Hu Yaoqin,Qiu Jinpeng,Zhao Jialian,et al.Effects of different anesthetic modes upon children with concealed penis[J].Journal of Clinical Pediatric Surgery,,19():728-733.[doi:10.3969/j.issn.1671-6353.2020.08.013]
Effects of different anesthetic modes upon children with concealed penis
- Keywords:
- Penis/SU; Anesthesia; Intravenous; Anesthesia; General; Anesthesia; Epidural
- CLC:
- R697+.1;R614.2+1;R614.2+4;R614.4+2
- Abstract:
- Objective To explore the effects of different anesthetic modes on anesthetic efficacy during and after operations of concealed penis in children. Methods A total of 90 children undergoing concealed penile surgery were prospectively enrolled and randomly divided into intravenous anesthesia plus ropivacaine and lidocaine sacral anesthesia group (group Ⅰ), intravenous anesthesia plus ropivacaine sacral anesthesia group (group Ⅱ) and laryngeal mask anesthesia plus ropivacaine sacral anesthesia group (group Ⅲ). Vital signs in different groups were monitored intraoperatively. Time from induction of anesthesia to beginning of operation, postoperative dosing frequency of analgesics, postoperative pain score at each timepoint, motor blockage score, duration of postanesthesia care unit (PACU), anesthetic cost and hospitalization length were recorded. Results The efficacy of anesthesia was satisfactory in all three groups and the anesthetic protocol remained unchanged during operation. No significant difference existed in time from induction of anesthesia to beginning of operation among three groups (P=0.58). Children in groups Ⅰ and Ⅱ were transferred postoperatively into PACU while those in group Ⅲ did so after removing laryngeal mask. Propofol consumed intraoperatively showed no difference between groups Ⅰ and Ⅱ (P=0.573). The concentration of sevoflurane was maintained at 1%-1.5% in group Ⅲ. PACU duration, pain score and postoperative use of analgesics showed no difference among three groups. As compared with groups Ⅱ and Ⅲ, group Ⅰ had motor blockage at 30 min post-operation (P<0.001). No difference was observed in postoperative nausea and vomiting (PONV) among three groups (P=0.455). There were delirium (n=7) and intensified excretions (n=3) while no symptom was observed in another two groups. The cost of anesthesia in group Ⅲ nearly doubled of those in groups Ⅰ and Ⅱ. No difference existed in hospitalization length among three groups. Conclusion Ropivacaine caudal blockage alone may achieve satisfactory anesthesia during concealed penis surgery, reduce the intubation-related complications, quicken the utilization of operating room and accelerate the postoperative recovery of children.
References:
1 Krane EJ,Weisman SJ,Walco GA.The national opioid epidemic and the risk of outpatient opioids in children[J].Pediatrics,2018,142(2):e20181623.DOI:10.1542/peds.2018-1623.
2 Gan TJ.Poorly controlled postoperative pain:prevalence,consequences,and prevention[J].J Pain Res,2017,10:2287-2298.DOI:10.2147/JPR.S144066.
3 Hassan PF,Hassan AS,Elmetwally SA.Caudal analgesia for hypospadias in pediatrics:comparative evaluation of adjuvants dexamethasone and dexmedetomidine combination versus dexamethasone or dexmedetomidine to bupivacaine:a prospective,double-blinded,randomized comparative study[J].Anesth Essays Res,2018,12(3):644-650.DOI:10.4103/aer.
4 Suresh S,Ecoffey C,Bosenberg A,et al.The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia[J].Reg Anesth Pain Med,2018,43(2):211-216.DOI:10.1097/AAP.0000000000000702.
5 纪淑敏,沈燕平,邹汶航.罗哌卡因联合利多卡因骶管阻滞对小儿腹腔镜斜疝手术的麻醉效果及安全性[J].中国生化药物杂志,2016,36(11):100-102.DOI:10.3969/j.issn.1005-1678.2016.11.029.Ji SM,Shen YP,Zou WH.Efficacy and safety of ropivacaine combined with lidocaine in caudal block for pediatric laparoscopic hernia surgery[J].Chin J Biochem Pharms,2016,36(11):100-102.DOI:10.3969/j.issn.1005-1678.2016.11.029.
6 黄振华,左云霞.利多卡因复合罗哌卡因骶管阻滞用于学龄期青春期男性患儿阴茎手术[J].西部医学,2009,21(6):920-922.DOI:10.3969/j.issn.1672-3511.Huang ZH,Zuo YX.The effect of Lidocaine and Ropivacaine combinations in caudal block for penis operation in school-age and adolescent patients[J].Med J West China,2009,21(6):920-922.DOI:10.3969/j.issn.1672-3511.
