Severe COVID-19 cases often progress to life-threatening conditions such as acute respiratory distress syndrome (ARDS), sepsis, and multiple organ dysfunction syndrome (MODS). Gelsolin (GSN), an actin-binding protein with anti-inflammatory and immunomodulatory properties, is a promising therapeutic target for severe COVID-19. Plasma GSN levels are significantly decreased in critical illnesses, including COVID-19, correlating with dysregulated immune responses and poor outcomes. GSN supplementation may mitigate acute lung injury, ARDS, and sepsis, which share pathophysiological features with severe COVID-19, by scavenging actin, modulating cytokine production, enhancing macrophage phagocytosis, and stabilizing the alveolar-capillary barrier. Preliminary data indicate that recombinant human plasma GSN improves oxygenation and lung function in severe COVID-19 patients with ARDS. Although further research is needed to optimize GSN therapy, current evidence supports its potential to mitigate severe consequences of COVID-19 and improve patient outcomes. This review provides a comprehensive analysis of the biological characteristics, mechanisms, and therapeutic value of GSN in severe COVID-19.

Background: Video-stylet-guided nasotracheal intubation (NTI) is an effective technique for airway management. However, the impact of the bend angle on the success rate of intubation remains unclear. Purpose: Does increasing the bend angle of a stylet to 90 degrees increase NTI success rate?. Study Design, Setting, Sample: This prospective randomized controlled trial was conducted in the operating room of a population-based hospital. Adult patients requiring NTI were recruited. Predictor/Exposure/Independent Variable: The primary predictor variable is the choice of stylet bend angle (90 degrees vs 70 degrees bend) in NTI. Main Outcome Variable(s): The primary outcome variables were success rates of NTI, defined as the proportion of successful intubation cases to total cases. Covariates: Demographics, intubation time, the distance from the thyroid prominence to the nostril, additional maneuvers applied during intubation, and cases of epistaxis were recorded. Analyses: The student's t-test was used to compare continuous variables between groups. Ordinal data (intubation attempts, head extension, and epistaxis) were analyzed using the Wilcoxon rank-sum test. As appropriate, frequency (external pharyngeal pressure) was analyzed using the c2 test or Fisher's exact test. A P value of <.05 was considered statistically significant. Results: Of the 103 subjects assessed for eligibility, 98 were enrolled in the study. The mean age (27.0 +/- 6.9 years vs 27.0 +/- 4.1 years, P = .972) and sex differences (male/female: 9/40 vs 7/42, P = .136) were comparable between groups. The overall success rate in the 70 degrees group was significantly lower than that in the 90 degrees group (91.8 vs 100%, P < .001). The intubation time in the 70 degrees group was significantly longer than that in the 90 degrees group (43.2 +/- 15.8 s vs 33.7 +/- 7.3 s, P < .001). Conclusions and Relevance: A 90 degrees bend angle of the stylet significantly improves the likelihood of successful NTI. (c) 2023 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 82:152-158, 2024

目的 观察3种喉镜辅助经鼻气管插管的临床效果.方法 选取2019年5月至2021年1月中国医学科学院北京协和医学院整形外科医院择期全身麻醉下行颌面外科手术的患者132例,随机分为Macintosh直接喉镜组(MA组)、Tosight视频喉镜组(TO组)和MDH电子软镜组(MD组),每组44例.记录导管到达口咽部时间、声门暴露时间、置入导管时间及插管总时间;记录插管次数、首次插管成功率、有无按压气管环、是否旋转导管置入和有无口鼻腔黏膜出血;记录患者血流动力学改变情况;记录术后2 h咽喉部并发症发生情况.结果 TO组和MD组能较好地暴露声门,均为44例,全部为C-L分级I级,高于MA组(36例),差异有统计学意义(P＜0.05);TO组和MD组首次插管成功率均为100.0％,高于MA组的90.9％,差异有统计学意义(P＜0.05);3组Mallampatti分级和插管总成功率差异无统计学意义(P＞0.05).与MA组和TO组比较,MD组鼻导管置入或软镜到达口咽部时间[(9.7±5.5)s]、声门暴露时间[(14.5±8.9)s]、置入导管时间[(27.9±13.9)s]、插管总时间[(52.0±14.9)s]均最长,但黏膜出血发生率(4.5％)及术后咽痛发生率(2.3％)最低,差异均有统计学意义(P＜0.05).3组插管过程血流动力学稳定,术后咽部不适、声音嘶哑发生率比较,差异均无统计学意义(P＞0.05).结论 3种喉镜均能很好地完成鼻插管,Tosight视频喉镜和MDH电子软镜能更好地暴露声门,首次插管成功率高;MDH电子软镜辅助经鼻插管时间长,但黏膜出血及术后咽痛发生率低.

