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Objective:To evaluate the effect of oxygen supply via the transnasal self-made pharyngeal oxygen catheter on the safe apnea time in pediatric patients undergoing tonsil surgery. Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 2-6 yr, weighing 10-20 kg, scheduled for elective tonsillectomy under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: transnasal self-made pharyngeal oxygen catheter for oxygen supply group (group NO) and control group (group C). Anesthesia was induced with intravenous midazolam, propofol, fentanyl and cis-atracurium, and then ventilation was performed with a mask, and the mask was removed when the exhaled oxygen concentration (C ETO 2) reached more than 90%.In group NO, the self-made oxygen catheter was implanted into the oropharynx through the nose, and the 100% oxygen at 10 L/min was aspirated through the humidification bottle until the intubation was successful.In group C, the transnasal self-made oxygen catheter was not implanted, and the rest of the protocol was similar to those previously described in group NO.The visual laryngoscope was implanted to simulate difficult airways.When SpO 2 ≤ 95% or the safe apnoea time reached 600 s, the observation of apnea was stopped, and mechanical ventilation was started after successful rapid endotracheal intubation.The safe apnea time (from removing the mask until SpO 2 decreased to 95%), value of C ETO 2 at the end of mask ventilation, and the minimum value of SpO 2 after stopping mask ventilation were recorded.Heat rate and mean arterial pressure were observed and recorded on admission to the operating room, immediately after onset of apnea and immediately after successful endotracheal intubation.The SpO 2, P ETCO 2 and cross-sectional area of gastric antrum were also recorded immediately after onset of apnea and immediately after successful endotracheal intubation, and the rate of increase in P ETCO 2 was calculated.The nasal bleeding, nasal dryness, postoperative pharyngeal discomfort and other adverse reactions were recorded when the self-made pharyngeal oxygen catheter was placed. Results:Compared with group C, the safe apnea time was significantly prolonged, the rate of increase in P ETCO 2 was decreased, the minimum value of SpO 2 after stopping mask ventilation was increased, and the heat rate, mean arterial pressure, SpO 2 and P ETCO 2 were increased immediately after successful intubation ( P<0.05), no significant change was found in C ETO 2 after stopping mask ventilation and cross-sectional area of gastric antrum at each time point in group NO ( P>0.05). No adverse reactions such as nasal bleeding, nasal dryness and postoperative pharyngeal discomfort were found when the self-made pharyngeal oxygen catheter was inserted in group NO. Conclusions:The oxygen supply with the transnasal self-made pharyngeal oxygen catheter technique can prolong the safe apnea time in the pediatric patients undergoing tonsil surgery.
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Objective To evaluate the efficacy of ultrasound-prepositioned four-point method for right internal jugular vein ( IJV) catheterization in the parturients at high risk of bleeding. Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱparturients diagnosed as having perni-cious placenta previa, aged 25-38 yr, weighing 60-90 kg, scheduled for elective cesarean section under general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: real-time ultrasonic guidance group ( group UG ) and ultrasound-prepositioned four-point method group ( group UF) . In group UG, the right IJV catheterization was performed under real-time ultrasound guidance: mov-ing the ultrasonic probe to make the mid-line of the cross section image of the right IJV overlap with the mid-line of the ultrasonic display screen, and the intersection of the mid-line of the IJV and the horizontal line of the annular cartilage was selected as the puncture point. In group UF, the right IJV catheterization was per-formed by using ultrasound-prepositioned four-point method as follows: moving the ultrasonic probe to make the midline of the right IJV cross-sectional images overlap with the midline of the ultrasound display screen, and marking the skin where the midpoint of the probe's long-axis was located as point A;transversely mov-ing the probe to the inside so that the tangent line of its inner edge overlapped with the midline of the ultra-sonic display screen, marking the skin where the midpoint of the probe's long-axis was located as point B ( the puncture site);at the proximal cardiac end of the right IJV, making point C at 2 cm from point B, and making point D ( the indicator point, direction of the puncture needle) at 2 cm from point A. After lo-cal infiltration anesthesia was performed in point B, the puncture needle was inserted towards the point D. The success rate of puncture, success rate of catheterization, catheterization operation time and complica-tions such as hematoma, intravascular catheter insertion or hemopneumothorax were recorded. Results The success rate of total catheterization was 100％ in two groups. Compared with group UG, the catheteriza-tion operation time was significantly shortened ( P<0. 01) , and no significant change was found in the suc-cess rate of puncture at first attempt, success rate of catheterization at first attempt or intravascular catheter insertion in group UF ( P>0. 05) . Conclusion Compared with real-time ultrasound guidance, ultrasound-prepositioned four-point method produces better efficacy when used for the right IJV catheterization in the parturients at high risk of bleeding.
