The Effect of Intranasal Dexmedetomidine on Emergence Delirium Prevention in Pediatric Ambulatory Dental Rehabilitation Under General Anesthesia: A Randomized Clinical Trial.

Purpose: Sevoflurane is the preferred anesthetic agent for induction and maintenance of ambulatory surgery due to its property of fast onset and recovery. However, it has been recognized as one of the major contributors of emergence delirium. The aim of this study was to evaluate the preventive effect of intranasal dexmedetomidine on the occurrence of emergence delirium in pediatric patients under general anesthesia with sevoflurane. Patients and Methods: Ninety pediatric patients undergoing dental rehabilitation under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=30 each in the 2 µg/kg dexmedetomidine, 1 µg/kg dexmedetomidine, and control with saline groups). The same volume (0.02mL/kg) of the mixed solution was dropped into the nasal cavity of the children 30 minutes before surgery. We used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level and incidence of delirium in the post-anesthesia care unit. Results: Compared with the control group, prophylactic use of different dosages of intranasal dexmedetomidine significantly reduces the incidence of ED and severe ED in PACU (P<0.001). Intranasal administration of 2 µg/kg dexmedetomidine was associated with a better acceptance of mask induction and a better tolerance of separation with parents. Conclusion: Both 2 µg/kg and 1 µg/kg intranasal dexmedetomidine can achieve ED preventive effects in PACU in dental rehabilitation under general anesthesia. A dosage of 2 µg/kg is more effective in preventing severe ED and providing better mask acceptance.

Willed-movement training reduces motor deficits and induces a PICK1-dependent LTD in rats subjected to focal cerebral ischemia.

Willed-movement (WM) training has been implicated in the promotion of motor function in human stroke survivors and focal ischemic rats. However, the molecular basis of changes in synaptic transmission following WM training remains unclear. In addition, studies examining the influence of rehabilitative training, such as skilled motor learning, on long-term depression (LTD) of synapses in the primary motor cortex have produced conflicting results. To identify the possible effects of willed movement on motor recovery, on expression of the protein interacting with C kinase 1 protein (PICK1), and on PICK1 related LTD, littermate rats were randomly divided into four groups: normal control, middle cerebral artery occlusion (MCAO), WM and environmental modification. Neurological and neurobehavioral assessments were performed for the rats with occlusion of the right middle cerebral artery. Double-labeling immunofluorescence staining was performed to detected expression of PICK1 and NeuN. Extracellular recordings were used to detect the basal extracellular field excitatory postsynaptic potentials and LTD with or without PICK1 inhibitor FSC231. The results showed that willed-movement training facilitated motor recovery after MCAO in rats, increased the PICK1 protein levels, and enhanced LTD in the ischemia hemisphere. The enhanced LTD for the rats after willed-movement training was attenuated by FSC231. Our results indicated that willed-movement training can enhance activity-dependent LTD through PICK1-dependent mechanisms in the ischemic hemisphere of rats.