To assess the effects of the number and duration of general anesthesia exposure on the sleep quality of 6–15-year-old school children who underwent plastic surgery. The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children (SDSC). The children were divided into two groups according to their exposure to general anesthesia: No General Anesthesia (NGA) and General Anesthesia (GA) groups. The GA group was further divided into three subgroups according to the number of exposures: Single-exposure, Double-exposure, and Multiple-exposure groups. The GA group was also subdivided into two groups according to the cumulative total time of anesthesia exposure: < 3 h and ≥ 3 h groups. Multivariate logistic regression analysis was used to confirm the potential factors that affect children with sleep disturbance (SDSC scores > 39) after general anesthesia exposure. Linear regression was used to analyze the correlation of the factors with the SDSC scores. The SDSC scores were higher in the GA group [35.4 ± 4.3 vs. 34.0 ± 3.6, P < 0.0001] as compared to the NGA group. The number of children with SDSC scores > 39 was also higher in the GA group [80 (17.5%) vs. 17 (7.4%), P < 0.0001]. More anesthesia exposure was correlated with higher total SDSC scores [34.5 ± 4.3 for single exposure vs 35.1 ± 3.9 for double exposure vs 37.5 ± 4.5 for multiple exposures, P < 0.0001] and a higher proportion of SDSC scores > 39 [24 (12.0%) for single exposure vs 24 (15.5%) for double exposure vs 32 (31.1%) for multiple exposures, P < 0.0001]. Longer anesthesia exposure was also correlated with higher total SDSC scores [34.4 ± 4.5 for < 3 h vs. 35.8 ± 4.2 for ≥ 3 h, P = 0.002]. The number of exposures to general anesthesia was a potential factor in sleep disturbance among children, determined based on logistic regression. Children who underwent plastic surgery between the ages of 6 and 15 years with general anesthesia exposure might have worse sleep quality and a higher incidence of sleep disorders. More frequent anesthesia exposure leads to worsened sleep quality and a higher incidence of sleep disorders. This study also confirmed that a longer duration of cumulative anesthesia exposure also leads to worse sleep quality.

Background: This multicenter prospective, randomized controlled clinical trial compared the clinical performance of supraglottic airway device (SAD) BlockBuster (TM) and laryngeal mask airway (LMA) Supreme for airway maintenance in anesthetized, paralyzed adult patients. Methods: A total of 651 adult patients scheduled for elective surgery in 13 hospitals were randomly allocated into BlockBuster group (n = 351) or Supreme group (n = 300). The primary outcome was oropharyngeal leak pressure (OLP). Duration and ease of insertion, fiberscopic view of positioning, airway manipulations, and complications were also assessed. Results: The OLP was significantly higher in BlockBuster group compared with Supreme group (29.9 +/- 4.2 cmH(2)O vs 27.4 +/- 4.3 cmH(2)O, p < 0.001). Success rate of insertion at the first attempt (90.2% vs 85.1%, p = 0.027), rate of optimal fiberscopic view (p = 0.002) and satisfactory positioning of SAD (p < 0.001) were significantly increased in BlockBuster group. Conclusions: Both SAD BlockBuster (TM) and LMA Supreme are safe, effective, and easy-to-use devices for airway maintenance in anesthetized, paralyzed adult patients, but the SAD BlockBuster (TM) is superior to LMA Supreme in terms of OLP, success rate at the first attempt, and fiber-optic view of positioning.

