ObjectiveTo evaluate effects of post-operative analgesia combined with parental presence on emergence agitation after sevoflurane anesthesia in children. Methods60 patients were randomly assigned into three groups with 20 cases each. After sevoflurane inhalation and being given rocuronium, all patients were intubated for mechanical ventilation. Then patients received caudal block. Patiens in group A and B were treated with diclofenac sodium suppositories before operation. To maintain anesthesia patients were adopted sevoflurane inhalation. Patients in group A and C were cared by nurses in post anesthesia care unit, whereas patients in group B added parental presence. Emergence agitation incidence, modified Aldrete scale, PAEDS, CHEOPS were all recorded. ResultsTherewas no difference of modified Aldrete scale among three groups( F =0.652 ,P ＞0. 05) ,but emergence agitation incidence in group C was more than those of group A and B. At each point PAEDS scores of group B were lower than those of group C( x2 =4. 566,7. 234,4. 124,6. 126, P ＜ 0. 05) ,also scores of group B were lower than those of group A at 10 min and 30 min(F=0.654,P＞0.05). PAEDS scores of group A were lower than those of group C at 20min and 30min(t =3.256,3.778,4.556,4.223 ,all P＜0.05). At 20min and 30min CHEOPS scores of group C were higher than those of group A and B ( F =1. 987, P ＞ 0.05 ). ConclusionPost-operative analgesia combined with parental presence could decrease the incidence of emergence agitation after sevoflurane anesthesia in children.

Objective To investigate the effect of two modes of ventilation on pediatric patients undergoing lung lobectomy.Methods Forty ASA Ⅰ～Ⅲ patients aged 2～10 years,undergoing lung lobectomy were randomly divided into VCV and PCV group(n=20).After general anesthesia,patients in VCV group were ventilated on volume-control mode maintaining 30min and then changed into pressure-control mode;patients in PCV group were ventilated on pressure-control mode maintaining 30min and then changed into volume-control mode.Ppeak,Pplat,Raw,MVI,MVE and EtCO2 were measured according to SSS monitor system.All the patients were treated with traumatic blood pressure measurement,and all the patients were analyzed during the period of pre-operation,30min and 60min after ventilation.Results Compared with VCV group,breathing mechanics MVI and MVE in the PCV group were increased(t=4.135,3.988,P＜0.05)and PaO2 in the PCV group was significantly increased(t=3.183,P＜0.05),as compared with those on volume-control mode.Conclusion PCV mode was benefit for preventing low oxygen in lung lobectomy surgery.

Child ; Hematology ; history ; History, 20th Century ; History, 21st Century ; Humans ; Pediatrics ; history ; Societies, Medical ; history

Objective To evaluate the effect and safety of combined intravenous-inhaled anesthesia and caudal block in laparoscopy for neonates. Methods Forty patients aged 5 ～ 28 days(ASA Ⅰ～Ⅱ)were randomly assigned to two groups with 20 cases in each.Patients in the treatment group received intravenous-inhaled anesthesia combined with caudal block(0.8% lidocaine 8 mg/kg),the control group received intravenous-inhaled anesthesia.Vital sign profiles,airway pressure,blood gas analysis and adverse effects were recorded. Results The changes of SBP,DBP and HR in treatment group were lower than those of control group at T2 and T3.All markers at T2,T3 were higher than those of T1 in control group.Airway pressure and PaCO2 were lower than those of control group at T2 and T3.However,airway pressure and PaCO2 at T2,T3 were higher than those of T1 in control group. Conclusion Combined intravenous-inhaled anesthesia and caudal block was effective in laparoscopy for neonates.

Objective To compare the clinical efficacy and safety of esomeprazole in treatment of elderly and young patients with gastric ulcer.Methods 120 cases of elderly patients with gastric ulcer and 95 cases of young and middle-aged patients with gastric ulcer were selected this study.Two groups of patients were treated with amoxicillin and clavulanate potassium dispersible tablets 0.457 g,tinidazole tablets 0.5 g and esomeprazole magnesium enteric coated tablets 20mg orally,once daily treatment 1 week for a course of treatment,1 week after continue to every morn-ing fasting taking esomeprazole 20mg,1 times/D,treatment for 3weeks.The clinical curative effect,Hp clearance rate and incidence of adverse reactions between two groups of patients after treatment were compared.Results The total effective rate in the treatment of elderly group patients (87.50%)compared with young and middle -aged group (92.63%),there was no significant difference (χ2 =1.52,P>1.52).Elderly group of patients with helicobacter pylori clearance rate (71.67%)compared with young and middle-aged group (76.84%),there was no significant difference (χ2 =0.74,P>0.74).The incidence of adverse reactions (8.33%)of elderly group had obvious differ-ences by comparing with young and middle -aged group (2.1 1%),and the difference was statistically significant (χ2 =3.90,P<0.05).Conclusion Application of esomeprazole based triple therapy in the treatment of the elderly and young people in the gastric ulcer could heal ulcers and eradicate Hp,but young and middle -aged patients is superior to the elderly group in terms of adverse reactions.

