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Objective:To investigate the efficacy and safety of the Steward Scale(S Scale)and the Modified Aldrete Scale (A Scale) for resuscitation of children undergoing gastrointestinal endoscopy with general anesthesia.Methods:A total of 199 underage children who underwent non-intubated gastrointestinal endoscopy with general anesthesia in Children′s Hospital, Zhejiang University School of Medicine from July to December 2022 were retrospectively included in this study and divided into preschool group (36 cases), low school-age group (75 cases) and high school-age group (88 cases) according to age. S Scale and A Scale were also performed to evaluate the recovery from anesthesia. The vital signs of the children and the time required for reaching the target were recorded, and the scoring efficiency and safety of the two scales were compared.Results:The time required for S Scale to reach the standard (17.50 ± 9.29) min was significantly lower than that of A Scale (20.80 ± 12.61) min, and the difference between the two groups was statistically significant ( t = 2.97, P<0.01). In the low school-age group, oxygen saturation (0.989 ± 0.010) of A Scale was higher than that of S Scale (0.980 ± 0.015), the difference was significant ( t = 2.17, P<0.05). The time required for S Scale to reach the standard was negatively correlated with age ( r = -0.385, P<0.01). There was no significant correlation between the time required for A scale to reach the standard and the children′s age ( r = -0.089, P>0.05). Conclusions:Although Steward Scale is more efficient than modified Aldrete Scale in evaluating anesthesia resuscitation in underage children undergoing gastrointestinal endoscopy with general anesthesia, modified Aldrete Scale is safer than Steward Scale and is more conducive to ensuring the life safety of children.
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Objective:To investigate the preschool period neurodevelopmental status and analyze the perioperative data which associated with delayed neurodevelopment in patients underwent antergrade cerebral perfusion(ACP).Methods:To access the preschool period neurodevelopmental status in patients underwent ACP using Griffiths mental development scale-Chinese(GDS-C). Patients were classified as normal development group(ND) and low development group(LD) depending on the outcomes of assessment. Perioperative data including age, weight, CPB time, aortic cross-clamp time, mean arterial pressure, ACP time and flow were analyzed retrospectively.Results:62 children who met the inclusion criteria, of which 19 were accessed by GDS-C scale. Fourteen cases were lagged in general quotient(GQ) compared with normal children. The outcomes of assessment in six subscales of GDS-C scale indicated that 13 cases were delayed in language(C) and practical reasoning(F). Eight cases were delayed in locomotor(A) and personal-social(B). Eleven cases were delayed in eye-hand coordination(D). Ten cases were delayed in performance(E). The children in LD group had significant longer CPB time and aortic cross-clamp time than those in ND group. There were no differences between two groups in other perioperative data.Conclusion:The incidence of preschool period neurodevelopmental delay after ACP in infants is relatively high. In detailed analysis, their language and practical reasoning ability are lagged significantly. In addition, the longer time of CPB and aortic cross-clamp are associated with the neurodevelopmental delay.
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Objective:To investigate multimodality imaging characteristics and clinical features of lymphomatosis cerebri (LC) and reasons for misdiagnosis,with the goal of potentially facilitating an early and accurate diagnosis for this often-missed disease.Methods:Clinical data and cerebral multimodality imaging findings from 11 patients with LC proven basing on pathology in the Affiliated Hospital of Guizhou Medical University from November 30, 2011 to December 28, 2020 were retrospectively extracted, analyzed, and reviewed in combination with the literatures.Results:The common presenting symptoms with subacute onset included cognitive decline (8/11), gait disturbance (9/11), and behavioral disturbance (5/11). Test of cerebrospinal fluid showed that the number of cells and the level of protein increased (8/10), the sugar content (2/10) and chloride (4/10) decreased. The imaging manifestations of 11 patients with LC were diffuse lesions of bilateral cerebral white matter in the both deep and lobar lesion distribution, involving the cerebral cortex and subcortical white matter in eight cases (8/11), basal ganglia in seven cases (7/11), thalamus in five cases (5/11), cerebellum in six cases and brain stem in six cases (6/11). All 11 patients showed equal or slightly low-density shadows on CT plain scan and slightly longer T 1WI and T 2WI signals on magnetic resonance imaging. Six cases (6/11) had no obvious enhancement in the early stage, and five cases and six follow-up cases showed heterogenous spots, patches, nodules or clusters of distinct enhancement. Diffusion-weighted imaging showed non restricted diffusion in nine (9/11) cases initially diagnosed, and restricted diffusion in two cases (2/11) and nine follow-up cases, which were hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient maps. Five patients (5/5) presented a marked decrease in N-acetyl aspartic acid (NAA)/creatine (Cr) and increase in choline (Cho)/Cr on hydrogen proton magnetic resonance spectrum, including an increase in lipid/Cr in three cases. One case (1/3) showed no abnormal increase in lesion metabolism, and two cases (2/3) showed slightly increased uptake on positron emission tomography/CT. Conclusions:Diffuse bilateral cerebral lesions especially in deep and lobar region, without enhancement or with patchy enhancement, marked decrease in NAA/Cr and increase in Cho/Cr and Lip/Cr are suggestive of LC. Misdiagnosis may be mainly due to insufficient understanding and improper brain biopsy.