目的 通过与Air-Q气管插管型喉罩的比较,评估SaCoVLM可视喉罩直视下指导儿童气管插管的临床效果.方法 选取2021年2-8月中国医学科学院北京协和医学院整形外科医院择期行全身麻醉下外耳再造手术患儿120例,采用随机数字表法分为Air-Q插管型喉罩组(A组)和SaCoVLM喉罩组(S组),每组60例.喉罩置入到位后,A组联合可视插管软镜完成插管,S组则在视频直视下实施气管插管.记录喉罩置入时间、喉罩退出时间及经喉罩气管插管时间和次数、调节手法;测量喉罩密封压;记录可视软镜在喉罩开口处的声门暴露分级、SaCoVLM可视喉罩声门暴露分级以及术后并发症的发生情况.结果 A组喉罩置入时间和喉罩退出时间短于S组[(14.1±7.2)s比(19.5±12.2)s、(18.4±5.1)s比(30.7±8.6)s],差异均有统计学意义(P＜0.05);A组气管插管时间长于S组[(39.8±9.5)s比(32.4±17.1)s],差异有统计学意义(P＜0.05);S 组密封压高于 A 组[(260±52)mmH2O比(204±48)mmH2O,1 mmH2O=0.009 8 kPa],差异有统计学意义(P＜0.05).拔除喉罩后,A组有4例喉罩尖端带血,S组有8例喉罩尖端带血、10例喉罩背面带血,两组比较差异有统计学意义(P＜0.05).结论 SaCoVLM可视喉罩可在喉罩内视频的指导下直接完成气管插管,插管时间明显缩短且较Air-Q插管型喉罩,且能获得更高的密封压.而Air-Q插管型喉罩的置入和退出更为容易,损伤相对较小.

BackgroundDexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is now widely used in procedural sedation and analgesia. This study was designed to observe and compare the efficacy and safety of DEX administered in two different modes.MethodsIn total, 100 patients were randomly divided into two groups to receive intravenous DEX 1 µg/kg over 15 min followed by 0.4–0.7 µg/kg/h infusion or DEX 1 µg/kg over 30 min followed by 0.4–0.7 µg/kg/h infusion. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), bispectral index (BIS), Ramsay Sedation Scores (RSS scores), the lowest respiratory rates (LRR), incidences of respiratory adverse events and frequencies of body movements were recorded. Recovery time, recall of intraoperative events, pain scores in PACU and satisfaction of patients and surgeons were assessed.ResultsThe BIS at time points from 5 min after anesthesia to the end of surgery in the intervention group were significantly higher (p < 0.05). The RSS scores at time points from 5 min after anesthesia to immediately after induction with DEX were significantly higher in the intervention group (p < 0.05). The HR at time points from the beginning of surgery to 30 min after local anesthesia, the MAP at time points from 30 min after local anesthesia to the end of surgery, and the RR at time points from 5 min after anesthesia to the end of surgery were significantly higher in the intervention group (p < 0.05). Patients in the intervention group had higher LRR, lower incidences of respiratory adverse events, and shorter recovery time (p < 0.05).ConclusionsDexmedetomidine infused with a loading dose over 30 min had less impact on patients’ hemodynamics and respiration and could shorten the recovery time after anesthesia in procedural sedation and analgesia.Clinical Trial RegistrationClinicalTrials.gov, identifier: ChiCTR1900027958.

SaCo(safe comfortable)可视喉罩是一种新型的国产可视喉罩,喉罩内置的摄像头可以持续观察喉罩的置入、留置、拔除的全部过程,为喉罩的安全使用提供方便.小耳畸形患儿有不同程度的半侧颜面短小或者小颌畸形,此类患儿咽腔容积小,困难气管插管的发生率较高[1-2].大量的临床观察已经证实,经喉罩和插管型喉罩可以快速完成气管插管,是目前解决困难插管最有效方法之一[3-4].由于普通喉罩没有可视功能,气管插管时需要联合使用可视插管软镜,增加了操作的步骤和设备需求,在一定程度上限制该方法的广泛使用.本研究观察小耳畸形患儿经SaCo可视喉罩实施气管插管的安全性,为患儿的气管插管和困难插管提供一种新的选择.

