Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia. Methods Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, Plt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5). Conclusions For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
目的:比较七氟醚吸入麻醉和丙泊酚、瑞芬太尼静脉麻醉用于小儿手术的临床效果。方法:100例1～8岁的患儿随机分为丙泊酚、瑞芬太尼组(A组)与七氟醚吸入组(B组）。麻醉诱导后,A组持续输注丙泊酚和瑞芬太尼维持麻醉,B组吸入七氟醚维持麻醉。术中根据生命体征调整丙泊酚、瑞芬太尼的输注速度及七氟醚的吸入浓度,记录术中循环变化、术后麻醉恢复情况。结果:与B组相比,A组术中MAP下降明显(Plt;005)。结论:与A组相比,B组术中生命体征控制平稳;术后清醒迅速、完全、平稳,拔管时间无明显差异。
目的:观察经喉罩全凭七氟醚吸入麻醉在小儿腹股沟疝手术中的临床应用效果。方法：60例ASAⅠⅡ级择期行腹股沟疝囊高位结扎术的患儿随机分成喉罩七氟醚组（实验组）和氯胺酮组（对照组）。实验组以七氟醚诱导后置入喉罩，经喉罩全凭七氟醚吸入维持麻醉，对照组以氯胺酮和异丙酚诱导和维持麻醉。比较两组血流动力学、呼气末CO2分压（PETCO2）、手术时间、苏醒时间、出室时间（在恢复室内停留时间）。记录术中和术后不良反应如体动反应、嗜睡、恶心呕吐等发生情况。结果：对照组在T3、T4、T5时点HR、BP均明显高于实验组相应时点（Plt;0.05）。实验组患儿苏醒时间和出室时间均明显低于对照组（Plt;0.05）。对照组体动反应和嗜睡发生率明显高于实验组（Plt;0.05）。实验组术后恶心发生率明显高于对照组（Plt;0.05）。结论：经喉罩全凭七氟醚吸入麻醉用于小儿腹股沟疝手术，术中经过更平稳，麻醉恢复更快，术中及术后不良反应少。
Objective We aimed to determine the efficacy and complication of sevoflurane maintenance in children. Methods Trials were collected through electronic searches of MEDLINE, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, and CMBdisk (from the date of building the database to April 2008). We also checked the bibliographies of retrieved articles. Results A total of 20 trials involving 1 592 patients were included. The Metaanalysis showed: ① Recovery time: sevoflurane was similar with propofol [WMD=0.22, 95%CI (–2.86, 3.30)], but slower than desflurane [WMD=5.01, 95%CI (2.87, 7.16)], and faster than isoflurane [WMD= –0.55, 95%CI (– 0.74, –0.37)]; ② Discharge time: sevoflurane was similar with propofol [WMD= –4.39, 95%CI (–10.02, 1.25)], desflurane[WMD=1.13, 95%CI (–3.25, 5.51)], and isoflurane [WMD= –8.17, 95%CI (–17.94, 1.60)]; ③ Postoperative agitation: sevoflurane was much more obvious than propofol [RR=5.53, 95%CI (2.99, 10.21)], but superior than desflurane [RR=0.55, 95%CI (0.35, 0.88)], and similar with isoflurane [RR=1.24, 95%CI (0.85, 1.800]; ④ Postoperative nausea and vomiting (PONV): sevoflurane was much more severe than propofol [RR=2.17, 95%CI (1.21, 3.90)], and no difference with desflurane [RR=0.88, 95%CI (0.61, 1.25)]; ⑤ Oculocardiac reflex: sevoflurane was less than propofol [RD= – 0.42, 95%CI (–0.56, –0.27)], and no difference with desflurane [RR=0.93, 95%CI (0.61, 1.41)]. Conclusion The limited current evidence shows no difference between sevoflurane and propofol in recovery time, while the effect of sevoflurane is faster than isoflurane and slower than desflurane. There are no differences among sevoflurane, desflurane, isoflurane, and propofol in discharge time. The incidence of postoperative agitation of sevoflurane is higher than that of propofol, but lower than that of other inhaled anesthetics. The incidence of PONV of sevoflurane is higher than that of propofol. The incidence of oculocardiac reflex of sevoflurane is lower than that of propofol and similar with that of desflurane.
目的 研究七氟醚诱导气管插管减轻短期内行两次手术的脑性瘫痪患儿术前焦虑的效果。 方法 2009年12月－2011年7月选择需要短期内行两次全身麻醉（全麻）手术的痉挛性脑性瘫痪患儿60例，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级。随机分为A组常规麻醉诱导气管插管（30例）和B组七氟醚诱导气管插管（30例）；分别在一期及二期手术术前访视时（M1、M3）、入手术室时（M2、M4）对两组患儿进行改良耶鲁围术期焦虑量表评估；并分别在一期及二期手术麻醉诱导期（N1、N2）对两组患儿进行诱导期合作度量表的标准评定。 结果 同组一期、二期手术比较，A组患儿二期手术术前焦虑更明显（P＜0.05），二期入手术室时焦虑更明显（P＜0.05），二期手术合作度更差（P＜0.05）；B组患儿两次手术术前焦虑无明显变化（P＞0.05），一期入手术室时焦虑明显（P＜0.05），一期手术合作度较差（P＜0.05）。两组之间，一期手术两组患儿焦虑情况无明显区别（P＞0.05），二期手术A组比B组的患儿焦虑更明显（P＜0.05），两次手术B组都比A组的患儿合作度更好（P＜0.05）。 结论 七氟醚麻醉诱导气管插管能够有效减轻短期内需要进行两次手术的痉挛性脑性瘫痪患儿的术前焦虑，提高患儿二期手术的合作度，提供良好的手术麻醉条件，保证患儿的围术期安全。