Objective To evaluate the relationship between the optimum preoperative fasting time and in tervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery by measuring the gastric antral cross-sectional area (CSA) using ultrasound.Methods Fifty ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing elective orthopedic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:6-h fast group (group CA) and 8-h fast group (group CB).Seventy-five ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing the emergency orthopedic surgery,were randomly divided into 3 groups according to the interval between eating and trauma:interval ≤ 1 h group (TA group,n =22),1 h ＜ interval ≤ 4 h group (TB group,n =26) and interval ＞ 4 h group (TC group,n =27).CSA was measured at 6 h after the last eating (T1) in group CA,8 h after the last eating (T2) in group CB and T1 and T2 in TA,TB and TC groups.Results There was no significant difference in CSA between group CA and group CB (P ＞ 0.05).Compared with group CA,CSA was significantly enlarged in TA and TB groups (P ＜ 0.05) and no significant change was found in group TC (P ＞ 0.05).Compared with group CB,CSA was significantly enlarged in TA group (P ＜ 0.05),and no significant change was found in TB and TC groups (P ＞ 0.05).Compared with group TA,CSA was significantly decreased at T1 in TC group and T2 in TB and TC groups (P ＜ 0.05),and no significant change was found at T1 in TB group (P ＞ 0.05).Compared with group TB,CSA was significantly decreased at T1 (P ＜ 0.05),and no significant change was found at T2 in TC group (P ＞ 0.05).Compared with the CSA measured at T1,CSA was significantly decreased at T2 in TB group (P ＜ 0.05),and no significant change was found at T2 in TA and TC groups (P ＞0.05).Conclusion For the pediatric patients undergoing emergency orthopedic surgery,when the interval between eating and trauma is within the period of 1-4 h,an 8-h preoperative fast is recommended; when the interval ＜ 1 h,an 8-h preoperative fast is still not able to achieve the aim of fasting and measures should be taken to avoid regurgitation of gastric contents; when the interval ＞ 4 h,the preoperative fasting time can be properly shortened to 6h.

Objective To assess the accuracy of ultrasonographic measurement of gastric fluid volume in predicting the occurrence of nausea and vomiting during and after emergency cesarean section.Methods Seventyseven ASA Ⅰ-Ⅲ patients aged 18-35 yr weighing 66-87 kg undergoing emergency cesarean section were divided into 3 groups according to the preoperative gastric fluid volume:group A ≤ 0.4 ml/kg (n =21); group B 0.4-0.8ml/kg (n =34) and group C ＞ 0.8 ml/kg (n =22).Gastric fluid volume was calculated by Bouvet regression equation,based on antral area of the stomach measured with M-Turbo ultrasonography system (Somo Site Co.USA).Cesarean section was performed under combined spinal-epidural anesthesia with 0.4％ ropivacaine.BP,HR and SpO2 were measured and recorded after entering the operating room,at skin incision and at the end of operation.The occurrence of nausea and vomiting was recorded during operation and within 1 h after operation.Results There was no significant difference in hemodynamic variables among the 3 groups.The incidence of nausea was comparable among the 3 groups:33％ in group A,35％ in group B and 46％ in group C,while the incidence of vomiting was significantly higher in group C (46％) than in group A (10％) and group B (15％).Conclusion The incidence of vomiting is significantly higher during and within 1 h after emergency cesarean section in patients with preoperative gastric fluid volume ＞ 0.8 ml/kg,but the incidence of nausea is not related to preoperative gastric fluid volume.

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by lowcurrent nerve stimulation when used to assist ultrasound-guided lumbar plexus block.Methods One hundred patients of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 50-85 kg,scheduled for elective unilateral knee arthroscopy,were selected and randomly divided into 2 groups (n =50 each) using a random number table:ultrasound assisted by nerve stimulator group (group SU) and ultrasound group (group U).The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU,the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture,and 0.5％ ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U,when the tip of the nerve stimulating needle was located around the lumbar plexus,which was confirmed by ultrasound,0.5％ ropivacaine 0.4 ml/kg was administrated.The time of puncture,depth of needle insertion,onset time of block and effective block were recorded.Motor block was assessed using the modified knee score,and the development of complications was recorded within 24 h after block.Results Compared with group U,the onset time of block was significantly shortened,the rate of effective block was increased,the degree of motor block was aggravated (P＜0.05),and no significant change was found in the time of puncture or depth of needle insertion in group SU (P＞0.05).No complications were observed in two groups.Conclusion Low-current (0.35 mA) nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block.

