Fentanyl-Propofol In Children Of Painless Gastroscopy

Background and objectiveGastroscopy has been widely carried out in clinical practice, with its advantages of simple diagnosis and treatment of the majority of the recognition of medical workers and patients. Endoscopy can not only assist a variety of clinical treatment to patients to reduce pain caused by disease, but also diagnosed the disease as a more intuitive way. Therefore, the clinical use is also increasing year by year, more and more attention. However, due to the development of endoscopy in the pediatric relatively slow, relatively few children to carry out endoscopy. In recent years, with the incidence of stomach diseases of children and increasing foreign bodies swallowed, children in the clinical application of endoscopy is also increasing. However, endoscopy is difficult for the children with their pain threshold is low relative to adults, which not only increased the difficulty of the operation, and intraoperative complications occurred, and therefore adverse events was correspondingly increased. Gastroscopy adverse action may bring more to the psychological impact in children, but also increased the concerns of parents of this medical practice. Therefore, in order to solve these problems, children of a suitable method of anesthesia painless gastroscopy become very important. Painless gastroscopy in children throughout the inspection process will enable children in a state of anesthesia, awareness and pain disappeared, to avoid or reduce the child's pain caused by lack of cooperation or adverse events and complications were also more calm and check Careful operation, thereby improving the quality of examination. As children unconscious in an examination, it is rarely a psychological impact, but also reduce the concerns of parents of such inspection. This study of different compatibility of propofol sedation, analgesia, and midazolam as control, compatibility observed during and after treatment in children with changes in vital signs and adverse reactions, and find the most reasonable method of anesthesia, while the drug way to make the safety and effectiveness evaluation.Materials and Methods1 Clinical data In August 2010 to February 2011 in Shandong University Qilu Children's Hospital who underwent gastroscopy selected the 150 cases in children aged 5 to 12 years old, Ages 5 to 12 years old, weighing 15-34kg, ASAⅠ-Ⅱ,95 cases were male,55 female patients. No children with gastroscopy contraindications. Cases are randomly divided into 5 groups:Simple application of propofol groups (group p), propofol-ketamine Group (PK group), propofol-fentanyl Group (PF group), midazolam-fentanyl Group (MF group), ketamine-Midazolam Group (MK), each group of 30 cases.2 Method Before operation in children with normal fasting 6h, water-ban 2H. Before each group of children were given scopolamine 0.01mg/kg to curb gland secretion, reduce secretions to laryngeal stimulation. Preoperative oral lubricating agent 10min 10ml, established venous channels, sodium and potassium and glucose fluid infusion, use precision infusion conditioner, liquid velocity control in 10ml/(kg.h). Physique weaker, smaller children, preoperative fasting can cause dehydration, preoperative intravenous added the amount of liquid, per dehydrated 1% transfusion 10ml/kg. Regular ECG, take left knees in children with Fowler's head backwards to keep the airway open, conventional nasal catheter oxygen. P group slow intravenous propofol or PF group 2-3mg/kg,PK group 0.3mg/kg ketamine or fentanyl respectively after the 1μg/kg and intravenous propofol 2-3mg/kg. MK Group or group of MF 0.3mg/kg ketamine or fentanyl respectively after the 1μg/kg, midazolam intravenous 0.05mg/kg again. Record all periods of blood pressure (BP), heart rate (HR), pulse oxygen saturation (SPO2). Records there is no apnea (breathing stopped than 10s), breathing difficulty or shortness of breath, and hypoxemia (SPO2<90%), low blood pressure (smaller than the underlying value of the 20%) and bradycardia (lower than the underlying value of 70%).Observation on the postoperative recovery time and postoperative complications, such as nausea, vomiting, headache, dizziness, irritability, and awareness in, and so on.3 Statistical analysis Data processing SPSS11.0 software, measurement data to'x±s said, comparing two sets of measurement data of t test, before, during and after operation between group comparison using analysis of variance, P<0.05 for statistically significant differences. ResultsAll checks are successfully completed, no serious adverse reactions. 1 In General Five groups of age, weight and sex ratio at birth, time of gastroscopy and mean arterial pressure (MAP), the difference was not statistically significant (P>0.05). Compared with the Group of p-groups, PK, PF group, MF group, time induced by MK Group (P<0.05); compare with PK group, the PF group, p, MF group, MK Group wake up time is higher than the control group (P<0.05);2 Comparison of SPO2, HR, MAP.Compared with other groups, in p-group of HR has a larger change in the minimum SPO2 values, (P<0.05), compared with the Group of p-groups,PF group,MF group,PK group,MK group administration lmin heart rate significantly faster than the control group (P<0.05).3 Patients in each group comparison of adverse reactions.Compared with other groups, p group under propofol dosage, mirror's resistance, low incidence of oxygenation is significantly higher than the control group (P<0.05); Compare with PK group,the PF group,p group,MF group,MK Group more (P<0.05).4 The comparison of adverse reactions after operation.Compared with other groups, high incidence of p-groups dizziness, headaches (P>0.05); Compared with the Group of p-groups,PF group,MF group,group P,MK Group irritation and nausea rate higher than the control group (P<0.05).ConclusionDistribution of propofol fentanyl anesthesia for painless gastroscope in children, the effect of, vital signs stable, less adverse reaction after operation, is the ideal method of compound drugs, and clinical outreach.