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简介：AbstractBackground:Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia (TIVA) or by inhalational anesthesia to increase the patient comfort. However, anesthesia-controlled time (ACT) can cause increased non-operative operating room (OR) time which may adversely affect the ORs efficiency. This study was aimed to compare the ACT of desflurane with that of propofol-remifentanil in strabismus ambulatory surgery.Methods:From November 2016 to December 2017, a total of 200 strabismus patients (aged 18-60 years old, and scheduled for elective ambulatory surgery at Zhongshan Ophthalmic Center) were randomly assigned to receive either propofol-based TIVA (group TIVA) or desflurane anesthesia (group DES) for maintenance of anesthesia. The primary outcome was the extubation time. Secondary outcomes included surgical time, anesthetic time, OR exit time, and Phase I and II recovery time. The intraoperative incidences of hypotension, bradycardia and oculocardiac reflex (OCR), and the incidences of any post-operative complications were recorded. Mann-Whitney U test and Chi-square or Fisher exact tests were used to compare the two groups.Results:We found that the extubation time (5.5 [3.9-7.0] vs. 9.7 [8.5-11.4] min, P < 0.001) and the incidence of prolonged time to extubation (0 vs. 6%, P = 0.029) in the DES group were significantly decreased compared with those in the TIVA group. The patients in the DES group displayed shorter OR exit time as compared with that in the TIVA group (7.3 [5.5-8.7] vs. 10.8 [9.3-12.3] min, P < 0.001). The patients using desflurane exhibited more stable hemodynamics during surgery than the patients using propofol-based TIVA, as demonstrated by lower incidences of hypotension (1% vs. 22%, P < 0.001), bradycardia (2% vs. 13%, P = 0.002), and OCR (17% vs. 44%, P < 0.001).Conclusion:DES enhanced the ophthalmic OR efficiency by reducing the extubation time and OR exit time, and provided more stable hemodynamics intra-operatively than TIVA in patients undergoing strabismus ambulatory surgery.Trial registration:ClinicalTrials.gov, No. NCT02922660; https://clinicaltrials.gov/ct2/show/NCT02922660?id=NCT02922660&draw=2&rank=1

简介：ForumofAnesthesiaandMonitoringisoneoftheleadingpublicationsforthespecialtiesofAnesthesia,IntensiveCareandPaininChina,sponsoredbyBeijingCommitteeofAnesthesiologistsofChineseMedicalAssociationandMedicalInformationLimited.Publishedsince1993,itiswidelyregardedasthepopularscientificjournalinthespecialty.Thisisevidencednotjustbyitscirculation,butbyitsinfluencestotheyounganesthetistsinChina.

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简介：Withtheadventofmoderntechniques,drugs,andmonitoring,generalanesthesiahascometobeconsideredanunlikelycauseofharm,particularlyforhealthypatients.Whilethisislargelytrue,newlyemergingclinicalandlaboratorystudieshavesuggestedthatexposuretoanestheticagentsduringearlychildhoodmayhavelong-lastingadverseeffectsoncognitivefunction.Thisconcernhasbeenthefocusofintensestudyinthefieldof

简介：AbstractTonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients’ families.

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简介：AbstractImportance:In children, anesthesia dosages are based on population pharmacokinetics and patient hemodynamics rather than patient-specific brain activity. Brain function is highly susceptible to the effects of anesthetics.Objective:The primary objective of this retrospective pilot study was to assess the prevalence of electroencephalography (EEG) burst suppression—a sign of deep anesthesia—in children undergoing general anesthesia.Methods:We analyzed EEG in patients aged 1-36 months who received sevoflurane or propofol as the primary anesthetic. Patient enrollment was stratified into two age groups: 1-12 months and 13-36 months. Burst suppression (voltage ≤ 5.0 mV, lasting > 0.5 seconds) was characterized by occurrence over anesthesia time. Associations with patient demographics and anesthetics were determined.Results:In total, 54 patients (33 males and 21 females) were included in the study [age 11.0 (5.0-19.5) months; weight 9.2 (6.5-11.0) kg]. The total prevalence of burst suppression was 56% (30/54). Thirty-three percent of patients experienced burst suppression during the surgical phase. The greatest proportion of burst suppression occurred during the induction phase. More burst suppression event occurrences (18/30) were observed in the patient under sevoflurane anesthesia (P = 0.024). Virtually all patients who received propofol boluses had burst suppression (P = 0.033). More burst suppression occurred in patients with hypotension (P < 0.001). During the surgical phase, a younger age was associated with more burst suppression (P = 0.002).Interpretation:EEG burst suppression was associated with younger age, inhalation anesthetics, propofol bolus, and lower arterial pressure.

