Significant Difference In Oxygen Saturation Research Articles

Awake Prone Positioning In COVID Positive Patients: A Retrospective Study.

While the advanced health care settings are struggling hard to handle the sudden surge of COVID-19 cases, resource poor settings in developing countries like Nepal can barely stand to fight the increasing number of severe cases. Easily available cost effective interventions would be great blessing for such settings. This study aimed to study if awake prone positioning can be used as such intervention in COVID 19. The retrospective study involved 150 patients admitted between November 2020 and January 2021 at Nepal Armed Police Force Hospital and met specific inclusion criteria. Data was obtained at four different time points in relation to prone position and was analysed using International Business Machines Statistical Package for the Social Sciences (SPSS) version 23. It was found that among 150 patients, majority (109; 72.7%) were males and 60(40%) had some comorbidities. The mean oxygen saturation was found to increase significantly from 87.18 %(SD 3.531) to 91.08(SD 2.206) after fifteen minutes of prone positioning. One way ANOVA test showed that there was significant difference in oxygen saturation between at least two time points. (F (3,596) = [180.005], p=0.000). Games Howell Post Hoc test for multiple comparisons showed that the mean value of SPO-2 was significantly different across all four time points, at significance level 0.05. This study found Awake Prone positioning as a promising cost effective and feasible intervention for improving oxygenation in COVID 19 and thus could be a blessing to the resource poor health care settings.

Midline Swaddling and Traditional swaddling Position and Their Influence on Physical and Autonomic sign on Newborn Babies.

The traditional method of swaddling is done with the arms and legs straightened and wrapped tightly with the hips in an adduction position, and the newborns are mostly carried out by traditional swaddling in Indonesia. When swaddling is properly done, infants show less awakening and longer sleep, better neuromuscular development, less physiological stress, better motor organization, and better self-regulation abilities. Improper swaddling can result in conditions that are detrimental for newborns, like SIDS, DDH, which cause stress. The early exposure of the neonates to stress results to residual symptoms in behavior and neurobiological disorders. This study aims to determine the effect of midline position compared to the traditional swaddling regarding physical and autonomics stress sign. The study population consisted of 194 newborns. The midline and traditionally swaddled were observed and recorded, physical and autonomic signs at birth, 10 minutes and 2 hours were documented. This study found that there is statistically significant difference between the groups in terms of cries at 10 minute and 2 hours and so with the heart rate and respiration rate at birth (p<0,05), and a significant difference in oxygen saturation at 10 minutes and 2 hours (p<0,05). Additionally, midline swaddling had a larger average decrease in heart rate and respiration rate, and increase in the oxygen saturation. Therefore, this study can deduce that, midline position swaddling has less stressful effect than the traditional position. The same research elsewhere in Indonesia will be costly. Future research would suggest for larger sample that may suggest a more accurate outcome.

The impact of intravenous dodecafluoropentane on a murine model of acute lung injury

IntroductionIntravenous oxygen therapeutics present an appealing option for improving arterial oxygenation in patients with acute hypoxemic respiratory failure, while limiting iatrogenic injury from conventional respiratory management.MethodsWe used an established two-hit murine model of acute lung injury (ARDS/VILI) to evaluate the effect of intravenous dodecafluoropentane (DDFPe) on oxygen saturation and bronchoalveolar lavage cell counts and protein levels. Twenty hours after challenge with intratracheal lipopolysaccharide, mice were intubated and ventilated with high tidal volumes (4 h) to produce acute lung injury. DDFPe (0.6 mL/kg) or saline was administered by IV bolus injection at the initiation of mechanical ventilation and again at 2 h. Oxygen saturation was measured every 15 min. Bronchoalveolar lavage was performed at the conclusion of the experiment.ResultsThe two-hit ARDS/VILI model produced substantial inflammatory acute lung injury reflected by markedly increased bronchoalveolar lavage (BAL) cell counts compared to BAL cell counts in spontaneous breathing controls (5.29 ± 1.50 × 10–6 vs 0.74 ± 0.014 × 10–6 cells/mL) Similarly, BAL protein levels were markedly elevated in ARDS/VILI-challenged mice compared with spontaneous breathing controls (1109.27 ± 223.80 vs 129.6 ± 9.75 ng/mL). We fit a linear mixed effects model that showed a significant difference in oxygen saturation over time between DDFPe-treated mice and saline-treated mice, with separation starting after the 2-h injection. DDFPe-treated ARDS/VILI-challenged mice also exhibited significant reductions in BAL cell counts but not in BAL protein.ConclusionDDFPe improves oxygen saturation in a murine model of ARDS/VILI injury with the potential for serving as an intravenous oxygen therapeutic.