目的 观察不同折弯角度可视管芯引导经鼻气管插管的效果.方法 选择择期行颌面手术经鼻气管插管的全麻患者120例,男19例,女101例,年龄18～60岁,ASAⅠ或Ⅱ级.根据插管时可视管芯前端折弯角度的不同,将患者随机分为三组:70°组、90°组和110°组.记录鼻孔-喉结的垂直距离(简称TND)、插管时间、插管次数、声门显露情况、插管辅助手法以及鼻出血情况.结果 三组TND差异无统计学意义.90°组、110°组插管时间明显短于70°组,插管成功率明显高于70°组(P<0.05).90°组、110°组插管时间、插管成功率差异无统计学意义.90°组声门显露级别明显优于70°组和110°组(P<0.05),70°组、110°组声门显露级别差异无统计学意义.三组插管时均采用头后仰的辅助手法,但70°组后仰程度大,而90°组、110°组多为轻度后仰.110°组有1例(2.5％)需辅助提颏,1例(2.5％)需助手辅助托下颌,而70°组则有6例(15.0％)需调整喉部位置.三组鼻出血发生率差异无统计学意义.结论 可视管芯引导经鼻气管插管时,与70°折弯角度比较,90°折弯角度插管时间更短、成功率更高、插管所需辅助调整更少.110°折弯角度插管时间和成功率和90°折弯角度接近,但需要更多的辅助调整.

Background : To observe and compare the efficacy and safety of dexmedetomidine administrated in two different modes in sedative and analgesic anesthesia. Methods : Sixty female patients, of American Society of Anesthesiologists physical status I or II, aged from 18-52 years and scheduled for elective plastic operations under sedative and analgesic anesthesia were randomly divided into a control group and an intervention group, with 30 patients in each group. All patients were administered IV midazolam 0.04mg/kg and a continuous infusion of 0.1 μg/kg/min of remifentanil at the beginning of anesthesia. Patients in the control group received IV dexmedetomidine (DEX) 1 μg/kg over 15 min followed by 0.4-0.7 μg/kg/h infusion while patients in the intervention group received IV DEX 1 μg/kg over 30 min followed by 0.4-0.7 μg/kg/h infusion. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), bispectral index (BIS) and Ramsay sedation scores (RSS) were recorded. The lowest respiratory rates (LRR), incidences of respiratory depression, incidences of oxygen supplementation by facial mask and thrusting the jaw, frequencies of body movements, and additional rescue drug administrations were also recorded. After surgery, recovery time, recall of intraoperative events, pain scores in postanesthesia care unit(PACU), and satisfaction of patients and surgeons were assessed. Results : The BIS at time points from 5 min after anesthesia to the end of surgery in the intervention group were significantly higher than those in the control group (P<0.05). The RSS scores at time points from 5 min after anesthesia to immediately after induction with DEX were significantly higher in the intervention group than those in the control group (P<0.05). The HR at time points from the beginning of surgery to 30 min after local anesthesia, the MAP at time points from 30 min after local anesthesia to the end of surgery, and the RR at time points from 5 min after anesthesia to the end of surgery were significantly higher in the intervention group than those in the control group (P<0.05). Compared with the control group, patients in the intervention group had higher LRR, lower incidences of respiratory depression, more oxygen supplementation by facial mask and thrusting the jaw, and a shorter recovery time (P<0.05). Conclusions : The two different dexmedetomidine administrations effectively sedated and provided analgesia for patients. Dexmedetomidine infused with a loading dose over 30 min had less impact on patients’ hemodynamics and respiration and could shorten the recovery time after anesthesia. Trial registration: Registered at the Chinese Clinical Trial Registry, registration number ChiCTR1900027958, date of registration: 07/12/2019.

Supreme喉罩是一次性双管喉罩,除咽部密封外,最新版的Supreme喉罩加入了创新的食道密封功能以降低误吸风险[1]. 国内外研究已充分证实Supreme喉罩的安全性和有效性[1-3]. AuraGain喉罩为新型一次性插管型双管喉罩,其通气道与上呼吸道解剖曲线相似,除了可用于术中气道维持外,还可作为引导气管插管的通道. 现有研究证实,其在临床应用中具有优异的表现,但各研究关于密封压的结果 并不一致. 本研究观察和比较Supreme喉罩与AuraGain喉罩用于乳腺整形手术的安全性和有效性,为临床使用提供参考.

