Membrane modification in enhancement of virus removal: A critical review.

Many waterborne diseases are related with viruses, and COVID-19 worldwide has raised the concern of virus security in water into the public horizon. Compared to other conventional water treatment processes, membrane technology can achieve satisfactory virus removal with fewer chemicals, and prevent the outbreaks of viruses to a maximal extent. Researchers developed new modification methods to improve membrane performance. This review focused on the membrane modifications that enhance the performance in virus removal. The characteristics of viruses and their removal by membrane filtration were briefly generalized, and membrane modifications were systematically discussed through different virus removal mechanisms, including size exclusion, hydrophilic and hydrophobic interactions, electronic interactions, and inactivation. Advanced functional materials for membrane modification were summarized based on their nature. Furthermore, it is suggested that membranes should be enhanced through different mechanisms mainly based on their ranks of pore size. The current review provided theoretical support regarding membrane modifications in the enhancement of virus removal and avenues for practical application.

A novel polymer enabled by polymerized small molecule strategy for tumor photothermal and photodynamic therapy.

Photothermal therapy (PTT) and photodynamic therapy (PDT) are effective method for tumor treatment. However, the limited variety and quantity of photothermal agents (PTAs) and photosensitizer (PSs) are still major challenges. Moreover, the cell apoptosis mechanism induced by PDT and PTT is still elusive. A fused-ring small molecule acceptor-donor acceptor' donor-acceptor (A-DA'D-A) type of Y5 (Scheme 1) has a narrow band-gap and strong light absorption. Herein, we used Y5 to polymerize with thiophene unit to obtain polymer PYT based on polymerized small molecule strategy, and PYT nanoparticles (PYT NPs) was prepared via one-step nanoprecipitation strategy with DSPE-PEG2000. PYT NPs had excellent biocompatibility, good photostability, high photothermal conversion efficiency (67%) and reactive oxygen species (ROS) production capacity under 808 nm laser irradiation (PYT NPs + NIR). In vitro and in vivo experiments revealed that PYT NPs + NIR had the ability to completely ablate tumor cells. It was demonstrated that cell apoptosis induced by PYT NPs + NIR was closely related to mitochondrial damage. This study provides valuable guidance for constructing high-performance organic PTAs and PSs for tumor treatment. Scheme 1 PYT enabled by polymerized small molecule strategy for tumor photothermal and photodynamic therapy.

Rapid urbanization affects microplastic communities in lake sediments: A case study of Lake Aha in southwest China.

Effective management of pollutants in urban environments is crucial for achieving sustainable cities. Microplastics, as an emerging pollutant widely present in contemporary environments, have received widespread attention in recent years. However, limited studies have reported the impact of rapid urbanization on regional microplastics. In this study, the abundance and composition of microplastic communities in the sediments of Lake Aha were analyzed using a "microplastic community" and slicing the sediments at 5 cm intervals. Results showed that microplastic abundance of sediments in Lake Aha was relatively high (up to 1700 items/kg) and decreased with increasing depth, with the highest abundance found in the surface layer (0-5 cm, 1090 ± 474 items/kg). Hierarchical cluster analysis (HCA), principal component analysis (PCA), and analysis of similarities (ANOSIM) revealed that the different sediment layers could be classified into high and low urbanization level groups based on the composition of microplastic communities. Linear discriminant analysis effect size (LEfSe) indicated that agricultural input was the main source of microplastic pollution during low urbanization levels, characterized by low abundance, large particle size, and high fiber proportion, while urban activities dominated during high urbanization levels, with high abundance, small particle size, high proportion of Polyethylene terephthalate (PET), fragments, and granules, and colorful microplastics. This study clarifies the impact of urbanization on the abundance and composition of microplastics in lake sediments, which has implications for more effective management and control of microplastic pollution in regions undergoing rapid urbanization.

Interfacial Assembly of Nanowire Arrays toward Carbonaceous Mesoporous Nanorods and Superstructures.