Comparison of oxygen saturation between Term and Preterm Newborns delivered by normal versus cesarean route

Introduction: Neonates undergo major physiologic changes during transition from intrauterine to extra-uterine period. Although, this transition is smooth mostly, 5-10% needs some assistance in breathing. The indications and timing of supplemental oxygen therapy to assist the newborn in this transition has been a matter of debate. Objective: To observe the range of oxygen saturation among healthy newborns in the first 10 minutes of life and to compare those with different gestation and mode of delivery. Materials and Methods: This cross-sectional study was conducted in the Department of Obs & Gynae, BSMMU for 9 months. All healthy neonates born by normal vaginal or cesarean delivery were included. For each newborn, oxygen saturation was recorded at 1, 5, and 10 minutes after birth and every 5 minutes thereafter till readings from both these sites crossed 90% and equalized. Parents were interviewed with a specific pre-designed and pre-tested questionnaire. Collected data were analyzed by using SPSS v20. Results: A total of 300 newborn data were analyzed. Newborns who were born by cesarean delivery had lower SpO2 than infants born vaginally (p <0.001) and they took longer time to reach SpO2>85%. The median SpO2 did not reach 90% until 5 minutes of life in either group. Significant difference in oxygen saturation was also found at 1, 5 & 10 minutes of life between pre-term & and term newborns (P value <0.001). Conclusion: Oxygen saturation was low in babies who were delivered by cesarean section compared to those delivered by normal vaginal route. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 368-373

DETERMINATION OF TREATMENT TIME AND EFFICACY WITH OXYGEN IN EXPERIMENTAL METHEMOGLOBINEMIA MODEL

Introduction: Methemoglobin, an abnormal form of hemoglobin, is one of the causes that should be considered primarily in severe central cyanosis. Methylene blue and ascorbic acid are used as the first-line therapies in methemoglobinemia. Experience with the use of oxygen therapy is not sufficient to conclude the duration of therapy. The aim of the present study is to find out the effects of oxygen therapy on drug or toxic agent-induced methemoglobinemia. Material and Method: First group rats (n=6) were administered 100 mg/kg prilocaine intraperitoneally, and the rats were kept at room temperature. The second group of oxygen group rats (n=6) were administered 100% oxygen at 10 liters/min. All rats were observed for 180 minutes, and blood gas and biochemical analyses were performed at the end of the experiment period. Results: Fifty percent of the rats in the room air group (n=3) died spontaneously at the end of the trial period, while all rats in the oxygen group (n=6) survived to the end of the trial period. When evaluated in terms of survival, a statistical difference was found between the groups (p <0.05). In addition, although there was a significant difference in oxygen saturation levels between the groups (p <0.05), there was no significant increase in partial arterial oxygen pressure, the primary determinant of oxygenation. Conclusion: This study revealed that rats are not suitable for this type of experimental study. Prilocaine doses did not cause high levels of methemoglobinemia due to mortality, so the goal and target could not be met. It has been concluded that this study can serve as a guide for choosing methodologies to be employed in planned future investigations of the topic.

