RESUMO
Objective To investigate different anesthetic effects of remifentanil, sufentanil, and fentanyl in the pediatric tonsilloadenoiectomy. Methods Totally 210 cases of tonsilloadenoiectomy enrolled in our institution from March 2016 to February 2017 were selected as study objects. Children were divided randomly into three groups, with 70 cases in each group, including remifentanil group, sufentanil group, and fentanyl group. Child patients in the remifentanil group were induced by remifentanil with 1μg/kg, and were maintained with 0.1μg · kg-1 · min-1. Remifentanil was withdrawn 5 minutes before the end of operation. Child patients in the sufentanil group were induced by sufentanil with 0.2 μg/kg, and were maintained with 0.1 μg · kg-1 · h-1. Sufentanil was withdrawn 30 minutes before the end of operation. Child patients in the fentanyl group were induced by fentanyl with 2μg/kg, and were maintained with 1μg·kg-1·h-1. Fentanyl was withdrawn 30 minutes before the end of operation. During the anesthesia, the indexes of heart rate (HR), mean arterial pressure (MAP), and oxygen saturation were recorded in the three groups. The time of eyelash reflex disappearance, pain reflex disappearance, postoperation eye open, and extubation were also recorded. The incidences of perioperative adverse events were compared between the three groups. Results HR and MAP at time points of anesthesia induction, 5 minutes after anesthesia induction, and 10 minutes after anesthesia induction were higher in the remifentanil group than those in the other two groups (P<0.05). And the differences of the above indexes at all time points between sufentanil group and fentanyl group showed no statistical significance (P>0.05). The time of pain reflex disappearance, postoperation eye open, and extubation were higher in the fentanyl group than those in the other two groups (P<0.05). And the differences of the above indexes between sufentanil group and remifentanil group showed no statistical significance (P>0.05). Incidence rate of postoperative agitation was higher in the remifentanil group than that in the other two groups (P<0.01). And the difference of incidence rate of postoperative agitation between the sufentanil group and fentanyl group showed no statistical significance ( P>0.05). Conclusion The effect of sufentanil is better than remifentanil and fentanyl in the anesthesia of pediatric tonsilloadenoiectomy, with fast effect, fast analepsia, stable haemodynamics, and low incidence rate of postoperative agitation.
RESUMO
Azoles are widely applied and largely effective as antifungals; however, the increasing prevalence of clinically resistant isolates has yet to be matched by approaches to improve the efficacy of antimicrobial therapy. In this study, using the model fungus Aspergillus nidulans and one of the most common human pathogen Aspergillus fumigatus as research materials, we present the evidence that calcium signaling is involved in the azole-antifungals-induced stress-response reactions. In normal media, antifungal-itraconazole (ITZ) is able to induce the [Ca(2+)]c increased sharply but the addition of calcium chelator-EGTA or BAPTA almost blocks the calcium influx responses, resulted in the dramatically decreasing of [Ca(2+)]c transient. Real-time PCR analysis verified that six-tested Ca(2+)-inducible genes-two calcium channels (cchA/midA), a calmodulin-dependent phosphatase-calcineurin (cnaA), a transcription factor-crzA, and two calcium transporters (pmrA/pmcA)-could be transiently up-regulated by adding ITZ, indicating these components are involved in the azole stress-response reaction. Defect of cnaA or crzA caused more susceptibility to azole antifungals than did single mutants or double deletions of midA and cchA. Notably, EGTA may influence Rh123 accumulation as an azole-mimicking substrate through the process of the drug absorption. In vivo studies of a Galleria mellonella model identified that the calcium chelator works as an adjunct antifungal agent with azoles for invasive aspergillosis. Most importantly, combination of ITZ and EGTA or ITZ with calcium signaling inhibitor-FK506 greatly enhances the ITZ efficacy. Thus, our study provides potential clues that specific inhibitors of calcium signaling could be clinically useful adjuncts to conventional azole antifungals in the Aspergilli.
