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Objective:To identify the risk factors for the first weaning failure following mandibular distraction osteogenesis in pediatric patients with Pierre Robin sequence (PRS).Methods:Clinical data of pediatric patients with PRS who underwent mandibular distraction osteogenesis from January 2018 to February 2023 were collected, including sex, age, premature birth, birth weight, surgical weight, cleft palate, syndrome type PRS, laryngeal/tracheobronchial malacia, simple congenital heart disease, complex congenital heart disease, preoperative mechanical ventilation, preoperative pulmonary infection, blood albumin concentration, difficulty in tracheal intubation under a visual laryngoscope, surgical duration, postoperative ventilator-associated pneumonia, duration of mechanical ventilation at first weaning, and traction length at first weaning. Children in whom the first postoperative machine withdrawal failed were included in observation group and matched to control cases(control group) in a 1∶4 ratio. The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for postoperative weaning failure. Results:There were significant differences in birth weight, cleft palate, duration of mechanical ventilation and traction length at first weaning, rate of combined cleft palate, preoperative pulmonary infection rate, rate of preoperative mechanical ventilation, and rate of postoperative ventilator-associated pneumonia between the two groups ( P<0.05). Binary logistic stepwise regression analysis showed that the preoperative mechanical ventilation ( OR=18.154, 95% CI 3.971-82.990, P<0.001) and postoperative ventilator-associated pneumonia ( OR=36.942, 95% CI 1.307-1043.985, P=0.034) were independent risk factors for first weaning failure after mandibular distraction osteogenesis, while birth weight gain ( OR=0.225, 95% CI 0.076-0.668, P=0.007) was a protective factor for first weaning failure ( P<0.05). Conclusions:Preoperative mechanical ventilation and postoperative ventilator-associated pneumonia are independent risk factors and birth weight gain is a protective factor for first weaning failure following mandibular distraction osteogenesis in pediatric patients with PRS.
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Objective To evaluate the efficacy of nasotracheal intubation for airway management in neonates with Pierre Robin sequence undergoing surgery with general anesthesia. Methods Sixty full-term neonates of both sexes with Pierre Robin Sequence, aged 2-28 days, weighing 2. 4-3. 8 kg, scheduled for elective mandibular distraction osteogenesis, were divided into 2 groups ( n=30 each) using a random num-ber table method: nasotracheal intubation group (group N) and orotracheal intubation group (group O). Combined intravenous-inhalational anesthesia was used during surgery. The success rate of intubation, intu-bation time, heart rate, mean arterial pressure and SpO2 during intubation, and occurrence of complica-tions during intubation were recorded, and the time of extubation and occurrence of complications after extu-bation were also recorded. Results Compared with group O, the intubation time was significantly short-ened, the first-time intubation success rate was increased, the heart rate and mean arterial pressure were decreased at 2 min after intubation, the lowest SpO2 was increased during intubation, and the incidence of pharyngeal soft tissue injury during intubation and hoarseness after extubation was decreased in group N ( P<0. 05) . Conclusion Nasotracheal intubation can be used for airway management in neonates with Pierre Robin sequence undergoing surgery under general anesthesia, and the efficacy is superior to that of orotra-cheal intubation.
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Objective To observe the effect of Nalmefene on postoperative recovery on neonates by laparoscopic pyloromyotomy. Methods Elective laparoscopic pyloromyotomy for 60 neonates under general anestheisa, aged 15 ~ 28 days, ASA Ⅱ~Ⅲ , were randomly divided into two groups: Nalmefene group (M group) and Naloxone group (L group), 30 cases in each. Nalmefene 0.25 μg/kg and Naloxone 1.00 μg/kg were respectively administrated in M group and L group when the procedures finished. Parameters SpO2, MAP, HR and RR were measured and analyzed statistically at different times: end of surgery before drugs were used (T0), 10 min after administration (T1), 30 mins after extubation (T2) and 2 h after extubation (T3). Meanwhile observing spontaneous breathing recovery time, extubation time, residence time at PACU and adverse events 24 s after surgery. Results There were no actual differences in the value of MAP, HR and SpO2 at T0, T1, T2 and T3 times in the two groups (P > 0.05). However, the values of RR was significant faster at T1, T2 and T3 times than that at T0 in both groups (P < 0.05), compared with L group, the value of RR at T1 was much faster in M group (P < 0.05). The times of extubation and residence at PACU have significant differences in M group than that in L group (P < 0.05). The adverse events in both groups have no differences. Conclusion Nalmefene can facilitate the recovery at laparoscopic pyloromyotomy on neonates. Compared with naloxone, it can reduce the extubation time, and promote the early rehabilitation.