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Objective To evaluate the effective dose of dexmedetomidine (DEX) for prevention of emergence agitation (EA) after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy.Methods 80 preschool children undergoing a selective tonsillectomy were randomly divided into 2 groups:intravenous group (total intravenous anesthesia,n =40) and inhalation group (sevoflurane inhaled anesthesias,n =40).According to the spot-slope method,intravenous group and inhalation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction.The EA,adverse effects,the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded.Results The ED50s for prevention of EA were 0.28 μg/(kg · h) in intravenous group and 0.34 μg/(kg · h) in inhalation group.The duration of children's staying post-anesthesia care unit (PACU) and the incidence of pain were significantly greater in those with EA than those without (P ＜ 0.05),and the incidence of the postoperative behavioral outcomes were not statically different (P ＞ 0.05).No severe adverse reactions were observed in 95％ confidence limits.Conclusions 0.28 (0.22-0.35) μg/(kg · h) and 0.34 (0.27-0.43) μg/(kg · h) of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy.
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Objective To determine the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Methods Parturients who underwent cesarean section and autologous blood withdrawal from August 2012 to June 2015 in our hospital were selected. The preoperative, intraoperative and postop-erative data of the parturients were collected retrospectively from electronic medical records. The parturients were divided into reinfusion group and non-reinfusion group according to whether the parturients received au-tologous blood reinfusion. Logistic regression analysis was used to stratify the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Results A total of 1604 parturients who received autolo-gous blood reinfusion were included in the study, with 757 cases in reinfusion group and 847 cases in non-reinfusion group. Placenta increta∕percreta, placenta previa with previous uterine surgery and complete pla-centa previa were the risk factors for autologous blood withdrawal-reinfusion in cesarean section (P<0. 05). The predictive model was exp( w) ÷ [1 + exp( w)],w = 1. 447 × placenta increta∕percreta ( corrected OR value)+0. 945×complete placenta previa (corrected OR value)+1. 361×placenta previa with previous uter-ine surgery (corrected OR value). The sensitivity and specificity of this model in predicting blood reinfusion were 56％ and 79％, respectively, the positive predictive value was 71％, and the negative predictive val-ue was 67％. Conclusion Placenta increta∕percreta, placenta previa with previous uterine surgery and complete placenta previa are high risk factors for autologous blood withdrawal-reinfusion in cesarean section, and routine preparation for autologous blood withdrawal-reinfusion is recommended.
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Objective:To compare the preventive effects of dezocine or parecoxib used alone or combination on emergence pain and agitation in the patients undergoing radical hysterectomy. Methods: Sixty ASA Ⅰ~Ⅱ patients undergoing radical hysterectomy were randomly divided into three groups. At the time of sewing incision, the dezocine group (group D, n=20) received dezocine in-travenous injection at the dosage of 0. 1 mg·kg-1, the parecoxib group (group P, n=20) received parecoxib intravenous injection at the dosage of 0.8 mg·kg-1, and the combination group (group DP, n=20) received 0.1 mg·kg-1dezocine and 0.8 mg·kg-1 parecoxib. When the operation was finished, the patients were transferred to the recovery room with endotracheal tubes, and recovered and extubated without the administration of reversal agents. Visual analogue scale ( VAS) for pain and Aono' s four-point scale for e-mergence agitation ( EA) were measured. The recovery time, extubation time, VAS, degree of EA and side effects such as nausea, vomiting, respiratory depression and hypersomnia during the emergence were also evaluated and recorded. Results:There were no sig-nificant differences in recovery time and extubation time among the three groups (P >0. 05). The VAS score and degree of EA in group DP were lower than that in group D (4. 65 ± 1. 69) and group P (5. 95 ± 1. 82) (P0. 05), and no side effects such as nausea, vomiting, respiratory depression and hypersomnia were detected during the emergence. Conclusion:Intravenous injection of 0. 1 mg·kg-1 dezocine combined with 0. 8 mg·kg-1 parecoxib at the time of sewing incision shows effective analgesia and emergence agitation reduction without obvious complications in the patients undergoing radical hysterecto-my.
