Visualization technology is more and more widely used in clinical anesthesia.Nerve block in pediatric anesthesia assisted by visual technique of ultrasound not only achieved the similar curative effect as traditional blind operation but also had lower incidence of complications,so this technology is more and more useful in pediatric anesthesia.This article reviewed the progress of the application of ultrasound guided nerve block in pediatric anesthesia.

From October 2014 to June 2015, among 5 800 pediatric patients underwent outpatient sedation in MRI and Special Inspection Departments at our hospital, the incidence of sedation-related ad-verse events was 272%(158 cases), and the mortality rate was 003%(2 cases)in pediatric outpa-tients. The common adverse events were nausea and vomiting(constituent ratio 3214%), regurgitation and aspiration(constituent ratio 2443%), respiratory depression(constituent ratio 2928%), agitation (constituent ratio 1571%)and delayed recovery(constituent ratio 143%). When chloral hydrate was used for sedation, it should be mixed with sugar to prevent the occurrence of nausea and vomiting; young age(especially preterm infant), diseases of respiratory system or nervous system and congenital heart dis-ease were the possible inducements to sedation-related adverse events, and intervention strategy should be performed to decrease the occurrence of adverse events and to improve the quality of sedation in pediatric outpatients.

Objective To evaluate the efficacy of Arndt endobronchial blocker (AEB) for airway management during one-lung ventilation (OLV) in pediatric patients.Methods Thirty pediatric patients,aged 4 months-12 yr,weighing 5.6-26.0 kg,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,scheduled for elective thoracotomy under OLV requiring the use of single lumen tracheal tube assisted by AEB,were enrolled in this study.OLV was performed with the AEB placed outside the single lumen tracheal tube in pediatric patients below 2 years old and with AEB inserted through the single lumen tracheal tube in pediatric patients ≥ 2 years old.The rate of successful establishment of artificial airway at first attempt,time of establishing artificial airway,time of pulmonary collapse,AEB malpositions and airway pressure before and after OLV were recorded,and the efficacy of lung collapse was evaluated.Results The rate of successful tracheal intubation of extraluminal and endoluminal AEB placement at first attempt was 100％ in 30 pediatric patients,and no high airway pressure was found after OLV.The efficacy of lung collapse was poor in one patient and good in one patient,and intraoperative AEB malpositions were found in two patients among the pediatric patients used extraluminal AEB placement.The efficacy of lung collapse was good in one patient,intraoperative AEB malposition was found in one patient,and SpO2 was decreased after OLV in one patient among the pediatric patients used endoluminal AEB placement.Conclusion Reasonably selecting the method of placing AEB followed by enhancing intraoperative airway management can be safely and effectively applied for OLV in pediatric patients.

Objective To evaluate the efficacy of general anesthesia combined with ultrasoundguided epidural block for laparoscopic surgery in neonates.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ neonates,aged 20-60 days,scheduled for elective radical operation for Hirschsprung's disease,were divided into 2 groups (n=30 each) using a random number table:general anesthesia group (group Ⅰ) and general anesthesia combined with ultrasound-guided epidural block group (group Ⅱ).Anesthesia was induced by inhaling 8％ sevoflurane.Anesthesia was maintained with Ⅳ sufentanil 0.2 μg/kg,cisatracurium 0.1 mg/kg and then with additional sufentanil 0.1 μg/kg and cisatracurium 0.05 mg/kg every hour and 2％-3％ sevoflurane was simultaneously inhaled in group Ⅰ.In group Ⅱ,anesthesia was maintained by inhaling 2％-3％ sevoflurane,epidural block was performed at L1.2 interspace,the catheter was caudally advanced into the epidural space under ultrasound guidance,0.8％ lidocaine was injected at a loading dose of 6 mg/kg,the local anesthetic diffusion in the epidural space was observed,and additional 0.8％ lidocaine 3 mg/kg was given every 30 min.Heart rate and mean arterial pressure were recorded at 5 min before pneumoperitoneum,during pneumoperitoneum,at extubation and after extubation.The extubation time,duration of recovery room stay and development of assisted ventilation after extubation were recorded.Pain was assessed and scored at 5 min before discharge from recovery room.The development of epidural block-related complications was recorded in group Ⅱ.Results Operation was smoothly completed with stable anesthesia in two groups.Compared with group Ⅰ,the mean arterial pressure was significantly decreased during pneumoperitoneum and after extubation,the extubation time and duration of recovery room stay were shortened,and the requirement for assisted ventilation after extubation and pain scores were decreased in group Ⅱ (P＜0.05 or 0.01).No epidural block-related complications were found in group Ⅱ.Conclusion General anesthesia combined with ultrasound-guided epidural block is safe and effective for laparoscopic surgery and is helpful for postoperative recovery in neonates.

AIM: To explore the effect and mechanism of Vinfluoxine on long-term learning and memory function in infant mice. METHODS: Sixty SD infant rats were randomly divided into Control group, Anesthesia group, Vinpocetine group (5 mg/kg), Vinpocetine group (10 mg/kg), GSK3β inhibition group (10 mg/kg), with 12 infant rats in each group. Two hours before anesthesia, the infant rats in each group were injected with the corresponding drugs. Except for the control group, each group continued to inhale 4% sevoflurane for 4 hours. After 8 weeks, the Morris Water Maze experiments were started. Immunofluorescence double stains were used to detect neuronal proliferation in the brain. Western Blot was used to detect the protein expression in the hippocampus. RESULTS: There was no significant difference in the incubation period of the rats in the early training groups. On the third day of training, compared with the control group, the rats in the anesthesia group reached a significantly increased platform incubation period (P<0.05); In contrast, the intervention of vinpocetine and SB216763 significantly reduced the latency of rats to reach the platform (P<0.05). And in the test, compared with Anesthesia group, the 10 mg/kg vinpocetine and SB216763 intervention rats achieved a significant reduction in the latency of the first time to the platform (P<0.05), and the number of platforms crossing increased significantly (P<0.05). At the same time, sevoflurane anesthesia mediated a significant decrease in the number of BrdU/NeuN positive cells in rats (P<0.05). In addition, sevoflurane mediated a decrease in Wnt3a expression, an increase in p-GSK3β expression, and a decrease in β-catenin expression in the hippocampus (P<0.05). The intervention of vinpocetine and SB216763 significantly reversed the expression of these cells and proteins. CONCLUSION: Vinpocetine improves the long-term learning and memory function of sevoflurane anesthesia-induced infant rats through Wnt/GSK3β/β-catenin signaling pathway.