Objective:To investigate the optimal dose of dexmedetomidine combined with propofol for anesthesia in patients undergoing modified electroconvulsive therapy (MECT).Methods:One hundred and sixty patients of both sexes, aged 20-60 yr, weighing 45-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective MECT, were allocated into 4 groups ( n=40 each) by a random number table method: different doses of dexmedetomidine combined with propofol group (D 1, D 2 and D 3 groups) and routine anesthesia group (group C). Dexmedetomidine 0.2, 0.4 and 0.6 μg/kg were intravenously injected in D 1, D 2 and D 3 groups, respectively, the equal volume of normal saline was given instead in group C, and propofol 1.0 mg/kg and succinylcholine 0.5 mg/kg were intravenously injected in turn 10 min later.Venous blood samples were collected before giving dexmedetomidine (T 0) and at 1 min after the end of MECT (T 1) for determination of the plasma epinephrine (E) and norepinephrine (NE) concentrations.Propofol consumption, occurrence of cardiovascular events, duration of epilespsy and energy suppression index were recorded. Results:Compared with group C, the plasma E and NE concentrations were significantly decreased at T 4, and the propofol consumption was reduced in D 1, D 2 and D 3 groups ( P<0.05). Compared with group D 2, the plasma E and NE concentrations were significantly increased at T 1 in group D 1 and decreased at T 1 in group D 3 ( P<0.05). The incidence of adverse cardiovascular events was significantly increased in group D 3 than in the other 3 groups ( P<0.05). There was no significant difference in duration of epilespsy or energy suppfession index among the 4 groups( P>0.05). Conclusion:The optimal dose of dexmedetomidine combined with propofol 1.0 mg/kg is 0.4 μg/kg when used for anesthesia in the patients undergoing MECT.

Objective:To investigate the current situation of medication near-miss reporting barriers for pediatric nurses for pediatric nurses and analyze its influencing factors.Methods:Using a multi-stage cluster sampling method, clinical pediatric nurses from 13 hospitals of Henan Province were selected as research objects from July to October 2020. General situation questionnaire, Hospital Safety Atmosphere Questionnaire, Medication Near-miss Reporting Barriers Scale, Multiple Leadership Style of Head Nurse Scale and Patient Safety Competency Nursing Staff Self-rating Scale were used for investigation, and related factors affecting medication near-miss reporting barriers for pediatric nurses were analyzed. A total of 1 104 questionnaires were distributed and 1 070 were effectively returned, with the effective recovery rate of 96.92%.Results:The reporting rate of 1 070 pediatric nurses who actively reported medication near-miss reporting barriers was 14.42%, and the score of Medication Near-miss Reporting Barriers Scale was (98.1±21.46) . The total scores of Hospital Safety Atmosphere Questionnaire was (77.36±12.97) , score of Multiple Leadership Style of Head Nurse Scale was (74.4±15.89) , and score of Patient Safety Competency Nursing Staff Self-rating Scale was (107.81±2.59) . The results of multiple linear regression analysis showed that educational background, entry length, job title, marital status, leadership style, patient safety competence, and hospital safety atmosphere were the main influencing factors of medication near-miss reporting barriers for pediatric nurses ( P<0.05) . Conclusions:The medication near-miss reporting barriers for pediatric nurses are common, which are influenced by educational background, years of employment, leadership style, hospital safety atmosphere and other factors. Nursing managers should strengthen pediatric nurses' awareness of medication near-miss reporting, implement transformational leadership style and improve patient safety competence and hospital safety atmosphere, so as to promote drug use safety of children.