Effects Of Desflurane On Postoperative Recovery Quality Of Pediatric Adenotonsillectomy

Objective: Desflurane,the new inhalation anesthetic,was used in the anesthesia maintenance phase of pediatric adenotonsillectomy,after that we observed the recovery quality during the recovery period,which could guide the clinical medication.Methods: 90 children in department of ENT in the Second Hospital of Jilin University,aged 3~7,were selected to undergo Radiofrequency ablation of tonsils and adenoids under low temperature plasma surgery,and their ASA(American Society of Anesthesiologists)level was Ⅰ.The patients were randomly divided into three groups:the experimental group was the desflurane group(Group D,n=30),the control group was the sevoflurane group(Group S,n=30)and the propofol group(group P,n=30).All children were forbidden to eat and drink before surgeryand the same drugs and methods were used in the induction of anesthesia.In the anesthesia maintenance phase after induction,Group D:The children wereinhaled desflurane at a concentration of 5.2 to 10% after endotracheal intubation,and were pumped remifentanil hydrochloride at the speed of 0.5 to 1.0 ug / kg / min.Group S: The children wereinhaled desflurane at a concentration of 2 to 3% after endotracheal intubation,and were pumped remifentanil hydrochloride at the speed of 0.5 to 1.0 ug / kg / min.Group P:I made a continuous pump of propofol and remifentanil hydrochloride which were at the speed of 9 to 15mg/kg/h and 0.5 to 1.0ug/kg/min.The HR,ECG,MAP,Sp O2 and PETCO2 were monitored continuously during the operation.I adjusted the dosage of narcotic drugs so that the three groups of patients’ HR and MAP fluctuated within 30% of the basal value,PETCO2 was maintained between 30 to 35 mm Hg,Sp O2 more than 95%.the drug were withdrawn immediately the surgery stopped,and the patients were transferred to the Post Anesthesia Care Unit(PACU)for mechanical ventilation,moreover,the oxygen flow rate of group D and group S was increased to 4 to 6L/min,the tubes were extracted when the childrens’ spontaneous breathing recovered and they could open eyes or cough,after the children were fully awake and could coordinate,we sent them to the wards.Recorded the following indicators:(1)MAP,HR and Sp O2 of the three groups inburglary time(T0),at the beginning of the operation(T1),10 minutes after operation(T2),at the end of surgery(T3),extubation time(T4),5 minutes after extubation(T5),the time out of PACU(T6).(2)Recorded the operation time(t0),the time of anesthesia(t1),Spontaneous breathing recovery time(from the use of muscle relaxant during anesthesia induction to spontaneous breathing recovery time,t2),As well as the time after the recovery of spontaneous breathing: eye opening or body moving time(t3),extubation time(t4),completely awake time(t5),PACU staying time(t6).(3)Recorded the PAED Agitation Score,the Ramsay Sedation Score and the FLACC Pain Score at the time of extubation(t7),5 minutes after extubation(t8),10 minutes after extubation(t9),20 minutes after extubation(t10),30 minutes after extubation(t11)of the three groups.(4)The incidence of postoperative adverse reactions.Results: 1.Comparison of the general situation of the patients: There was no significant difference in sex ratio、age、height、 body weight and ASA grading between group D and group S,group D and group P.2.Comparison of hemodynamics: The MAP,HR and Sp O2 had no significant difference between group D and group S,group D and group P at the time T0 to T6.3.There was no significant difference in the time of t0 to t2 between group D and group S,group D and group P.but in the time t3 to t6,the group D and group S,group D and group P had significant difference(P<0.05).4.Comparison of PAED agitation score: There was statistically significant difference in PAED agitation score between group D and group S at t7 and t8(P <0.05),but there was no significant difference between group D and group P.There was no significant difference in PAED agitation score between group D and group S,group D and group P at the time t9 to t11.5.Comparison of Ramsay sedation score: The Group D and Group S,the Group D and Group P had no statisticallysignificant difference in Ramsay sedation scoreat the time t7 to t11.6.Comparison of FLACC pain score: The Group D and Group S,the Group D and Group P had no significant difference in FLACC pain score at the time t7 to t11.7.Comparison of postoperative adverse reactions: The incidence of postoperative nausea and vomiting was higher in Group D than that in Group P,but it was lower than that in group S,but they all had nosignificant difference.There was no statistically significant difference in the incidence of somnolence after operation between the experimental group and the control group.Three groups of patients had no respiratory depression and pruritus after surgery.Conclusions: 1.Desflurane can be safely used as an anesthetic maintenance drug for pediatric adenotonsillectomy and has a higher quality of recovery.2.With the application of desflurane the postoperative recovery and extubation of the children is fast and stable,the sedative and the analgesic effect is better,the PACU staying time of desfluraneis shorter than that of sevoflurane and propofol.3.The incidence of postoperative nausea and vomiting of desflurane was higher than that of propofol,but there was no significant difference.