翻译：张恒睿 徐医麻醉2024级硕士研究生
审校：赵林林 徐医附院麻醉科
EDITORIAL
社论
1.The power of POCUS in every pocket: Handheld ultrasound the new essential tool?
口袋里的 POCUS：手持式超声波是新的必备工具？
EDUCATIONAL REVIEW
教育评论
1.What an anesthesiologist should know about pediatric arrhythmias
麻醉医生应了解的儿科心律失常知识
2.A review of the perioperative management of direct oral anticoagulants for pediatric anesthesiologists
儿科麻醉医生对直接口服抗凝剂围手术期管理的回顾
RESEARCH REPORT
研究报告
1.Anesthetic-sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial
儿童牙科手术全静脉麻醉期间右美托咪定的麻醉保护作用：随机对照试验
Abstract
摘要
Background
背景
Dexmedetomidine, an α2-adrenergic agonist, reduces propofol and remifentanil requirements when used as an adjunct to total intravenous anesthesia in adults, but studies in a pediatric population are sparse. This study investigates the magnitude of dose-sparing effects of a postinduction dexmedetomidine bolus on propofol and remifentanil requirements during pediatric surgery.
右美托咪定是α2-肾上腺素能激动剂，可减少成人全凭静脉麻醉时对异丙酚和瑞芬太尼的需求，但对儿科人群的研究却很少。本研究探讨了在小儿手术中，诱导后右美托咪定栓剂对丙泊酚和瑞芬太尼需求量的剂量节省效应的大小。
Methods
方法
In this randomized, double-blind, controlled trial, children aged 2–10 years undergoing elective dental surgery were assigned to one of four groups: placebo, 0.25 mcg/kg dexmedetomidine, 0.5 mcg/kg dexmedetomidine, and 1 mcg/kg dexmedetomidine. Maintenance with fixed-ratio propofol and remifentanil total intravenous anesthesia followed a bispectral index (BIS)-guided algorithm designed to maintain a stable depth of anesthesia. The primary outcomes were time-averaged maintenance infusion rates of propofol and remifentanil. Secondary outcomes in the postanesthetic care unit included sedation scores, pain scores, and time to discharge.
在这项随机、双盲、对照试验中，接受择期牙科手术的 2-10 岁儿童被分配到四组中的一组：安慰剂组、0.25 微克/千克右美托咪定组、0.5 微克/千克右美托咪定组和 1 微克/千克右美托咪定组。使用固定比例的异丙酚和瑞芬太尼全静脉麻醉，按照双谱指数（BIS）指导算法维持稳定的麻醉深度。主要结果是异丙酚和瑞芬太尼的时间平均维持输注率。麻醉后治疗病房的次要结果包括镇静评分、疼痛评分和出院时间。
Results
结果
Data from 67 patients were available for analysis. The median [interquartile range] propofol infusion rate was lower in the 1 mcg/kg dexmedetomidine group (180 [164–185] mcg/kg/min) versus placebo (200 [178–220] mcg/kg/min): percent change −10.0%; 95% CI −2.4 to −19.8; p = 0.013. The remifentanil infusion rate was also lower in the 1 mcg/kg dexmedetomidine group (0.089 [0.080, 0.095] mcg/kg/min) versus placebo (0.103 [0.095, 0.106] mcg/kg/min): percent change, −13.7%; 95% CI −5.47 to −21.0; p = .022. However, neither propofol nor remifentanil infusion rates were significantly different in the 0.25 or 0.5 mcg/kg dexmedetomidine groups. In the postanesthesia care unit, there were no differences in pain or sedation scores, and time to discharge was not significantly prolonged in any dexmedetomidine group.
有 67 名患者的数据可供分析。1 mcg/kg 右美托咪定组的异丙酚输注率中位数[四分位间范围]（180 [164-185] mcg/kg/min）低于安慰剂组（200 [178-220] mcg/kg/min）：百分比变化-10.0%；95% CI -2.4至-19.8；p = 0.013。1 mcg/kg 右美托咪定组的瑞芬太尼输注率（0.089 [0.080, 0.095] mcg/kg/min）也低于安慰剂组（0.103 [0.095, 0.106] mcg/kg/min）：百分比变化为 -13.7%；95% CI -5.47 至 -21.0；p = .022。然而，0.25 或 0.5 mcg/kg 右美托咪定组的异丙酚和瑞芬太尼输注率均无显著差异。在麻醉后治疗、病房，疼痛或镇静评分没有差异，任何右美托咪定组的出院时间都没有明显延长。
Conclusion
结论
Dexmedetomidine 1 mcg/kg reduced the propofol and remifentanil requirements during maintenance of anesthesia in children when administered as a postinduction bolus.
右美托咪定 1 mcg/kg 作为诱导后单次给药可减少儿童麻醉维持过程中对异丙酚和瑞芬太尼的需求。
2.Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery—A review of 148 cases
接受综合 II 期手术的左心发育不全综合征患者的围手术期麻醉管理--148 例病例回顾
Background
背景
Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap.
