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Objective:It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models.However,for the limitation that the animal models can-not fully mimic the dose and duration in clinical settings especially for dental general anesthesia,the cli-nical significance of anesthetics exposure on developing central nervous system remains undetermined. Therefore,we conducted the current study in order to observe the fluctuation of intelligence quotient (IQ)after the administration of dental general anesthesia comparing to that before surgery.We conducted the current study in order to observe the fluctuation of intelligence quotient (IQ)after the administration of dental general anesthesia compared with that before surgery.Methods:Thirty two patients,ASA Ⅰ, who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology,aged 4 to 6.5 years,were enrolled in this prospective study.Patients with severe learning difficulties or communication disorders were excluded.Written and informed consent was obtained from each patients’family which was fully explained of the purpose and method of study. Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence (Urban version)before and 2 weeks after dental anesthesia.They were treated by experienced pediatric dentists and the sevoflurane,propofol and nitrous oxide were used for general anesthesia by anesthetist. Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extrac-tion.The examiners and scorers for IQ had technical training in the test administration.All the patients were tested by the same examiner and with standardized guide language.Each subtest was scored accor-ding to the tool review.Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ. Statistical analyses were performed by SPSS 18.0.All the scores of subtests and 3 types of IQ were ex-pressed as x-±s.Paired two-tailed t test was applied and P cant.Results:The results of intelligent assessment from 28 subjects were collected.The anesthetic time was (163.4 ±32.6)min and the number of treated teeth was 12.1 ±2.3,mean age (4.60 ±0.41 ) years;age range=4.04 to 5.44 years.Among the patients,there were 13 girls and 15 boys.There was no significant difference in gender distribution.The postoperative full IQ (128.46 ±10.85 )was higher than that before surgery (124.64 ±11.46,P=0.017).We found that the elevation of performance IQ, to a large extent,contributed to this change in full IQ (P=0.007).Correspondingly,there was no sta-tistical difference in the verbal IQ,which was 119.68 ±11.74 to 120.21 ±15.61 (P=0.854).Con-clusion:Dental general anesthesia has no negative effect on the intelligence of preschool children,who were treated under general anesthesia by sevoflurane,propofol and nitrous oxide for 2 to 4 hours.The full IQ and performance IQ were slightly enhanced after treatment which can be explained by the memory effect.
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Objective To explore the influence of preferred contract-altering system on contracted nurses to provide reference for stabilizing a team of high quality nursing.Method A scale on effort-reward unfairness(ERI)was used to investigate the ERI conditions among 348 contracted nurses before and after the enforcement of preferred contract-altering system.Results The scores on satisfaction with nursing work and the security in nursing work after the enforcement of the system were higher than before the enforcement(P<0.01).The ratio between effort and reward after the enforcement was lower than before the enforcement(P<0.01). Conclusions The preferred contract-altering system may enhance the job security and sense of belonging.It may decrease the ERI condition among contracted nurses,which are beneficial for stabilizing the nurses team,retaining talents and increasing the group’s competitiveness and vigour.
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Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.
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Objective:To assess the safety,effectiveness and acceptability of oral midazolam sedation for dental treatment in children.Methods: Twenty-three health children aged 4 to 14(ASA Ⅰ),who were classified as 4 or 5 by modified Venham's clinic anxiety and cooperative behavior rating scale,referred for dental treatment were included in the study.Each child was treated under sedation with oral midazolam(0.15-0.70 mg/kg),and totally 45 sedations were conducted.At each visit,heart rate,arterial oxygen saturation,respiration rate,sedation and behavioral scores were recorded.The level of acceptance and satisfaction of the patients and their guardians were recorded after the treatment.Results: Among the 23 children,19 were boys and 4 were girls with mean age of 6.2 years old.In all the 45 treatments,the heart rate,respiratory rate and arterial oxygen saturation levels were within acceptable clinical limits.Forty planned treatments were completed satisfactorily.Oral sedation was ineffective in 3 children,and they were treated under general anesthesia.Only 2 guardians refused to have oral midazolam sedation again.Six of seven children who had regular dental check-up could be treated under normal condition.Conclusion: Oral midazolam(0.15-0.70 mg/kg) could be a safe and acceptable approach of sedation for pediatric dental patients.
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Objective:To study the feasibility of using sevoflurane induction in infants' removing stitches after cleft lip surgery. Methods:60 infants after cleft lip surgery were randomly divided into three groups:group K (ketamine group,n=20),group S (sevoflurane group,n=20) and group SN (sevoflurane and nitrous oxide group,n=20). Group K were given intramuscular ketamine 5 mg/kg,midazolam 0.05 mg/kg and atropine 0.01 mg/kg. Group S were induced with inhalation of 8% sevoflurane under 6 L/min oxygen. Group SN were induced with inhalation of 8% sevoflurane under 4 L/min nitrous oxide and 2 L/min oxygen. After induction,anesthesia was continued with inhalation of sevoflurane under 3 L/min oxygen for 2 min before starting removing stitches. HR and SpO2 were monitored regularly during operation. The induction time,recovery time,occurrence of head moving,complication such as respiratory depression and increased secretion were recorded. Results:Induction and recover time in group S and group SN were similar,but faster than that of group K. Head moving in group S and group SN were less than that in group K. There happened glossoptosis and increased secretion in all the three groups,but no differences were found significantly. Conclusion:Inhaled induction of sevoflurane has more rapid induction and recover compared with intramuscular ketamine,and can be used safely in infants' removing stitches after cleft lip surgery. Additional inhalation of nitrous oxide can not shorten infants' induction and recovery time than sevoflurane inhalation alone.
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Objective:To investigate the effect of ciwujia Injection and Jiangxianmei combination for acute cerebral infarction. Methods:86 patients with cerebral infarction were divided into 2 groups. 43 cases in the treatment group were dripped intravenously with 60ml ciwujia Injection and 250ml physiological saline. 43 cases in the control group were treated only with Jiangxianmei. Both of groups were also treated with other therapeutic method. The hemorheology and blood fat of patients in two groups before and after treatment were determined. Results:The cure rate of the treatment groups in two weeks was 41.86%, which is superior to the control group (20.93%) ( x 2=4.37,P0.05). The treatment group was superior to the control group in improving hemorheological index and blood fat metabolism ( P