Synthesis of anisotropic carbonaceous nano- and micro-materials with well-ordered mesoporous structures has attracted increasing attention for a broad scope of applications. Although hard-templating method has been widely employed, overcoming the viscous forces to prepare anisotropic mesoporous materials is particularly challenging via the universal soft-templating method, especially from sustainable biomass as a carbon resource. Herein, the synthesis of biomass-derived nanowire-arrays based mesoporous nanorods and teeth-like superstructures is reported, through a simple and straightforward polyelectrolyte assisted soft-templating hydrothermal carbonization (HTC) approach. A surface energy induced interfacial assembly mechanism with the synergetic interactions between micelles, nanowire, nanorods, and polyelectrolyte is proposed. The polyelectrolyte acts not only as a stabilizer to decrease the surface energy of cylindrical micelles, nanowires and nanorods, but also as a structure-directing agent to regulate the oriented attachment and anisotropic assembly of micelles, nanowires, and nanorods. After a calcination treatment, the carbon nanorod and teeth-like superstructure are successfully coupled with Ru to directly produce supported catalysts for the hydrogen evolution reaction, exhibiting much better performance than the isotropic nanospheres based catalyst. This HTC approach will open up new avenues for the synthesis of anisotropic materials with various morphologies and dimensions, expanding the palette of materials selection for many applications.

Successful percutaneous left atrial appendage occlusion for atrial fibrillation in a patient with mirror-image dextrocardia: a case report.

BACKGROUND: Dextrocardia is a rare congenital condition (1/10,000-12,000) and AF is uncommon (1-2%). Therefore, the occurrence of the two conditions is rare. Percutaneous left atrial appendage occlusion (LAAO) is a treatment to prevent atrial fibrillation (AF)-associated thromboembolic events. CASE PRESENTATION: An 85-year-old female with known situs inversus totalis, persistent AF, and stroke was treated with oral anticoagulation, but she was suffering from constant gingival bleeding. Her CHA2DS2VASc score was 6 points (abnormal, ≥ 2), and her HAS-BLED score was 4 points (abnormal, ≥ 3). The transthoracic echocardiography (TTE) demonstrated left atrial (LA) enlargement (46 mm) and 50% of ejection fraction. She underwent percutaneous LAAO for stroke recurrence prevention using a Watchman occluder. The operation was successful but with technical differences compared with a standard case because of the dextrocardia. CONCLUSION: This is the first reported case of a percutaneous LAAO in situs inversus dextrocardia. This case indicates the feasibility of LAAO in congenital cardiac malposition combined with AF.

Integration of Quantum Confinement and Alloy Effect to Modulate Electronic Properties of RhW Nanocrystals for Improved Catalytic Performance toward CO2 Hydrogenation.

The d-band center and surface negative charge density generally determine the adsorption and activation of CO2, thus serving as important descriptors of the catalytic activity toward CO2 hydrogenation. Herein, we engineered the d-band center and negative charge density of Rh-based catalysts by tuning their dimensions and introducing non-noble metals to form an alloy. During the hydrogenation of CO2 into methanol, the catalytic activity of Rh75W25 nanosheets was 5.9, 4.0, and 1.7 times as high as that of Rh nanoparticles, Rh nanosheets, and Rh73W27 nanoparticles, respectively. Mechanistic studies reveal that the remarkable activity of Rh75W25 nanosheets is owing to the integration of quantum confinement and alloy effect. Specifically, the quantum confinement in one dimension shifts up the d-band center of Rh75W25 nanosheets, strengthening the adsorption of CO2. Moreover, the alloy effect not only promotes the activation of CO2 to form CO2δ- but also enhances the adsorption of intermediates to facilitate further hydrogenation of the intermediates into methanol.

Octahedral Pd@Pt1.8Ni core-shell nanocrystals with ultrathin PtNi alloy shells as active catalysts for oxygen reduction reaction.

