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Objective:To investigate the pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual in infants and young children undergoing daytime surgery.Methods:One hundred and four pediatric patients of either sex, aged 3-36 months, of American Society of Anesthesiologists Physical Status classification Ⅱ, with body mass index of 18.5-28.0 kg/m 2, diagnosed with oblique inguinal hernia and/or hydrocele, scheduled for laparoscopic high ligation of hernia sac and/or high ligation of sphingoid surgery, were included in the study. Intraoperative neuromuscle relaxation was assessed by transdermal stimulation of the ulnar nerve in the wrist using a TOF Guard monitor. Rocuronium 0.9 mg/kg, propofol 3 mg/kg, and sufentanyl 0.5 μg/kg were intravenously injected for anesthesia induction, and propofol 6-8 mg·kg -1·h -1 was intravenously infused to maintain anesthesia. The pediatric patients were divided into Ⅰgroup and Ⅱ group according to the degree of postoperative neuromuscular block. In group Ⅰ, sugammadex 2 mg/kg was intravenously injected when TOF returned to T 2 recurrence. In group Ⅱ, sugammadex 4 mg/kg was intravenously injected when the single stimulation count was 1 or 2 after tetanic stimulation. At 2 and 10 min after rocuronium administration, at the end of operation, 2 and 10 min after sugammadex administration, and when the children met the standard of leaving the resuscitation room, venous blood samples were collected for determination of plasma concentrations of rocuronium and sugammadex using ultra-high performance liquid chromatography-mass spectrometry. Pharmacokinetic parameters were determined using the Pheonix WinNonlin software. The onset of rocuronium and time for recovery of TOF ratio to 90% were recorded. Results:The pharmacokinetics of sugammadex was fitted to the nonlinear mixed-effect satrioventricular model.There was no significant difference in the peak concentration, area under the drug concentration-time curve, elimination half-life, apparent clearance, apparent volume of distribution, mean retention time, and time for TOF ratio returning to 90% between the two groups ( P> 0.05). Conclusions:The pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual is fitted to a nonlinear mixed-effect satrioventricular model, and sugammadex 2 and 4 mg/kg have similar pharmacokinetics in infants and young children undergoing daytime surgery.
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Objective:To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods:A total of 117 pediatric patients with congenital heart disease, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 3-36 months, weighing 5-20 kg, scheduled for elective transthoracic echocardiography under outpatient sedation, were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine: Dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure: auricular acupressure with Wang Bu Liu Xing (semen vaccariae) seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min, dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.After the examination, auricular acupoint pressure therapy was continued at home, and pressing-rubbing at the acupoints was manipulated for 3 times daily, one of which was performed at 30 min before going to bed, for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score ≥2 within 30 min after giving dexmedetomidine, sedation was considered to be successful.The onset time of sedation, examination time, waiting time, recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia, hypotension, hypertension, hypoxemia, nausea and vomiting, respiratory depression, restlessness, hyperactivity, action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results:Compared with intranasal dexmedetomidine, the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased ( P<0.05), and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure ( P>0.05). Conclusion:Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.
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Objective To evaluate the effects of different fluid therapy protocols on postoperative nausea and vomiting (PONV) in pediatric patients undergoing ambulatory surgery.Methods A total of 160 pediatric patients,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 3-7 yr,weighing 14-24 kg,with body mass index ＜30 kg/m2,undergoing elective lower abdominal ambulatory surgery,were randomized into Ⅰ and Ⅱ groups (n=80 each) using a random number table method.Lactated Ringer's solution 10 ml · kg-1 · h-1 and 30 ml · kg-1 · h-1 were intravenously infused in group Ⅰ and group Ⅱ,respectively.Ibuprofen 20 mg/kg was given orally after operation to maintain Face Legs Activity Cry Consolability score ＜4.The development of PONV and thirst and requirement for antiemetics was recorded within 24 h postoperatively.The time of first PONV,time of first thirst and score for satisfaction of family members were also recorded.Results Compared with group Ⅰ,the incidence of PONV and thirst was significantly decreased,the time of first requirement for antiemetics and time of first thirst were prolonged,and the score for satisfaction of family members was increased (P＜ 0.05),and no significant change was found in the requirement for antiemetics in group Ⅱ (P＞0.05).Conclusion Intravenously infusing fluid 30 ml · kg-1 · h-1 can decrease the occurrence of PONV when compared with intravenously infusing fluid 10 ml · kg-1 · h-1 in pediatric patients undergoing ambulatory surgery.