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Intraoperative cell salvage ( IOCS) was conducted during cesarean delivery from May 2011 to April 2016 in our hospital: when the volume of autologous blood collected from the surgical field≥800 ml during surgery and the parturients′hemoglobin≤100 g∕L after hemorrhage, the autologous blood was centrifuged, concentrated, washed and then filtered using a leucocyte depletion filter before reinfusion. IOCS was carried out in 1 085 cases during cesarean delivery within 5 yr. For the parturients who underwent IOCS, the percentage of patients who did not require transfusion of allogeneic red blood cells was 82.95%(900 cases), the percentage of patients who required plasma transfusion was 41.66% (452 cases), the percentage of patients who required platelet transfusion was 3.32% (36 cases), and no autologous blood transfusion?related adverse reactions were found during surgery and hospital stay. In conclusion, IOCS could be safely and effectively used for blood?saving effect in cesarean delivery.
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Objective To study the relationship between the expressions of vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor receptor-2 (KDR) in cervical carcinoma and the formation of cervical cancer and lymph node metastasis.Methods We selected 72 cervical carcinoma tissues,their corresponding adjacent tissues and 36 normal cervical tissues which have been resected in the Maternal and Child Health Care Hospital of Baoji of Shaanxi Province from January 2010 to December 2013.The mRNA and protein expressions of VEGF-C and KDR were examined by semi-quantitative PCR and enzyme linked immunosorbent assay in these tissues.The relationships between the expressions of VEGF-C and KDR and the formation of cervical cancer and lymph node metastasis were analyzed.Results The mRNA levels of VEGF-C in 72 cases of cervical cancer tissues and its corresponding adjacent tissues were 4.67 ± 1.05 and 2.02 ± 0.65,which were significantly higher than those in normal cervical tissues (0.36 ± 0.06),with significant differences (t =2.247,P =0.025;t =1.379,P =0.027).The protein levels of VEGF-C in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 68.30 ± 17.10 and 48.20 ± 12.70,which were significantly higher than those in normal cervical tissues (18.40 ± 10.70),with significant differences (t =4.357,P =0.016;t =6.337,P =0.012).The mRNA levels of KDR in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 3.52 ± 0.95 and 1.92 ± 0.87,which were significantly higher than those in normal cervical tissues (0.72 ±0.36),with significant differences (t =3.127,P =0.023;t =1.214,P =0.028).The protein levels of KDR in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 47.20 ± 15.60 and 38.60 ± 11.30,which were significantly higher than those in normal cervical tissues (16.40 ± 9.40),with significant differences (t =3.667,P =0.020;t =0.986,P =0.032).The expression level of VEGF-C protein in 72 cases of cervical cancer tissues was not correlated with age (x2 =0.54,P =0.17),tissue type (x2 =0.34,P =0.25),depth of invasion (x2 =5.39,P =0.08),pathological grade (x2 =0.78,P =0.11),but was correlated with tumor size (x2 =22.34,P =0.02),clinical stage (x2 =32.14,P =0.01) and lymph node metastasis (x2 =15.58,P =0.03).The expression level of its receptor KDR was correlated with tumor size (x2 =13.78,P =0.04),tissue type (x2 =32.74,P =0.01),pathological grade (x2 =13.72,P =0.04),depth of invasion (x2 =10.27,P =0.04),clinical staging (x2 =20.25,P =0.02) and lymph node metastasis (x2 =19.52,P =0.02),but was not correlated with age (x2 =4.17,P =0.09).Conclusion The expression levels of VEGF-C and KDR are correlated with the growth,invasion and metastasis of cervical cancer,which are good indicators of the lymph node metastasis.