Forming core-shell and alloy structures offers generally two ways to design efficient Pt-based catalysts for oxygen reduction reaction (ORR). Here, we combined these two strategies and invented a versatile aqueous route to synthesize octahedral Pd@Pt1.8Ni core-shell nanocrystals. The Pt/Ni atomic ratios in the resultant shells can be varied from 0.6 to 1.8, simply by changing the amounts of Pt and Ni precursors, with the other conditions unchanged. Experimental studies showed that the mass activities of as-prepared catalysts were 5 times higher than that of the commercial Pt/C. We believe that the ultrathin PtNi shells enclosed by {111} facets made it possible to reduce the Pt content while retaining the catalytic activity toward ORR. This strategy may be extended to the preparation of other multimetallic nanocrystals with shaped and ultrathin alloy shells, which is conducive to design highly active catalysts.

Bibliometric analysis of pediatric dental sedation research from 1993 to 2022.

Statement of problem: Bibliometric analysis methods were used to evaluate pediatric dental sedation research and to identify topical hotspots using quantitative and qualitative methodologies. Purpose: To conduct bibliometric analysis on the retrieved data and to foresee the development of trends and hotspots in this research area. Material and methods: We retrieved appropriate research articles from the Web of Science Core Collection on January 1, 2023. VOSviewer, Citespace and the Bibliometrics website were used to conduct bibliometric analysis on the retrieved data. GraphPad Prism 10.0 (GraphPad, San Diego, CA, USA) was used to conduct the statistical analysis. Results: A total of 396 publications on pediatric sedation in dentistry, published between 1993 and 2022, were retrieved from online databases. The USA published most papers. Furthermore, the most frequent countries who cooperated were the USA and Canada. Six of the top ten publishing establishments were USA based. Papers on the research have appeared primarily in the journals of Dentistry and Anesthesiology. Keyword co-occurrence and co-citation cluster analysis revealed that the most common topics mainly were: dental anxiety; conscious sedation; dental caries; midazolam; propofol; hypoxemia. Conclusions: During the three decades, the focus of pediatric sedation research has been on drugs, dental anxiety and procedural sedation. Keyword burst detection indicated that procedural sedation; adverse event; respiratory depression is an emerging research hotspot.

Corrigendum: Virtual reality in managing dental pain and anxiety: a comprehensive review.

[This corrects the article DOI: 10.3389/fmed.2023.1285142.].

A hybrid unsupervised clustering method for predicting the risk of dental implant loss.

OBJECTIVES: The aim of this study was to predict the risk of dental implant loss by clustering features associated with implant survival rates. MATERIALS AND METHODS: Multiple clinical features from 8513 patients who underwent single implant placement were retrospectively analysed. A hybrid method integrating unsupervised learning algorithms with survival analysis was employed for data mining. Two-step cluster, univariate Cox regression, and Kaplan‒Meier survival analyses were performed to identify the clustering features associated with implant survival rates. To predict the risk of dental implant loss, nomograms were constructed on the basis of time-stratified multivariate Cox regression. RESULTS: Six clusters with distinct features and prognoses were identified using two-step cluster analysis and Kaplan‒Meier survival analysis. Compared with the other clusters, only one cluster presented significantly lower implant survival rates, and six specific clustering features within this cluster were identified as high-risk factors, including age, smoking history, implant diameter, implant length, implant position, and surgical procedure. Nomograms were created to assess the impact of the six high-risk factors on implant loss for three periods: 1) 0-120 days, 2) 120-310 days, and 3) more than 310 days after implant placement. The concordance indices of the models were 0.642, 0.781, and 0.715, respectively. CONCLUSIONS: The hybrid unsupervised clustering method, which clusters and identifies high-risk clinical features associated with implant loss without relying on predefined labels or target variables, represents an effective approach for developing a visual model for predicting implant prognosis. However, further validation with a multimodal, multicentre, prospective cohort is needed. CLINICAL SIGNIFICANCE: Visual prognosis prediction utilizing this nomogram that predicts the risk of implant loss on the basis of clustering features can assist dentists in preoperative assessments and clinical decision-making, potentially improving dental implant prognosis.

Pre-school children single inhalation anesthetic exposure and neuro-psychological development: a prospective study and Mendelian randomization analysis.

