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Objective:To construct an intelligent performance measurement system of gastrointestinal endoscopy and to analyze its value for endoscopic quality improvement.Methods:The intelligent gastrointestinal endoscopy performance measurement system was developed by using the deep convolutional neural network (DCNN) and deep reinforcement learning, based on the Digital Imaging and Communications in Medicine. Images were acquired of patients undergoing gastrointestinal endoscopy at Digestive Endoscopy Center of Renmin Hospital of Wuhan University from December 2016 to October 2018. The system applied cecum recognition model (DCNN1), images in vitro and in vivo recognition model (DCNN2), and identification model at 26 gastric sites (DCNN3) to monitor indices such as cecal intubation rate, colonoscopic withdrawal time, gastroscopic inspection time, and gastroscopic coverage. Images of 83 gastroscopies and 205 colonoscopies acquired at Digestive Endoscopy Center of Renmin Hospital of Wuhan University from March to November 2019 were randomly selected to examine the effectiveness of the system. Results:The intelligent gastrointestinal endoscopy performance measurement system consisted of quality analysis of both gastroscopy and colonoscopy, including all indices, and could be generated automatically at any time. The accuracy for cecal intubation rate, colonoscopic withdrawal time, gastroscopic inspection time, and gastroscopic coverage were 92.5% (172/186), 91.7% (188/205), 100.0% (83/83), 89.3% (1 928/2 158), respectively.Conclusion:The intelligent performance measurement system for gastrointestinal endoscopy can be recommended for the quality control of gastrointestinal endoscopy, from which endoscopists can get feedback and improve the quality of gastrointestinal endoscopy.
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Objective To evaluate the efficacy of the flexible laser endotracheal intubation light-wand device in guiding tracheal intubation in pediatric patients. Methods Ninety pediatric patients of both sexes, aged 4-8 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elec-tive surgery under general anesthesia requiring oral tracheal intubation, were divided into 2 groups ( n=45 each) using a random number table method: flexible laser endotracheal intubation lightwand device group ( group A) and direct laryngoscope group ( group B) . After induction of anesthesia, orotracheal intubation was carried out with a flexible laser endotracheal intubation lightwand device in group A or with a direct la-ryngoscope in group B. The development of hypertension and tachycardia during intubation, intubation time, and rate of successful intubation were recorded. The development of complications such as sore throat, hoarseness, aphonia and dysphagia was recorded at 24 h after surgery. Results Compared with group B, no significant change was found in the total rate of successful intubation ( P>0. 05) , the rate of successful intubation at first attempt was significantly increased, incubation time was shortened, and the in-cidence of hypertension and tachycardia during intubation and sore throat after surgery was decreased in group A ( P<0. 05) . Conclusion The flexible laser endotracheal intubation lightwand device produces bet-ter efficacy in guiding tracheal intubation when compared with direct laryngoscope in pediatric patients.
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Objective To evaluate the a.ccuracy of ultrasound in verifying endotracheal tube (ETT) position in neonates.Methods Sixty neonates of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 2-28 days,weighing 2.5-4.8 kg,scheduled for urachal fistula/urachal resection or inguinal hernia repair under general anesthesia,were divided into 2 groups (n=30 each)using a random number table method:auscultation group and ultrasound group.Confirmation of ETF position was performed in two stages.In the first stage,misplacement of ETT into esophagus was identified using auscultation and ultrasound techniques after intubation,and end-tidal carbon dioxide pressure was considered as the gold standard for identification of esophageal intubation.In the second stage,misplacement of ETY into bronchus was identified using auscultation and ultrasound after confirming ETT position was within the trachea,and electronic bronchoscope served as the gold standard for identification of bronchial intubation.Results Compared with auscultation group,the accurate rate of identification of bronchial intubation was significantly increased in ultrasound group (P＜0.05).The sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of auscultation for identification of esophageal intubation was 100％,96.3％,75％ and 100％,respectively.The sensitivity,specificity,PPV and NPV of auscultation for identification of bronchial intubation was 33.3％,95.8％,66.7％ and 85.2％,respectively.The sensitivity,specificity,PPV and NPV of ultrasound for identification of esophageal or bronchial intubation were all 100％.Conclusion Ultrasound can verify ETT position accurately in neonates.
