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Nalbuphine reduces the incidence of emergence agitation in children undergoing Adenotonsillectomy: A prospective, randomized, double-blind, multicenter study
To evaluate the effect of nalbuphine on emergence agitation (EA) in children undergoing adenotonsillectomy.
Multicenter, prospective, double-blind, randomized controlled trial.
The First People's Hospital of Foshan and three other participating institutions in China, from April 2020 to December 2021.
Eight hundred patients, 3–9 years of age, American Society of Anesthesiologists (ASA) classification I or II, undergoing elective adenotonsillectomy were included.
Nalbuphine (0.1 mg/kg) or saline was administered intravenously.
The incidence of EA; the pediatric anesthesia emergence delirium (PAED) scale; and the faces, legs, activity, cry, and consolability (FLACC) scales. Extubation time, duration of post-anesthesia care unit (PACU) stay, anesthesia nurses' and parents' satisfaction, and other side effects.
The incidence of EA in the nalbuphine group was lower than that in the saline group 30 min after extubation (10.28% vs. 28.39%, P = 0.000). In addition, the FLACC scores in the nalbuphine group were lower than those in the saline group 30 min after extubation (P < 0.05). Furthermore, the proportion of moderate-to-severe pain cases (FLACC scores >3) was significantly lower in the nalbuphine group than in the saline group (33.58% vs. 60.05%, P = 0.000). Adjusting the imbalance of postoperative pain intensity, the risk of EA was still lower in the nalbuphine group at 0 min (OR, 0.39; 95% CI, 0.26–0.60; P = 0.000), (OR, odds ratio; CI, confidence interval), 10 min (OR, 0.39; 95% CI, 0.19–0.79; P = 0.01), and 20 min (OR, 0.27; 95% CI, 0.08–0.99; P = 0.046) than in the saline group. There were no significant differences in extubation time, duration of PACU stay, nausea and vomiting, or respiratory depression between the two groups (P > 0.05).
Nalbuphine reduced the incidence of EA in children after adenotonsillectomy under general anesthesia, which may be involved in both analgesic and non-analgesic pathways.
•Nalbuphine could reduce emergence agitation in children after general anesthesia.•Nalbuphine did not increase extubation time and duration of PACU stay.•Nalbuphine did not increase the incidence of breath depression and nausea and vomiting.
Journal Article
The effect of the timing and dose of dexmedetomidine on postoperative delirium in elderly patients after laparoscopic major non-cardiac surgery: A double blind randomized controlled study
There were few clinical data dosing and timing regimen for preventing postoperative delirium. The present study aimed to investigate the effect of the timing and dose of dexmedetomidine on postoperative delirium in elderly patients after laparoscopic major non-cardiac surgery.
A total of 354 patients >65 years of age undergoing laparoscopic major non-cardiac surgery under general anesthesia received a dexmedetomidine 1 μg/kg bolus followed by 0.2–0.7 μg/kg/h infusion from induction of anesthesia to the end of surgery [group D1]); a dexmedetomidine (1 μg/kg bolus [group D2]); or saline (group S) 15 min before the end of surgery.
The incidence and duration of delirium for 5 days after surgery and the cytokine (tumor necrosis factor-alpha TNFα, interleukin [IL]-1 β, IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1 h and 24 h after surgery.
Group D1 reduced incidence and duration of delirium and group D2 decreased its duration in patients with delirium compared to group S. IL-6 levels were significantly lower at 1 h and 24 h after surgery in group D1 than in group S, and lower at 24 h after surgery than in group D2. IL-6 levels in group D2 were significantly lower only at 1 h after surgery than in group S. However, IL-6 levels in delirious patients in group D2 were significantly lower at 1 h and 24 h after surgery than those in group S. Cortisol levels 1 h after surgery were significantly lower in groups D1 and D2 than in group S.
The dose and timing of dexmedetomidine appeared to be important in preventing delirium. The reduced incidence and duration of delirium by dexmedetomidine was associated with reduced levels of IL-6 24 h after surgery.
•Perioperative long duration of dexmedetomidine reduces the incidence and severity of postoperative delirium.•Dexmedetomidines also reduced the inflammatory cytokines such as IL-6.•IL-6 at 24 h after surgery may be an important factor in predicting postoperative delirium.
Journal Article
Anesthesia-induced electroencephalogram oscillations and perioperative outcomes in older adults undergoing cardiac surgery
Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.
This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.
Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; P = 0.004). This finding was not significant in adjusted analysis (ORadj 0.92, 95 % CI: 0.81 to 1.03; P = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (ORadj 0.80, 95 % CI: 0.71 to 0.91; P < 0.001). Findings were conserved in exploratory and sensitivity analyses.
In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.
Clinical trial registration: Registration Number: NCT02856594
•Secondary analysis of 394 participants in the MINDDS Study.•Intraoperative alpha power varied with measures of preoperative cognitive and physical health.•Intraoperative alpha power also predicted postoperative delirium, 30-day readmission, but not non-home discharge.•On adjusted analysis, intraoperative alpha power robustly predicted non-home discharge.•Intraoperative EEG oscillations change as a function of cognitive and physical health and predict perioperative outcomes.
Journal Article
The Emergence and Growth Path of Shanzhai Firms
Shanzhai refers to a set of dynamic strategies for firms to grow out of counterfeiting. Shanzhai firms have traditionally been perceived as counterfeiters from the emerging economies producing cheap and low-quality products. This trend has changed in recent years when Shanzhai firms have grown into market leaders and have introduced leading technologies and applications. This paper focuses on the growth of Shanzhai firms by exploring how Shanzhai firms and Shanzhai industries emerged. We further investigate the context that supports the emergence of Shanzhai firms into market leaders. We leverage two case studies using the growth path of two market leaders in their respective industries to illustrate the two paths leading to the emergence of Shanzhai firms. We attempt to show that although Shanzhai firms start out with low legitimacy, these firms grow their legitimacy over time by building their core competitiveness in their respective industries.
Journal Article
The effect of repeated maternal voice orientation on postoperative emergence agitation in children following tonsillectomy and adenoidectomy: A randomized controlled trial
Evaluate the efficacy of repeated maternal voice orientation in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing elective tonsillectomy and adenoidectomy.
Randomized controlled trial.
A tertiary hospital.
360 children aged 5–12 years undergoing elective tonsillectomy and adenoidectomy.
Patients were randomized into three groups: maternal voice orientation group (Group O), maternal voice awakening group (Group A), and a control group (Group C) receiving silent recordings.
The primary outcome was the incidence of EA, defined by a Pediatric Anesthesia Emergence Delirium (PAED) score of 12 or higher. Secondary outcomes included the severity of EA (PAED score > 14), postoperative pain (assessed using FLACC and NRS scales), and recovery profiles in the Post-Anesthesia Care Unit (PACU).
Maternal voice orientation (Group O) significantly reduced the incidence of EA compared to the control group and Group A, especially notable in the 5–8 year subgroup. Group O showed the lowest PAED scores immediately post-extubation and at 10 min.
Repeated maternal voice orientation effectively reduces the incidence and severity of EA among pediatric patients, supporting its inclusion in pediatric anesthesia recovery protocols to improve postoperative outcomes.
•Maternal voice orientation lowers EA post-anesthesia.•Maternal voice effective across age groups.•Maternal voice orientation shortens extubation time, awakening time, and PACU stay.
Journal Article