目的 探讨Levitan用于经鼻气管插管的可行性和安全性.方法 选取2019年3～8月中国医学科学院北京协和医学院整形外科医院100例经鼻气管插管的全麻患者,随机分为Levitan组(L组)和Macintosh组(M组),记录两组插管时间、插管次数、声门显露分级及插管相关并发症发生情况.结果 患者全部成功插管,L组和M组首次插管成功率分别为98％(49/50)和96％(48/50);L组声门显露更佳、插管时间更短[(32.1±12.8)s比(39.4±9.8)s,P＜0.05];两组鼻出血及术后咽痛的发生率差异无统计学意义.结论 Levitan和Macintosh喉镜均可安全有效地用于经鼻气管插管,且Levi-tan声门显露更好、插管时间更短.

目的 对比观察颌面手术咽后壁纱布填塞及手术部位对术后咽喉痛的影响.方法 选取2017年9月至2018年5月中国医学科学院整形外科医院70例美国麻醉医师协会(American Society of Anesthesiologist,ASA)分级Ⅰ级的颌面手术患者,随机分为A组(无咽后壁纱布组,35例)和B组(咽后壁纱布组,35例),处理方式为全身麻醉后有或无咽后壁纱布填塞,观察术后1h、4h、12h、24 h患者咽喉痛情况及术区在口裂上、下时的咽喉痛情况.结果 术后1h、4h、12h、24 h,A组咽喉痛的发生率分别为80.0％、91.4％、91.4％、82.8％,B组发生率分别为68.6％、88.6％、88.6％、80.0％,组间比较差异无统计学意义(P＞0.05).术区仅涉及口裂以上者,术后咽喉痛的总体发生率为61.1％;术区涉及口裂下者,术后咽喉痛的发生率为100％,差异有统计学意义(P＜ 0.001).结论 颌面手术是否应用咽后壁纱布,对术后咽喉痛发生率可能无影响,手术损伤可能是颌面手术咽喉痛的主要原因之一.

目的 观察无管芯环状弯曲气管导管用于患儿气管插管的效果.方法 择期全麻气管插管下完成整形外科手术患儿105例,男88例,女17例,年龄4～12岁,ASA Ⅰ或Ⅱ级,按气管导管的弯曲方式随机分成三组,每组35例:环状弯曲组(RB组)、自然弯曲组(NB组)和管芯弯曲组(SB组).记录声门暴露时间、插管时间、插管次数、一次插管成功情况、插管后喉镜片是否带血;记录术后2h咽喉部并发症的发生情况.结果 三组声门暴露时间差异无统计学意义.NB组插管时间明显短于SB组[(22.7±13.6)s vs (25.2±10.6)s,P＜0.05].SB组全部一次完成气管插管,RB组和NB组分别有2例(6％)和8例(23％)需要第二次完成气管插管.RB组一次插管成功率明显高于NB组(94.3％ vs 77.1％,P＜0.05).RB组和NB组各有1例喉镜有血,SB组无一例喉镜有血.SB组有9例(26％)术后咽部疼痛,明显多于RB组的2例(6％)和NB组的1例(3％)(P＜0.05).结论 无管芯环状弯曲气管导管可相对提高患儿首次插管成功率,术后咽部不适明显减少,是一种安全便捷有效的插管方式.

丙泊酚联合阿片类药物镇静镇痛麻醉可减少术中的应激及不良记忆,改善和增强局麻效果,提高局麻患者的舒适度和满意度,是整形外科手术常用的麻醉方式[1]. 丙泊酚闭环麻醉是将 TCI 技术与监测麻醉深度的脑电双频指数(bispectral index,BIS)有机结合的麻醉技术,脑电监测 TCI注射泵可根据BIS测量值与设定的闭环目标值进行实时比对,自动调整丙泊酚的输注速度,维持合适和稳定的镇静深度[2-4] .

