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Title: [Study of the effects of hydromorphone on emergence agitation of children anesthetized by sevoflurane].
Author: Chu LY, Pan CX.
Journal: Zhonghua Yi Xue Za Zhi; 2018 Jul 24; 98(28):2250-2253. PubMed ID: 30078280.
Abstract:
Objective: To observe the effect of hydromorphone on emergence agitation of children anesthetized by Sevoflurane. Methods: One hundred patients without any analgetic, aged 3 to 7 years, ASA Ⅰ-Ⅱ, undergoing strabismus surgery in Beijing Tongren Hospital from March, 2017 to December, 2017 were selected and they were randomly divided into two groups(n=50), H group and F group by random number table. After standardized tidal volume method induction by 8% sevoflurane and oxygen, suiltable laryngeal mask was inserted, and each patient was left spontaneously breathing anesthetized by 2.5%-3.0% sevoflurane.Ten minutes before the surgery, patients in H group were administered a dose of 0.01 mg/kg hydromorphone (diluted to 5 ml with normal saline) by pump control injection in 10 min, whereas patients in F group administered a dose of 1 μg/kg fentanyl in the same way. After the surgery , the patient was sent to postanesthesia care unit. A nurse who was blinded measured the vital signs, pediatric anesthesia emergence delirium(PAED) score, face legs activity cry consolability behavioral pain assessment tool(FLACC) score, the time of opening the eyes and departing from postanesthesia care unit(PACU), and the occurence rates of hypoxemia, swirl or nausea, drowsiness, and other scores. Results: The incidence of emergence agitation(EA) in H group was lower than in F group, whether EA was defined as PAED>10 (18.0% vs 28.0%, P>0.05) or PAED>12(12.0% vs 24.0%, P>0.05), there were not significant differences between them. The ratio of patients whose PAED>15 in F group was 12.0%, while the ratio of H group was 0, there was significant difference between the two groups(P=0.027). The occurrence rates of swirl, glossocoma in H group were 0 and 10.0% while those of F group were all 6.0%, there were no significant differences between the two groups(P>0.05). Conclusions: Comparing with fentanyl, hydromorphone can prevent the occurrence rate of EA of the children anesthetized by sevoflurane equally, even decrease the occurrence rate of the severe EA more observably, and reduce postoperation pain more significantly with less occurrence rate of swirl or nausea. Glossocoma need be paid attention to when HM is administered. 目的： 观察氢吗啡酮预防儿童七氟烷全麻术后躁动的效果。 方法： 选择2017年3至12月北京同仁医院择期行斜视手术患儿100例，年龄3～7岁，美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级。采用随机数字表法分为2组：氢吗啡酮组(H组)、芬太尼组(F组)。两组均采用潮气量法进行七氟烷吸入诱导，置入喉罩后保留自主呼吸，术中2.5%～3.0%七氟烷维持麻醉。手术开始前10 min，H组将0.01 mg/kg氢吗啡酮以生理盐水稀释到5 ml，在10 min内泵控静注，F组以同样的方法给予芬太尼1 μg/kg。术毕由同一名恢复室护士(对分组不知情)观察并定时记录术后躁动评分(PAED)、镇痛评分(FLACC)、睁眼时间、出恢复室时间、低氧、舌后坠、头晕、嗜睡、恶心呕吐等不良反应发生率。 结果： 如果以PAED>12分为躁动标准，H组躁动发生率为12.0%，F组的发生率为24.0%；如果以PAED>10分为躁动标准，H组躁动发生率为18.0%，F组的发生率为28.0%；两组比较差异均无统计学意义(均P>0.05)；F组PAED>15分的患者比例为12.0%，H组为0，两组比较差异有统计学意义(P＝0.027)。H组术后头晕的发生率为0，舌后坠发生率10.0%，F组头晕、舌后坠发生率均为6.0%，但两组比较差异均无统计学意义(均P>0.05)。 结论： 氢吗啡酮不仅可以达到与芬太尼同样预防术后躁动的效果，而且明显降低严重躁动患儿的比例，并可显著减轻苏醒期疼痛，不伴有明显恶心头晕反应；但需要警惕舌后坠的发生。.

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