The Study Of Clinical Application Using Dexmedetomidine In Pediatric Non Endotracheal Anesthesia

Pediatric non endotracheal anesthesia is frequently used in pediatric surgery especially refered to upper limb,inferior belly and body surface.Pediatric non endotracheal anesthesia is a method using intravenous anesthetic or inhalation anesthetic combined with small dose analgesic or nerve block but no tracheal intubation to meet pediatric surgery. It is necessary to not only keep air way unobstructed, respiration and circulation stabile, but request adequate analgesic and sedative. So it is a challenge to anesthesiologist and means more risk.Dexmedetomedine is high-choice excitomotor of adrenoceptora2. Since Dexmedetomedine appeared in domestic market in2009,more and more national physicians haved identified the value of the clinical application in adult,but the application of Dexmedetomedine in children was seldom reported in domestic academic. It is reported that Dexmedetomedine was a kind of good medicine to respiratory and circulatory systems of children, which character is dose-related sedative and analgesic, also, is suitable for pediatric non endotracheal anesthesia.In this study,intravenous infusion of dexmedetomedine combined with intermittent injection of Ketamine was used in pediatric burn patients undergoing change dressing,and combined with nerve block was used in pediatric surgery refered to upper limb and inferior belly for sedative.We then observered pediatric respiratory,circulatory parameter,emergence time and recover quality.In the end of this study,we evaluated safety and efficacy of dexmedetomedine used in pediatric non endotracheal anesthesia.Part1Comparison of dexmedetomidine combined with ketamine to simple ketamine used for pediatric burn patients undergoing change dressingsObjective:To evaluate clinical effective and safety of dexmedetomidine combined with ketamine used in pediatric burned patients undergoing change dressing. Methods:Two different sedative methods were chosen to20pediatric burned children in hospital undergoing change dressings respectively. In group A,we administered dexmedetomidine as a loading dose of6microgxkg(-1)×h(-1) for10minutes followed by bolus1.0mg/kg ketamine,whereafter maintain infusion of0.6microg×kg(-1)×h(-1) followed by bolus0.5mg/kg ketamine according to requirement. While in group B was the same volume of normal saline combined with ketamine. Cross-over design and double blind method were emphasized in this clinical research. During the procedure, MAP, HR, RR, ETCO2, SpO2and Ramsay scale were recorded. The operation completion time, ketamine consumption and eye-open time were recorded in detail too. PAED and POVN were observed in PACU.We also inquired satisfaction of surgeons and parents. Results:In T2-T6time point,Pediatric hemodynamics of sedative method A was more stationary than that of B, Ramsay scale in mehtod A was lower than B at T2time point. Anapnea influence of two sedative modality were similar (p>0.05).Eye-open time using sedative modality A was longer than B,but PEAD-scale, POVN-scale were more lower in modality A. Parents’ satisfation score was higher in modality A (p<0.05). Conclusion:Administering dexemedetomidine combined ketamine to pediatric burn patients was more safer because of stationary hemodynamics and minimal Anapnea influence. In this research dexemedetomidine couldn’t reduce ketamine consumption and prolonged recovery-time probably, but dexemedetomidine combined ketamine improved children recovery quality, which was safe and effective for pediatric burn patient undergoing change dressing.Part2A comparison of efficacy of sedation with dexmedetomidine versus sevoflurane in pediatric general anesthesia combined nerve blockObjective:To compare the efficacy of sedation with dexmedetomidine versus sevoflurane in pediatric general anesthesia combined nerve block.Methods:Sixty children aged2-7yd,who undergo surgery in upper limb or inferior belly,were randomly divided into2groups(n=30each):dexmedetomidine group (group D) and sevoflurane group (group S). After nerve block,a loading dose of dexmedetomidine1.0μg/kg was injected in10minute,followed by influsion at1.0μg/kg-h in group D.And in group S, children were sedated by sevoflurane using anesthesia mask with ETAG in1.3%-1.5%.Then respiration,circulation,sedation, recovery quality of2groups were compared.Results:Compared with S group,MAP at each time point was more higher in group D in spite of a descent in both groups.HR were significantly slower in group D than group S. PAED-scale evaluated by nurse in PACU is lower in group D than group S,but the emergence time was significantly decreased in group S. Conclusion:Both dexmedetomidine and sevoflurane could be used in pediatric general anesthesia combined nerve block securely.Compared with sevoflurance,dexmedetomidine affected blood prussure gently,meanwhile degraded heart rate effectually and securely.Dexmedetomidine prolonged emergence time probalbly,but improved emergence quarlity.delirium was significantly decreased in children using dexmedetomidine.