Characteristics and Outcomes of COVID-19 Patients with Diabetes Mellitus at the University of Muhammadiyah Malang General Hospital

The number of confirmed cases of COVID-19 in East Java is 590,531 (9,41% of total national confirmed cases)\. The death toll in the province is 31,774. Diabetes Mellitus (DM) can cause systemic complications such that COVID-19 patients with DM have a high risk of serious illness and mortality. The characteristics and outcomes of COVID-19 patients with DM at the University of Muhammadiyah Malang General Hospital have never been reported before. Data were taken from medical records at the University of Muhammadiyah Malang General Hospital. The diagnosis of COVID-19 was obtained from a positive PCR swab. DM diagnosis was made by studying the patient history of DM or Random Blood Glucose (RBG) >200 mg/dL or HbA1c >7% sampling. Characteristics of the patients were age, gender, length of treatment, history of DM, and adherence to DM control. The supporting examinations were leukocytes, platelets, O2 saturation, RBG, HbA1c, CRP, and D-dimer, which were grouped into two groups: recovered and dead. Data were analyzed with the SPSS version 28. COVID-19 patients with DM from June 2020 to May 2021 were 206 (23.09%) out of 892 confirmed COVID-19. The majority of cases occurred in men (51.5%) and occurred in the age range of 51-60 years (38.3%). The number of patients who died was 38 (18.4%). The average platelet value was 286,191, the average leukocyte value was 7804, the average oxygen saturation was 90%, the average HbA1c value was 9.4%, the average CRP value was 68.99mg/L, and the average D-dimer value is 13,39ng/mL There was a significant difference in oxygen saturation and D-Dimer between recovered and dead patients. There were no significant differences in the results of other investigations.
 Keywords: COVID-19, DM, mortality, University of Muhammadiyah Malang General Hospital

Pain parameters for buffered and non-buffered anesthetic injections in children undergoing dental procedures

Background: Dental procedures, such as injections, usually cause pain and make children uncomfortable and uncooperative. One approach for reducing pain is the use of buffered anesthetics. Purpose: The research objective was to assess the pain parameters between buffered and non-buffered anesthetic injections, based on oxygen saturation, pulse rate, and the self-reporting of pain by the children. Methods: The research method was quasi-experimental, with purposive sampling of 19 children. Pain parameters, based on oxygen saturation and pulse rate, were measured using a pulse oximeter. The self-reporting of pain used the Wong–Baker FACES® pain rating scale. Statistical analysis used a t-test and Mann–Whitney test with P < 0.01 taken as statistically significant. Results: The results showed a significant difference in oxygen saturation before and after the injection of buffered and non-buffered anesthetics (P = 0.0002). Delivering the buffered anesthetics were reported to be less painful than non-buffered anesthetics. The oxygen saturation and pulse rate were inversely proportional to the self-reporting of pain in children. Statistical analysis showed no significant difference between oxygen saturation (P = 0.5) and pulse rate (P = 0.4886) in those receiving buffered and non-buffered anesthetics. However, there was a significant difference in the self-reporting of pain between the two groups (P = 0.00000262). Conclusion: Pain parameters could be measured physiologically and psychologically. This research concludes that physiologically, there was no difference in pain parameters, based on oxygen saturation and children’s pulse rate. Psychologically, there was a difference in the self-reporting of pain; 14 children reported that delivering the buffered anesthetic was painless.

운동 종료 후 호흡보조 도수기법 적용이 심장박동회복에 미치는 즉각적인 효과

Purpose: This study was designed to investigate the effects of the application of the manual assistive breathing technique on heart rate recovery.
 Methods: In this study, 20 subjects were randomly assigned and divided into an experimental group and a control group. The experimental group received manual breathing assistance by a therapist immediately upon completion of exercise. In contrast, the control group rested without intervention after exercise. In this study, the heart recovery rate, rate of perceived exertion (RPE), and oxygen saturation were measured.
 Results: The experimental group who used the manual assistive breathing technique showed a significant difference in heart rate recovery and RPE at 30 s compared with the control group. However, no significant difference in oxygen saturation was observed between the two groups. Therefore, the manual assistive breathing technique was effective in heart rate recovery within a short time.
 Conclusion: In conclusion, the manual assistive breathing technique is recommended for subjects who must recover their heart rates quickly.

