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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative patient-controlled intravenous analgesia in pediatric patients undergoing lower extremity orthopedic surgery.Methods:Sixty-eight pediatric patients of both sexes, aged 3-15 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, undergoing elective lower extremity orthopedic surgery under general anesthesia, were divided into 2 groups ( n=34 each) by the random number table method: TEAS group (group T) and control group (group C). In group T, the bilateral Hegu and Neiguan acupoints were stimulated starting from 10 min before induction of anesthesia until the end of procedure, with the frequency of disperse-dense wave of 2/10 Hz, and the current intensity was gradually adjusted to the maximum intensity (10-15 mA) that children could tolerate. In group C, the electrodes were applied to the same acupoints, but electrical stimulation was not applied. The severity of pain was assessed by the Faces Pain Scale-Revised scale immediately after returning to the ward and at 2, 24 and 48 h after operation. The emergence agitation was evaluated using the Pediatric Anesthesia Emergence Delirium scale. The intraoperative consumption of propofol and remifentanil and time to extubation after stopping administration were recorded. The time to first pressing of patient-controlled analgesia (PCA), effective pressing times of PCA on 1st and 2nd days after surgery and postoperative adverse reactions such as postoperative nausea and vomiting, pruritus, drowsiness, and respiratory depression were recorded. Results:Compared with group C, the Faces Pain Scale-Revised scale scores were significantly decreased immediately after returning to the ward and at 2, 24 and 48 h after operation, the incidence of emergence agitation and intraoperative consumption of remifentanil were decreased, the time to extubation was shortened, the time to first pressing of PCA was prolonged, and the effective pressing times of PCA on 1st and 2nd days after surgery were decreased ( P<0.05). There was no significant difference in the intraoperative consumption of propofol and incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:TEAS can effectively enhance the effect of postoperative patient-controlled intravenous analgesia in pediatric patients undergoing lower extremity orthopedic surgery.
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Objective To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients.Methods Sixty pediatric patients of both sexes with hydronephrosis,aged 3-12 yr,of American Society of Anesthesiologists physical status I or Ⅱ,undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019,were divided into 2 groups using a random number table method:control group (group C,n =28) and ERAS group (n =32).In ERAS group,preoperative ERAS education was carried out,the time of preoperative food and water deprivation was shortened,pediatric patients drank glucose water at 2 h before surgery,anesthetic regimen was optimized,lung protective ventilation and target-directed fluid therapy were performed,and intraoperative warming and multi-mode antiemetic measures were carried out during operation,and multi-mode analgesic measures were taken after operation,and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C,the traditional concept was adopted for perioperative management.Immediately after tracheal intubation,at 30 min and 1 and 2 h after establishing pneumoperitoneum,at 5 min after the end of pneumoperitoneum and at 5 min after extubation,the airway peak pressure and tidal volume were recorded,and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation,time of first intake,the first postoperative off-bed time,the first flatus time,time of pulling out the ureter and drainage tube,and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4,fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading,and postoperative complications included nausea and vomiting,abdominal distension,abdominal pain,incision infection,abdominal infection,anastomotic leakage,fever,etc.Results Compared with group C,the preoperative food and water deprivation time was significantly shortened,the time of postoperative extubation was prolonged,the postoperative length of hospital stay,time of first intake,the first postoperative off-bed time,the first flatus time,and time of pulling out the ureter were shortened,airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum,arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P＜0.05 or 0.01),and no significant change was found in the incidence of postoperative agitation,nausea and vomiting,incision infection,abdominal infection or fever in group ERAS (P＞0.05).No intraoperative adverse cardiovascular events were found,and no pediatric patients required rescue analgesia after operation in two groups.Conclusion ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.