丙泊酚闭环麻醉将靶控输注技术与监测麻醉深度的脑电双频指数有机结合,通过反馈机制维持设定的麻醉深度.目前丙泊酚闭环麻醉已应用于全身麻醉、镇静麻醉以及与其他麻醉方式相结合的联合麻醉.丙泊酚闭环麻醉不仅可用于身体条件较好的一般患者,也可用于老年、小儿、肥胖及重症患者,并能有效避免麻醉过深.丙泊酚闭环麻醉可以维持稳定的麻醉深度,避免麻醉过深或过浅,术后谵妄和认知功能障碍的发生率降低,但其总的给药量与是否使用闭环麻醉无相关性.各种因素对脑电双频指数的影响以及反馈的延迟导致了丙泊酚闭环麻醉的局限性.

Objective To observe the effect of remifentanil infusion on circulatory response and extubation-related adverse effects to the children undergoing ear reconstruction surgery with general anesthesia in tracheal extubation period.Methods A total of 60 cases with Ⅰ-Ⅱ of ASA assessment rating,who would undergo elective ear reconstruction surgery with autologous rib cartilage were randomly divided into a remifentanil group and a control group,30 cases each.Both groups were induced by anesthesia sufentanil + propofol + rocuronium and maintained by anesthesia remifentanil + propofol + 60％ N2O.Inhalation and intravenous anesthetics were discontinued 5 minutes before the end of the surgery.The patients in the remifentanil group were continuously injected remifentanil[0.05 μg/(kg · min] from the end of the surgery to extubation.The patients in the control group were not injected remifentanil from the end of the surgery to extubation.The spontaneous breathing recovery time,awaking time,extubation time,and the mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2) at the time points of before induction of anesthesia (T0),the end of the surgery (T1),extubation (T2),1 minute after extubation (T3),3 minutes after extubation (T4),5 minutes after extubation (T4) were recorded respectively.The responses to extubation,respiratory inhibition,nausea and vomiting in 5 min after extubation were recorded.Results MAP,HR of the two groups were significantly decreased at T1,increased at T2 and T3;while significantly decreased at T4 and T5,approaching to the level at T1 (P ＜ 0.05).MAP at T2 and T3 were significantly higher than MAP at T0 in the control group(P＜0.05).MAP at all the time points except T5 were significantly lower than MAP at T0 in the remifentanil group (P ＜ 0.05).HR at T2 and T3 were significantly higher than HR at T0 in both groups (P ＜ 0.05).MAP,HR at T2 and T3 in the remifentanil group were significantly lower than those in the control group (P ＜ 0.05).SpO2 of the cases at the different time points had no significant differences in the remifentanil group and the control group(P ＞ 0.05).The incidence of the response to extubation in the remifentanil group were significantly lower than that in the control group [(1.33 ± 0.60) scores vs (2.03 ± 0.90) scores,P ＜ 0.05].There were no significant differences in spontaneous breathing recovery time,awaking time,extubation time and observer's assessment of alertness/sedation scale of the two groups (P ＞ 0.05).The incidence of the respiratory inhibition,nausea and vomiting of the two groups had no statistically significant differences(P ＞0.05).Conclusion By continuous injection of remifentanil[0.05 μg/(kg · min)] on pediatric patients with general anesthesia in tracheal extubation period,it can significantly reduce the risk of cardiovascular reaction and the cough response,without prolonging anesthesia recovery time.

目的 比较Supreme喉罩与Ambu AuraOnce喉罩用于乳腺整形手术患者的可行性和安全性.方法 选择100例择期行乳房整形手术的全麻患者,ASA Ⅰ ～Ⅱ级,年龄17～50岁,BMI＜ 30 kg/m2,随机分为Supreme喉罩组(S组)与Ambu AuraOnce喉罩组(A组).记录2组患者喉罩置入时间、置入次数、置入过程中调整情况、密封压、气道压、置入成功后纤维支气管镜下对位情况及术后并发症发生情况.结果 2组患者的喉罩置入时间、置入成功率、置入过程中调整情况、纤维支气管镜下对位情况及术后并发症发生情况差异均无统计学意义,S组的密封压和气道压高于A组[(23.7±3.7) cmH2O vs.(20.7±3.2)cmH2O,(11.0±1.7)cmH2O vs.(10.4±1.0)cmH2O,P均＜0.05].结论 Supreme喉罩与Ambu AuraOnce喉罩均可安全有效地用乳腺整形手术患者,置入时间短、成功率高、并发症低,Supreme喉罩较Ambu AuraOnce喉罩能获得更高的密封压.

