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Objective To evaluate the effect of hypothermia on the endotracheal tube cuff pressure during cardiopulmonary bypass in the pediatric patients with congenital heart disease. Methods Forty pedi-atric patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, aged 1 months-14 yr, weighing 3-58 kg, scheduled for elective surgery for congenital heart disease using cardiop-ulmonary bypass, were included in this study. All the pediatric patients were intubated with a cuffed endo-tracheal tube. After anesthesia induction and endotracheal intubation, the air was injected into the cuff to make the cuff pressure reach 20 cm H2 O ( baseline) . The endotracheal tube cuff pressure was recorded when the esophageal temperature was reduced to 34, 32, 30, 28 and below 28℃ and returned to 28, 30, 32, 34 and 36 ℃. Results The cuff pressure was significantly decreased when the esophageal temperature was reduced to 30 and 28 ℃ and below 28 ℃ and returned to 28, 30, 32 and 34 ℃ as compared with the baseline ( P<0. 05) . Conclusion Hypothermia can reduce the endotracheal tube cuff pressure during car-diopulmonary bypass, and it is recommended to routinely monitor the cuff pressure in the pediatric patients with congenital heart disease.
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Objective To evaluate the effect of injecting alkalinized lidocaine into the tracheal tube cuff on the responses to extubation in pediatric patients.Methods One hundred and twenty-six pediatric patients,aged 3-13 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective abdominal surgery under general anesthesia requiring oral tracheal intubation,were divided into 3 groups (n =42 each) using a random number table:control group (group C),normal saline group (group NS) and alkalinized lidocaine group (group L).Air was injected into the tracheal tube cuff in group C.Normal saline was injected into the tracheal tube cuff in group NS.Alkalinized lidocaine was injected into the tracheal tube cuff in group L.Cuff pressure was monitored and maintained below 20 cmH2O.The differences in mean arterial pressure (ΔMAP) and heart rate (ΔHR) immediately after stopping inhalation of anesthetics and immediately after extubation were calculated.The response to extubation was defined as Δ MAP or / HR＞20％ of the baseline value and/or development of moderate and severe bucking and agitation.The development of coughing,hoarseness and sore throat during the period in postanesthesia care unit and the period from being discharged from postanesthesia care unit until 8 h after extubation were recorded.Results Compared with group C and group NS,the incidence of response to extubation and sore throat was significantly decreased (P＜0.05),and no significant change was found in the incidence of coughing or hoarseness in group L (P＞0.05).The volume of the alkalized lidocaine solution in the cuff was (4.2±2.3) ml[(60±33) mg] in group L.No cuffdamage was found in three groups.Conclusion Injecting alkalinized lidocaine into the tracheal tube cuff can safely and effectively inhibit responses to extubation and is helpful in improving outcomes in pediatric patients.
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Objective To observe and compare anatomical position between pediatric internal jugular vein and common carotid artery in children patients of different ages with ultrasonic technique.Methods Four hundred and ninety-six cases of pediatric patients undergoing selective operation,ASA physical status Ⅰ or Ⅱ,were selected in this study,they were 380 males and 116 females ranging from 0 to 12 years.Image position of internal jugular vein and common carotid artery above the clavicle were detected with ultrasonic technique for all pediatric patients,positions of internal jugular vein and common carotid artery for different patients were classified according to different angles,anatomical position between pediatric internal jugular vein and common carotid artery in different age groups (newborn group,infant group,toddler group,preschool children group and school-age children group) were compared.Results In area between 0°-30°,the ratios of right puncture of infant group,toddler group,preschool children group and school-age children group were significantly higher than those of the left (infant group: 42.3% vs 0%;toddler group: 48.8% vs 1.6%;preschool children group: 57.5% vs 2.7%;school-age children group: 58.0% vs 2.1%)(P90°,there was no statistical difference between the ratios of the right puncture and the left in all groups.Conclusion The success rate of right internal jugular vein puncture of children was higher than that of the left.Conditions in the newborn group were different from that in the other age groups.
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Objective To evaluate the efficacy of bispectral index (BIS) in guiding sevoflurane anesthesia in children. Methods Forty-eight ASA Ⅰ or Ⅱ pediatric patients aged 1-12 yr undergoing elective urological surgery were randomized into 2 groups ( n = 24 each) : group Ⅰ control and group Ⅱ BITS. Each group was further divided into 3 subgroups according to the age (n = 8 each) : subgroup A ( 1 yr≤age < 3 yr) ,subgroup B (3 yr≤ age<6 yr ) and subgroup C (6 yr≤age ≤ 12 yr). The patients were premedicated with IM atropine 0.015-0.02 mg/kg. Anesthesia was induced with 5% sevoflurane and 60% N2O in O2. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. Anesthesia was maintained with inhalation of sevoflurane and,50% N2O in O2 and intermittent Ⅳ bolnses of vecuronium and fentanyl. In BIS group, BIS was maintained at 40-60 during operation and at 60-75 during the 15 min before the end of surgery. BIS was monitored and recorded but not available to the anesthesiologist in control group and the depth of anesthesia was maintained based on hemodynamic changes and clinical signs. MAP, HR, end-tidal sevoflurane concentration, BIS, emergence time, extubation time and PACU discharge time were recorded. The amount of sevoflurane consumed was calculated. Results There was no significant difference in the demographic data between the cotresponding age groups of BIS and control group. The BIS were maintained at 40-60 in control group. The BIS was significantly higher in BIS group than in control group except the subgroup A. The end-tidal sevoflurane concentration was significantly lower, and the emergence time, extubation time and PACU discharge time were significantly shorter in BIS group than in control group. There was no significant difference in MAP and HR between the 2 groups. Conclusion BIS monitoring can reduce sevoflurane consumption and allow faster emergence from sevoflurane anesthesia in children over 1 yr of age.