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Objective@#To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients.@*Methods@#Sixty pediatric patients of both sexes with hydronephrosis, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019, were divided into 2 groups using a random number table method: control group (group C, n=28) and ERAS group (n=32). In ERAS group, preoperative ERAS education was carried out, the time of preoperative food and water deprivation was shortened, pediatric patients drank glucose water at 2 h before surgery, anesthetic regimen was optimized, lung protective ventilation and target-directed fluid therapy were performed, and intraoperative warming and multi-mode antiemetic measures were carried out during operation, and multi-mode analgesic measures were taken after operation, and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C, the traditional concept was adopted for perioperative management.Immediately after tracheal intubation, at 30 min and 1 and 2 h after establishing pneumoperitoneum, at 5 min after the end of pneumoperitoneum and at 5 min after extubation, the airway peak pressure and tidal volume were recorded, and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation, time of first intake, the first postoperative off-bed time, the first flatus time, time of pulling out the ureter and drainage tube, and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4, fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading, and postoperative complications included nausea and vomiting, abdominal distension, abdominal pain, incision infection, abdominal infection, anastomotic leakage, fever, etc.@*Results@#Compared with group C, the preoperative food and water deprivation time was significantly shortened, the time of postoperative extubation was prolonged, the postoperative length of hospital stay, time of first intake, the first postoperative off-bed time, the first flatus time, and time of pulling out the ureter were shortened, airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum, arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P<0.05 or 0.01), and no significant change was found in the incidence of postoperative agitation, nausea and vomiting, incision infection, abdominal infection or fever in group ERAS (P>0.05). No intraoperative adverse cardiovascular events were found, and no pediatric patients required rescue analgesia after operation in two groups.@*Conclusion@#ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.
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To investigate the effects of platelet glycoproteins after infusion of four kinds of solutions in vivo (30ml/kg), 105 patients for selective cholecystectomy were randomly divided into four groups.Normal saline was infused in group A patients,dextran 70 for group B, urea linked gelatin for group C, and modified fluid gelatin for group D. Blood samples from patients were taken before the infusion and two hours and three hours after the infusion for the measurement of platelet adhesion(PAdT), vonWillebrand factor (vWF), and glycoproteinⅠb/Ⅰx (GPⅠb/Ⅰx). As compared with other groups the level of vWF and GPⅠb/Ⅰx decreased significantly in group B( P
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Objective To investigate the effects of magnitude of surgical trauma and duration of operation on aggregation and adhesion of platelets during laparoscopy and conventional laparotomy cholecystectomy. Methods Thirty ASA Ⅰ-Ⅱpatients(male 11, female 19) undergoing elective cholecystectomy were studied . The mean age was(45 .2 ? 8.3) years and mean body weight(63.3 ?12. 6)kg. The patients were divided into two groups: laparoscopy group(group LC) and laparotomy group(group OC). Patients who took any drugs which may affect blood coagulation were excluded. Blood routine examination, coagulation and bleeding time were normal in all patients. In both groups anesthesia was induced with fentanyl 0. 1-0.2mg, propofol 2mg/kg and vecuronium 0.1mg/kg and maintained with isoflurane inhalation. Venous blood samples were taken after induction of anesthesia and 1h and 2h after operation was started. 10ml of blood was withdrawn from median cubital vein for the measurement of platelet adhesion(PAdT) and plasma level of platelet membrane glycoprotein(GPⅠ b/Ⅰ x) and von Willebrand factor(vWF) . Venepuncture was made at first attempt without using tourniquet. Plastic syringes were used and first 2ml of blood withdrawn was discarded . Glass ball method was used for measurement of PAdT which was calculated according to the following equation: Rate of platelet adhesion(% ) = /(No. of platelet before adhesion-No. of platelet after adhesion) No. of platelet before adhesionGP Ⅰ b/Ⅰ x and vWF levels were measured using ELISA method. Results There was no significant difference in PAdT and GP Ⅰ b/Ⅰ x and vWF levels after induction of anesthesia between two group. PadT level was significantly lower at 1 and 2h during surgery in group LC than that in group OC. GPⅠh/Ⅰx level was higher at 1h during operation in group OC than that in group LC and was much higher at 2h during surgery. vWF level decreased significantly at 2h during operation in both groups. Conclusions Platelet adhesion rate increases during operation and the severer the trauma the higher the platelet adhesion rate. GPⅠ b/Ⅰ x level is higher in group OC during operation than that in group LC probably due to severity of trauma. vWF is consumed during operation.
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Objective To investigate the effects of gelatins and dextran on fibrinogen and platelet glycoproteinⅡb/Ⅲa (GPⅡb/Ⅲa).Methods One hundred and five patients for selective cholecystectomy were randomly divided into four groups. In groupⅠ normal saline 30ml/kg was infused, in groupⅡ dextran-70 30ml/kg,in groupⅢ urea-linked gelatin 30ml/kg and group Ⅳ modified fluid gelatin 30ml/kg. The blood samples were taken before infusion ,two hours and three hours after the infusion, to measure platelet maximum aggregation rate (MAR), levels of Fbg and GPⅡb/Ⅲa,respectively.Results As compared with those in other groups, MAR and level of GPⅡb/Ⅲa decreased significantly in groupⅡ(P