Developing a new pediatric extracorporeal membrane oxygenation (ECMO) program.

We aimed to critically evaluate the effectiveness of a designated ECMO team in our ECMO selection process and patient outcomes in the first 3years of our low-volume pediatric ECMO program. We conducted a retrospective chart review of patients who received an ECMO consultation between thestart of our program in March 2015 and May 2018. Wegathered clinical and demographic information on patients who did and did not receive ECMO, and described our selection process. We reflected on the processes used to initiate our program and our outcomes in the first 3years. Sixty-nine patients received consultations, and of those, 50 patients were potential candidates. 19 (38%) of the candidates were ultimately placed on ECMO. There were statistically significant differences in oxygen saturation, paO2, oxygenation index, A-aDO2, lactate, and pH between the patients who went on ECMO and who did not. We improved our outcomes from 0% survival to discharge in 2015, to 60% in 2018, with an average of 63% survival to discharge over the first 3years of our program. In a low-volume pediatric ECMO center, having a designated team to assist in the patient selection process and management can help provide safe and efficient care to these patients, and improve patient outcomes. Having a strict management protocol and simulation sessions involving all members of the medical team yields comfort forthe providers and optimal care for patients. This study describes our novel structure, processes, and outcomes, which we hope will be helpful to others seeking to develop a new pediatric ECMO program.

The blunted vascular endothelial growth factor-A (VEGF-A) response to high-altitude hypoxia and genetic variants in the promoter region of the VEGFA gene in Sherpa highlanders.

BackgroundSherpa highlanders demonstrate extraordinary tolerance to hypoxia at high altitudes, which may be achieved by mechanisms promoting microcirculatory blood flow and capillary density at high altitudes for restoring oxygen supply to tissues. Vascular endothelial growth factors (VEGFs) are important signaling proteins involved in vasculogenesis and angiogenesis which are stimulated by hypoxia. We hypothesize that the VEGF-A, the major member of the VEGF family, and the gene encoding VEGF-A (VEGFA) play a part in the adaptation to high-altitude hypoxia in Sherpa highlanders.MethodsFifty-one Sherpa highlanders in Namche Bazaar village at a high altitude of 3,440 meters (m) above sea level and 76 non-Sherpa lowlanders in Kathmandu city at 1,300 m in Nepal were recruited for the study. Venous blood was sampled to obtain plasma and extract DNA from each subject. The plasma VEGF-A concentrations were measured and five single-nucleotide polymorphisms (SNPs, rs699947, rs833061, rs1570360, rs2010963, and rs3025039) in the VEGFA were genotyped. The VEGF-A levels and allelic frequencies of the SNPs were compared between the two populations.ResultsA significant difference in oxygen saturation (SpO2) was observed between the two ethnic groups locating at different elevations (93.7 ± 0.2% in Sherpas at 3,440 m vs. 96.7 ± 0.2% in non-Sherpas at 1,300 m, P < 0.05). The plasma VEGF-A concentration in the Sherpas at high altitude was on the same level as that in the non-Sherpas at low altitude (262.8 ± 17.9 pg/ml vs. 266.8 ± 21.8 pg/ml, P = 0.88). This result suggested that the plasma VEGF-A concentration in Sherpa highlanders was stable despite a high-altitude hypoxic stimulus and that therefore the Sherpas exhibited a phenotype of blunted response to hypoxic stress. Moreover, the allele frequencies of the SNPs rs699947, rs833061, and rs2010963 in the promoter region of the VEGFA were different between the Sherpa highlanders and non-Sherpa lowlanders (corrected P values = 3.30 ×10−5, 4.95 ×10−4, and 1.19 ×10−7, respectively).ConclusionsSherpa highlanders exhibited a blunted VEGF-A response to hypoxia at high altitudes, which was speculated to be associated with the distinctive genetic variations of the SNPs and haplotype in the promoter region of VEGFA in Sherpa highlanders.