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Objective To compare the development of gastric insufflation related to different peak inspiratory pressures (PIPs) during facemask ventilation in the pediatric patients.Methods Ninety male pediatric patients,aged 2-4 yr,of American Society of Anesthesiologists physical status Ⅰ,scheduled for elective surgery under general anesthesia,were randomly divided into 5 groups (n =18 each) using a random number table:PIP 8 cmH2O group (group P8),PIP 10 cmH2O group (group P10),PIP 12 cm H2O group (groupP12),PIP 14cmH2O group (group P14) and PIP 16 cmH2O group (group P16).Anesthesia was induced with fentanil,propofol and rocuronium in sequence.After loss of eyelash reflex,positive pressure facemask ventilation was performed for a 120 s period in pressure-controlled mode.Gastric insufflation was detected by real-time ultrasonography of the antrum,and cross-sectional antral area was measured using ultrasonography before facemask ventilation and at 120 s of facemask ventilation.The pulse oximetry (SpO2),tidal volume (VT),end-tidal pressure of carbon dioxide (PETCO2) and end-tidal oxygen concentration (ETO2) were recorded at 30,60,90,and 120 s of facemask ventilation.The development of gastric insufflation and hypoventilation was recorded.Results Compared with group P8,the incidence of gastric insufflation was significantly increased in group P16 (P＜0.01),and no significant change was found in the incidence of gastric insufflation in the other groups (P＞0.05),the incidence of hypoventilation was significantly decreased,VT and ETO2 were increased,and PET CO2 was decreased in P12,P14 and P16 groups,and PETCO2 was significantly decreased at 120 s of facemask ventilation (P＜ 0.05 or 0.01),and no significant change was found in the other parameters in group P10 (P＞0.05).Compared with P12 and P14 groups,VT was significantly increased,PEHTCO2 was decreased at 120 s of facemask ventilation (P＜0.05),and no significant change was found in the incidence of hypoventilation and ETO2 in group P16 (P＞0.05).There was no significant difference between group P12 and group P14 in the incidence of hypoventilation,VT,PETCO2 and ETO2 (P＞0.05).The pediatric patients showed a certain CO2 accumulation [PETCO2 (40.6±4.0) mmHg] at 120 s of facemask ventilation in group P8,and the pediatric patients showed excessive ventilation [PETCO2 (23.6± 1.4) mmHg],and cross-sectional antral area was not measured using ultrasonography in three cases because of excessive gastric insufflation in group P16.Conclusion PIP at 12-14 mmHg in pressure-controlled ventilation mode can not only ensure adequate preoxygenation and but also avoid excessive gastric insufflation during facemask ventilation in the pediatric patients.
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Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.
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Objective To observe the effect of general anesthesia induction with fentanil on parturient undergoing cessrean section and Apgar score of newborn. Methods Forty-two example cesarean section under general anesthesia were induced with fentanil 4μ/kg, propofol 1.5-2.0 mg/kg, atracurium 0.5mg/kg.Observed the change of hemodynamics parameter of parturientand 1 min,5 min Apgar score of newborn. Results Parturient woman blood stream dynamics Was stable. The premature delivery, the low body weight, the polyembryony or the anaesthesia had used the hypnotics group, its newborn 1 min Apgar score was obviously lower than that had not merged above situations(P＜0.01),but the newborn 5 min Apgar score was not significantly different(P＞0.05).Conclusions Fentanil used in cesarean section general anesthesia induction, parturient woman blood stream dynamics is stable, affects not obviously to newborn's Apgar scoure. But regarding the premature delivery, the polyembryony, the low body weight or the pregnant woman used the hypnotics, cegaresn section general anesthesia induction with fentanil should be supposed to use cautiously.