| Approaching Anesthesia for Tracheal Foreign Body Removal in Young Children: A Compar-ison of Sevoflurane and Sodiumγ-HydroxybutrateIntroductionBecause tracheal foreign body in young children is a frequent emergency of ear nose throat department (ENT department) , the patients require removal of foreign body through bronchoscope. There are four principal traits of this removal:1. Patients are almost young children and can not go with it.2. In the process of operations, children must breath spontaneously, but we also need relax muscle to some extent.3. Anesthesia and operation use the same airway.4. Time of operation is short.For the above-mentioned reasons, we can see that the effect of anesthesia is significant. And the safe of general anesthesia play an essential role of operating smoothly and passing the period of analepsia safely. So that, we have to adopt the anesthetic drugs, which have the merits, short time of inducing and analepsia, satisfied conditions of teasing larynx, stable hemodynamics, etc.This article is approaching the more effective and safer anesthesia for tracheal foreign body removal in young children, comparing sevoflurane and Sodiumγ-Hydroxybutrate.Materials and Methods1. Materials1.1 General data: 77 children planed to take the removals of tracheal foreign body from November 2005 to September 2006. They are 7 months to 5 years old, sex unlimited. And their bodies weight 8.5 to 16.5Kg. If they have one of the conditions listed bellow, they will be ruled out: (1) congenital heart disease; (2) hepatic and renal disfunction; (3)pneumatocele; (4) pulmonaryatelectasis; (5) centralnervous system disease; (6) other congenital diseases.1.2 Investigational drugs: Sevoflurane; Sodiumγ-Hydroxybutrate; Ketamine; Efrane; Kits ofβ2 microglobulin.1.3 Testers: All-round anesthetic machine(Detax Ohmeda7000 American); Multifunction monitor (Detax Ohmeda S/5 American) ; Bronchoscope.2. Methods2.1 The grouping: Randomly give the children different anesthetic methods. According to the anesthetic method, they were divided into two groups, group sevoflurane (S) and groupγ.2.2 Anesthetic method: Before the operation, children of.the two groups had eaten or drink nothing for 4-6 hours. They were injected intramuscularly atropine by 0.015-0.02 mg/kg. After they went into operating room, we let them dorsal decubitus and link the electrocardiogram monitor. Then they were induced to fall asleep with different anesthetic method. In addition, they were all surface anesthetized by 2% lidocaine before placing the bronchoscope and injected intravenous dexamethasone 3-5rag.2.2.1 Group S: After children went into operating room, they were forced to breathe in 4% sevoflurane-O2 by 4L/rain to induce quickly ,but remaining spontaneously breathing on base of unobstructed air tube. When anesthetizing to steady breath and circulation, the operator teased larynx to place the bronchoscope. Then according to the operation condition we remained the depth of anesthesia by breathing in 2.5%-4% sevoflurane after placing the bronchoscope. And to avoid oxygen deficiency, we made them breathe in O2 from the lateral aperture of bronchoscope, prorenate assisting respiration.2.2.2 Groupγ: After children went into operating room, they were injected intravenous Sodiumγ-Hydroxybutrate by 80-100mg/kg. Breathing in oxygen with face mask for 5-10min, we gave them ketamine by 2～3mg/kg. Then according to the operation condition we remained the depth of anesthesia by boosting ketamine or breathing in 2.5% Efrane after placing the bronchoscope.2.3 Monitor index: We mainly observed saturation of blood oxygen(SpO2), heart rate(HR), systolic blood pressure(SBp), diastolic blood pressure(DBp) and respiration rate(RR) of some key point moments, such as going into operating room (T1), before placing the bronchoscope (T2) , after placing the bronchoscope (T3) , retreating the bronchoscope (T4) and analepsia. And we also writing down how many children held breath, bucked, submaxillatensed, laryngeal hydrosarcaed, glossocomaed, cried or restlessed, disgorged. At the same time, we recorded the time of inducing and analepsia. And detectingβ2-microglobulin of urine within post-operation 2 hours. Then we compare the conditions of the two groups.2.4 Statistical analysis: We analyzed the data with the statistical software SPSS11.0. Measurement dada Was recorded as mean+standard differentiation (χ±s). Enumeration data was analyzed with x2 test, and measurement dada was analyzed with t test. We appointed P＜0.05 as that the difference had significance.Results1.General statesThe children of two groups were all accepted the removal of tracheal foreign body. There were no significant differences in sex rate, age and body weight (P＞0.05). And There was no significant difference in the mean of operating time through t test (P＞0.05)2.Breath and circulationWe mainly observed SpO2, HR, SBp, DBp and RR of some key point moments, such as going into operating room (T1) , before placing the bronchoscope (T2) , after placing the bronchoscope (T3) , retreating the bronchoscope (T4) .2.1 The change of SpO2: When children went into operating room, they were almost oxygen deficiency to different extents. These conditions were relieved after inducing. SpO2 descended a little again when the bronchoscope was placed. There was no significant difference in the change of SpO2 of the key point moments through t test (P＞0.05).2.2 The change of HR: HR of the children of two groups slowed down and tended to stabilization. There was no significant difference in the change of HR of the key point moments through t test (P＞0.05) .2.3 The change of Bp: Bp of the children of two groups slowed down and tended to stabilization. There was no significant difference in the change of Bp of the key point moments through t test (P＞0.05) .2.4 The change of RR: RR of group S descended obviously when they went into anesthesia, and obviously ascended after placing bronchoscope. That of groupγreflected this trend too but not obviously. There was no significant difference in the change of RR of the key point moments through t test (P＞0.05).3The complications in or after the operation3.1 Breathholding or bucking in the operation: The incidence rate of Breathholding or bucking in the operation in group S was much lower than that of groupγ. There was significant difference in the two groups through x2 test (P＜0.05).3.2 Breathholding in analepsia: The incidence rate of breathholding in the time of analepsia in group S was much lower than that of groupγ. There was significant difference in the two groups through x2 test (P＜0.05).3.3 Glossocoma after the operation: The incidence rate of glossocoma after the operation in group S was much lower than that of groupγ. There was significant difference in the two groups through x2 test (P＜0.05).3.4 Crying or restlessness after the operation: The incidence rate of crying or restlessness after the operation in group S was much higher than that of groupγ. There was significant difference in the two groups through x2 test (P＜0.05).3.5 In this study, we detect 20 patients'β2-MG of urine within post-operation 2 hours. There are 8 and 12 respective in the S andγgroup. And the data of one patient in S group is higher than the top-level of the normal data. There was no significant difference in the complications the through x2 test (P＞0.05).3.6 Other complications of the two groups in or after the operation: There was no significant difference in other complications the through x2 test (P＞0.05). 4The time of inducing and analepsiaThe time of inducing to fall asleep and analepsia in group S was shorter than that in groupγ. There was significant difference in the time of analepsia through t test (P＜0.05). There was no significant difference in the time of inducing to fall asleep through t test (P＞0.05).ConclusionsThe time of falling asleep of two groups has significant difference. And the children in two groups had not appeared obviously respiratory depression, Laryngeal edema, hyperkinesis laryngis, bradycardia, kidney damages, etc. But palinesthesia time of group sevoflurane is much less than that of groupγ. Some complications in group sevoflurane such as breathholding or bucking in the operation, breathholding in analepsia and glossocoma were obviously less than those of groupγ. In addition, many aspects of group sevoflurane such as the time of inducing tofall asleep, breathholding when placing in or out the bronchoscope, breathing or cyclical stability were also better than those of groupγ. However, The incidence rate of crying or restlessness after the operation in group sevoflurane was much higher than that of groupγ.
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