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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.
RESUMEN
<p><b>BACKGROUND</b>Active tuberculosis (TB) with negative results of sputum smear is difficult to be identified. Till now, there is no effective and noninvasive diagnostic method. This study evaluated the diagnostic power of Mycobacterium tuberculosis T-cell (T.SPOT®.TB) assays for active TB.</p><p><b>METHODS</b>We retrospectively screened 450 suspected TB patients that were hospitalized in the Respiratory Department of Henan Province People's Hospital from June 2015 to June 2016. The patients were divided into the active, previous, and non-TB groups according to their final diagnosis. We evaluated the diagnostic value of the T-SPOT®.TB assay by constructing receiver operating characteristic (ROC) curves and calculating the optimal diagnostic cutoff value. In addition, we compared the levels of A antigen (ESAT-6) and B antigen (CFP-10) in active TB.</p><p><b>RESULTS</b>The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of T-SPOT®.TB for active TB were 89.78%, 63.16%, 0.56, 0.92, 2.47, and 0.16, respectively. For active TB, the area under the ROC curve (AUC) of the A antigen (0.89) was higher than that of the B antigen (0.86). The AUC of the A antigen for active TB was largest at a cutoff value of 13.5 spot-forming cells (SFCs) per 2.5 × 105 peripheral blood mononuclear cells (PBMCs). The AUC of the A and B antigens was 0.60 and 0.58 for previous TB. The levels of A and B antigen in the active TB group were significantly different from those in the previous- and non-TB groups (A antigen: χ2 = 105.41, P< 0.01 and B antigen: χ2 = 91.03, P< 0.01; A antigen: χ2 = 12.99, P< 0.01 and B antigen: χ2 = 8.56, P< 0.01, respectively). There were no significant differences in the levels of A and B antigens between the non-TB group and previous TB group (A antigen: χ2 = 1.07, P> 0.05 and B antigen: χ2 = 0.77, P> 0.05).</p><p><b>CONCLUSIONS</b>T-SPOT®.TB has high sensitivity and specificity for the diagnosis of active TB at a cutoff value of 13.5 SFCs per 2.5 × 105 PBMCs and is not influenced by previous TB.</p>