Safety and efficacy of pentazocine-midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma.

Background and AimRadiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA.MethodsWe studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined.ResultsThe median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups.ConclusionA combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.

Oxygen Saturation in Primary Teeth of Individuals With Sickle Cell Disease and Sickle Cell Trait.

PurposeTo determine oxygen saturation in the pulp of primary teeth in children with sickle cell disease (SCD) and sickle cell trait (SCT) for establishing the usefulness of pulse oximetry in screening and monitoring of SCD or therapy.Materials and MethodsA cross-sectional study among 30–60 months children with sickle cell disease (SCD) and sickle cell trait (SCT) compared with healthy children (HbAA). A pulse oximeter (BCI 3301) recorded oxygen saturation on six anterior primary maxillary teeth and on index fingers. Data were analyzed using SPSS version 20.0. Mean oxygen saturation for teeth and fingers was calculated. Comparison of Mean across groups was done using post hoc analysis in one-way ANOVA (Bonferroni test). Pearson correlation coefficient was calculated for mean oxygen saturation on fingers and teeth. Level of significance was set at 0.05.ResultsAltogether 360, 102, and 96 teeth were examined from children with SCD, SCT, and HbAA respectively. 53% of participants were girls. The mean age of participants was 46.3 months ± 9.4 SD. Low mean oxygen saturation (77.5%) was recorded from teeth of children with SCD relative to those with SCT and HbAA (>86%; P = 0.00). There was no statistically significant difference in oxygen saturation on teeth between children with SCT and HbAA. The mean oxygen saturation on fingers was found to be above 97.2% regardless of sickle cell status. There was no correlation between oxygen saturation on teeth and fingers.ConclusionPulse oximeter detected a lower oxygen saturation in dental pulp of primary teeth of participants with SCD (HbSS) relative to those with SCT (HbAS) and HbAA. Oxygen saturation on fingers remained unaffected regardless of sickle cell disease status. Although more studies are needed, our study shows that when other conditions affecting peripheral tissue oxygen delivery are ruled out, the low pulse oximetry in primary teeth may be indicative of SCD. The oximeter may also be useful in monitoring response to SCD therapy targeted at improving oxygen carrying capacity and delivery.

Effects of semi-upright swings on vital signs in NICU infants.

The aim of this study was to compare the impact of a semi-upright swing with a standard crib on vital signs in infants in the neonatal intensive care unit (NICU). We performed a within-subjects' comparison of vital signs of NICU infants corrected to ≥34 weeks of gestation and placed in the supine position versus the semi-upright position in a swing. The primary outcome was the mean oxygen saturation, and the secondary outcomes were the mean heart rate, the proportion of time with oxygen saturation (SpO2) <90%, and respiratory rate. Of the 65 infants, 34 (57%) were male and 32 (50%) were black. The mean ± SD gestational age at birth was 32.4 ± 5.1 weeks. In all, 40% were on noninvasive respiratory support. There were no significant differences in oxygen saturation, heart rate, time with oxygen desaturation defined by SpO2 < 90%, or respiratory rate between the supine and semi-upright positions. A higher risk of desaturations was observed in infants without respiratory support (RR, 1.24, 95% CI, 1.15-1.33) and low-birth-weight infants (RR, 1.55, 95% CI, 1.42-1.69). The placement of infants in a semi-upright swing resulted in no discernible differences in averaged vital signs compared to the supine position in NICU infants. We identified no significant differences in averaged oxygen saturation, heart rate, or respiratory rate among NICU infants placed in a semi-upright swing compared to the supine position. Desaturation events occurred at a higher frequency in low-birth-weight infants and those on room air when placed in the swing, although none required oxygen supplementation. The results from the current study support that it is probably safe to use semi-upright swings in the NICU environment, although additional studies are necessary for generalization to the unmonitored home environment.