Objective To evaluate the efficacy of dexmedetomidine injected into axillary sheath in alleviating the tourniquet pain during brachial plexus block with ropivacaine.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 52-85 kg,scheduled for the replantation of amputated finger,were randomly divided into 2 equal groups (n =30 each):ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).All patients underwent axillary brachial plexus block guided by a nerve stimulator.When the intensity of electric stimulation ≤ 0.4 mA,flexion of fingers or wrist still existed,and the local anesthetic was injected into the axillary sheath.0.5％ ropivacaine 40ml was injected in group R.0.5％ ropivacaine mixed with 100μg dexmedetomidine 40ml was injected in group DR.The pressure of inflation was set at 200-250mmHg,and the stress duration was 120 min.Tourniquet pain and the level that the patients could tolerate was evaluated using visual analog scale (VAS) at 120 min of stress status.The patient' s satisfaction with anesthesia was rated and the development of adverse cadiovascular events and local and systemic adverse reactions were recorded.Excessive sedation was measured with Ramsay score in group DR.Results Compared with group R,the tourniquet pain that the patients could tolerate was significantly increased,the severity of tourniquet pain was reduced and the incidence of adverse cadiovascular events was decreased in group DR (P ＜ 0.01).No serious tourniquet-related complications were observed in both groups.No patients developed excessive sedation in group DR.Conclusion Dexmedetomidine 100μg injected into the axillary sheath can safely and effectively alleviate the tourniquet pain when used during brachial plexus block with ropivacaine.

Objective To evaluate the value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients who required ultrasound-guided lumbar plexus block,aged 18-60 yr,weighing 55-85 kg,were randomly divided into 3 groups (n=30 each):sterile protective film group (group F),traditional physical method group (group TP) and traditional chemical method group (group TC).The probe was sterilized using a sterile protective film in group F,using a sterile glove in group TP,and using 70%-80% alcohol in group TC.Microbiological detection of probe was carried out subsequently,and the relative sterility was defined as the total number of colonies was less than or equal to 5 cfu/cm2.The time spent in sterilizing probe and in performing lumbar plexus block was recorded.The sterile qualified rates of scanning surface and handle of probe were calculated.The ultrasonic image quality was assessed by using a 4-point scale,and the number of display areas was recorded by Moro method.Results Compared with group TP,the time spent in sterilizing probe and in performing lumbar plexus block was significantly prolonged,the sterile qualified rate of probe handle and ultrasonic image quality were increased,and the number of display areas was increased in group F (P<0.05).Compared with group TC,the time spent in sterilizing probe was significantly shortened,and the sterile qualified rates of scanning surface and handle were increased in group F (P<0.05 or 0.01).Conclusion The probe sterile protective film exerts simple operation,strict sterile effect and little influence on ultrasonic image,the efficacy is superior to that of traditional methods,and it is more suitable for probe sterilization when applied to ultrasound-guided peripheral nerve block.

Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade (method M) and anterior neck soft tissue quantification measured by ultrasound (method U) were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was (23.0±3.0) mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy ((1.9±2.2) mm).The sensitivity,specificity and accuracy of method U were 91％,92％ and 92％,respectively,and of method M were 77％,81％ and 80％,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.

OBJECTIVE:To observe the clinical efficacy of the Humai powder for chemotherapy phlebitis. METHODS:80 pa-tients with chemotherapy phlebitis were randomly divided into treatment group and control group with 40 cases in each group. Treat-ment group was given Humai powder for external use,1 h/time,2 times/d;control group was given Hirudoid cream for external use,2 times/day. Venous pain,red and swollen disappearance time,and overall clinical efficacy were compared between 2 groups after treatment 48 hours. RESULTS:The time of red and swollen disappearance and pain disappearance in treatment group were shorter than in control group,with statistical significance (P<0.05);there was no statistical significance in clinical efficacy (cure rate + significant efficiency)between 2 groups(P>0.05),while cure rate of treatment group was significantly higher than that of control group (P<0.05). CONCLUSIONS:Humai powder can relieve clinical symptom of patients with chemotherapy phlebitis and has high cure rate.

