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@#Objective To investigate the effect of pulmonary ultrasound on pulmonary complications in ultra-fast-track anesthesia for congenital heart disease surgery. Methods In 2019, 60 patients with congenital heart diseases underwent ultra-fast-track anesthesia in Shenzhen Children's Hospital, including 34 males and 26 females with the age ranging from 1 month to 6 years. They were randomly divided into a normal group (group N, n=30) and a lung ultrasound optimization group (group L, n=30). Both groups were used the same anesthesia method and anesthetic compatibility. The group N was anesthetized by ultra-fast-track, the tracheal tube was removed after operation and then the patients were sent to the cardiac intensive care unit (CCU). After operation in the group L, according to the contrast of pre- and post-operational lung ultrasonic examination results, for the patients with fusion of B line, atelectasis and pulmonary bronchus inflating sign which caused the increase of lung ultrasound score (LUS), targeted optimization treatment was performed, including sputum suction in the tracheal tube, bronchoscopy alveolar lavage, manual lung inflation suction, ultrasound-guided lung recruitment and other optimization treatments, and then the patients were extubated after lung ultrasound assessment and sent to CCU. The occurrence of pulmonary complications, LUS, oxygenation index (OI), extubation time, etc were compared between the two groups. Results Compared with the induction of anesthesia and 1 hour after extubation of the two groups, the incidence of pulmonary complications in the group L (18 patients, 60.0%) was lower than that in the group N (26 patients, 86.7%, χ2= 4.17, P=0.040) and the rate of patients with LUS score reduction was higher in the group L (15 patients, 50.0%) than that in the group N (7 patients, 23.3%, χ2=4.59, P=0.032). The correlation analysis between the LUS and OI value of all patients at each time point showed a good negative correlation (P<0.05). Extubation time in the group L was longer than that in the group N (18.70±5.42 min vs. 13.47±4.73 min, P=0.001). Conclusion Ultra-fast-track anesthesia for congenital heart disease can be optimized by pulmonary ultrasound examination before extubation, which can significantly reduce postoperative pulmonary complications, improve postoperative lung imaging performance, and help patients recover after surgery, and has clinical application value.
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Mechanical ventilation with lung protective ventilation strategy not only results in decreased mortality and reduced postoperative pulmonary complications in patients with acute lung injury/acute respiratory disease syndrome,but also is beneficial to healthy patients.Factors influencing the prognosis of lung protective ventilation strategy is detailed in this article.
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Objective To compare the effect of target controlled infusion (TCI) and man controlled infusion (MCI) of propofol in pain-free endoscopic ultrasonography.Methods Sixty patients undergoing pain-free endoscopic ultrasonography were divided into TCI group and MCI group by random digits table method,each group 30 patients.Operation time,dose of propofol,time to loss consciousness and recovery time were recorded.The level of mean artery pressure (MAP) and heart rate (HR) were recorded before induction (T0),before operation (T1),5 min afteroperafion (T2) and 5 min afterawake (T3).Cases with bucking,aspiration,laryngeal spasm,pulse oxygen saturation (SpO2) lower than 0.90,MAP lower than 50 mmHg (1 mmHg =0.133 kPa) and HR lower than 50 bpm were recorded.Results Dose of propofol was higher in MCI group than that in TCI group,time to loss consciousness was shorter in MCI group than that in TCI group,recovery time was shorter in TCI group than that in MCI group,there was significant difference (P ＜ 0.01).The level of MAP and HR on T1 were significantly lower than those on T0 between two groups (P ＜ 0.05).The level of MAP and HR on T1 in TCI group were signifcantly higher than those in MCI group (P ＜ 0.05).The rate of bucking between two groups had no significant difference (x2 =0.37,P ＞ 0.05).The rate of anoxemia in TCI group was 10.0％ (3/30),in MCI group was 66.7％ (20/30),there was significant difference (x2 =20.38,P ＜ 0.01).The rate ofMAP lower than 50 mmHg in TCI group was 6.7％ (2/30),in MCI group was 30.0％ (9/30),there was significant difference (x2 =5.46,P ＜ 0.05).The rate of HR lower than 50 bpm between two groups had no significant difference (x2 =3.35,P ＞ 0.05).Conclusion Compared with MCI,patients induced by TCI mode are more stable in blood pressure,and more safe.
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Objective To evaluate the effects of penehyclidine hydroehloride as an atropine alternative on angioearpy and glandular secretions when premedieated in ketamine complex total intravenous anesthesia(TIVA)in children.Methods Forty patients aged 3-10 years undergoing ketamine and propofol complex TIVA were randomly divided into two groups.Penehyclidine hydrochloride(group P,n=20)or atropine(group A,n=20)was premedicated intramuscularly 30 min before anesthesia.Heart rate(HR),mean arterial pressure(MAP),breath rate(R)and the amount of saliva secretion(SS)were recorded before premedication(0 min),10 min,20 min,30 min,60 min and 150 min after.Results (1)SS reduced significantly 20 min,30 min and 60 min after premedication in both groups(P＜0.01),and in 150 min,it was still in a significantly reduced level in group P(P＜0.01),which was significantly lower than that in group A(P＜0.01).(2)MAP,HR and R in group P showed no significant differences before and after premedication(P＞0.05).But in group A,HR increased significantly at 20 min,30 min and 60 min after premedication(P＜0.05 or＜0.01),MAP increased significantly at 30 min and 60 min after premedication(P＜0.01),and meanwhile of them were also significantly higher than those in group P(P＜0.05 or＜0.01).Conclusions Penehychdine hydrochloride can effectively reduce respiratory glandular secretion with longer persistence,and nearly has no influence on HR and blood pressure,which suggests it could be a superior to atropine alternative as an anesthesia premedication in children.