| Background It is difficult to express and evaluate the levels of consciousness,anesthesia depth,and pain in pediatric patients objectively and truthfully.With the development of neurobiology and technology,there has been new research progress in electroencephalogram EEG monitoring of pediatric patients.As a monitoring method that can directly reflect the electrical activity of the cerebral cortex,the application of processed EEG monitoring has a new stage in assessing the level of consciousness,monitoring the depth of anesthesia and reflecting the level of pain.Patient status index(PSI),burst suppression rate(SR),and polysomnography(PSG)are gradually being promoted in the pediatric population.However,due to the lack of basic population data,research on pediatric patients has been greatly affected and limited.Purpose Study 1:Observe the changes in PSI during general anesthesia in pediatric patients of different age groups,evaluate the feasibility of PSI as an observational indicator for distinguishing different stages of anesthesia.Compare the differences in PSI between age groups and analyze the influencing factors of PSI under general anesthesia.Study 2:Observing the occurrence and distribution of burst suppression during general anesthesia in preschool children,comparing the differences in SR among different age groups,and analyzing the influencing factors of SR during general anesthesia.Study 3:Compare the effects of different postoperative analgesic prescriptions on the PSG of pediatric patients on the night after surgery and analyze the feasibility of reflecting the analgesic effect of pediatric patients through postoperative PSG monitoring.Methods Study 1:242 preschool children undergoing elective surgery under general anesthesia were divided into three groups:0-3 months,3-12 months,and 1-7 years old.The general information including height,weight,gender,age,surgical type,and ASA grade,was recorded.Monitor PS I throughout the entire process immediately after entering the operating room.Sevoflurane inhalation induction was used,and sevoflurane combined with remifentanil was mainly used to maintain anesthesia.The general anesthesia process is divided into 7 event segments according to "awake","induction","shallow anesthesia"(0.2-0.5MAC),"moderate anesthesia"(0.6-1MAC),"withdrawal","spontaneous respiratory recovery",and"extubation".The corresponding event segments are recorded for the mean in heart rate and blood pressure,and the mean,maximum,minimum,and range of changes(the difference between the maximum and minimum values)in PSI.Compare the mean,maximum,minimum,and range of changes of PSI within different event segments within three age groups.Perform ROC curve analysis on PSI between adjacent events and calculate the area under the curve.Compare PSI within the same event segments among three age groups.Establish a multi-level model to evaluate the influencing factors of PSI under general anesthesia in preschool children.Study 2:242 patients in three groups of 0-3 months,3-12 months,and 17 years old underwent SR monitoring throughout the elective surgery under general anesthesia.Sevoflurane inhalation induction and sevoflurane combined with remifentanil maintenance was used.Calculate the mean values of heart rate and blood pressure,the mean and maximum vales of SR within the corresponding event segments based on 7 event segments:"awake","induction","shallow anesthesia"(0.2-0.5MAC),"moderate anesthesia"(0.6-1MAC)," withdrawal","spontaneous respiratory recovery",and"extubation".Within three age groups,analyze the incidence of SR>2 in different event segments,compare the SR values within each event segment,and analyze the anesthesia events corresponding to the SRmax value.Compare the SRmax values within the same event segments among three age groups.Establish a multi-level model to evaluate the influencing factors of SR under general anesthesia in preschool children.Study 3:56 children aged 1-10 years who used intravenous analgesia pump after elective surgery under general anesthesia were randomly divided into two groups:continuous intravenous infusion of dextrometomidine 0.3 ug/kg/h plus sufentanil 0.04 ug/kg/h analgesia and intravenous infusion of sufentanil 0.04 ug/kg/h analgesia.After the operation,children were transferred to the surgical intensive care unit,the ECG,blood pressure and pulse oxygen saturation were continuously monitored and recorded until transferred to the general ward.From 8:00 pm on the day of surgery to 8:00 am the next day,polysomnography(PSG)was performed using the SONMO watch’s electroencephalogram recording system(SOMNO media GmbH).All complications of postoperative analgesia including respiratory depression,hypoxemia,bradycardia,hypotension,nausea and vomiting were recorded.Compare the differences in the sleep structure of PSG and the occurrence of adverse reactions between the two groups of children.Results Study 1:There were significant differences in the mean and minimum values of PSI among different anesthesia events in three age groups,which can reflect the trend of general anesthesia changes.The accuracy of PSI as an index for guiding different anesthesia states is relatively high in children aged 1-7y,starting from "withdrawal" event.There are statistically significant differences in the mean,maximum,minimum,and numerical range of PSI within the same event among the three age groups.The younger the age,the smaller the value of PSI under the same event,and the larger the range of variation.The influencing factors of PSI analyzed by a multi-level model include heart rate,body weight,and different anesthetic events,i.e.different concentrations of drugs.Study 2:Within the three age groups,6.5%in the 0-3month group had no SR throughout the entire process,and there was a significant difference in SR between different anesthesia events.91.3%of children experienced SR>2 during the "moderate anesthesia",with the highest incidence of SR occurring during the "moderate anesthesia",accounting for 64.5%.47.5%of children in the 3-12month group had no SR.The SR value during the"moderate anesthesia" was significantly different from other event segments,with 35.4%of children experiencing SR>2 during the "moderate anesthesia",and the highest incidence of SR occurred during the "moderate anesthesia" event,accounting for 34.3%.SR in children under 1 year old shows a trend of variation with changes in drug concentration.74.5%of children aged 1-7 had no SR,and there was a significant difference in SR between the "induction" period and other event segments.12.5%of children had SR>2 during the "induction",and the highest incidence of SR was in the "induction",accounting for 12.2%.There were significant differences in the incidence of SR>2 and SRmax within the same event segments among different age groups.Study 3:When the postoperative analgesia was dextmedetomidine combined with sufentanil,the duration of light sleep and deep sleep was prolonged,and the duration and proportion of REM sleep were reduced.Sleep fragmentation duration and fragmentation index are higher.Conclusion Study 1:The trend of PSI index changes during general anesthesia can reflect the changes in anesthesia depth and has certain advantages in monitoring depth and guiding clinical medication.However,there are different numerical distributions and changes within different age groups,and there are many influencing factors in clinical applications.Therefore,more detailed confounding factors and age grouping studies are needed to accurately reflect the depth of anesthesia.Study 2:Burst suppression is commonly present in pediatric patients under general anesthesia,with significant differences in SR among different age groups and varying distribution patterns.The older the age,the lower the incidence and value of SR under general anesthesia.Children under 1 year old may experience SR as the concentration of anesthetic drugs increases,while children over 1 year old are more likely to experience SR>2 during the induction period.Therefore,for infants and young children under 1 year old,more attention should be paid to the dosage of anesthetic drugs.Study 3:PSG monitoring can observe changes in the duration and proportion of each sleep cycle,awakening frequency,fragment duration,and index of pediatric patients after surgery.The postoperative analgesic regimen of compound dexmedetomidine can have a certain impact on the sleep staging of pediatric patients on the night of surgery.It is suggested that postoperative PSG monitoring can indirectly evaluate the effectiveness of postoperative analgesia in pediatric patients,helping to further optimize the analgesic plan. |
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