The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis.

BACKGROUND: This study systematically evaluated the safety and efficacy of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population as well as whether the results met the information required to draw conclusions. OBJECTIVE: To evaluate the safety and efficacy evaluation of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population. METHODS: PubMed, Cochrane library, Web of Science and Ovid MEDLINE were searched to obtain randomized controlled trials (RCTs) comparing dexmedetomidine with control medicine and comparing different doses of dexmedetomidine. RESULTS: There were a total of 16 RCTs for a total of 3240 patients. Dexmedetomidine slowed down the heart rate (HR; mean difference: -13.27; 95% CI: -16.41 to 10.14; P < 0.001) and reduced postoperative delirium (risk ratio [RR]: 0.31; 95% CI: 0.20-0.50; P < 0.001), the number of pain patients (RR: 0.48; 95% CI: 0.30-0.75; P = 0.002), and desaturation (RR: 0.34; 95% CI: 0.13-0.89; P = 0.03) compared with the control group. The limitation was that it was difficult to determine the range of low- and high-dose dexmedetomidine. CONCLUSION AND RELEVANCE: Dexmedetomidine slowed down intraoperative HR within the normal range, which might reduce myocardial oxygen consumption. It reduced postoperative pain and postoperative complications: delirium and desaturation. Dexmedetomidine showed no dose-dependent increase in the procedural sedation time of pediatric patients. Clinically, dexmedetomidine can improve pediatric procedural sedation and postoperative behavior, and it can be considered as a related medicine for safety in pediatric surgery.

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy.

BACKGROUND: A high prevalence of postoperative complications is closely associated with a worse short- and long-term outcome. This current study aimed to investigate potential risk factors including albumin-to-fibrinogen ratio (AFR) for severe postoperative complications (SPCs) in surgical gastric cancer (GC) patients. METHODS: Elderly patients (≥65 years) with primary GC who underwent elective radical laparoscopic gastrectomy under general anesthesia were included. According to the Clavien-Dindo classification system, the severity of complications was assessed from Grade I to V and SPCs were defined as C-D Grade ≥ IIIa. The clinicopathological features, operative-associated characteristics, postoperative recovery and laboratory tests were compared between patients with or without SPCs. Receiver operating characteristic (ROC) curve analysis using Youden's Index was established for determining the predictive value and cut-off threshold of AFR for SPCs. Binary univariate and multivariate logistic regression models were used to assess factors influencing SPCs. RESULTS: A total of 365 elderly GC patients were finally included in the analysis, of which 52 (52/365, 14.2%) patients had developed SPCs within postoperative 30 days. Preoperative AFR level predicted SPCs in surgical GC patients with an AUC of 0.841, a sensitivity of 76.36% and a specificity of 80.77%, respectively (P < 0.001). The multivariate analysis revealed that a lower AFR level (OR: 1.94, 95% CI: 1.09-3.36, P = 0.017) and an older age (OR: 1.81, 95% CI: 1.06-3.04, P = 0.023) were two independent predictive factors for SPCs in surgical GC patients. CONCLUSIONS: Preoperative AFR level is a useful predictor for SPCs in elderly GC subjects after radical laparoscopic gastrectomy.

[Effects of different ventilation mode on pulmonary function during minor operation of general anesthesia with SLIPA laryngeal mask].

OBJECTIVE: To retrospectively analyze the effects of different ventilation modes on pulmonary function during minor operation of general anesthesia with streamlined liner of the pharynx airway (SLIPA) laryngeal mask and assess its safety of spontaneous respiration during general anesthesia. METHODS: A total of 76 adult patients (aged 28 - 44 years old, American Society of Anesthesiologists physical status I-II) scheduled for operations were randomly allocated into the mechanical ventilation and spontaneous respiration group (n = 38 each). Anesthetic induction was performed intravenously with propofol (2 mg/kg), sulfentanyl (0.5 µg/kg) and cisatracurium besylate (0.3 mg/kg) (in mechanical ventilation group). Anesthesia was maintained by sevoflurane at 0.7 minimum alveolar concentration (MAC), mixture of atmosphere and oxygen at 1:1 and a continuous infusion of propofol at the speed of 4 mg×kg(-1)h(-1). Neostigmine (2 mg) and atropine (1 mg) were administered intravenously before the extraction of SLIPA laryngeal mask in order to antagonize the residual effects of muscle relaxation. The parameters including heart rate (HR), mean blood pressure (MAP) and end-tidal pressure of CO(2) (P(ET)CO(2)), blood gas analysis and the alveolar-arterial oxygen gradient [P(A-a)DO(2)], respiratory index (RI) and dead volume/tidal volume (V(D)/V(T)) were calculated at Different time points. RESULTS: No significant differences were found in HR (spontaneous respiration group: 76 ± 7, 78 ± 6, 79 ± 7/min; mechanical ventilation group: 77 ± 6, 80 ± 5, 79 ± 6/min), MAP (spontaneous respiration group: 91 ± 10, 89 ± 9, 90 ± 9mm Hg; mechanical ventilation group: 89 ± 10, 88 ± 9, 92 ± 8) mm Hg at the monitored time points between two groups (P > 0.05). At the time of 30 min and 60 min after insertion, the pH value was significantly lower in spontaneous respiration group (7.351 ± 0.028, 7.338 ± 0.025) than those in mechanical ventilation group (7.391 ± 0.031, 7.389 ± 0.032). The values of PaCO(2) (42 ± 4, 46 ± 6) mm Hg and P(ET)CO(2) (41 ± 5, 45 ± 3) mm Hg were higher than those in mechanical ventilation group (37 ± 3, 35 ± 5; 37 ± 4, 36 ± 4) mm Hg (P < 0.05). No significant difference was found in the P(A-a)DO(2), RI or V(D)/V(T) at the monitored time points between two groups (P > 0.05). CONCLUSION: Neither mechanical ventilation mode nor spontaneous respiration ventilation mode has any effect upon pulmonary function by during minor operation of general anesthesia with SLIPA laryngeal mask. Spontaneous respiration can offer a sufficient supply of oxygen but it carries the risk of CO(2) accumulation.