The use of a double-lumen central venous catheter for airway management in pediatric patients undergoing laryngeal papillomatosis surgery.

PURPOSE: To evaluate the efficacy and safety of a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a double-lumen central venous catheter (DLCVC) in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis. METHODS: Thirty-six pediatric patients with laryngeal papillomatosis undergoing suspension laryngoscopic surgery were anesthetized with oxygen and volatile anesthetic insufflation while spontaneously breathing. Anesthesia was induced by inhalation of 8% sevoflurane in oxygen by mask. Atropine, dexamethasone, lidocaine, and midazolam were administered intravenously. The tip of a 7Fr DLCVC was inserted below the glottis after placement of the laryngoscope and establishing suspension. Anesthesia was maintained with insufflation of 4-6% sevoflurane and oxygen with a total fresh gas flow of 6 l·min(-1) through the 14G (larger lumen) of the DLCVC. Endtidal carbon dioxide tension (PetCO2) was monitored using the other lumen of the DLCVC, which was connected to the CO2 sampling line. Duration of the procedure as well as total anesthesia time was recorded. Electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and PetCO2 were also monitored. Arterial blood was sampled for blood gas analysis including pH, PaO2 , PaCO2 , and actual base excess (ABE). Complications, including intraoperative patient movement, hypoxemia (SpO2 < 95% during oxygen insufflation), nausea, vomiting, bronchospasm, and arrhythmias, were recorded. RESULTS: There was a significant increase in PetCO2 and PaCO2 (P values <0.05) as well as a decrease in ABE, pH, and PaO2 (P values <0.05) in samples collected before and after surgery. MAP, HR, and SpO2 after surgery were not significantly different from after induction values (P values >0.05). During surgery, SpO2 < 95% in three cases and body movements in three cases were observed. No patient had any other of the complications previously described. Furthermore, no postsurgical endotracheal intubation was needed in any patient. CONCLUSION: After establishing an adequate depth of anesthesia, a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a DLCVC is feasible in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.

[Clinical comparison of sevoflurane and propofol anesthesia with propofol and remifentanil anesthesia for children with cleft lip and palate repair surgery].

OBJECTIVE: To compare the clinical efficacies and safety of sevoflurane and propofol versus remifentanil and propofol anesthesia for children with cleft lip and palate repair surgery. METHODS: Upon the approval of hospital ethical committee,a total of 60 pediatric patients undergoing cleft lip and palate repair surgery were recruited from two hospitals between April 2011 and December 2012. All patients were randomly divided into 2 groups (n = 30 each). Group S:sevoflurane and propofol anesthesia; and group R: propofol and remifentanil anesthesia.Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded at the time before the induction (T0), after 2 min of induction (T1), the beginning of surgery (T2) and the end of surgery (T3).Intubating satisfaction, time to extubation,incidence of emergence agitation, postoperative nausea and vomiting, and the complications of the airway were recorded. RESULTS: Satisfactory intubation rate was 90% in group S, versus 83% in group R. And there was no significantly difference between the two group. There were no significantly difference between the two group with MAP and HR.Compared with T0, There were significantly difference with MAP and HR at T1, T2 in group R (P < 0.05). The incidence of emergence agitation was significantly higher in group S (7 cases) than that in group R (2 cases).there were no records of nausea, vomiting and laryngospasm. CONCLUSION: Under an adequate depth anesthesia, these two anesthesia techniques are safe for cleft lip and palate repair surgery, emergence agitation was high in sevoflurane anesthesia, propofol and remifentanil anesthesia provides lower heart rate.

Effects of sevoflurane on the expression of tau protein mRNA and Ser396/404 site in the hippocampus of developing rat brain.

BACKGROUND: General anesthesia induces a transient hyperphosphorylation of tau protein that is associated with neurotoxicity in neonatal rats, but the mechanism remains unknown. The current study sought to investigate the effects of sevoflurane on the levels of tau phosphorylation at phosphor-Ser396/404 and total tau mRNA in the hippocampus of neonatal rats. MATERIALS AND METHODS: Thirty-six 7-day-old rats were randomly exposed for 6 h to either 3% sevoflurane (S) or air (NC) as a placebo. They were sacrificed at 1, 7 and 14 days after the anesthesia, respectively, and thus assigned to S1d , S7d , S14d , NC1d , NC7d , and NC14d groups (n = 6). Their brain tissues were harvested and then subjected to histopathologic, Western blot and real-time polymerase chain reaction analysis. RESULTS: Microtubule cytoskeletons were arranged in neat parallel rows in rats exposed only to air, whereas the microtubules were arranged in a disorderly and intermittent (nonparallel) fashion in rats exposed to sevoflurane. The levels of tau mRNA in the S1d and S7d groups were significantly higher than those in the NC1d and NC7d groups. There was no significant difference in the levels of tau mRNA between the S14d and NC14d groups. The levels of tau protein at Ser404 in the S1d , S7d, and S14d groups were significantly higher than those in NC1d , NC7d, and NC14d groups. The levels of tau protein at Ser396 in the S1d , and S7d groups were significantly higher than those in the NC1d , and NC7d groups, while there was no significant difference in the levels of tau protein at Ser396 between the S14d group and the NC14d group, respectively. CONCLUSION: In rat hippocampus, sevoflurane was associated with microtubular disarray as well as increased levels of tau mRNA and excessive phosphorylation of tau protein at Ser396 and Ser404. This implicates that sevoflurane may induce neurotoxicity.

[Anesthetic management for pediatric congenital laryngomalacia].

OBJECTIVE: To explore our experience of anesthetic management for pediatric congenital laryngomalacia operation. METHODS: A total of 27 pediatric patients with congenital laryngomalacia were treated at our hospital between December 2010 and November 2012. All patients were anesthetized by intravenous anesthesia of propofol-remifentanil and spontaneous breathing. Oxygen was insufflated at a rate of 4 L/min through an endotracheal tube near glottis. Propofol was set at a constant rate of 100 µg · kg(-1) · min(-1). The initial dose of remifentanil at 0.05 µg·kg(-1)·min(-1) was adjusted in 0.05 µg·kg(-1)·min(-1) increments to titrate a 50% reduction in baseline respiratory rate. Heart rate (HR), mean arterial pressure, pulse oxygen saturation (SpO2), respiratory rate (RR), operation time, anesthesia time and remifentanil rate were recorded. Adverse events and interventions were also examined. RESULTS: Comparison with induction of anesthesia, HR and RR changed significantly intraoperatively (P < 0.05). MAP, SpO2 were no significantly change during operation (P > 0.05). The induction time was 9-12 min and the highest remifentanil rate stood at (0.18 ± 0.03) µg·kg(-1)·min(-1). Body movements occurred in 3 (11%) patients and a bolus of propofol was administered. Desaturation below 95% occurred in 2 (7%) patients in which interventions were offered by decreasing the remifentanil infusion rate. No complications such as cough, hypoxemia, laryngospasm or bronchospasm, nausea or vomiting, arrhythmia were observed. CONCLUSION: Key points of anesthetic management for pediatric congenital laryngomalacia include sufficient preoperative evaluation, spontaneous respiration anesthesia technique with total intravenous anesthesia, suitable anesthesia depth and intensive intraoperative monitoring.