The effect of virtual reality on pain, anxiety, and fear during burn dressing in children: A randomized controlled study

Aim and objectivesVirtual Reality (VR) can be used during painful procedures in children. This research was conducted to determine the effect of VR on the pain, anxiety, and fear levels experienced by patients during burn dressing. MethodsA randomized between groups study design was used to test whether VR reduced pain, fear, and anxiety during burn wound cleaning. The experimental (VR group) (n = 33) and the control group (n = 32) were determined using the simple randomization method for the children participating in the study (n = 65). The data were collected using the Wong–Baker FACES Pain Rating Scale, Children’s Fear Scale, and State- Trait Anxiety Inventory for Children. In addition, oxygen saturation and heart rate measurements were recorded before and after the procedure. ResultsUsing a between groups t-test, burn injured children in the group that received virtual reality (M = 2.6, SD = 1.9, SE= 0.21) showed significantly less pain intensity during burn wound care than the No VR control group (M = 4.2, SD =1.0, SE= 0.19, t = −5.89, p < 0.005). Similarly, the VR group reported significantly lower fear during wound care (M= 2.24, SD = 1.1, SE=0.19) than the No VR control group (M=3.72, SD = 0.6, SE=0.10, t = 6.70, p < 0.005), and on a scale from 0 to 100, patients in the VR group showed significantly less anxiety (36.46, SD = 8.1, SE=1.40) than patients in the No VR group (M= 53.16, SD = 7.4, SE=1.35, t = 8.52, p < 0.005). Heart rate during wound care was significantly lower in the VR group (M=119.60, SD = 8.1, SE=1.40) than in the No VR control group (M=129.56, SD = 10.64, SE=1.88, t = −4.25, p < 0.005). However, no significant difference in Oxygen saturation was found, (VR = 97.03, SD = 0.90, SE= 0.17, vs. No VR = 96.94, SD = 0.29, SE=0.23, t = 0.326, p > 0.05). ConclusionsVR is an effective method in reducing pain, fear, and anxiety caused by burn dressing in children aged 7–12. The use of VR during burn dressing was determined to have positive results on some physical and psychological parameters.

Correlation between retinal oxygen saturation and the haemodynamic parameters of the ophthalmic artery in healthy subjects.

The aim of the study was to obtain the values of oxygen saturation in retinal vessels and ophthalmic blood flow parameters in a healthy Caucasian population and assess whether the oximetry parameters are affected by the flow rate or the vascular resistance. The spectrophotometric retinal oximetry and colour Doppler imaging (CDI) of retinal vessels were successfully performed with 52 healthy subjects (average age 29.7 ± 5.6 years). The retinal oximeter simultaneously measures the wavelength difference of haemoglobin oxygen saturation in retinal arterioles and venules. The arteriolar and venular saturation in both eyes was measured. The peak systolic (PSV) end diastolic (EDV) velocities, resistive (RI) and pulsatility (PI) indices were obtained for both eyes using CDI in the ophthalmic artery. A paired t-test and two sample t-tests were used for statistical analyses. The correlation was assessed using the Pearson coefficient correlation. The mean oxygen saturation level was 96.9 ± 3.0% for the retinal arterioles and 65.0 ± 5.1% for the retinal venules. The A-V difference was 31.8 ± 4.6%. The mean of the measured haemodynamic parameters was PSV 46.6 ± 9.4 cm/s, EDV 12.0 ± 3.5 cm/s, PI 1.68 ± 0.38 and RI 0.74 ± 0.05. No significant difference in oxygen saturation and haemodynamic parameters was found between the left and the right eyes or the dominant and non-dominant eye. The oximetry and ultrasound values were sex independent. The Pearson correlation coefficient demonstrated a significant yet weak negative correlation between A-V difference and RI (r = -0.321, p = 0.020). A negative correlation between A-V difference and resistance index was observed, suggesting that reduced oxygen consumption may reflect the increased vascular tone of the ophthalmic vessels, which is likely determined by autoregulatory mechanisms.

