| Now it takes more and more attention on the mental nursing of the pediatric patients. Traditional pathway of pediatric induction of anesthesia is intramuscular injection, however, the pain will bring obviously anxiety, fear, crying, discomfort and nervousness to the children. If the psychological preparation is not suitable or the induction method is impressed to the infant or child, it may result in the fear, enuresis, depression, anxiety and negative behavioral changes of them. Sevoflurane is a new inhalational anesthetic agent with low blood/ gas partition coefficient that makes induction, analepsia from anesthesia rapid, and make the anesthesia depth easily controlled and stable hemodynamics, non-irritating odor which doesn't irritate the respiratory tract, so it is widely used in the induction and maintenance of the anesthesia. Some researches are concern on the use of sevoflurane combined with nitrogen monoxide, which can shorten the induction time. But use of nitrogen monoxide will degrade the concentration of oxygen and it has the characteristics of diffusible hypoxia, this will cause the hypoxia of pediatric patients and increase the incidence of complications. In this research, we choose 40 pediatric patients and compare"multiple-deep-breath"rapid inhalational induction with 8% sevoflurane with intramuscular induction with ketamine to analyze the incidence of complication during the induction, effective time, emergence time and the changes of hemodynamics respectively, aged 3 to 7 years, who undergoing the adenotonsillectomy.Objective: To study the effects of general anesthesia induction with sevoflurane and ketamine, the incidence of complication during the induction, effective time, emergence time and the changes of hemodynamics are recorded respectively, and we discuss clinical advantage and disadvantage of the two methods, the rationality, feasibility and safety of rapid inhalational anesthesia of sevoflurane for the pediatric anesthesia induction, and provide clinical evidence for anesthetic techniques selection.Methods: Forty children, aged 3 to 7 years, ASA physical status I were collected in the First Hospital of Jilin University from September, 2007 to January, 2008, who applied the general anesthesia without tracheal intubation and scheduled for adenotonsillectomy. They were randomly allocated to receive the inhalational induction anesthesia with sevoflurane (group S, n=20) and intramuscular injection induction anesthesia with ketamine (group K, n=20). All of them were fasting for 4 to 6 hours, and received atropine 0.01mg/kg before entering the operating room. Data of heart rate, blood pressure and pulse oxygen saturation (SpO2) was recorded: right after they entered OR (operating room) (T0), when they got induction (T1), when the eyelash reflex lost (T2), when the pain reaction lost (T3), and after the surgery started for 1 min (T4). Data of the procedure time was recorded: loss of eyelash reflex (t1), loss of pain reaction (t2),surgery time (t3), emergence time after the surgery (t4). The cooperative status of the children were observed: whether the children refused the inhalational anesthesia or not,whether they had the circumstance of bucking, laryngospasm, respiratory depression, secretion increase, abnormal movements, breath holding during the induction stage, nausea, vomit, regurgitation, aspiration, emergence delirium during postoperative stage or not. All data was analyzed by SPSS 14 statistical software and expressed as x±s. Paired samples t-test was used in measurement data, Chisquare test were used in enumeration data. P<0.05 displays a significant difference, which represented statistical significance.Results: 1. There was no significant difference in background data between two groups, like children's sexuality, age, weight and ASA physical status. 2. In group S, heart rate increased a little at T1 and it was obviously faster at T2 and T3 than T0 (P<0.05), then it returned to the level of T0 at T4. In group K, heart rate was obviously faster at T1, T2, T3 and T4 than T0 (P<0.05). The difference of heart rate between two groups at T2 to T4 was obvious, and had the statistical significance (P<0.05). 3. The blood pressure increased at T1 briefly, the difference didn't display the statistical significance. At T2 to T4, the blood pressure decreased obviously in group S (P<0.05), but the descending extent was less than 20%. In group K, the blood pressure increased a little at T1 and T4, however it was markedly higher at T2 and T3 than T0 (P<0.05). The blood pressure in group K was obviously higher than group S at T2 to T4 (P<0.05), and the difference represented statistical significance. 4. Compared with group K, the procedure data: time of loss of eyelash reflex (t1), time of loss of pain reaction (t2),surgery time (t3), emergence time after the surgery (t4) reduced obviously in group S (P<0.05), and the difference represented statistical significance. 5. Compared with T0, SpO2 was no obvious changes at T1 to T4 in group S. In group K, SpO2 was lower than T0 at T1 to T4 (P<0.05), but SpO2 of two groups was both over 95% in our studying time. 6. Circumstance of holding breath, bucking and hiccup didn't occur during the stage of induction in both of two groups. At the postoperative time, there was no complication of postoperative nausea and vomiting or emergence delirium. The cooperative status and the parental satisfaction with anesthesia method of group S was markedly higher than group K (P<0.05). Two children refused the mask inhalational anesthesia method and pushed the mask, but after the explanation, they cooperated well and the procedure was successful. Two children had abnormal movements during the induction stage in group S, and one of them had enuresis. Eight children cried and had secretion increase (P<0.05) during the induction stage in group K. In group K, during the emergence time, one child had laryngospasm, he was pressurized oxygen by mask, and then the status was relieved. One child had nightmare in group K. None of them had the abnormal behavior and paresthesia in both of two groups.Conclusion: 1. That"multiple-deep-breath"rapid inhalational induction with 8% sevoflurane for the children scheduled for adenotonsillectomy can be accepted by pediatric patients easier, and act quickly and safely, meanwhile the satisfaction of their parents with the inhalational induction is higher, which reduces the preoperative anxiety and psychological stress reaction caused by intramuscular injection of ketamine. 2. Combined use of fentanyl and propofol after the inhalational induction with sevoflurane, the hemodynamics is stable during the perioperation and the surgery time is also shortened. This method can provide good emergence status, with low occurrence of delirium and agitation. 3. Combined with ketamine and propofol, it can make the adverse reaction of sympathetic nervous excitation result from ketamine decrease to maintain the stable hemodynamics. It can also reduce the occurrence of psychiatric symptom and postoperative delayed analepsia, but it should pay attention to the cooperative effect of respiratory depression. |