Background: For children who are unable to cooperate due to severe dental anxiety (DA), dental treatment of childhood caries under Dental General Anesthesia (DGA) is a safe and high-quality treatment method. This study aims to evaluate the impact on neurocognitive functions and the growth and development of children 2 years after dental procedure based on previous research, and further establish a causal relationship between general anesthesia (GA) and changes in children's neurocognitive functions by incorporating Mendelian Randomization (MR) analysis. Methods: Data were collected and analyzed from 340 cases of S-ECC procedures of preschool children conducted in 2019. This involved comparing the neurocognitive outcomes 2 years post-operation of preschool children receiving dental procedures under general anesthesia or local anesthesia. Physical development indicators such as height, weight, and body mass index (BMI) of children were also compared at baseline, half a year post-operation, and 2 years post-operation. We performed a Mendelian randomization analysis on the causal relationship between children's cognitive development and general anesthesia, drawing on a large-scale meta-analysis of GWAS for anesthesia, including multiple general anesthesia datasets. Results: Outcome data were obtained for 111 children in the general anesthesia group and 121 children in the local anesthesia group. The mean FSIQ score for the general anesthesia group was 106.77 (SD 6.96), while the mean score for the local anesthesia group was 106.36 (SD 5.88). FSIQ scores were equivalent between the two groups. The incidence of malnutrition in children in the general anesthesia group was 27.93% (p < 0.001) before surgery and decreased to 15.32% (p > 0.05) after 2 years, which was not different from the general population. The IVW method suggested that the causal estimate (p = 0.99 > 0.05, OR = 1.04, 95% CI = 5.98 × 10-4-1.82 × 103) was not statistically significant for disease prevalence. This indicates no genetic cause-and-effect relationship between anesthesia and childhood intelligence. Conclusion: There were no adverse outcomes in neurocognitive development in 2 years after severe early childhood caries (S-ECC) procedure under total sevoflurane-inhalation in preschool children. The malnutrition condition in children can be improved after S-ECC procedure under general anesthesia. Limited MR evidence does not support a correlation between genetic susceptibility to anesthesia and an increased risk for intelligence in children.

Symmetric and asymmetric Au-AgCdSe hybrid nanorods.

This paper describes a facile method for synthesis of Au-AgCdSe hybrid nanorods with controlled morphologies and spatial distributions. The synthesis involved deposition of Ag tips at the ends of Au nanorod seeds, followed by selenization of the Ag tips and overgrowth of CdSe on these sites. By simply manipulating the pH value of the system, the AgCdSe could selectively grow at one end, at both the ends or on the side surface of a Au nanorod, generating a mike-like, dumbbell-like, or toothbrush-like hybrid nanorod, respectively. These three types of Au-AgCdSe hybrid nanorods displayed distinct localized surface plasmon resonance and photoluminescence properties, demonstrating an effective pathway for maneuvering the optical properties of nanocrystals.

Comparison of the enhanced attachment and proliferation of the human mesenchymal stem cells on the biomimetic nanopatterned surfaces of zein, silk fibroin, and gelatin.

Natural proteins have been reported to positively affect the attachment and proliferation of cells. For the first time, zein, a plant protein, was utilized to make patterned surface mimicking the extracellular matrix to assist the attachment and proliferation of stem cells. Zein would promote the attachment and proliferation of the stem cells more than 10 times of that of gelatin and silk fibroin, respectively, which are popular protein selections for the formation of the biomaterial scaffolds. The more the surface was covered by zein, the more the stem cell grown. It was revealed that the stem cells would grow and stretch in the direction of the patterns, and the stem cells preferred to grow in the grooves in the size of 8 µm, that was similar to the size of the stem cells, rather than the size larger or smaller than that of the cells, such as 50 and 2 µm. It was concluded that zein is a better choice than silk fibroin and gelatin with highly potential for the formation of patterned surface and structure as the biomaterial scaffolds for stem cell therapy.

Distribution and removal mechanism of microplastics in urban wastewater plants systems via different processes.

