Observation of Short-Term Sevoflurane Anesthesia for Lumbar Puncture in Children

doi:10.3877/cma.j.issn.1673-5250.2014.06.012

Objective

To observe the effect of short-term sevoflurane anesthesia for lumbar puncture in children.

Methods

From February 2013 to February 2014,113 children who underwent lumbar puncture in Guangzhou Women and Children's Medical Center were included in the study. They were divided into group S (sevoflurane inhaled,n= 58) and group D(diazepam injection,n= 55)according to different ways of sedation. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangzhou Women and Children's Medcial Center. Informed consent was obtained from each participants' parents. No significant difference was found in general clinical data such as age, sex and degree of illness between two groups (P >0.05). The vital signs were observed in both groups. The duration of lumbar puncture, one-time puncture success rate and total success rate of puncture were recorded. The adverse events such as body movement during the operation were also recorded.

Results

① Heart rate at T₂ was obviously higher than that of T₁ in group S(t= - 6.39,P<0.05). Heart rates at T₃ ,T₄ were also higher than T₁ in group D(t = 8.8,6.82 ; P<0.05). There were significant differences in heart rate at T₂ ,T₃ ,T₄ between two groups(t = 4.909,- 13.382,- 12.733; P<0.01) .②Compared with the other observing time, blood oxygen saturation (Spo₂ ) at T₃ was decreased obviously in group D(t= - 7.70,- 7.74, - 7.91; P< 0.05). There was significant difference in Spo₂ at T₃ between two groups(t = 8.141,P<0.01).③No one had body movement during the operation in group S,and 1 case quited the operation(1.7% ). forty cases (72.7%) had body movement during the operation in group D,and 8 cases quited the operation( 14.5% ). ④There were significant differences in one-time puncture success rate and total puncture success rate between two groups (P<0.05).⑤The duration of lumbar puncture in group S was (7.6±2.1) min, which was obviously shorter than (16.0± 8.7) min of group D(P<0.05).⑥ The anesthesia time was (78.3 ± 21.4) s and recovery time was (7.3± 2.1) min in group S.

Conclusions

Short-term sevoflurane anesthesia can improve one-time puncture success rate and shorten the duration of the lumbar puncture. It also can reduce the potential nerve damage.

Key words: Lumbar puncture, Sevoflurane, Child

表1 两组患儿不同观察时刻的HR比较（次/min，±s）

Table 1 Comparison of heart rate changes between two groups at different observation time（次/min，±s）

组别	例数	T₁	T₂	T₃	T₄
S组	58	97.6±10.9	104.1±11.9^a	86.1±7.7	87.4±7.1
D组	55	97.9±14.2	93.7±10.4^a	123.8±19.5	125.9±21.2
t值		-0.135	4.909	-13.382	-12.733
P值		0.893	<0.01	<0.01	<0.01

表1 两组患儿不同观察时刻的HR比较（次/min，±s）

Table 1 Comparison of heart rate changes between two groups at different observation time（次/min，±s）

组别	例数	T₁	T₂	T₃	T₄
S组	58	97.6±10.9	104.1±11.9^a	86.1±7.7	87.4±7.1
D组	55	97.9±14.2	93.7±10.4^a	123.8±19.5	125.9±21.2
t值		-0.135	4.909	-13.382	-12.733
P值		0.893	<0.01	<0.01	<0.01

表2 两组患儿不同观察时刻的Spo₂比较(±s)

Table 2 Comparison of Spo₂ changes between two groups at different observation time(±s)

组别	例数	T₁	T₂	T₃	T₄
S组	58	99.1±0. 8	99.2±1.2	99.4±0.8	99.6±0.6
D组	55	99.3±0.8	99.4±0.8	94.7±4.2	99.3±0.8
t值		-1.178	-1.124	8.141	1.602
P值		0.241	0.264	<0.01	0.112

表2 两组患儿不同观察时刻的Spo₂比较(±s)

Table 2 Comparison of Spo₂ changes between two groups at different observation time(±s)

组别	例数	T₁	T₂	T₃	T₄
S组	58	99.1±0. 8	99.2±1.2	99.4±0.8	99.6±0.6
D组	55	99.3±0.8	99.4±0.8	94.7±4.2	99.3±0.8
t值		-1.178	-1.124	8.141	1.602
P值		0.241	0.264	<0.01	0.112

表3 两组患儿穿刺情况比较[n(%)]

Table 3 Comparison of condition of patients with lumbar puncture between two groups[n(%)]

组别	例数	一次性穿刺成功率	总穿刺成功率	穿刺时间（min, ±s）
S组	58	50(86.2)	58 (98.3)	7.6±2.1
D组	55	36(65.5)	47 (85.5)	16±8.7
_χ²/t值		6.686	6.331	-14.73
P值		<0.05	<0.05	<0.05

表3 两组患儿穿刺情况比较[n(%)]

Table 3 Comparison of condition of patients with lumbar puncture between two groups[n(%)]

组别	例数	一次性穿刺成功率	总穿刺成功率	穿刺时间（min, ±s）
S组	58	50(86.2)	58 (98.3)	7.6±2.1
D组	55	36(65.5)	47 (85.5)	16±8.7
_χ²/t值		6.686	6.331	-14.73
P值		<0.05	<0.05	<0.05