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

ObjectiveThe present study is designed to study the analgesic and sedative effect of different doses of dexmedetomidine combined with butorphanol in continuous analgesia after a cesarean section.MethodsA total of 60 puerperae undergoing a cesarean section recruited from a single center were divided into three groups according to the postoperative continuous analgesia protocol: control group (100 mL of normal saline containing 10 µg/kg fentanyl and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), DB1 group (100 mL of normal saline containing 1.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), and DB2 group (100 mL normal saline containing 2.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h). We compared the blood pressure, heart rate, oxygen saturation, VAS score, Ramsay score, and adverse reactions of puerperae among the three groups after surgery.ResultsThe baseline data all have no significant difference in the three groups (p > 0.05). Compared with those in the control group, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB1 group and DB2 group were significantly decreased at 6, 24, and 48 h (P < 0.05), while the Ramsay scores of the puerperae in DB1 group and DB2 group were significantly increased at 6, 24, and 48 h (p < 0.05). At the same time, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB2 group were significantly lower than those in the DB1 group (P < 0.05), while the Ramsay scores of the puerperae in DB2 group were significantly higher than those in the DB1 group (P < 0.05). Also, there is no significant difference in oxygen saturation and adverse reactions of puerperae among the three groups after surgery (p > 0.05).ConclusionDexmedetomidine combined with butorphanol can improve the analgesic and sedative effects in continuous analgesia after a cesarean section, and the analgesic and sedative effects of dexmedetomidine in the high-dose group are better than those in the low-dose group.

The effect of sensory stimulation on apnea of prematurity

ObjectivesThe study aims to assess the effect of sensory stimulation on apnoea among premature newborns. MethodsThirty preterm newborns that were diagnosed with apnoea of prematurity, had a gestational age between 32 and 34 weeks, had low birth weight, and were appropriate for gestational age from 1200 to 2000 g were included in this prospective randomized study. Subjects were divided into two equivalent groups: a control group that received the standard care including nasal oxygen (one litre per minute) and caffeine citrate, and a study group that received the same care plus sensory stimulation (tactile, proprioceptive, and kinaesthetic). Participants’ heart rate, oxygen saturation, and apnoea frequency were measured by the neonatal intensive care unit team using a pulse-oximeter. The sensory stimulation sessions were 10 min, 3 times per day, totalling 30 min over a 7 day period. ResultsThere was a significant decrease in heart rate within both groups after receiving treatment from before treatment (p < 0.05), with no significant differences between the two groups. Furthermore, there was no significant difference in oxygen saturation within the groups after treatment compared with the levels before treatment, with no significant differences between the two groups (p > 0.05). Before treatment, there was a non-significant difference in the apnoea rate between both groups (p = 0.464), whereas there was a significant decrease in the apnoea rate of the study group after treatment compared with the control group (p = 0.031). ConclusionSensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.

Patient satisfaction with deep versus light/moderate sedation for non-surgical procedures: A systematic review and meta-analysis.