7 Mayhew D,Mendonca V,Murthy BVS.A review of ASA physical status-historical perspectives and modern developments[J].Anaesthesia,2019,74(3):373-379.DOI:10.1111/anae.14569.Epub 2019 Jan 15.
8 van Hoff SL,O’Neill ES,Cohen LC,et al.Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis[J].Paediatr Anaesth,2015,25(7):668-676.DOI:10.1111/pan.12669.
9 Crellin DJ,Harrison D,Santamaria N,et al.The psychometric properties of the FLACC scale used to assess procedural pain[J].Pain,2018,19(8):862-872.DOI:10.1016/j.jpain.2018.02.013.
10 Katz D,Hamburger J,Gutman D,et al.The effect of adding subarachnoid epinephrine to hyperbaric bupivacaine and morphine for repeat cesarean delivery:a double-blind prospective randomized control trial[J].Anesth Analg,2018,127(1):171-178.DOI:10.1213/ANE.0000000000002542.
11 Yoshioka S,Takedatsu H,Fukunaga S,et al.Study to determine guidelines for pediatric colonoscopy[J].World J Gastroentero,2017,23(31):5773-5779.DOI:10.3748/wjg.v23.i31.5773.
12 Walker BJ,Long JB,Sathyamoorthy M,et al.Complications in Pediatric Regional Anesthesia:An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network[J].Anesthesiology,2018,129(4):721-732.DOI:10.1097/ALN.0000000000002372.
13 Kendall MC,Alves LJC,Suh EI,et al.Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients:an updated systematic review of randomized controlled trials[J].Local Reg Anesth,2018,11:91-109.DOI:10.2147/LRA.S185554.
14 李杰,张瑞芹.小儿基础麻醉的研究进展[J].临床小儿外科杂志,2018,17(8):631-635.DOI:10.3969/j.issn.1671-6353.2018.08.017.Li J,Zhang RQ.Research progress of basic anesthesia for children[J].J Clin Ped Sur,2018,17(8):631-635.DOI:10.3969/j.issn.1671-6353.2018.08.017.
15 中华医学会小儿外科学分会心胸外科学组.基于快速康复的小儿外科围手术期气道管理专家共识[J].中华小儿外科杂志,2019,40(7):577-582.DOI:10.3760/cma.j.issn.0253-3006.2019.07.001.Expert Group on Perioperative Airway Management in Pediatric Surgery.Expert Consensus on Perioperative Airway Management Based on Enhanced Recovery after Pediatric Surgery[J].Chin J Pediatr Surg,2019,40(7):577-582.DOI:10.3760/cma.j.issn.0253-3006.2019.07.001.
16 von Ungern-Sternberg BS,Boda K,Chambers NA,et al.Risk assessment for respiratory complications in paediatric anaesthesia:a prospective cohort study[J].Lancet,2010,376(9743):773-783.DOI:10.1016/S0140-6736(10)61193-2.
17 Tait AR,Burke C,Voepel-Lewis T,et al.Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections[J].Anesth Analg,2007,104(2):265-270.DOI:10.1213/01.ane.0000243333.96141.40.
18 Luce V,Harkouk H,Brasher C,et al.Supraglottic airway devices vs tracheal intubation in children:a quantitative meta-analysis of respiratory complications[J].Paediatr Anaesth,2014,24(10):1088-1098.DOI:10.1111/pan.12495.
19 Fang XZ,Gao J,Ge YL,et al.Network Meta-analysis on the efficacy of dexmedetomidine,midazolam,ketamine,propofol,and fentanyl for the prevention of sevoflurane-related emergence agitation in children[J].Am J Ther,2016,23(4):e1032-e1042.DOI:10.1097/MJT.0000000000000321.
20 Cannesson M,Kain Z.Enhanced recovery after surgery versus perioperative surgical home:is it all in the name[J].Anesth Analg,2014,118(5):901-902.DOI:10.1213/ANE.0000000000000177.
21 Girsberger SA,Schneider MP,L?ffel LM,et al.Effect of thoracic epidural ropivacaine versus bupivacaine on lower urinary tract function[J].Anesthesiology,2018,128(3):511-519.DOI:10.1097/ALN.0000000000001980
22 Piper SL,Laron D,Manzano G,et al.A comparison of lidocaine,ropivacaine and dexamethasone toxicity on bovine tenocytes in culture[J].J Bone Joint Surg,2012,94(6):856-862.DOI:10.1302/0301-620X.94B6.29063.
Memo
收稿日期:2019-12-24。
基金项目:浙江省自然科学基金（编号：YZOHI00019）
通讯作者:舒强,Email:shuqiang@zju.edu.cn