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Objective To observe the clinical effect and safety of using Sufentanil in children's enteroscopy under general anesthesia. Methods 80 ASA Ⅰ ~ Ⅱ children, aged 5~10 years, weighed 18~35 kg, who scheduled for enteroscopy, were randomly divided into two groups: group Sufentanil (group S, n = 40) and group Fentanyl (group F, n = 40). Group S were given Sufentanil 0.2 μg/kg and Propofol 2.50 mg/kg in intravenous injection, group F were given Fentanyl 2.0 μg/kg and Propofol 2.50 mg/kg in intravenous injection. Proseal laryngeal mask airway (PLMA) was inserted when eyelash reflex disappeared and the submaxilla was loosen, and Propofol 6.00 ~8.00 mg/(kg?h) and 2% ~ 3% Sevoflurane inhalation for anesthesia maintenance. Parameters of HR, MAP, SpO2 and RR were recorded at different times: before induction (T0), insertion of PLMA (T1), enteroscopy to the ileocecal valve (T2) and end of operation (T3). Also, time of induction and recovery, pain on injection, perioperative body movement, intraoperative regurgitation, glossocoma, nausea and vomiting, throat pain and agitation were also recorded. Results Compared with T0, HR and MAP at T1 and T2 were significantly higher in group F (P 0.05). RR in both groups were significantly lower at T1 compared with T0 (P 0.05). HR, MAP and RR were significantly lower in group S than that in group F at T1 and T2 times (P < 0.05). Pain on injection, body movement and agitation were significantly lower in group S than that in group F (P < 0.05). Induction and recovery time in group S were significantly shorter than that in group F (P < 0.05). Conclusions The anesthetic effect of Sufentanil for combined intravenous and inhalation anesthesia in children's enteroscopy is safe and satisfactory. It could provide more smoothly intraoperative hemodynamics and higher quality of awakening.
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Objective To observe the impact of Dezocine used before end of operation on postoperative recovery and safety effect on postoperative pain in children receiving laparoscopic appendectomy. Methods 60 ASAⅠ ~ Ⅱcases of aged 4~10 yr, underwent laparoscopic appendectomy, were randomly divided into 3 groups: Dezocine group (D group), Fentanyl group (F group) and control group (normal saline group), 20 cases in each group. Remifentanil combined with Propofol and Sevoflurane was given for conducting endotracheal intubation general anesthesia. At 30 min before the end of operation, D group was given Dezocine 0.10 mg/kg, while F group fentanyl 1.0 μg/kg, and the control group was given same volume of normal saline. 5 min before the end of the operation anesthetics disabled, then extubation until children open eyes on call and spontaneous breathing recovered satisfactorily. Observe and record MAP, HR, SPO2 and respiration rate (RR) at different times:drug withdrawal, extubation and 5 min after ex﹣tubation, while also record extubation time, Riker sedation-agitation scores and face, legs, activity, cry and consola﹣bility (FLACC) scores and adverse reactions in the recovery period (within 30 min after extubation). Results MAP and HR at extubation and 5 min after extubation in N group and F group were higher than that in D group (P 0.05). The Riker sedation-agitation scores and the FLACC scores at 30 min after extubation in D group were significantly lower than those in the F and N groups (P<0.05), adverse reaction such as respiratory inhi﹣bition, nausea, vomiting, lethargy, headache were not found in the 3 groups. Conclusion Intravenous Dezocine before the end of operation in children's laparoscopic operation can make awake quickly and smoothly, allow small hemo﹣dynamic changes, and can reduce postoperative pain and restlessness.
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Objective To evaluate the efficacy of sniffing position in alleviating glossoptosis during the emergence from anesthesia in children. Methods Two hundred pediatric patients who developed glos?soptosis during the emergence from anesthesia, aged 2-8 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were randomly divided into 4 groups ( n=50 each) using a random number table:head extension position group ( group A ) , head tilted position group ( group B ) , oropharyngeal airway group ( group C) and sniffing position group ( group D) . Alleviation of glossoptosis, and occurrence of la?ryngospasm, agitation, vomiting and oral hemorrhage were recorded. Alleviation rate was calculated. Re?sults Compared with group A, the alleviation rate was significantly increased in C and D groups, the alle?viation rate was decreased in group B, and the incidence of laryngospasm, agitation and oral hemorrhage was increased in group C ( P<0?05 ) . Conclusion Sniffing position can effectively alleviate glossoptosis during the emergence from anesthesia in children with good safety.