Background:Deep sedation relieves a patient's anxiety and stress during the procedure by inducing patient unconsciousness. However, it remains unclear whether deep sedation actually improves patient satisfaction with the procedure. Therefore, we performed a systematic review and meta-analysis to compare the satisfaction of patients undergoing deep sedation with that of those undergoing light/moderate sedation during non-surgical procedures.Methods:A comprehensive literature search was performed using electronic databases (search until September 2020). The primary outcome was whether patient satisfaction was higher after deep sedation or light/moderate sedation. The secondary outcome was the relative safety of deep sedation compared with light/moderate sedation in terms of oxygen saturation, systolic blood pressure, and heart rate. The tertiary outcomes were the relative procedure and recovery times for deep versus light/moderate sedation.Data from each of the trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for patient satisfaction were evaluated using relative risk (RR) with the 95% confidence interval (CI). The pooled effect estimates for continuous data are expressed as weighted mean difference with the 95% CI. We assessed heterogeneity with the Cochrane Q statistic and the I2 statistic. The risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation approach were used as the quality assessment method.Results:After removing unrelated studies and applying the exclusion criterion, 5 articles satisfied the inclusion criteria. Patient satisfaction was significantly higher in those who received deep sedation compared with light/moderate sedation (relative risk = 1.12; 95% CI, 1.04–1.20; P = .003; Cochrane Q = 25.0; I2 = 76%).There was no significant difference in oxygen saturation, systolic blood pressure, heart rate, and procedure times according to whether the procedures were performed under deep or light/moderate sedation. However, the recovery time was significantly prolonged in patients under deep sedation.Conclusions:Our meta-analysis suggests that deep sedation resulted in improved patient satisfaction compared with light/moderate sedation. Deep sedation is recommended for patients undergoing procedures because it improves patient satisfaction. However, respiration and circulation should be carefully monitored both intra-operatively and postoperatively.

Right lateral position can improving oxygen saturation and respiratory rate on under-five children with pneumonia.

Pediatric patients with pneumonia experience respiratory distress in the form of shortness of breath and rapid breathing, which affects oxygen saturation. Oxygen saturation and respiratory rate can be increased by providing the right lateral position. Fulfillment of oxygen will affect the healing of children and can reduce the length of stay in hospital. The purpose of this study was to identify the effect of right lateral positioning on oxygen saturation and respiratory rate in under-five children with pneumonia. The study design was a quasi-experimental pre-posttest with control group design. Respondents were 32 infants with pneumonia, (right lateral=16 and control group=16), selected by consecutive sampling. Univariate and bivariate analyzes were performed. There was a significant difference in oxygen saturation before and after right lateral position (p-value=0.000) and there was a significant difference in the respiratory rate before and after right lateral position (p-value=0.000). The results can be used to improve health services by promoting the right lateral position as a selftreatment intervention for increasing oxygen saturation and stabilizing respiratory rate in infants with pneumonia.

Feasibility of using a non-sedation protocol for evaluation of neonatal congenital heart disease by using a 16-cm wide-detector computed tomography with a low radiation dose: preliminary experience from a single pediatric medical center.

The aim of this study is to explore the feasibility of using a non-sedation protocol for the evaluation of neonatal congenital heart disease by using 16-cm wide-detector CT with a low radiation dose. Thirty-four neonates (group 1) were enrolled to undergo cardiac CT without sedation between August 2018 and March 2019. The control group (group 2) comprising 20 inpatient neonates was sedated. Cardiac CT was performed using 16-cm area detector 320-row CT with free breathing and prospective ECG-triggering scan mode. The examination completion time, radiation dose, and image quality were compared between the groups. The results of cardiac CT for patients in group 1 who underwent surgery were compared with surgical findings. Intergroup differences in body weight, age, examination completion time, radiation dose, and image quality evaluation were not significant. There was no significant difference in oxygen saturation before and after the examination in group 1. In all, 98 separate cardiovascular abnormalities in 27 group 1 patients were confirmed using surgical reports. The overall sensitivity, specificity, positive predictive value, and negative predictive value of cardiac CT were 94.90%, 100.0%, 100.0%, and 98.53%. The non-sedation protocol can be applied in neonates with congenital heart disease by using 16-cm wide-detector CT with a low radiation dose. Based on the image quality obtained, non-sedative examination did not extend the examination completion time and helped avoid the possible side effects of sedative drugs.