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Objective:To determine the optimal concentration of inhaled oxygen in pediatric patients undergoing laparoscopic choledochal cyst resection under general anesthesia.Methods:Seventy-five pediatric patients of both sexes, aged 1-3 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with body mass index of 15-18 kg/m 2, with expected operation time≥3 h, scheduled for elective laparoscopic choledochal cyst resection with general anesthesia, were divided into 3 groups ( n=25 each) using a random number table method: C 40 group (FiO 2=40%), C 30 group (FiO 2=30%) and C 21 group (FiO 2=21%). Blood samples were collected from the radial artery for blood gas analysis after operation for determination of oxygenation index (OI), respiratory index (RI), alveolar-arterial oxygen partial pressure difference (PA-aO 2) and arterial-alveolar oxygen partial pressure ratio (PaO 2/PAO 2). The occurrence of high risk events of hypoxia (SpO 2<94%), extubation time, and occurrence of pneumonia and atelectasis at day 7 after operation were recorded. Results:Compared with C 21 group, PaO 2, PAO 2, PA-aO 2 and RI were significantly increased, PaO 2/PAO 2 was decreased, and the incidence of high risk events of hypoxia was decreased in C 30 and C 40 groups, and the incidence of atelectasis in C 30 group and pneumonia and atelectasis in C 40 group was increased at day 7 after operation ( P<0.05). Compared with C 30 group, PaO 2, PAO 2, PA-aO 2 and RI were significantly increased, and PaO 2/PAO 2 was decreased in C 40 group ( P<0.05). Conclusions:The optimal concentration of inhaled oxygen recommended is 21%-30% in the pediatric patients undergoing laparoscopic choledochal cyst resection under general anesthesia.
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Objective To evaluate the efficacy of regional cerebral oxygen saturation(rSO2) combined with neuroelectrophysiological monitoring in guiding intraoperative blood pressure management in elderly patients undergoing carotid endarterectomy. Methods Thirty patients of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective carotid endar-terectomy, were divided into 2 groups(n=15 each)using a random number table: control group(group C)and rSO2combined with neuroelectrophysiological monitoring group(group M). During occlusion of carotid artery, the vasoactive drugs were used to make systolic blood pressure(SBP)increase by 20%-30% of the baseline value in group C and to make rSO2not less than 20% of the baseline value, the ampli-tude of somatosensory evoked potential P40 not less than 50% of the baseline value and the amplitude of e-lectroencephalogram voltage not less than 50% in group M. SBP and rSO2were recorded immediately after intubation(T1), at 5 min after anesthesia induction(T2), at 5 min after blocking the carotid artery (T3), at 5 min after opening the carotid artery(T4)and immediately after extubation(T5). Decrease in rSO2≥20% of the baseline value was recorded. The carotid artery occlusion time, myocardial oxygen con-sumption and consumption of vasoactive drugs during occlusion were recorded. Results Compared with group C, SBP was significantly decreased at T3, and the consumption of vasoactive drugs and myocardial oxygen consumption were reduced in group M(P<0.05), and no significant change was found in rSO2at each time point in group M(P>0.05). Decrease in rSO2≥20% of the baseline value was not found in two groups. Conclusion rSO2combined with neuroelectrophysiological monitoring provides guidance for intra-operative blood pressure management in patients undergoing carotid endarterectomy.
