RESUMO
The data of pediatric patients who underwent scoliosis surgery from July 2016 to July 2019 were collected retrospectively.The pediatric patients were divided into traditional ventilation group (T group) and lung-protective ventilation group (P group) based on the ventilator settings.Standardized tidal volume(V T)was obtained by V T/ideal body weight (IBW). Patients with standardized V T ≥ 8 ml/kg and without positive end-expiratory pressure (PEEP) were included in group T, and patients with V T <8 ml/kg and PEEP 4-8 cmH 2O were included in group P. The propensity score was used to match the baseline information and intraoperative variables in the two groups.A total of 415 pediatric patients accepted screening, and 171 cases were successfully matched, including 92 cases in group T and 79 cases in group P. Compared with group T, the incidence and grade of pulmonary complications were significantly decreased at day 30 after operation, postanesthesia care unit stay time was shortened, body temperature was decreased at 24 h after operation, V T, standardized V T and oxygenation index were decreased, P ETCO 2, PEEP, ventilation frequency and I∶ E were increased ( P<0.05), and no significant change was found in IBW, PaCO 2, incidence of postoperative surgical complications and anesthesia-related complications, plasma C-reactive protein concentration and white blood cell count at 24 h after operation, hospitalization time and hospitalization cost in group P ( P>0.05). In conclusion, the lung-protective ventilation strategy low V T combined with PEEP can decrease the risk of postoperation lung complications and is helpful in improving prognosis in the pediatric patients undergoing scoliosis surgery as compared with traditional mechanical ventilation strategy.
RESUMO
Objective To evaluate the effect of obstructive jaundice on recovery from sevoflurane anesthesia in pediatric patients. Methods A total of 80 pediatric patients scheduled for elective surgery were included, 42 pediatric patients with biliary atresia scheduled for Kasai operation served as obstructive jaundice group ( group OJ ) , and 38 pediatric patients scheduled for other operations served as control group ( group C) . Pediatric patients were 1-4 months old and full?term infants, and weighed 3.2-8.0 kg. Anesthesia was maintained with inhalation of 2%-4% sevoflurane during surgery, and pediatric patients inhaled 4% sevoflurane staring from peritoneum closure until the end of surgery. The duration from closing sevoflurane vaporizer to BIS value reaching 60, 70, 80 and 90 was recorded. The duration from stop of sevoflurane inhalation to BIS value returning to 60, 70, 80 and 90 was recorded. The duration from termination of sevoflurane inhalation to the time for tidal volume returning to 6 ml∕kg, to the time for muscle strength recovering to grade Ⅲ, to spontaneous eye opening and to tracheal extubation, and the corresponding BIS values were recorded. BIS value while entering the operating room, BIS value at the end of surgery, and the highest BIS value during recovery from anesthesia were recorded. The occurrence of delayed emergence from anesthesia was recorded. Results Compared with group C, the duration from termination of sevoflurane inhalation to spontaneous eye opening and to tracheal extubation were significantly prolonged, and BIS value at the end of surgery was decreased, and no significant change was found in the other parameters in group OJ. No pediatric patients developed delayed emergence from anesthesia in the two groups. Conclusion When only sevoflurane is used for inhalation anesthesia, although the time for recovery from anesthesia is prolonged, it shows no significant difference clinically in pediatric patients with obstructive jaundice.
RESUMO
Objective To explore the effect on ultrasound localization method with radial artery cannulation in infants.Methods Sixty infants (1 month-1year old)undergoing elective surgical proce-dures required artery pressure,were randomly divided into two groups:ultrasound localization group (group B):the infants were used of portable B ultrasound probe in the wrist with two dimensional ul-trasound image to determine the body position of the radial artery;control group (group C):tradi-tional palpation determine the radial artery puncture position.One puncture success rate,total punc-ture success rate,the period of puncture time and incidence of complications were recorded;MAP, the radial artery diameter,the vertical distance from the ultrasound probe to the skin and the length from the puncture spot to the radial artery were also measured.Results The success rate of first puncture in group B was higher than that of group C (P <0.05),the times of puncture and procedure time were significantly less than those of group C (P <0.05),the incidence of hematoma was lower than that in group C (P <0.05).Conclusion The application of ultrasound-guided method for radial artery cannulation is safe and reliable with accurate localization,highly successful rate of puncture at first time,lower complication and shorter time for placement.