| Background and ObjectiveAtrial septal defect(ASD) is one of clinical common congenital heart diseases, with the incidence of about 20% and some genetic predisposition. In clinical observations, we found that the main pathological changes occur in the heart, because the heart was in the long-term load, so it caused the heart to left ventricular volume load overweight, which in turn have left ventricular expansion, and can lead to chronic arrhythmia and left ventricular function damage in patients with atrial septal defects affect cardiac power capability and hemodynamic changes. At present, most scholars advocated for patients with atrial septal defects should be implemented interatrial septum closure as soon as possible.The study shows that patients with atrial septal defects the heart is in a state of overload for a long time, induced cardiac remodeling occurs, the longer this remodeling occurs, the smaller the risk of postoperative reshape, eventually lead to pulmonary hypertension and heart failure, so the patients should be accepted interatrial septum closure as soon as possible. Interatrial septum closure has been widely used in clinical practices, and now it is also regarded as one of the most effective means of treatment in patients with atrial septal defects. For patients with atrial septal defects, closure is not only improve the symptoms, also can prevent the further expand of the heart, therefore regardless of age, there are symptoms of atrial septum closure in patients with atrial septal defects should be implemented as soon as possible, and for asymptomatic patients should also be active treatment. Clinical studies suggest that any form of patients with atrial septal defects can benefit from the interatrial septum closure. In patients with atrial septal defects in childhood-onset more, in order to ensure the interatrial septum closure smoothly, the needs of and the patients with general intravenous anesthesia.During anesthesia for neonates, it needs to maintain the depth of anesthesia. Anesthesia too deep or too shallow are prone to accidents, so the choice of anesthetic is crucial. For children with commonly used anesthetic method has used alone ketamine intravenous anesthesia.There is also using ketamine combined propofol on patients with general intravenous anesthesia, but in the process of operation more easily appear adverse effects such as respiratory depression, and on the depth of anesthesia is not easy to control. Therefore need a new kind of effective method of anesthesia, asked the anesthetic effect on the children's heart and breathing is small, work fastly. Ketamine is a kind of commonly used in clinical traditional intravenous anesthetics, and only a strong analgesic action of drugs, in the practical application is mainly suitable for surface anesthesia, short surgery and its impact on the respiratory system is not obvious. Dexmedetomidine is a new drug with many advantages, first of all, its performance can make the patients to sleep quickly, but also easy to wake up. And it has analgesic effect and no respiratory inhibition, and the right supporting microphones set for sympathetic nervous activity of the central nervous system also has certain inhibition, is widely applied in clinical in recent years. So in this study we chose the ketamine combined different doses Dexmedetomidine set inpediatric patients with atrial septal defects scheduled for the interatrial septum of closure. MethodsThis study has obtained hospital medical ethics committee approval, and with the children the guardian signed the informed consent. Ninty patients with atrial septal defects undergoing general anesthesia at our hospital in 2014-2015 were enrolled into the study, and all the children with ASA class I or ?, aged 3 to 11, 12-44 kg weight. All the children without heart and lung function abnormalities, and the history of oxygen, no high risk or fetal congenital malformation. 90 patients were randomly divided into three groups, group of D1, D2 and D3 group, 30 cases in each group. Exclusion criteria: patients with a history of allergy of ketamine and Dexor patients with other serious cardiovascular disease or severe liver and kidney function is not complete, and the patients that lack of oxygen or other diseases hypoplasia, children with gender, age, body mass, such as illness is no statistically significant difference.All patients with preoperative fasting, 6 hours, forbidden to drink 4 h. All the patients were monitored the blood pressure(BP), electrocardiogram(ECG), blood oxygen saturation(SPO2). All the patients were give 0.01-0.02 mg/kg intravenous injection atropine, dexamethasone, 0.1 to 0.5 mg, ketamine 1.0 mg/kg anesthesia induction, then the fixed load of dex 0.5 ug/kg which was infused in 10 minutes. Then the D1, D2, D3 group respectively by intravenous infusion right set Dexmedetomidine 0.6 ug/kg/H, 1.0 ug/kg/ H, 1.2 ug/kg/ H until the end of surgery, the entire low flow oxygen nasal catheter(2-3 l/min), respiratory depression occurs auxiliary breath, functioning on additional ketamine anesthesia when shallow vein of 0.5 mg/kg, intraoperative such as HR below 60 BPM, the additional atropine as appropriate. In the ward(T0), and an additional 1 min after ketamine(T1), 5 min(T2), the right finish mi fixed load infusion(T3), maintain the quantity 15 min after the infusion(T4), After the surgery(T5), awake(T6), record the BP, HR, SPO2 and BIS value, record the amount of ketamine, operation time, wake up of time, with or without respiratory depression, agitation and atropine and ketamine additional medications. ResultsThree groups of children with BP, HR, SPO2 and BIS value comparison: When compared with T0, T4, T5, 3 groups BIS value is reduced,and the HR of D2 and D3 group of T4, T5 decrease(P<0.05), There was no statistically significant difference BP and SPO2.Three groups of operation time and wake up time: Compared with group D1, D2 and D3 group atropine additional rate more, less dosage of ketamine total, reduce the incidence of respiratory depression(P<0.05). D3 group and D2, atropine additional rate increased(P < 0.05).Ketamine has no additional D2 and D3 group. Three groups of children with no awakening period agitation. ConclusionsWe use the ketamine 1.0 mg/Kg injection and Dexmedetomidine 0.5 ug/Kg by intravenous, then 1 ug/Kg maintain input. These are used for closure with the atrial septal defects, The patients remain static in the operation.We are easy to control the depth of sedation, and the patients have less bad reaction after surgery.So this methed has more safety than others metheds. |
PDF Full Text Request