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Objective To evaluate the reliability of ultrasonography used to guide the selection of uncuffed endotracheal tube (ETT) size for pediatric patients.Methods Eighty pediatric patients requiring endotracheal intubation for elective surgery under general anesthesia,aged 2-6 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomized into 2 groups (n=40 each) using a random number table:control group and ultrasonography group.In control group,the internal diameter of an uncuffed ETT was determined according to age-based formulas.In ultrasonography group,the outer diameter of an uncuffed ETT was determined according to the transverse diameter of the subglottic airway at the level of the cricoids cartilage measured by ultrasonography.The air leak test was performed after intubation,and either a larger or a smaller size of ETT selected was considered as a failure of intubation.The failure of intubation and postoperative complications related to intubation were recorded.Results Compared with control group,the total failure rate of intubation and failure rate due to the smaller size of ETT selected were significantly decreased in ultrasonography group (P＜0.01).There was no significant difference in the incidence of intubation-related complications between the two groups (P＞0.05).Conclusion Ultrasonogra-phy can be used to guide the selection of ETT size for pediatric patients.
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Objective To investigate the effect of various doses of dezocine on the prevention of emergence agitation after sevoflurane anesthesia in children .Methods 100 children aged from 1 to 3 years old were randomly divided into 4 groups with 25 cases each :the 0 .03 mg/kg dezocine group (group D1) ,the 0 .05 mg /kg dezocine group (group D2) ,the 0 .10 mg/kg dezocine group (group D3) and the control group .Anaesthesia was induced with 6% sevoflurane and 1 μg/kg remifentanil .Anaesthesia was maintained with 1 .5% - 2 .5% sevoflurane and remifentanil .Different doses of dezocine 0 .03 mg/kg ,0 .05 mg/kg ,0 .10 mg/kg ,and the same volume saline were administered before surgery .The incidence of emergence agitation was assessed with 5 points scale and the severity of emergence agitation was assessed with Pediatric Anesthesia Emergence Delirium (PAED) scale .The time to remove the laryngeal mask airway ,the time to be discharged from the post-anesthesia care unit (PACU) ,FLACC and Ramsey scores ,post-operative nausea and vomiting were recorded and considered .Results Compared with the control group ,the incidence of emergence agitation and PAED scales of D2 and D3 group were significantly lower than it (P < 0 .05) .Compared with the control group , FLACC scores of D2 and D3 group were lower than it(P< 0 .05) .At the same time ,Ramsey scores of D2 and D3 were higher than that of the control group(P < 0 .05) .Moreover ,Ramsey score of D3 was higher than D2(P < 0 .05) .The time span of being dis-charged from the PACU of D3 was significantly longer than that of the other groups(P< 0 .05) .Conclusion Dezocine of 0 .05 mg/kg and 0 .10 mg/kg both can reduce the incidence of emergence agitation effectively ,and there is no significant difference between the effect of the two doses .However ,the dose of 0 .05 mg/kg has a better performance in the time span for being discharged from the PACU .