0.05). The core temperature, levels of TNF-?,IL-6 and IL-8 were lower at t2 and t3 in group Ⅱ than those in group Ⅰ (P

Objective To analyze the effect of different methods of anesthesia maintenance on clinical efficacy and postoperative recovery in elderly patients with gynecological diseases undergoing laparoscopic surgery.Methods A total of 80 elderly patients with gynecological diseases scheduled for laparoscopic surgery were enrolled in this study in our hospital from January 2015 to December 2016.All the patients were randomly divided into two groups of anesthesia maintenance:an intravenous anesthesia alone (n=40) and a combined intravenous and inhaled anesthesia (n =40).The pre-and post-anesthesia changes in arterial blood gas,blood pressure,heart rate and cognitive function,and postoperative complications were analyzed and compared between the two groups.Results There were no significant differences between the two groups in the times of palinesthesia,extubation and talking (all P＞ 0.05).After anesthesia,the levels of arterial blood gas,the blood pressure and the heart rate were relatively stable in both groups,and their differences between the two groups were without statistically significant (all P ＞ 0.05).While,the postoperative cognitive function recovered more rapidly in patients receiving intravenous anesthesia alone for anesthesia maintenance than in those receiving a combined intravenous and inhaled anesthesia,especially at 6 h after extubation.The Mini-mental State Examination (MMSE) score was significantly higher in patients receiving intravenous anesthesia alone (28.8 ± 0.5) than in patients receiving a combined intravenous and inhaled anesthesia (25.1 ±0.6),with statistically significant difference (P＜ 0.05).In addition,there was no statistical difference between the two groups in the incidence of complications.Conclusions As anesthesia maintenance,both an intravenous anesthesia alone and a combined intravenous and inhaled anesthesia can ensure a successfully laparoscopic surgery for gynecological diseases in elderly patients.However,the impact on cognitive function after laparoscopic surgery is smaller in the maintenance of intravenous anesthesia alone than in a combined intravenous and inhaled anesthesia in elderly patients.Intravenous anesthesia alone can be used in elderly patients to receive laparoscopic surgery as routine anesthesia maintenance.

Objective To analyze related perioperative risk factors of acute respiratory distress syndrome (ARDS) early after orthotopic liver transplantation (OLT).Methods The cases from the recipients having undergoing OLT,aged from 15 to 65 years and having no chronic respiratory diseases and hyoxemia were collected.The exclusive criteria were as follows:(1) the patients dead or automatic discharging at the day after the OLT or during the OLT; (2) the patients suffered from severe surgical technic complications; (3) initial poor graft function occurred; (4) marginal donor; (5) pulmonary wedge pressure (PAWP)＞ 2.394kPa.251 patients were enrolled in this analysis,who were grouped according to whether they developed ARDS (group B) or not (group A) in the first postoperative day.The analyzed factors were as follows:(1) the sex,age and weight of the recipients; (2) preoperative variables of recipients:Child-Pugh and Model for end-stage liver disease (MELD) score,left vent ricular ejection fractions,oxygenation index,the serum levels of creatinine,BUN,TB,albumin,prealbumin,fibrinogen and hemoglobin,white blood cells (WBC),platelet count and international normalized ratio (INR) ; (3) the variables of donator:age,the time of warm and cold ischemia; (4) the intraoperative variables:operative time,anhepatic phase,the volumes of hemorrhage and blood-transfusion (red cell suspension and plasma),transfusion volume; (5) postoperative variables of recipients:the serum levels of creatinine,blood urea nitrogen (BUN),total bilirubin (TB),albumin,alanine aminotransferase (ALT),sodium and potassium,fibrinogen and hemoglobin,WBC,platelet count and INR.Results The mild ARDS incidence early after OLT was 25.5 ％ (65/251) and the moderate or severe was 4.8％ (12/265).Single factor analysis showed that the factors having significant difference between group A and group B were as follows:the age of the recipients,preoperative variables (Child-Pugh and MELD score,the preoperative serum levels of BUN,TB,prealbumin,fibrinogen and hemoglobin,WBC,platelet count and INR),the intraoperative variables (the volumes of hemorrhage and blood-transfusion including red cell suspension and plasma) and the postoperative variables (the serum levels of BUN,TB,sodium,fibrinogen and hemoglobin,WBC,platelet count and INR).The significant factors were put to the analysis of LOGISTIC regression,and the results showed that the age of recipients,preoperative Child-Pugh score,BUN and INR,intraoperative hemorrhage volume,postoperative serum level of sodium were the independent risks contributing to ARDS.Conclusion The mild ARDS incidence early after OLT was high but the the moderate or severe incidence was low.The age of recipients,preoperative Child-Pugh score,BUN and INR,intraoperative hemorrhage volume and postoperative serum level of sodium may be the main risk factors to lung injury after OLT.

