Zhong Mengjie,Xie Yingxiang,Chen Xia,et al.Application and safety analysis of target-controlled infusion of propofol in bronchoalveolar lavage for children with mycoplasma pneumoniae pneumonia under bispectral index monitoring[J].Journal of Clinical Pediatric Surgery,2025,(05):462-467.[doi:10.3760/cma.j.cn101785-202407023-012]
Application and safety analysis of target-controlled infusion of propofol in bronchoalveolar lavage for children with mycoplasma pneumoniae pneumonia under bispectral index monitoring
- Keywords:
- Mycoplasma Pneumoniae; Bronchoalvelar Lavage; Propofol; Surgical Procedures; Operative; Child
- Abstract:
- Objective To evaluate the efficacy and safety of target-controlled infusion (TCI) of propofol under bispectral index (BIS) monitoring in children with mycoplasma pneumoniae pneumonia (MPP) undergoing bronchoalveolar lavage (BAL) with a flexible bronchoscopy. Methods A prospective study was conducted on 104 MPP children aged 3-8 years (ASA classification Ⅰ-Ⅱ) scheduled for BAL at Children’s Hospital of Soochow University between March 2021 and March 2023.Patients were randomized into two groups (n=52):the TCI group,which received TCI of propofol starting at 2 μg·mL-1,and the constant-rate infusion (CI) group,which received propofol at 3-5 mg·kg-1·h-1.Both groups underwent anesthesia with midazolam (0.05 mg·kg-1),fentanyl (2 μg·kg-1),and cisatracurium (0.12 mg·kg-1) under BIS monitoring.Intraoperative parameters,including mean arterial pressure (MAP),heart rate (HR),and oxygen saturation (SpO2),were recorded at pre-induction (T0),bronchoscope arrival at carina (T1),start of lavage (T2),end of lavage (T3),and 30 minutes post-drug discontinuation (T4).Agitation and Ramsay sedation scores were assessed during bronchoscope insertion and at 10,20,and 30 minutes after bronchoscope removal.Pre-and postoperative plasma cortisol and blood glucose levels were measured,and adverse events were recorded. Results There were no significant differences in MAP,HR,or SpO2 at T0 between the two groups (P>0.05).MAP was lower in the TCI group at T1,T3,and T4 compared to the CI group (P<0.05),but no significant differences were observed at T2,nor in HR and SpO2 across all time points (P>0.05).No significant differences were found in the time from anesthesia induction to bronchoscope insertion,surgical duration,or time to full recovery of consciousness (P>0.05).The average number of bronchoscope reinsertions was lower in the TCI group (P<0.05).Agitation and Ramsay scores during bronchoscope insertion showed no significant differences (P>0.05),but agitation scores were significantly lower and Ramsay sedation scores higher at bronchoscope removal and at 10,20,and 30 minutes afterward in the TCI group (P<0.05).Postoperative plasma cortisol and blood glucose levels increased in both groups (P<0.05),but were significantly lower in the TCI group compared to the CI group (P<0.05).The incidence of adverse events did not differ significantly between groups (P>0.05). Conclusions Target-controlled infusion of propofol under BIS monitoring provides effective anesthesia with minimal hemodynamic and stress responses in children with MPP undergoing BAL.
References:
[1] Tsai TA,Tsai CK,Kuo KC,et al.Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children[J].J Microbiol Immunol Infect,2021,54(4):557-565.DOI:10.1016/j.jmii.2020.10.002.
[2] Gami A,Rinaldi K,Degefe YT,et al.Bronchoalveolar lavage in a pediatric population[J].Am J Clin Pathol,2022,157(5):678-684.DOI:10.1093/ajcp/aqab177.
[3] 胡璟,滑蕾,霍良红,等.儿童闭环靶控丙泊酚输注充分麻醉时间比的影响因素分析[J].临床小儿外科杂志,2021,20(5):458-463.DOI:10.12260/Icxewkzz.2021.05.012. Hu J,Hua L,Huo LH,et al.Analysis of influencing factors of adequate anesthesia time ratio of closed-loop infusion of propofol in children[J].DOI:10.12260/Icxewkzz.2021.05.012.
[4] Sekiguchi R,Kinoshita M,Kawanishi R,et al.Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients:a single-center,randomized,controlled trial[J].BMC Anesthesiol,2023,23(1):14.DOI:10.1186/s12871-023-01974-9.
[5] Liu GL,Zhang JM,Wang F,et al.Effect of bispectral index-guided total intravenous anesthesia in younger children:a prospective,randomized,controlled trial[J].Front Neurol,2022,13:1028582.DOI:10.3389/fneur.2022.1028582.
[6] 中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.DOI:10.3760/cma.j.issn.2095-428X.2015.17.006. Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association,Editorial Board of Chinese Journal of Applied Clinical Pediatrics.Expert consensus on diagnosis and treatment of mycoplasma pneumoniae pneumonia in children (2015)[J].Chin J Appl Clin Pediatr,2015,30(17):1304-1308.DOI:10.3760/cma.j.issn.2095-428X.2015.17.006.