Objective To investigate the efficacy of adductor canal block (ACB) under the guidance of ultrasound for postoperative analgesia in the pediatric patients undergoing knee operation.Methods Sixty pediatric patients,aged 3-12 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 12-35 kg,scheduled for elective unilateral knee operation,were selected and randomly divided into 2 equal groups using a random number table:ultrasound-guided ACB group (group ACB) and ultrasound-guided femoral nerve block (FNB) group (group FNB).After induction of general anesthesia,ACB or FNB was performed under the guidance of ultrasound,and 0.3％ ropivacaine 1 ml/kg was injected.Anesthesia was maintained with intravenous infusion of remifentanil combined with propofol,and bispectral index value was maintained at 40-60.Immediately after injection of local anesthetics (T0),and at 4,8,12 and 24 h after injection (T1-4),analgesic efficacy was assessed using the FLACC pain scale,and quadriceps strength was assessed by manual muscle testing.Satisfactory analgesia was defined as FLACC score ≤ 3,and obvious quadriceps weakness was defined as manual muscle testing grade 0-2.The complications associated with nerve block (such as local anesthetic toxicity,bleeding at the puncture site,hematoma),and occurrence of postoperative nausea and vomiting and delayed emergence were recorded.Results There was no significant difference between two groups in the rate of satisfactory analgesia at T1-T4 (P＞ 0.05).Compared with group FNB,the incidence of obvious quadriceps weakness was significantly lower at T1-T3 (P＜0.05),and no significant change was found at T4 in group ACB (P＞0.05).There was no significant difference in the incidence of nausea or retching between two groups (P＞0.05).Complications associated with nerve block,vomiting and delayed emergence were not observed in the two groups.Conclusion Ultrasound-guided ACB can be safely and effectively used for postoperative analgesia in the pediatric patients undergoing knee operation,and it has less influence on the quadriceps strength than FNB.

Objective To evaluate the reliability of ultrasound for rapid identification of esophageal intubation in the patients with difficult airway.Methods Twenty-one patients requiring orotracheal intubation, aged 20-75 yr, with body mass index of 25-32 kg/m2, of ASA physical status Ⅰ or Ⅱ , Cormack-Lehane grade Ⅲ or Ⅳ under direct laryngoscope, undergoing elective general anesthesia, were selected.The carotid artery, trachea and esophagus were identified by ultrasonic scanning at suprasternal notch before induction of anesthesia.After induction of anesthesia, tracheal intubation was performed.During intubation, ultrasound was performed to detect esophageal intubation.After intubation, mechanical ventilation was performed.Auscultation of bilateral breath sounds was carried out to evaluate the tube position.The position of the tube was subsequendy determined through partial pressure of end-tidal CO2 monitoring.Results The sensitivity and specificity of ultrasound in identifying esophageal intubation were both 100％ in the patients with difficult airway.Conclusion Ultrasound can rapidly and effectively identify esophageal intubation in the patients with difficult airway.

Objective To develop a new treament strategy for Kasabach-Merritt syndrome.Methods Three infants who were diagnosed with Kasabach-Merritt syndrome and suffered from thrombocytopenia as well as bleeding and clotting disorders were treated with percutaneous selective digital subtraction angiography combined with transarterial hardened embolization under general anesthesia.Sclerosing agents included bleomycin A5 (4.0 mg),iodized oil (1.5 ml),dexamethasone (2.5 mg) and iopamidol (3 ml).Polyvinyl alcohol mixed with iopamidol (at a volume fraction of 0.5) served as the embolic material.Results All the three patients were successfully treated by the minimally invasive surgery.The amount of blood platelet returned to normal within 24 hours after the operation.On the fourth day,all the patients were discharged from hospital with the restoration of coagulation function.Revisits at one month and three months after the operation showed that hemangiomas markedly shrank and even subsided,and blood platelet count was maintained within normal range.Conclusions Percutaneous selective digital subtraction angiography combined with transarterial hardened embolization can result in a recovery of blood platelet count and shrinkage of hemangioma,and may serve as a minimally invasive treatment option for Kasabach-Merritt syndrome.