ABSTRACT
The concept of the Bezold-Jarisch reflex(BJR)has experienced more than 100 years,which is that the left ventricular unmyelinated vagus nerve input receptors are stimulated by drugs or me-chanical pull,the stimulation was then integrated by the vagus nerve afferent brain stem nucleus and trans-mitted to the vascular movement center to form vagal nerve output enhancement,leading to severe bradycar-dia,peripheral vasodatation,hypotension and even cardiac arrest,e.g,a cardiovascular inhibitory reaction.Although BJR is applied in clinical anesthesia,insufficient attention has been paid to it,resulting in absence of the mechanism analysis of related sudden severe bradycardia,hypotension,and even cardiac ar-rest in perioperative period.
ABSTRACT
Remimazolam （toluenesulfonate） is a new type of ultra short-acting water-soluble benzodiazepine sedative-hypnotic drug， which was launched in China on December 26， 2019， for sedation during routine gastroscopy and colonoscopy as well as induction and maintenance under general anesthesia， breaking a 30-year period in which no innovative sedation drugs were marketed in China. This article reviewed the pharmacological characteristics， safety and combined use of remimazolam. Remimazolam had the advantages of high clearance rate， short action time， rapid recovery， stable hemodynamics， and low respiratory inhibition. It is independent of liver and kidney metabolism， and can be quickly antagonized by flumazenil， with little impact on the cognitive function of patients. Remimazolam has shown good respiratory and circulatory stability in combination with intravenous anesthetics such as propofol and esketamine， and opioid analgesics such as sufentanil， remifentanil， and alfentanil， as well as advantages such as rapid awakening and recovery. However， its safety still needs to be further monitored and explored during clinical use.
ABSTRACT
Objective:To explore the effect of virtual reality (VR) on the emergency management of pediatric anesthesia.Methods:Four kinds of perioperative critical events were selected as VR training content, and the training objects were 60 residents who took part in the standardized residency training in Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine. Through theoretical examination and questionnaire survey, the training effect and the anxiety of residents after critical events were evaluated. The data were input into Graphpad Prism 5 software, and the quantitative data conforming to normal distribution were expressed as (mean ± standard deviation), and compared by nonparametric test and t test of two independent samples between groups. Qualitative data were expressed in terms of rate, and the 2× k trend chi-square test was used to compare the scores of the two groups. Results:All the residents took part in the theoretical assessment of the management of pediatric anesthesia emergencies. Compared with the offline theoretical teaching, the average scores of the students who underwent VR training were higher, and the incidence of anxiety was significantly reduced.Conclusion:VR simulation teaching in the department of anesthesiology can fully arouse the enthusiasm of residents and make them overcome the fear of dealing with pediatric anesthesia emergencies.
ABSTRACT
We made our specific teaching program for these students with evidence-based medicine theory,according to their teaching characteristics. They studied the research methods of evidencebased medicine,and learned to search informations,write reviews,discuss clinical cases, design subjects under the guidance of teachers. Their scientific research ability was improved after these practices and training program.