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简介：AbstractBackground:There is limited evidence of the effects of local anesthesia (LA) on outcomes of non-surgical periodontal treatment (NSPT), in particular among the Chinese. This retrospective cohort study aimed to evaluate the effects of LA on short-term treatment outcomes of NSPT and to determine under what circumstances LA should be prescribed to improve these outcomes.Methods:Data from periodontal examinations of 3980 patients were used. The data were from 3-month re-evaluation records of an electronic periodontal charting record system in the Department of Periodontology of Peking University School and Hospital of Stomatology from June 2008 to January 2015. Descriptive analyses included changes in probing depth (PD) and the Mazza bleeding index (BI). Two-level (patient and tooth) logistic regression models and three-level (patient, tooth, and site) linear regression models were constructed to analyze the influence of LA on PD for all teeth/sites and teeth/sites with an initial PD ≥ 5 mm. Decreases in PD and BI at sites under LA using the initial PD were also compared.Results:A significantly higher mean decrease in PD after NSPT was found in the LA group than in the no local anesthesia (NLA) group (0.98 vs. 0.54 mm, t = 24.12, P < 0.001). A significantly higher probability of decreases was found in the LA group in BI (percentages of teeth with BI > 1 and BI > 2) for all teeth (16.7% vs. 13.8%, t=3.75, P < 0.001; 34.7% vs. 28.1%, t = 6.73, P < 0.001) and PD for teeth with PD ≥ 5 mm (32.3% vs. 17.3%, t = 28.48, P < 0.001). The difference in PD between the LA and NLA groups increased as the initial PD increased. The difference between the two groups was 0.12 to 0.22 mm for sites with a baseline PD < 7 mm; however, it increased to 0.41 to 1.37 mm for sites with a baseline PD ≥ 7 mm.Conclusions:LA improved the decrease in PD after NSPT. Root debridement at sites with initial PD ≥ 7 mm should be performed under routine LA.

简介：Toothextractionwasperformedin60casesunderdigitalacupointpressureanes-thesiawitharemarkablecurativeeffect.Thecurativeeffectwashigherforlooseteeth.Theeffectiveratewas100%.Thetoothextractionunderdigitalacupointpressureanesthesiahasmanyadvantages.Toothextractioncanbeperformedonlybypressingacertainacupointwithsafety,convenienceande-conomy.Themethodavoidsthesideeffectsofnarcoticandreducesthepatient’sfearofaninjectionofnarcotic.

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简介：镇静可以在指导的transrectal超声(TRUS)期间疼痛地导致减小前列腺活体检视。我们试图在在护理费用的指导TRUS的前列腺活体检视和相关增加期间评估propofol和remifentanil注入的联合的功效和安全。从1月到2010年9月，经历transrectal前列腺活体检视的100个人被使随机化进二个组。在组1，50个病人收到了propofol和remifentanil的联合注入；在组2，50个病人收到了lidocaine果冻。在指导TRUS的活体检视被执行以后，疼痛和耐心的满足被一个10点评估视觉模拟规模(管)，和一张费用相关的耐心的满足问询表被所有病人完成。病人们也被问他们是否将愿意由一样的方法经历重复活体检视。在1看了显著地更低的管的组的病人在组2比那些得分(吝啬的管分数：0.9±；1.1对6.3±；2.5；P<；0.001)。另外，耐心的满足规模在组1是显著地更高的(P=0.002)。尽管全面费用在组1是显著地更高的(P=0.006)，就费用而言的耐心的满足规模在这个组(P=0.009)也是更高的。propofol和remifentanil的联合在指导TRUS的前列腺活体检视期间是到减少病人疼痛和增加病人满足的一条安全、有效的路。尽管费用在收到了镇静，期望的组是更高的，病人展出了提高的满足和心甘情愿由一样的方法重复活体检视。

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