Importance:Dexmedetomidine inhibits the inflammatory response associated with cardiopulmonary bypass(CPB)and protects neural function.However,the mechanism of dexmedetomidine’s anti-inflammatory pathway is unclear.Ob...Importance:Dexmedetomidine inhibits the inflammatory response associated with cardiopulmonary bypass(CPB)and protects neural function.However,the mechanism of dexmedetomidine’s anti-inflammatory pathway is unclear.Objective:To investigate the effect of dexmedetomidine on the cognitive level and expression of inflammatory factors in children with congenital heart disease undergoing intraoperative CPB.Methods:Ninety children with congenital heart disease were recruited and randomly divided into 3 groups of 30 children in each.In Group 1,a 1.0μg·kg-1·h-1 intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia,followed by a 0.2μg·kg-1·h-1 infusion until the surgical incision.In Group 2,a 0.5μg/kg intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia,followed by a 0.1μg·kg-1·h-1 infusion until the surgical incision.The control group was given physiological saline using the same method as in Groups 1 and 2.The serum levels of nuclear factor-kappa B(NF-κB),S-100βprotein,neuron-specific enolase(NSE),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were measured before the surgery(T1),at the end of CPB(T2),2 hours after CPB(T3),6 hours after CPB(T4),and 24 hours after CPB(T5).The Wechsler Intelligence Scale for children(WISC)was measured before the operation and at 3,6,and 12 months after the operation to evaluate the neurodevelopmental state of the children.Results:The levels of the NF-κB,S-100βprotein,NSE,TNF-α,IL-6 were significantly higher at T2,T3,or T4 than before the surgery(T1)in the control group or the dexmedetomidine groups.However,the increases of NF-κB,TNF-α,IL-6,S-100βand NSE levels were significantly smaller in the dexmedetomidine groups than those in the control group(P<0.017).The WISC scores were similar among the three groups before or after the operation.Interpretation:The increases in NF-κB,TNF-α,and IL-6 levels indicated aggravation of the inflammatory reaction and the increase S-100βprotein and NSE levels indicated that the nervous system was damaged.Administration of dexmedetomidine to children with congenital heart disease undergoing intraoperative CPB can inhibit the inflammatory response and may ameliorate the neurodevelopmental damage caused by CPB.展开更多
Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring re...Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring revealed serious complications of cardiothoracic surgery.Case presentation:A 3-year-old boy with a body weight of 15 kg presented with a>1-month history of a heart murmur.At the moment of arterial catheter ligation,the PETCO_(2) decreased from 37 to 15 mmHg,while the blood pressure,heart rate,and airway resistance did not change significantly.After re-separation of the ligation catheter,the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus.Conclusion:This case suggests that PETCO_(2) monitoring reflects the circulatory status and pulmonary blood flow.展开更多
Introduction:Congenital analgesia is a rare autosomal recessive hereditary disease.The primary damage of congenital analgesia is central structure damage of comprehensive pain perception.Case presentation:A 1-year-old...Introduction:Congenital analgesia is a rare autosomal recessive hereditary disease.The primary damage of congenital analgesia is central structure damage of comprehensive pain perception.Case presentation:A 1-year-old Han Chinese boy was admitted to hospital because of a tongue bite.He had no response to noxious stimulation of the body surface and was diagnosed with congenital analgesia.A small dose of remifentanil was intravenously injected during anesthetic induction to reduce the stress response caused by endotracheal intubation.A certain depth of anesthesia should be guaranteed during anesthetic induction and surgery to alleviate the stress response induced by endotracheal intubation and the operation.Conclusion:Opioid analgesics are not required for general anesthesia in patient with congenital insensitivity to pain.With a heat dissipation barrier in patients with congenital insensitivity to pain with anhidrosis,body temperature,end-tidal carbon dioxide and bispectral index should be monitored.展开更多
基金Scientific and Technological Projects of Henan Province,China(no.182102310440)Medical Science R&D Program of Henan Province,China(no.2018020598)International Research Laboratory Program of Henan Province,China(no.201605-005).
文摘Importance:Dexmedetomidine inhibits the inflammatory response associated with cardiopulmonary bypass(CPB)and protects neural function.However,the mechanism of dexmedetomidine’s anti-inflammatory pathway is unclear.Objective:To investigate the effect of dexmedetomidine on the cognitive level and expression of inflammatory factors in children with congenital heart disease undergoing intraoperative CPB.Methods:Ninety children with congenital heart disease were recruited and randomly divided into 3 groups of 30 children in each.In Group 1,a 1.0μg·kg-1·h-1 intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia,followed by a 0.2μg·kg-1·h-1 infusion until the surgical incision.In Group 2,a 0.5μg/kg intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia,followed by a 0.1μg·kg-1·h-1 infusion until the surgical incision.The control group was given physiological saline using the same method as in Groups 1 and 2.The serum levels of nuclear factor-kappa B(NF-κB),S-100βprotein,neuron-specific enolase(NSE),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were measured before the surgery(T1),at the end of CPB(T2),2 hours after CPB(T3),6 hours after CPB(T4),and 24 hours after CPB(T5).The Wechsler Intelligence Scale for children(WISC)was measured before the operation and at 3,6,and 12 months after the operation to evaluate the neurodevelopmental state of the children.Results:The levels of the NF-κB,S-100βprotein,NSE,TNF-α,IL-6 were significantly higher at T2,T3,or T4 than before the surgery(T1)in the control group or the dexmedetomidine groups.However,the increases of NF-κB,TNF-α,IL-6,S-100βand NSE levels were significantly smaller in the dexmedetomidine groups than those in the control group(P<0.017).The WISC scores were similar among the three groups before or after the operation.Interpretation:The increases in NF-κB,TNF-α,and IL-6 levels indicated aggravation of the inflammatory reaction and the increase S-100βprotein and NSE levels indicated that the nervous system was damaged.Administration of dexmedetomidine to children with congenital heart disease undergoing intraoperative CPB can inhibit the inflammatory response and may ameliorate the neurodevelopmental damage caused by CPB.
文摘Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring revealed serious complications of cardiothoracic surgery.Case presentation:A 3-year-old boy with a body weight of 15 kg presented with a>1-month history of a heart murmur.At the moment of arterial catheter ligation,the PETCO_(2) decreased from 37 to 15 mmHg,while the blood pressure,heart rate,and airway resistance did not change significantly.After re-separation of the ligation catheter,the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus.Conclusion:This case suggests that PETCO_(2) monitoring reflects the circulatory status and pulmonary blood flow.
基金Scientific and Technological Projects of Henan Province,China(no.182102310440)Medical Science R&D Program of Henan Province,China(no.2018020598)International Research Laboratory Program of Henan Province,China(no.201605-005)。
文摘Introduction:Congenital analgesia is a rare autosomal recessive hereditary disease.The primary damage of congenital analgesia is central structure damage of comprehensive pain perception.Case presentation:A 1-year-old Han Chinese boy was admitted to hospital because of a tongue bite.He had no response to noxious stimulation of the body surface and was diagnosed with congenital analgesia.A small dose of remifentanil was intravenously injected during anesthetic induction to reduce the stress response caused by endotracheal intubation.A certain depth of anesthesia should be guaranteed during anesthetic induction and surgery to alleviate the stress response induced by endotracheal intubation and the operation.Conclusion:Opioid analgesics are not required for general anesthesia in patient with congenital insensitivity to pain.With a heat dissipation barrier in patients with congenital insensitivity to pain with anhidrosis,body temperature,end-tidal carbon dioxide and bispectral index should be monitored.
