ABSTRACT. The current study was performed to investigate the effects of midazolam on immune function in pediatric patients after surgery and possible mechanism involved. Patients who needed sedation for more than 2 consecutive days after undergoing surgery in the Pediatric Surgery Department of our hospital were enrolled for the study. Fiftysix patients (5-14 years old) were randomly divided into midazolam and propofol treatment groups (N = 28 each in each group). Pediatric patients received midazolam or profolol via continuous intravenous administration, and their plasma cytokine levels were compared after 48 h. Cultured rat C6 brain glioma cells were pretreated with a range of concentrations of midazolam or propofol for 60 minutes prior to incubation with 10 ng/mL IL-1β in serum-free medium or vehicle for 36 h. IL-6 concentration was subsequently measured using ELISA. In comparison with levels measured before the infusion of midazolam for 48 h, concentrations of all cytokines decreased, with the differences in IL-1β, IL-8, and TNF-α concentrations reaching significance (all P < H.B. Lu et al. 10008©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (3): 10007-10014 (2015) 0.05). Midazolam significantly suppressed the IL-1β-induced release of IL-6 in rat C6 glioma cells. This inhibition was concentration-dependent between 0.3 and 3 μM, with 3 μM concentration of midazolam decreasing the IL-1β-induced release of IL-6 by 43.58%. Midazolam can significantly inhibit the release of cytokines in pediatric patients after surgery. One of the mechanisms may be the inhibition of IL-1β-induced release of IL-6 in the central nervous system.

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BACKGROUND Epiglottic cysts is a rare but potentially lethal supraglottic airway pathology in infants due to the high risk of cannot intubation or cannot ventilation. Awake fiberoptic intubation appeared to be the safest technique, but it is very challenging in infants with large epiglottic cysts. Even it has the risk of airway loss. We report that cyst aspiration is an effective treatment as the first-choice procedure for airway management in an infant with large epiglottic cysts. CASE SUMMARY A 46-day-old male infant weighing 2.3 kg presented to the emergency room with difficulty feeding, worsening stridor, and progressive respiratory distress. Epiglottic cysts was diagnosed, but fibro bronchoscopy examination failed, as the fiberoptic bronchoscope was unable to cross the epiglottic cysts to the trachea. The infant was transferred to the operating room for emergency cystectomy under general anesthesia. Spontaneous respiration was maintained during anesthesia induction, and cyst aspiration was performed as the first procedure for airway management under video laryngoscopy considering that the preoperative fibro bronchoscopy examination failed. Then, the endotracheal tube was intubated successfully. Cystectomy was performed uneventfully, and the infant was safely transferred to the intensive care unit after surgery. The infant was extubated smoothly on the third postoperative day and discharged on the eighth day after surgery. On follow-up 1 year after the surgery, a normal airway was found by fibro bronchoscopy examination. CONCLUSION Epiglottic cyst aspiration can be considered the first procedure for airway management in infants with large epiglottic cysts.

IntroductionCardiopulmonary resuscitation (CPR) is the most critical procedure in the rescue of patients with sudden cardiac death (SCD). The success rate of CPR remains far below expectations, which made CPR education identified as the top priority for SCD. CPR training using the virtual reality (VR) technique is a feasible training method, with a wider population and lower cost, but its efficacy remains controversial. Thus, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of the VR technique on CPR quality.Methods and analysisWe will search PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases from inception to November 2021, to identify randomised controlled trials and the first period in randomised cross-over trials assessing the efficacy of VR techniques versus non-VR techniques for adult participants accepting adult CPR training. No language restrictions will be considered. Data synthesis will be performed using RevMan V.5.4 and Stata/MP V.16.0. Outcome measures will be present as relative risk with 95% CIs for dichotomous data and mean difference with 95% CIs for continuous data. The primary outcome will be the CPR quality defined as chest compression rate and depth. Secondary outcomes will be the overall performance of CPR. Heterogeneity will be assessed by the χ2 test and I2 statistic. Data will be synthesised by either fixed-effects or random-effects models according to the I2 value. Trial sequential analysis and modified Jadad Scale will be used to control the risks of random errors and evaluate the evidence quality. Egger’s regression test and funnel plots will be used to assess the publication bias.Ethics and disseminationEthical approval was not required for this systematic review protocol. The findings will be disseminated through peer-reviewed publications.PROSPERO registration numberCRD42021281059.