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The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. People can be infected through respiratory droplets, airborne and close contact. Pediatric airway foreign body is a common otorhinolaryngology emergency, especially occurred in 1 to 3-year-old children. It usually causes complications like airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The common practice in otorhinolaryngology emergency room is to perform direct laryngoscope, bronchoscope and foreign body removal. Medical staff need to be closely contacted with these children during surgical operation, who may produce massive droplets and aerosols during examination. With a combination of characteristics of surgical operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.
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The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. The virus infection is mainly transmitted by respiratory droplets, airborne and close contact. Pediatric foreign body in the respiratory tract is a common otorhinolaryngology emergency, especially occurred in 1-3 years old children, and usually causes airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The principle treatment in otorhinolaryngology emergency room is direct laryngoscope, bronchoscope and foreign body removal. Due to the close contact between the relevant medical staff and child during the operation, a large number of droplets and aerosols can be produced during the reactive cough of the child. Combined with the characteristics of the operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.
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OBJECTIVE@#To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst.@*METHODS@#One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (=65) and control group (=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups.@*RESULTS@#Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (<0.05 or <0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (<0.01), but the incidence of edema after operation was lower (<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (<0.05) and the total cost of hospitalization was reduced (<0.01).@*CONCLUSIONS@#ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.
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Child , Humans , Case-Control Studies , Choledochal Cyst , Economics , General Surgery , Enhanced Recovery After Surgery , Reference Standards , Length of Stay , Postoperative ComplicationsABSTRACT
Objective: To investigate the changes of haemodynamics, pulmonary mechanics and blood gas in volume controlled and pressure controlled ventilatory patterns during one-lung ventilation (OLV). Methods: 20 patients with patent ductus arteriosus (PDA) underwent left thoracotomy PDA ligation with right OLV. The patients were divided into three groups: two-lung ventilation with volume controlled (TLV-VCV), one-lung ventilation with volume controlled (OLV-VCV), and one-lung ventilation with pressure controlled (OLV-PCV). After two-lung ventilation with VCV, one-lung ventilation was started by VCV and the ventilation mode was then switched to PCV. All measurements were made 25 min after initiation of the ventilation mode. The respiratory mechanics index was measured by side stream spirometry (SSS), including peak airway pressure (Ppeak), plateau pressure (Pplat), airway resistance (Raw), lung compliance (Cdyn) and inspiratory and expiratory minute ventilation (Mvi, Mve). Cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), left ventricular ejectiontime (LVETi), and aortic blood flow acceleration (ACC) were also measured, by using the transesophageal Doppler (TED) monitor. Arterial blood gases was determined in every ventilation mode. Results: Ppeak、Pplat and Raw were significantly higher during OLV-VCV than that during TLV-VCV (P
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Objective To investigate the effect of different modes of one-lung ventilation ( OLV) on respiratory mechanics, hemodynamics and arterial oxygen tension ( PaO2) in pediatric patients. Methods Thirty-four ASA Ⅰ - Ⅱ patients (14 male, 20 female) aged 2-10 yr, weighing 8-26 kg undergoing abdominal surgery or operations on extremities were enrolled in this study. The patients were premedicated with intramuscular phenobarbital 2-3 mg ? kg-1 and atropine 0.015 mg ? kg-1 . In the operating room the patients were given intramuscular midazolam 0.25 mg? kg-1 and ketamine 2.5 mg ? kg-1 before intravenous line and EGG, NIBP and SpO2 monitoring were established. Anesthesia was induced with intravenous fentanyl 3-5 ?g kg-1 and vecuronium 0.1 mg? kg-1 and maintained with isoflurane inhalation supplemented with intermittent iv boluses of fentanyl and vecuronium. In patients aged over 5 yr Univent (Fuji Corpi) was inserted and left main bronchus was blocked during OLV. In patients less than 5 yr ordinary tracheal tube was inserted and was advanced into right main bronchus during OLV. Correct positioning of the tube was checked by fiberoptic bronchoscopy or auscultation. The test consisted of three steps : firstly two-lung ventilation (TLV) with volume-control mode; secondly OLV with volume-control mode;lastly OLV with pressure-control mode. During first and second step VT was set at 8-10 ml kg-1 and respiratory rate was adjusted to maintain PETCO2 between 4.5-6.0 kPa. During the third step (OLV with pressure-control mode) the inspiratory pressure was set according to the plateau pressure during step 1 and 2 (volume-control mode). Each step was maintained for 25 min before respiratory mechanics , hemodynamics and PaO2 were measured and recorded.Results During OLV with volume-control mode (second step) , peak pressure (Ppeak), plateau pressure (Pplat) and airway resistance (Raw) were significantly higher but dynamic compliance was significantly lower, cardiac output (CO) and stroke volume (SV) were significant lower but systemic vascular resistance (SVR) was significantly higher and PaO2 was significantly lower than those during first step (two lung ventilation with volume-control mode) (P