Microplastic pollution threatens water systems worldwide. As one of the most important parts of city wastewater treatment, wastewater treatment plants are not only microplastics interception barriers but also emission sources. Water samples were collected from each sewage treatment plant stage and sludge from the sludge dewatering room. Microplastics were extracted using wet peroxide oxidation and flotation, and the abundance, size, shape, and polymer type of microplastics were detected. Basis on the results, the influence of each process on the removal rate and characteristics of microplastics under the same influent source was analysed. The influent microplastic concentration in this study was 32.5 ± 1.0 n/L, which rapidly decreased after treatment. The removal rates of the sequencing batch reactor activated sludge, cyclic activated sludge, and anaerobic anoxic oxic technologies were 73.0%, 75.6%, and 83.9%, respectively. Most microplastics were transported to the sludge, and the concentration of microplastics in dehydrated sludge was 27.2 ± 3.1 n/g. Microplastics removal occurred primarily during the primary and secondary stages. Disposal processes, settling time, and process design affected wastewater treatment plant microplastic removal rates at each stage. Significant differences in microplastic characteristics were observed at each stage, with the most abundant being fragment shaped, particle sizes of 30-100 µm, and black in colour. Sixteen polymer types were identified using a Raman spectrometer. The predominant polymers are polypropylene, polyethylene, and polyethylene terephthalate. This study demonstrates that optimising the process design of existing wastewater treatment plants is crucial for the prevention and control of microplastic pollution. It is suggested that the process settings of contemporary wastewater treatment plants should be studied in depth to develop a scientific foundation for avoiding and managing microplastic pollution in urban areas.

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures: a prospective cohort study.

BACKGROUND: Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery. MATERIALS AND METHODS: The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg -1 , and when the Modified Observer's Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg -1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events. RESULTS: A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg -1 (95% CI 1.95-2.01 mg·kg -1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10-24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations. CONCLUSION: The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg -1 . For children aged 2-6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.

Virtual reality in managing dental pain and anxiety: a comprehensive review.

Objectives: This study aimed to identify, analyze, and summarize the clinical efficacy of virtual reality (VR) distraction therapy for oral treatment in different hospital settings in contrast to medical interventions that induce anxiety and pain. Furthermore, this review aimed to determine the implications for research and clinical practice of VR distraction therapy. Data: This review investigated the clinical efficacy of VR in the oral treatment of procedural pain or anxiety. Quality assessment of the included studies was conducted. A narrative synthesis of the collected data was performed. Sources: Literature studies from six electronic databases were searched for a comprehensive review, namely, the Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (Central), MEDLINE (PubMed), EMBASE, Scopus, and Web of Science. Study selection: One thousand five hundred twenty-two patients aged between 0 and 60 years who used VR during dental treatment were included in this review. Among these studies, 8 and 14 studies comprised adult and pediatric patients. Conclusion: Overall, the reviewed studies underscore the efficacy of VR to mitigate pain and anxiety in the context of dental treatment. VR is an innovative pain and anxiety management approach that facilitates dental treatment patients to immerse themselves in a virtual world while using distractions to reduce pain and anxiety. Clinical significance: VR is an effective and novel non-pharmacological method of behavioral management that contributes to improving medication safety for dental patients. VR as a distractive approach can reduce the fear associated with medical interventions and prevent severe pain sensitivity, anxiety, and medical avoidance among adults and children.

Multifunctional Droplets Formed by Interfacially Self-Assembled Fluorinated Magnetic Nanoparticles for Biocompatible Single Cell Culture and Magnet-Driven Manipulation.

The ability to encapsulate and manipulate droplets with a picoliter volume of samples and reagents shows great potential for practical applications in chemistry, biology, and materials science. Magnetic control is a promising approach for droplet manipulation due to its ability for wireless control and its ease of implementation. However, it is challenged by the poor biocompatibility of magnetic materials in aqueous droplets. Moreover, current droplet technology is problematic because of the molecule leakage between droplets. In the paper, we propose multifunctional droplets with the surface coated by a layer of fluorinated magnetic nanoparticles for magnetically actuated droplet manipulation. Multifunctional droplets show excellent biocompatibility for cell culture, nonleakage of molecules, and high response to a magnetic field. We developed a strategy of coating the F-MNP@SiO2 on the outer surface of droplets instead of adding magnetic material into droplets to enable droplets with a highly magnetic response. The encapsulated bacteria and cells in droplets did not need to directly contact with the magnetic materials at the outer surface, showing high biocompatibility with living cells. These droplets can be precisely manipulated based on magnet distance, the time duration of the magnetic field, the droplet size, and the MNP composition, which well match with theoretical analysis. The precise magnetically actuated droplet manipulation shows great potential for accurate and sensitive droplet-based bioassays like single cell analysis.