[1]	Singh PM, Trikha A, Sinha R, et al. Sevoflurane induction procedure : cost comparison between fixed 8 % versus incremental techniques in pediatricpatients[J]. AANA J, 2014, 82(1) : 32–37.
[2]	沈亚儿，邬盈云，夏莲芳.不同干预方法对提高小儿腰穿质量的对比分析[J].中国实用神经疾病杂志，2007，10(4)：120.
[3]	刘美玲.自制约束带在小儿腰穿术中的应用[J].科技通报，2000，16(3)：238–240.
[4]	张庆民，王道斌.腰椎穿刺后腰背部痛痛24例[J].中华儿科杂志，2003, 4l(4)：305–306.
[5]	Fein D, Avner JR, Khine H. Pattern of pain management during lumbar puncture in children[J]. Pediatr Emerg Care, 2010, 26 (5): 357–360.
[6]	Cronan KM, Wiley JF II. Lumbar puncture//Henretig FM, King C, ed.Textbook of Pediatric Emergency Procedures[M]. Baltimore, MD: Williams & Wilkins, 1997: 546-547.
[7]	American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Task Force on Pain in Infants, Children and Adolescents. The assessment and management of acute pain in infants, children, and adolescents [J]. Pediatrics, 2001, 108 (3) : 793–797.
[8]	Anand KJ. International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn[J]. Arch Pediatr Adolesc Med, 2001, 155 (2) : 173–180.
[9]	彭志宏，昌克勤，毕好生.七氟醚快速吸人诱导在小儿法洛四联征手术麻醉中的应用[J].临床麻醉学杂志，2003，11(3)：686–687.
[10]	张溪英，郭曲练，王江平，等.七氟烷用于小儿诱导及维持麻醉的临床研究[J].中南大学学报：医学版，2007，32(3)：505–506.
[11]	肖旭，李继强，冯英，等.七氟烷对小儿短小手术麻醉效果的系统评价[J].中国循证医学杂志，2011，11(10)：1184–1191.
[12]	Breakey VR, Pirie J, Goldman RD. Pediatric and emergency medicine residents' attitudes and practices for analgesia and sedation during lumbar puncture in pediatric patients [J]. Pediatrics, 2007, 119 (3) : 631–636.
[13]	Pinheiro JM, Furdon S, Ochoa LF. Role of local anesthesia during lumbar puncture in neonates[J]. Pediatrics, 1993, 91(2) :379–382.
[14]	Sharma SK, Gajraj NM, Sidawi JE, et al. EMLA cream effectively reduces the pain of spinal needle insertion[J]. Reg Anesth, 1996, 21(6):561–564.
[15]	Carraccio C, Feinberg P, Hart LS, et al. Lidocaine for lumbar punctures. A help not a hindrance[J]. Arch Pediatr Adolesc Med, 1996, 150(10):1044–1046.

[1]	Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[2]	Baofu Zhang, Jin Yu, Jingjing Ye, Jiangen Yu, Xiaohui Ma, Xiwang Liu. Echocardioimagedata diagnosis of anomalous pulmonary venous connection caused by congenital malposition of the septum primum[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1074-1080.
[3]	Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[4]	Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.
[5]	Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[6]	Jiu Wang, Jun Chen, Xia Zhu, Yangjin Mima, Sheng Zhao, Xinlin Chen, Jianhua Li, Shuang Wang. Effect of implementing fetal systemic ultrasound screening in Material and Child Health Hospital of Shannan[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 728-733.
[7]	Jie Mi, Chen Chen, Jialing Li, Haina Pei, Hengbo Zhang, Fei Li, Dongjie Li. Analysis of the characteristics of children's head and face trauma[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(06): 511-515.
[8]	Tao Ma, Chunwei Ye, Tao Liu, Wenxi Peng, Zhipeng Li. Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 605-610.
[9]	Lei Wang, Shaohua Wang, Haizhen Niu, Tengfei Yin. Application of early warning intervention based on risk assessment in perioperative nursing of children with inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 768-772.
[10]	Fang Li, Rui Xu, Yangyang Li, Xiuquan Shi. Application of the concept of evidence-based medicine in children with inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 782-786.
[11]	Wenzhong Duan, Yanxia Bai, Wenting Xu, Hongxia Qi, Zhijian Lyu. Anesthetic effects of sevoflurane and propofol in hepatectomy: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 640-645.
[12]	Lei Lyu, Xiao Feng, Kaiming He, Kaining Zeng, Qing Yang, Haijin Lyu, Huimin Yi, Shuhong Yi, Yang Yang, Binsheng Fu. Value of revised King's score in evaluation of live transplantation timing for children with acute liver failure due to Wilson's disease and literature review[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 661-668.
[13]	Xiangyu Zhu, Jianmei Wang, Hui Zhang, Hongying Ye. Correlation analysis between left ventricular function parameters and liver cirrhosis using non-invasive left ventricular pressure-strain cycle[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 494-498.
[14]	Shaohong Zhuo, Xiuling Lin, Cuimei Zhou, Weilian Xiong, Xingzao Ma. Application value of CD64 index combined with serum SAA/CRP and PCT in the diagnosis of children with infectious gastrointestinal diseases[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 505-509.
[15]	Jing Li, Lingling Zhang, Wei Xing. Value of concept of interest induction before anesthesia induction in pediatric surgery and its effect on family satisfaction[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 812-817.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export