[7] Tang XL,Ren H,Qian J,et al.Bronchoalveolar lavage improved ventilation/perfusion matching in pediatric severe mycoplasma pneumoniae pneumonia with lung consolidation[J].Pediatr Pulmonol,2023,58(1):350-352.DOI:10.1002/ppul.26174.
[8] Ma HY,Cai YH,Zhong JW,et al.The effect of remimazolam-based total intravenous anesthesia versus sevoflurane-based inhalation anesthesia on emergence delirium in children undergoing tonsillectomy and adenoidectomy:study protocol for a prospective randomized controlled trial[J].Front Pharmacol,2024,15:1373006.DOI:10.3389/fphar.2024.1373006.
[9] 卢易,陈丽芬,刘华程,等.吸入和全凭静脉麻醉用于患儿纤维支气管镜检查效果的比较[J].临床麻醉学杂志,2020,36(12):1161-1164.DOI:10.12089/jca.2020.12.004. Lu Y,Chen LF,Liu HC,et al.Comparison of the effects of inhalation and total intravenous anesthesia in children undergoing fiber-optic bronchoscopy[J].J Clin Anesthesiol,2020,36(12):1161-1164.DOI:10.12089/jca.2020.12.004.
[10] Ko CC,Hung KC,Illias AM,et al.The use of remimazolam versus propofol for induction and maintenance of general anesthesia:a systematic review and meta-analysis[J].Front Pharmacol,2023,14:1101728.DOI:10.3389/fphar.2023.1101728.
[11] Doi M,Morita K,Takeda J,et al.Efficacy and safety of remimazolam versus propofol for general anesthesia:a multicenter,single-blind,randomized,parallel-group,phase IIb/III trial[J].J Anesth,2020,34(4):543-553.DOI:10.1007/s00540-020-02788-6.
[12] 张立立,白小丽,陈蕾,等.瑞芬太尼联合丙泊酚靶控输注维持麻醉在扁桃体切除术患儿中的应用效果[J].河北医科大学学报,2022,43(4):476-480.DOI:10.3969/j.issn.1007-3205.2022.04.021. Zhang LL,Bai XL,Chen L,et al.Application effect of remifentanil combined with propofol target-controlled infusion to maintain anesthesia in children undergoing tonsillectomy[J].J Hebei Med Univ,2022,43(4):476-480.DOI:10.3969/j.issn.1007-3205.2022.04.021.
[13] 金丹,许学兵,陈超,等.经鼻滴注右美托咪定对全凭静脉麻醉下包皮环扎术小儿围术期情绪应激反应的影响[J].广东医学,2021,42(3):294-297.DOI:10.13820/j.cnki.gdyx.20202498. Jin D,Xu XB,Chen C,et al.The effect of intranasal dexmedetomidine on perioperative emotional stress response in children for circumcision[J].Guangdong Med J,2021,42(3):294-297.DOI:10.13820/j.cnki.gdyx.20202498.
[14] 李清伟,郑文婧,谷志杰,等.瑞芬太尼-丙泊酚靶控输注维持麻醉在小儿扁桃体摘除术中的应用效果及对患儿围术期血流动力学的影响[J].临床误诊误治,2019,32(4):25-29.DOI:10.3969/j.issn.1002-3429.2019.04.007. Li QW,Zheng WJ,Gu ZJ,et al.Application effect of remifentanil-propofol by target controlled infusion to maintain anesthesia in children undergoing tonsillectomy and their effect on perioperative hemodynamics[J].Clinical Misdiagnosis & Mistherapy,2019,32(4):25-29.DOI:10.3969/j.issn.1002-3429.2019.04.007.
[15] Meng DM,Zhang XZ,Yu PJ,et al.Analysis of influence factors of pharmacodynamics of propofol with target-controlled infusion during anesthetic recovery period[J].Int J Clin Pharmacol Ther,2021,59(2):109-115.DOI:10.5414/CP203742.
[16] Shi S,Gan L,Jin CN,et al.Effects of propofol combined with lidocaine on hemodynamics,serum adrenocorticotropic hormone,interleukin-6,and cortisol in children[J].World J Clin Cases,2022,10(24):8506-8513.DOI:10.12998/wjcc.v10.i24.8506.
[17] 丁洋子,张奉超,李立,等.麻醉深度监测丙泊酚伍用瑞芬太尼对扁桃体腺样体手术患儿血流动力学和应激反应的影响[J].重庆医学,2022,51(1):70-75.DOI:10.3969/j.issn.1671-8348.2022.01.015. Ding YZ,Zhang FC,Li L,et al.Effects of propofol combined with remifentanil on hemodynamics and stress response in children undergoing tonsillar adenoidectomy under anesthesia depth monitoring[J].Chongqing Med J,2022,51(1):70-75.DOI:10.3969/j.issn.1671-8348.2022.01.015.
Memo
收稿日期:2024-7-10。
基金项目:苏州市科技计划(医疗卫生科技创新)项目(SKY2022055)
通讯作者:王谦,Email:q_wang0302@suda.edu.cn