Objective To investigate the correlation between serum C-reactive protein (CRP) level and carotid atherosclerotic plaque calcification in patients with ischemic stroke or transient ischemic attack (TIA).Methods The patients with non-cardiogenic ischemic stroke or TIA in anterior circulation performed head and neck vascular CTA at 1-6 months from the time of onset were enrolled prospectively.The demographic and clinical data were collected and serum CRP levels were detected.Univariate and multivariate logistic regression analyses were used to determine the correlation between the serum CRP level and the carotid atherosclerotic plaque calcification.Results A total of 165 patients were enrolled.Their age was 62.4± 10.6years,male patients accotnted for 66.7％;113 patients (68.5％)had carotid atherosclerotic plaque calcification (calcification group),52 (31.5％) did not have carotid atherosclerotic plaque calcification (non-calcification group).The age of the calcification group (median,interquartlle;66 [58-73] years vs.58 [51-66] years;Z=-3.738,P＜0.001) and CRP levels (1.9 [0.5-3.8] mg/L vs.0.0 [0.0-2.2] mg/L;Z =-4.126,P ＜ 0.001) were significantly higher than those of the non-calcification group.There were no significant differences in other baseline clinical data between the two groups.Multivariate logistic regression analysis showed that age (odds ratio 1.063,95％ confidence interval 1.024-1.104;P =0.001) and CRP levels (odds ratio 1.209,95％ confidence interval 1.030-1.419;P=0.020) were still significantly correlated with the plaque calcification after adjusting for other confounding factors.Conclucions Carotid plaque calcification was correlated with older age and increased serum CRP level in patients with ischemic stroke or TIA.

OBJECTIVE: To evaluate the efficacy of volume therapy with sodium acetate Ringer solution during the perioperative period in children with cyanotic congenital heart disease (CHD). METHODS: The children who underwent elective surgery for cyanotic CHD admitted to Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiaotong University from September to December 2018 were divided into three groups according to random number table with the informed consent of their legal representatives. All of the children received volume therapy with infusion of sodium acetate Ringer solution intravenously upon anesthesia induction. The volume of infusion was calculated according to the "4-2-1" formula (group A, the rehydration volume was 4 mL×kg^-1×h^-1 for the first 10 kg body weight, 2 mL×kg^-1×h^-1 for the second 10 kg, and 1 mL×kg^-1×h^-1 for the third 10 kg and above), and the volume was increased by 50% or 100% in groups B and C, respectively. The intravenous infusion lasted for 30 minutes in all the three groups. Arterial blood gas analysis was performed before and 30 minutes after infusion to observe the acid-base status and electrolyte level. Pulse oxygen saturation (SpO₂), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) before and 10, 20, 30 minutes after infusion, central venous pressure (CVP) at 30 minutes after infusion were recorded, as well as adverse events occurred after infusion. RESULTS: Twenty-six children with cyanotic CHD, 17 male and 9 female, aged from 1 to 36 months, body weight 3.6 to 16.0 kg, and America Society of Anesthesiologists (ASA) level of III or IV, were enrolled in the study. The pH value in group B at 30 minutes after infusion was significantly higher than that before infusion (7.35±0.05 vs. 7.32±0.06, P < 0.05), while no significant changes were found before and after infusion in the other two groups. The hematocrits (Hct) after infusion in three groups were significantly lower than those before infusion (0.433±0.141 vs. 0.473±0.146 in group A, 0.324±0.054 vs. 0.372±0.063 in group B, 0.363±0.097 vs. 0.418±0.111 in group C, all P < 0.01), indicating that all the children in the three groups achieved effective hemodilution. However, there was no significant difference in blood gas analysis before and after infusion among the three groups. The level of blood lactic acid (Lac) in all CHD children was decreased from (1.33±0.63) mmol/L to (0.98±0.36) mmol/L after infusion of sodium acetate Ringer solution, the serum Ca²⁺ concentration was decreased from (1.22±0.06) mmol/L to (1.19±0.06) mmol/L, and the serum Cl^- concentration was increased from (108.74±2.70) mmol/L to (109.77±2.54) mmol/L with the statistically significant differences (all P < 0.01). However, no significant difference was found in Lac or electrolyte levels before and after infusion among the three groups. There was no significant difference in vital signs before and after infusion among the three groups, but the period of infusion had an effect on SpO₂ (F = 5.998, P < 0.01), HR (F = 34.279, P < 0.01) and SBP (F = 4.345, P < 0.05). HR in groups A and C were significantly lower than those before infusion, and SBP in group A was decreased gradually with the prolongation of infusion time. The CVP value at 30 minutes after infusion in group B was higher than that in group A. No adverse reactions such as rash or anaphylactic shock occurred after infusion of sodium acetate Ringer solution in all children. CONCLUSIONS The perioperative volume therapy with sodium acetate Ringer solution in children with cyanotic CHD can effectively prevent the increase in Lac level and does not aggravate metabolic acidosis. The volume of infusion was well tolerated by all the children without disturbing the hemodynamic parameters.
Child, Preschool ; China ; Cyanosis/therapy* ; Female ; Fluid Therapy ; Heart Defects, Congenital/therapy* ; Humans ; Infant ; Infant, Newborn ; Infusions, Intravenous ; Male ; Perioperative Care ; Sodium Acetate/administration & dosage* ; Treatment Outcome