl 1.0 μg/kg, and the control group was given same volume of normal saline. 5 min before the end of the operation anesthetics disabled, then extubation until children open eyes on call and spontaneous breathing recovered satisfactorily. Observe and record MAP, HR, SPO2 and respiration rate (RR) at different times:drug withdrawal, extubation and 5 min after ex﹣tubation, while also record extubation time, Riker sedation-agitation scores and face, legs, activity, cry and consola﹣bility (FLACC) scores and adverse reactions in the recovery period (within 30 min after extubation). Results MAP and HR at extubation and 5 min after extubation in N group and F group were higher than that in D group (P<0.05);Compared with drug withdrawal time, HR and MAP at extubation and 5 min after extubation in group F and N were much higher (P< 0.05); MAP, HR, SPO2 and RR had no statistically significant difference in D group at each time point (P> 0.05). The Riker sedation-agitation scores and the FLACC scores at 30 min after extubation in D group were significantly lower than those in the F and N groups (P<0.05), adverse reaction such as respiratory inhi﹣bition, nausea, vomiting, lethargy, headache were not found in the 3 groups. Conclusion Intravenous Dezocine before the end of operation in children's laparoscopic operation can make awake quickly and smoothly, allow small hemo﹣dynamic changes, and can reduce postoperative pain and restlessness.

Objective To evaluate the relevance of PET CO 2 ,TcPCO 2 and PaCO 2 in pediatric patients with congenital heart disease.Methods Eighty pediatric patients with congenital heart disease were scheduled for elective cardiac operation with cardiopulmonary bypass,aged 1 month to 5 years, 42 male and 38 female,were divided into 4 groups:group N1,cyanotic type congenital heart disease with severe pulmonary hypertension;group N2,cyanotic type congenital heart disease without pul-monary hypertension;group N3,non-cyanotic congenital heart disease with severe pulmonary hyper-tension;group N4,non-cyanotic congenital heart disease with mild pulmonary hypertension or normal of pulmonary artery pressure,20 cases in each group.The same anesthesia methods were selected in each group.PET CO 2 ,TcPCO 2 and PaCO 2 before operation were recorded,and the relevance among them was analyzed.Results In groups N1,N2 and N3,the differences of PET CO 2 and PaCO 2 were significant,,while the difference was relatively small in group N4;the difference of TcPCO 2 and PaCO 2 were relatively small between the four groups.In Groups N1,N2 and N3,the values of TcP-CO 2-PaCO 2 value were significantly less than that of PET CO 2-PaCO 2 ;in group N4,TcPCO 2-PaCO 2 value was obviously higher than that of PET CO 2-PaCO 2 values (P < 0.01 ).Correlation analysis of PET CO 2 and PaCO 2 showed that R2 in the groups N1,N2,N3,N4 were 0.028,0.1 97,0.390, 0.71 1(P >0.05,0.02