Effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring / 南方医科大学学报

OBJECTIVE@#To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring.@*METHODS@#Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded.@*RESULTS@#No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)(@*CONCLUSIONS@#In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.

Efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients / 中华麻醉学杂志

Objective:To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods:A total of 117 pediatric patients with congenital heart disease, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 3-36 months, weighing 5-20 kg, scheduled for elective transthoracic echocardiography under outpatient sedation, were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine: Dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure: auricular acupressure with Wang Bu Liu Xing (semen vaccariae) seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min, dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.After the examination, auricular acupoint pressure therapy was continued at home, and pressing-rubbing at the acupoints was manipulated for 3 times daily, one of which was performed at 30 min before going to bed, for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score ≥2 within 30 min after giving dexmedetomidine, sedation was considered to be successful.The onset time of sedation, examination time, waiting time, recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia, hypotension, hypertension, hypoxemia, nausea and vomiting, respiratory depression, restlessness, hyperactivity, action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results:Compared with intranasal dexmedetomidine, the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased ( P<0.05), and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure ( P>0.05). Conclusion:Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.

Molecular mechanism underlying the inhibitory effect of propofol on lipopolysaccharide-induced pyroptosis of mouse bone marrow-derived macrophages / 南方医科大学学报

OBJECTIVE@#To investigate the molecular mechanism underlying the inhibitory effect of propofol on pyroptosis of macrophages.@*METHODS@#Macrophages derived from bone marrow were extracted and divided into three groups: control group, LPS+ATP group and propofol+LPS+ATP group. The control group was not given any treatment; LPS+ATP group was given LPS 1 μg/mL stimulation for 4 h, then ATP 4 mM stimulation for 1 h; Propofol+LPS+ATP group was given propofol+LPS 1 μg/mL stimulation for 4 h, then ATP stimulation for 1 h. After treatment, the supernatant and cells of cell culture were collected. the cell activity was detected by CCK8 and flow cytometry. The inflammatory cytokines IL-1βand IL-18 were detected by Elisa. Western blot was used to detect the expression of caspase-1 protein and TLR4 on cell membran Immunohistochemical fluorescence was used to detect apoptosis of cells.@*RESULTS@#LPS+ATP significantly decreased the viability of the macrophages and increased the cellular production of IL-1β and IL-18, activation of caspase-1 protein and the expression of TLR-4 on the cell membrane ( < 0.05). Treatment with propofol obviously reversed the changes induced by LPS+ATP.@*CONCLUSIONS@#LPS+ATP can induce pyroptosis of mouse bone marrow-derived macrophages, and propofol effectively inhibits such cell death, suggesting that propofol anesthesia is beneficial during operation and helps to regulate the immune function of in patients with sepsis.

Effects of different fluid therapy protocols on postoperative nausea and vomiting in pediatric patients undergoing ambulatory surgery / 中华麻醉学杂志

Objective To evaluate the effects of different fluid therapy protocols on postoperative nausea and vomiting (PONV) in pediatric patients undergoing ambulatory surgery.Methods A total of 160 pediatric patients,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 3-7 yr,weighing 14-24 kg,with body mass index ＜30 kg/m2,undergoing elective lower abdominal ambulatory surgery,were randomized into Ⅰ and Ⅱ groups (n=80 each) using a random number table method.Lactated Ringer's solution 10 ml · kg-1 · h-1 and 30 ml · kg-1 · h-1 were intravenously infused in group Ⅰ and group Ⅱ,respectively.Ibuprofen 20 mg/kg was given orally after operation to maintain Face Legs Activity Cry Consolability score ＜4.The development of PONV and thirst and requirement for antiemetics was recorded within 24 h postoperatively.The time of first PONV,time of first thirst and score for satisfaction of family members were also recorded.Results Compared with group Ⅰ,the incidence of PONV and thirst was significantly decreased,the time of first requirement for antiemetics and time of first thirst were prolonged,and the score for satisfaction of family members was increased (P＜ 0.05),and no significant change was found in the requirement for antiemetics in group Ⅱ (P＞0.05).Conclusion Intravenously infusing fluid 30 ml · kg-1 · h-1 can decrease the occurrence of PONV when compared with intravenously infusing fluid 10 ml · kg-1 · h-1 in pediatric patients undergoing ambulatory surgery.