ABSTRACT
Objective@#To investigate the influence of trached extubation time on the emergent agitation during the recovery of sevoflurane combined anesthesia in infants. @*Methods@#Sevoflurane, propofol and remifentanil were combined to maintain general anesthesia after intubation. The propofol infusion was stopped 10 minutes before the operation, and the remifentanil infusion was stopped 5 minutes before the end of the operation. The sevoflurane concentration was reduced to 1%, and the oxygen flow was adjusted to 6 L/min when the sevoflurane inhalation was stopped. Ninety infant patients with cleft palate were randomized into 3 groups (n=30): 30 patients in group A were extubated within 5 minutes, 30 patients in group B were extubated between 5 and 10 minutes, and 30 patients in group C were extubated after 10 minutes. A postoperative agitation score was given after extubation and recorded away from the operating room. Propofol was administered when agitation occurred. The recovery time after the operation and time away from the operating room were recorded. @*Results@# The recovery times of group A, group B, and group C were 21.8 ± 2.5 minutes, 21.4 ± 2.1 minutes and 20.9 ± 1.3 minutes, respectively, although the differences were not significant (P > 0.05). The times away from the operating room of group A, group B, and group C were 8.1 ± 1.6 minutes, 5.2 ± 2.0 minutes and 2.1 ± 0.7 minutes, respectively, and the differences were statistically significant (P < 0.05). When endotracheal intubation was removed, the incidence of agitation in group A (26/30) was higher than that in group B (16/30) and group C (5/30), and the differences were statistically significant (P < 0.05). The incidence of agitation in group B was also significantly different from that in group C (P < 0.05). @*Conclusion@#Propofol, which is used to control coughing and prolong the extubation time, can effectively prevent emergent agitation during the recovery period from sevoflurane-based anesthesia in infants. The optimum time of extubation was 15 minutes.
ABSTRACT
Objective@#To evaluate the clinical manifestations, pathological features, treatment methods and prognosis of aggressive fibromatosis of the head and neck. @*Methods@# One patient with aggressive fibromatosis of the neck was analyzed, and the relevant literature was reviewed. @*Results@#Head and neck lesions account for approximately 12 to 15% of aggressive fibromatosis, which is a rare type of borderline tumor that is commonly characterized by a hard texture, painlessness (but occasionally with pain), hidden growth and poor mobility. Such tumors can result in facial deformity and invasion of the skull base or main nerves, and blood vessels and can compress the airway. MRI is the preferred method for preoperatively determining the size and location of the lesion. The characteristic low T1 and T2 signals of collagen fiber are helpful for the diagnosis of the tumor. The disease has clear pathological features, with tumors consisting of long spindle fibroblasts and myofibroblasts arranged in parallel fascicles with various levels of collagen formation. The tumor cells exhibit the characteristics of infiltrative growth, ill-defined cell membranes and variable amounts of cytoplasm. Pathologic mitosis and atypia are not seen. Characteristic immunohistochemical features include expression of Vim(+), HHF-35(+), CD34(-), S-100(-) and Ki-67(+). The disease is locally invasive, and patients may relapse easily, but distant metastases are not observed. The primary treatment is surgical resection. Chemotherapy, hormone therapy and biological treatments have auxiliary functions in the treatment of these tumors.@*Conclusion @# Aggressive fibromatosis of the head and neck has no specific clinical features; the diagnosis depends primarily on pathological examination. The main treatment is radical surgical resection. Radiotherapy, chemotherapy and biological treatment can be used in combination with surgery in cases of incomplete resection or recurrence.