左心发育不全综合征患者接受综合二期手术，这是实现丰坦循环混合方法的第二阶段。综合二期手术的复杂性被认为是一个潜在的限制因素，有关其麻醉管理的信息也很有限。本研究旨在填补这一空白。
Methods
方法
A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected.
一项单中心回顾性队列研究分析了148例接受综合二期手术的HLHS患者，分为A组（病情稳定，n = 116）和B组（需要术前静脉注射肌力治疗，n = 32）。研究人员收集了患者的人口统计学数据、术中血流动力学、麻醉管理和术后结果。
Results
结果
Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A.
依托咪酯（40%）是最常用的诱导药物，其次是艾司卡胺（24%）、咪达唑仑（16%）和异丙酚（13%）。吸入诱导很少有必要（2%），仅在 A 组患者中出现。在诱导药物的选择上，各组之间没有统计学差异。心肺旁路术后管理包括中度低通气、吸入一氧化氮（100%）以及米力农（97%）和去甲肾上腺素（77%）血液动力学支持。B 组患者更经常需要额外的左西孟旦（20%）和肾上腺素（18%）。8名患者（5%）需要体外膜肺氧合，组间无差异。将芬太尼改为瑞芬太尼总体上缩短了术后通气时间。然而，B 组患者的通气时间（6.3 小时对 3.5 小时）和重症监护室住院时间（22 天对 14 天）明显更长。院内死亡率为 5%（A 组：4%，B 组：9%）。长期生存分析显示，A 组具有明显优势。
Conclusion
结论
The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups.
使用短效阿片类药物和调整通气模式可优化肺血流并快速过渡到自主呼吸。使用米力农、去甲肾上腺素，辅以左西孟旦和肾上腺素为高危患者提供不同的血流动力学支持，可减轻对术前容量负荷右心室的影响。不过，观察到不同组间的长期存活概率存在差异。
3.Auricular laser acupuncture as an adjunct for parental anxiety management during children's surgery: A randomized-controlled study
耳穴激光针灸作为儿童手术期间家长焦虑管理的辅助手段：随机对照研究
4.Links between mutations in functionally separate arms of mitochondrial complex I and responses to volatile anesthetics
线粒体复合物 I 功能独立臂的突变与挥发性麻醉剂反应之间的联系
5.The effect of intraoperative methadone on postoperative opioid requirements in children undergoing orchiopexy: A randomized clinical trial
术中使用美沙酮对肛门成形术患儿术后阿片类药物需求的影响：随机临床试验
6.Assessment of the antinociceptive effect of a single fentanyl bolus dose in children: A pharmacokinetic and pharmacodynamic analysis based on the nociception level index during sevoflurane general anesthesia
评估单次芬太尼栓剂对儿童的镇痛作用：基于七氟醚全身麻醉期间痛觉水平指数的药代动力学和药效学分析
7.Assessment of accuracy of two pulse oximeters in infants with cyanotic and acyanotic congenital heart diseases
评估两种脉搏血氧仪在患有紫绀型和无紫绀型先天性心脏病婴儿中的准确性
CLINICAL CORRESPONDENCE
临床通信
1.Successful ultrasound-guided supraclavicular brachial plexus continuous blockade for traumatic amputation of digits in a 3-year-old child: A case report
超声引导下锁骨上臂丛连续阻断术成功治疗一名 3 岁儿童的外伤性截肢：病例报告
SCIENTIFIC LETTER
科学信件
1.Cumulative sum (CUSUM) analysis to assess caudal block performance among anesthesia residents
累积总和（CUSUM）分析法评估麻醉科住院医生的尾椎阻滞表现
LETTER TO THE EDITOR
致编辑的信
1.Medial infraclavicular (costoclavicular) block in children
儿童锁骨下（肋锁）内侧阻滞
2.Comments on Elmitwalli et al ‘Use of high-flow nasal cannula versus other noninvasive ventilation techniques or conventional oxygen therapy for respiratory support after pediatric cardiac surgery: A systematic review and meta-analysis’
对 Elmitwalli 等人 "在小儿心脏手术后使用高流量鼻插管与其他无创通气技术或传统氧疗进行呼吸支持：系统回顾和荟萃分析
3.Preventing hypothermia in infants – Sustainable improvements or the Hawthorne effect?
预防婴儿体温过低--可持续改进还是霍桑效应？
4.Advancing infant anesthesia: PEEP's age-specific impact on atelectasis and apnea time
推进婴儿麻醉：PEEP 对肺不张和呼吸暂停时间的特定年龄影响
5.Can learning from military history help us improving neonatal intubation success rates?
学习军事历史能否帮助我们提高新生儿插管成功率？
COMMENTARY
评论
1.Editor's picks for the pediatric anesthesia article of the day: June 2024
编辑推荐的当日儿科麻醉文章：2024 年 6 月