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Objective To investigate the effect of dezocine on emergence agitation (EA) during recovery from sevoflurane-based anesthesia in children.Methods Ninety ASA Ⅰ or Ⅱ children,aged 3-6 yr,weighing 14-31 kg,were randomized into 3 groups (n =30 each):fentanyl group (group F),dezocine group (group D)and control group (group C).Anesthesia was induced with inhalation of 8 ％ sevoflurane and iv injection of atracurium 0.5 mg/kg and remifentanil 1 μg/kg and maintained with inhalation of 2％-3 ％ sevoflurane and infusion of remifentanil at 0.1-1.0 μg· kg-1 · min-1.In groups F,D and C,fentanyl 2 μg/kg,dezocine 0.05 mg/kg and the equal volume of normal saline were injected intravenously 10 min before the end of surgery,respectively,and inhalation of sevoflurane was stopped at the end of operation.The extubation time and length of stay in the postanesthesia care unit (PACU) were recorded.Agitation and the duration were recorded when the children were in PACU.The degree of EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.Pain was evaluated using the Children' s Hospital of Eastern Ontario Pain Scale (CHEOPS) and sedation was measured with Ramsay score.The complications such as respiratory depression,postoperative nausea and vomiting were recorded within 24 h after operation.Results Compared with group C,the incidence of EA and PAED scores were significantly decreased and the duration of EA was shortened in groups F and D,CHEOPS scores were decreased at each time point after operation and Ramsay scores were increased at T1 in group F,and CHEOPS scores were decreased and Ramsay scores were increased at each time point after operation in group D (P ＜ 0.05).Compared with group F,the incidence of EA and PAED scores were significantly decreased,CHEOPS scores were decreased at each time point after operation,and Ramsay scores were increased at T2 (P ＜ 0.05),and no significant change was found in the duration of EA in group D (P ＞ 0.05).There was no significant difference in the extubation time and length of stay in the PACU between the three groups (P ＞ 0.05).Conclusion Dezocine 0.05 mg/kg can safely and effectively prevent EA during recovery from sevoflurane-based anesthesia in children and produces better efficacy than fentanyl.
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Objective To compare pharmacodynamics of rocuronium in neonates,infants,young children and children.Methods One hundred and sixty ASA Ⅰ or Ⅱ pediatric patients undergoing elective surgicalprocedures under total intravenous anesthesia(TIVA)were divided into 4 groups according to ages(n=40 each):neonate group(0-28d),infant group(28 d<age 12 months),young children group(1 yr<age≤3 yr)and children group(3 yr<age≤10 yr).Twenty patients Were randomly selected from each group,and rocuronium was administered iv by using cumulative dose-response technique at four doses(an initial dose of 40 μg/kg, 80 μg/kg,120μg/kg and 120μg/kg in neonate,infant,young children and children groups respectively,and three increments of 40μg/kg each).After each administration,TOF response was observed.When T1 was stable, the next administration was given.50%,90%and 95%effective dose(ED50,ED90.ED95)were calculated by Probite method.Twenty patients were randomly selected in each group were given rocuronium 2 times of ED95.The onset time,duration of peak effect.clinical duration.total duration and recovery index were recorded.Results ED50,ED90 and ED95 of rocuronium were significantly higher in young children and children groups than in neonate group(P<0.01),but there there was significant difference in the indices mentioned above between infant and neonate group(P>0.05).Onset time of muscle relaxation.clinical duration and total duration were significantly shorter and recovery index lower in the other 3 groups than in neonate group(P<0.01).but there was nosignificant difference in the duration of peak effect among the 4 groups(P>0.05).ED50,ED90 and ED95 of rocuronium were significantly higher in children group than in young children group(P<0.01).Conclusions There are significant differences in dose-effect and time-effect relationships among different age children and neonate is more sensitive to rocuronium than the other age children.
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OBJECTIVE To analyze the monitoring performance and testing efficacy and reliability of standardized disposable B-D test pack and standard linen test pack,and summarize the corrective actions based on failure analyses for future reference.METHODS The two different test packs were employed to evaluate the vacuum performance of dynamic air removal sterilizer.RESULTS We enrolled 400 standardized disposable B-D test packs and standard linen test packs respectively.The disposable pack failed 4 cases with the success ratio 99%,while the linen pack failed 30 cases with the success ratio 92.5%.CONCLUSIONS The poor conformity of hand-made linen test pack,variation of steam pressure,sterilizer failure,and unprofessionalism of sterilizer operator contribute as main failure causes in B-D test.Standardized disposable B-D test pack can decrease subjective factors significantly,and the test results are more reliable and standardized.