| Objective:To study effect of small dose of naloxone synergistic with neostigmine on general anesthesia recovery?hemodynamic changes and incidence of adverse effects after extubation.Supply the anesthesiologists with a new way to speed up general anesthesia recovery of infants and young children.Method:Using a randomized,double-blind,control design,54 infants and young children,ASA ???,including 36 cases of inguinal hernia,the communicating hydrocele 12 cases,6 cases of cryptorchidism,aged from 3 to 36 months,weight 6 to 17KG,scheduled for general anesthesia with intubation,were divided randomly into naloxone group,atropine groupand normal saline group(control group).All children over the age of 1 year old preoperative fasting for 6 hours,forbidden to drink for 2 hours;children under 1 year old fasting for 4 hours,forbidden to drink 2 hours.Did not give premedication.Connected Vital signs monitor and continuously monitor noninvasive blood pressure(NIBP),heart rate(HR),pulse oxygen saturation(SPO2),electrocardiogram(EEG),and Endtidal carbon dioxide patial pressure(PETC02).Mask to give the children of 8%sevoflurane until the children fall asleep and maintained with 2-3%sevoflurane.0.02mg/kg hydrochloric acid penehyclidine were given to children after seting up upper extremity venous channels.Infused Ringer's lactate liquid at the speed of 10?15mlˇ kg-1 ˇ h-1 to supply physical:requirements.Giving fentanyl 3ug/kg,cis-atracurium 0.1mg/kg before intubation.Connected to the anesthesia machine after intubation with IPPV,tidal volume 8ml/kg,frequency of 16-25 beats/min,maintaining PET CO2 35-45mmHg,Pmax set 15cmH20.Anesthesia was maintained with 3-4%sevoflurane and intermittent venous injectiong of fentanyl lug/kg and cis-atracurium 0.05mg/kg.Cis-atracurium was no longer chased 30 min before the end of surgery ˇ All anesthetics were stopped when the skin was sutured.When the children regained natural respiratory at the end of operation,chindren in naloxone group were intravenously injected of naloxone 2ug/kg and neostigmine 20ug/kg;chindren in atropine group were intravenously injected of atropine lOug/kg and neostigmine 20ug/kg,chindren in control group were intravenously injected of 5ml normal saline.All monitoringindicators include:1.Recorded and compared the value of SBP,HR,at To(at the moment of injecting test drugs),T1(1min after injecting test drugs),T2(2min after injecting test drugs),T3(3min after injecting test drugs),T4(4min after injecting test drugs),T5(5min after injecting test drugs),T6(6min after injecting test drugs).2.Time to natural eye-opening(teo),time to tracheal extubation(te)and time to leave operation room(tl)were also recorded and compared.3.Incidence of adverse effects such as oxygen desaturation,nausea and vomiting,laryngospasm,emergence delirium were observed and compared Results:There were no significant difference in patients as to age,weight,gender,duration of surgery and infant/child ratio among three groups(P>0.05).There were also no obvious difference in homedynatics parameters after injection(P>0.05).However,compared with control group,time to natural eye-opening,time to tracheal extubation and time to leave operation room were apparently shorter in naloxone group and atropine group(P<0.05).Incidence of oxygen desaturation is obiviously lower(P<0.05).There were no evident defference as to incidence of nausea and vomiting,laryngospasm,emergence delirium(P>0.05).Compared with atropine group,time to eye-opening,time to tracheal extubation and time to leave operation room were apparently shorter in naloxone group(P<0.05).Incidence of oxygen desaturation is obiviously lower(P<0.05).There were no evident defference as to incidence of nausea and vomiting,laryngospasm,emergence delirium(P>0.05).Conclusion:Small dose of naloxone synergistic with neostigmine can speed up general anesthesia recovery of infants and young children and reduce the incidence of oxygen desaturation but has no influence on hemodynamic parameter. |
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