Quantitative analysis of the role played by poly(vinylpyrrolidone) in seed-mediated growth of Ag nanocrystals.

This article presents a quantitative analysis of the role played by poly(vinylpyrrolidone) (PVP) in seed-mediated growth of Ag nanocrystals. Starting from Ag nanocubes encased by {100} facets as the seeds, the resultant nanocrystals could take different shapes depending on the concentration of PVP in the solution. If the concentration was above a critical value, the seeds simply grew into larger cubes still enclosed by {100} facets. When the concentration fell below a critical value, the seeds would evolve into cuboctahedrons enclosed by a mix of {100} and {111} facets and eventually octahedrons completely covered by {111} facets. We derived the coverage density of PVP on Ag(100) surface by combining the results from two measurements: (i) cubic seeds were followed to grow at a fixed initial concentration of PVP to find out when {111} facets started to appear on the surface, and (ii) cubic seeds were allowed to grow at reduced initial concentrations of PVP to see at which concentration {111} facets started to appear from the very beginning. We could calculate the coverage density of PVP from the differences in PVP concentration and the total surface area of Ag nanocubes between these two samples. The coverage density was found to be 140 and 30 repeating units per nm(2) for PVP of 55,000 and 10,000 g/mol in molecular weight, respectively, for cubic seeds of 40 nm in edge length. These values dropped slightly to 100 and 20 repeating units per nm(2), respectively, when 100 nm Ag cubes were used as the seeds.

Effect of different factors on treatment of oily wastewater by TiO2/Al2O3-PVDF ultrafiltration membrane.

An ultrafiltration membrane developed by our research group was applied to treat simulated emulsified oil wastewater. ATR-FTIR, SEM, TEM, and Zeta potential analyzes demonstrated that the modified ultrafiltration membrane (MM) has excellent stability and anti-fouling capacity than origin membrane (OM), which possesses a pure water flux of 260 L·m-2·h-1 and oil/water (o/w) rejection of 98.5 ± 0.33%. Inorganic salt CaCl2 has more considerable influence than MgSO4 and NaCl under the same mass concentration in the two membranes UF process. Along with concentration increasing, flux sharply reduces; meanwhile, the rejection has an opposite trend. Moreover, permeation flux has a maximum value, and the rejection also gets its optimal state under neutral conditions during the pH value of 2-12. The membrane also exhibits excellent anti-fouling performance and anti- o/w adsorption properties with an adsorption rate below 0.8% compared with OM, which has an adsorption rate of nearly 2.1%, respectively. A kind of new UF membrane developed by our research group was applied to treat simulated o/w. ATR-FTIR, SEM, TEM, and Zeta potential analyzes demonstrated that PVDF-Al2O3/TiO2 material has excellent stability and anti-fouling capacity. CaCl2 has the greatest influence than MgSO4 and NaCl under the same mass concentration. Moreover, permeation flux has maximum value and the rejection also gets its optimal state under neutral conditions during pH 2-12. The membrane also exhibits excellent anti-fouling performance and anti-O/W adsorption properties with adsorption rate below 0.8% compared with OM which has an adsorption rate nearly 2.1%, respectively.

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial.

BACKGROUND: Emergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia. OBJECTIVE: The study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications. METHOD: This was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 µg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 µg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge. RESULTS: The incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO2) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} -1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed. CONCLUSIONS: Intravenous infusion of 0.2 µg/kg/min and 0.4 µg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 µg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 µg/kg/min alfentanil dose. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2100043320).