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Objective To investigate the effect of oleanolic acid pretreatment on hepatic ischemiareperfusion (I/R) injury in rats. Methods One hundred and twenty-eight male SD rats weighing 230-250 g were randomly divided into 4 groups (n = 32 each): sham operation group (group S), I/R group, 0.5% sodium carboxymethyl cellulose group (group CMC) and oleanolic acid preconditioning (group OA). Partial liver ischemia was produced by clamping hepatic portal vein and hepatic arteries for 60 min with atraumatic mini-clamp, followed by 12 h of reperfusion in group I/R, CMC and OA. Oleanolic acid suspension 100 mg/kg was infused intragastrically in group OA, while the equal volume of 0.5% CMC-Na (in group CMC) and drinking water (in group S and I/R) was infused intragastrically instead once a day for 7 days, and then hepatic I/R was performed at day 8. The left liver was removed and blood sample was taken from inferior vena cava at 0, 3, 6 and 12 h ofreperfusion for determination of serum alanine amino transferase (ALT) activity, superoxide dismutase (SOD)activity, malondialdehyde (MDA) and glutathione (GSH) content, and expression of phospho-phosphatidylinositol3-kinase (p-PI3K), Akt, p-Akt, Bcl-2, Bax, p-Bad and Bad in the liver, and microscopic examination. Results Serum ALT activity and MDA content in the liver were significantly increased, SOD activity and GSH content in the liver were significantly decreased, expression of p-PI3K, p-Akt, Bax, Bad and p-Bad was up-regulated, and Bcl-2 expression was down-regulated during reperfusion in group I/R, CMC and OA as compared with group S (P ＜0.05). Compared with group I/R, serum ALT activity and MDA content in the liver were significantly decreased, SOD activity and GSH content in the liver were significantly increased, expression of p-PI3K, p-Akt,Bcl-2 and p-Bad was up-regulated, and expression of Bad and Bax was down-regulated during reperfusion in group OA (P ＜ 0.05), but no significant change was found in the indexes mentioned above in group CMC (P ＞ 0.05).Serum ALT activity and MDA content in the liver were significantly lower, SOD activity and GSH content in the liver were significantly higher, expression of p-PI3K, p-Akt, Bcl-2 and p-Bad was significantly higher, and expression of Bad and Bax was significantly lower during reperfusion in group OA than in group CMC (P ＜ 0.05).The pathological changes in the liver were milder in group OA than in group I/R. Conclusion Oleanolic acid pretreatment can alleviate hepatic I/R injury by activating PI3K/Akt signaling pathway and inhibiting apoptosis.
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Objective To investigate the effects of lithium chloride pretreatnent on cognitive function after laparotomy in aged rats. Methods Forty-eight male SD rats aged 18 months, weighing 550-700 g were randomly divided into 3 groups (n = 16 each): group Ⅰ control (group C); group Ⅱ operation (group O) and group Ⅲ lithium chloride preconditioning (group L). In group L lithium chloride 2 mmol/kg was injected intraperitoneally (IP) once a day for 7 consecutive days before exploratory laparotomy. In group C and group O equal volume of normal saline was injected instead of lithium chloride. The animals were anesthetized with IP 2 % pentobarbital 0.25 ml/100 g. Morris water-maze (MWM) test was performed at day 4-6 after operation in 8 animals in each group. Another 8 animals were killed at 24 h after operation and their brains were immediately removed for determination of IL-1β content and expression of total glycogen synthase kinase-3β (GSK-3β) and p-GSK-3β in hippocampus by ELISA and Western blot respectively. Results Compared with group C the escape latency and swimming distance were both significantly prolonged at day 4-6 after operation in group O, while in group L only swimming distance was prolonged at day 4 after operation. The IL-1β content in hippocampus was significantly higher and the expression of p-GSK-3β was significantly lower in group O than in group C and L. There was no significant difference in total GSK-3β among the 3 groups. Conclusion Lithium chloride pretreatment can improve the cognitive function after laparotomy in aged rats by inhibiting GSK-3β activity and attenuating inflammatory response in hippocampus.