Objective To investigate the effect of intravenous dexmedetomidine injection(1 μg/kg)on the intubating conditions after inhalation induction with sevoflurane 8% and nitrous oxide(N2O)50% in children. Methods Totally 122 patients aged 4-10 years with an American Society of Anesthesiologists physical statusⅠ undergoing elective plastic surgery under general anesthesia were randomly divided to dexmedetomidine group(intraveneously injected with dexmedetomidine 1μg/kg)and control group(injected with normal saline)by using the random sampling table.On arrival of the operating room,anesthesia was induced with sevoflurane 8% and N2O 50% in oxygen 50%.When the patient became unconscious,the intravenous cannula 24# was inserted on the dorsum of hand.One minute later,laryngoscopy and tracheal intubation were performed.The intubating conditions were assessed by the scoring system in the previous study. Results The rates of acceptable conditions were 97% and 90% in dexmedetomidine group and in control group(P=0.143),and the rates of excellent conditions were 82% and 67%(P=0.04),respectively.In dexmedetomidine group,there were no signifi-cant differences of mean arterial presser and heart rate between the time-point of before intubation and the time-point of immediately after intubation.Conclusion Intravenous bolus of dexmedetomidine(1 μg/kg)can effectively improve the intubating conditions after inhalation induction of sevoflurane 8% and N2O 50% in children and make the hemodynamics more stable during tracheal intubation.

Objective To evaluate and compare the efficacy and safety of sedative and analgesic anesthesia in surgical patients with supine and prone position .Methods Sixty female patients, American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged from 18 -53 years, scheduled for elective plastic operations under sedative and analgesic anesthesia combined with local anesthesia were divided into two groups according to their surgical positions: supine group ( n=30 ) and prone group ( n=30 ) .All patients received Ⅳ dexmedetomidine ( DEX) 1 μg/kg over 15 min followed by 0.4 -0.7 μg/kg/h infusion. Both groups were administered Ⅳ midazolam 0.04 mg/kg and a continuous infusion of remifentanil of 0.1 μg/kg/min at the beginning of anesthesia .Heart rate ( HR) , mean arterial pressure (MAP), pulse oximetry (SpO2), respiratory rate (RR), bispectral index (BIS) and Ramsay sedation scores ( RSS) were recorded at the following time points: before anesthesia ( T0 ) , 5 min after induction with midazolam ( T1 ) , 10 min after induction of midazolam ( T2 ) , immediately after induction with DEX( T3 ) , the beginning of local anesthesia ( T4 ) , the beginning of surgery ( T5 ) , 30 min after anesthesia induction ( T6 ) , 60 min after anesthesia induction ( T7 ) , immediately after turning off DEX infusion (T8), the end of surgery (T9).Incidences of respiratory depression, incidences of apnea, oxygen supplementation by facial mask and jaw-thrust, frequencies of body movements and additional rescue medication were also recorded .After surgery , recall of events during surgery , the visual analogue scales (VAS) for pain in PACU, the satisfaction levels of patients and surgeons were also assessed .Results No significant differences were found in MAP , SpO2 , RR, BIS, RSS scores at any time point between two groups (all P >0.05).There were no significant differences in incidences of respiratory depression , frequencies of body movements and additional rescue medication during surgery between groups ( all P>0. 05).Neither were recall of events during surgery , the visual analogue scales (VAS) for pain and the satisfaction levels of patients and surgeons after surgery (all P>0.05).The HR at time points of T0, T1, T2 in prone group were significantly higher than those in supine group (all P<0.05).Compared with the supine group , the incidences of apnea , oxygen supplementation by facial mask and jaw-thrust in prone group were significantly lower .Conclusions Sedative and analgesic anesthesia is effective and safe for patients with prone surgical position and has a lower incidence of upper airway obstruction during surgery than patients in supine surgical position .