Study On The Appropriate Dose Of Sufentanil For Agitation In School-age Children After Strabismus Surgery During Induction

Objective:Evaluating the efficacy and safety of sufentanil in analgesia and sedation after strabismus surgery in children.By adjusting the dose of sufentaniL during induction of general anesthesia,the effective and safe dose of sufentanil in this efficacy was explored.Further analyze its clinical mechanism,to provide a certaintheoretical basis for the control of sufentanil's does for analgesic sedation after other short general anesthesia in children,such as strabismus surgery.Method:Collected 70 cases in the fourth affiliated hospital of Kunming University anaesthesiology department from August 2017 to March 2018,which accepted general anaesthesia and Strabismus surgery,all of them were School-age children(6 to 12 years old).Atropine 0.01m.kg-1,a certain amount of sufentanil,medium long-chain propofol 2.5?3mg.kg-1,and atracurium 0.5mg.kg-1 were is injected into the blood vessel when the anesthetic was given,connected anesthesia to control breathing,followed by endotracheal intubation,then adjusting breathing parameters according to age and weight,maintaining PETCO2 at 31 to 35 mmHg[1].Inhaled 1.0-1.3MAC sevoflurane during surgery to maintain anesthesia,accord ing to clinical indications to determine the depth of anesthesia and adjust the inhaled concentration of sevoflurane.No special intravenous injections were made during the operation.According to the up-down fluctuation method described by Dixon[]and the preliminary experiment,the initial dose of sufentanil was 0.3 ?g.kg-1[3].According to the observation index was increased or decreased by 0.05 ?g.kg-1 each time.Then find the appropriate dose of sufentanil for induction of postoperative analgesia and sedation at induction.If the child has prolonged extubation,respiratory depression and other adverse reactions,if necessary(Extubation time>30min),the corresponding antagonist drugs,such as naloxone 0.01mg.kg-1.In this experiment,the endotracheal intubation operations were performed by the attending physician and above,and the sedation and analgesia assessment was performed by the same anesthesiologist.Observe and record the hemodynamic changes,extubation time,postoperative analgesia,sedation and adverse reactions of the children before and after administration,during the insertion and extubation,and after extubation.All data was processed using statistical software SPSS 19.0(IBM SPSS Statistics 19.0).Sequential data were analyzed by probit regression,Calculate 50%and 95%of the effective dose of sulfentanyl for satisfactory sedation,ED50(95%CI)and ED95(95%CI),and 50%and 95%of the dose of sufentanil for adverse reactions,TD50(95%CI)and TD95(95%CI).The data of changes in hemodynamic use much variable ANOVA analysis,there was statistical significance if P<0.05.Results:The probability of postoperative agitation and adverse reactions and the time of extubation were all related to the dose of sufentanil during induction of anesthesia.With the increase of sufentanil dose,the probability of postoperative agitation was reduced,but the probability of adverse reactionsthe was decreased,such as sleepiness.The extubation time increased with the increase in the dose of sufentanil.Satisfactory analgesic effects after the operation,the ED50 and ED95 of the doses of sufentanil for administration were 0.274 ?g.kg-1(95%CI 0.247?g.kg-1?0.292?g.kg-1)and 0.316?g.kg-1(95%Cl 0.296 ?g.kg-1?0.377?g.kg-1).Satisfactory sedative effects after the operation,the ED50 and ED95 of the doses of sufentanil for administration were 0.290?g.kg-1(95%CI 0.220?g.kg-1?0.325?g.kg-1)and 0.452 ?g.kg-1(95%CI 0.403?g.kg-1?0.586 ?g.kg-1).Adverse reactions,the TD50 and TD95 of the doses of sufentanil for administration were 0.552 ?g.kg-1(95%CI 0.464?g.kg-1?1.140?g.kg-1)and 0.847?g.kg-1(95%CI 0.640?g.kg-1?2.466?g.kg-1).Conclusion:For strabismus surgery in school-aged children with operative time<1 h,the doses of sufentanil is 0.316 ?g.kg-1 to 0.452 ?g.kg-1 when induced by general anesthesia,which can effectively prevent the recovery of postoperative children.The hemodynamics of the children before anesthesia and after anesthesia were relatively stable,and adverse reactions occurred less during anesthesia and after anesthesia.