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[喉、气管和支气管肿瘤内镜手术中的全身麻醉与肺通气]

[General anesthesia and ventilation of the lungs in endoscopic surgery of tumors of the larynx, trachea and bronchi].

作者信息

Torchinskiĭ L G, Osipova N A, Vetsheva M S, Sokolov V V, Zhelezkina N V, Ivanova L M

出版信息

Anesteziol Reanimatol. 2001 Sep-Oct(5):22-6.

Abstract

Clinical study was carried out during 116 total anesthesias for endoscopic operations on the larynx, trachea, and bronchi. Multicomponent total anesthesia was based on fentanyl, calypsol, diprivane, and dormicum microdoses in combination with local lidocaine anesthesia of the airways and premedication with nonsteroid antiinflammatory drugs. Interventions on the larynx and proximal part of the trachea were carried out with the patients' spontaneous respiration retained; during interventions on the middle part of the trachea, forced ventilation of the lungs (FVL) was carried out through an intubation bronchoscope; and during total anesthesia for operations on the tracheal bifurcation, high-frequency FVL of the intact lung was carried out. Stable hemodynamics and gas exchange, hypercapnia, and moderate respiratory acidosis were observed in patients operated on under both types of FVL. No serious complications during and immediately after surgery and anesthesia were observed. Hence, the choice of the method of total anesthesia and ventilation of the lungs in endoscopic interventions on the airways depends on the level of lesions and degree of airway obstruction.

摘要

对116例喉、气管和支气管内镜手术进行了全身麻醉的临床研究。多成分全身麻醉以芬太尼、卡立普索、丙泊酚和咪达唑仑微量剂量为基础,联合气道局部利多卡因麻醉和非甾体抗炎药术前用药。对喉和气管近端进行干预时保留患者自主呼吸;对气管中部进行干预时,通过插管支气管镜进行肺强制通气(FVL);在气管分叉手术的全身麻醉期间,对健侧肺进行高频FVL。在两种FVL方式下接受手术的患者均观察到稳定的血流动力学和气体交换、高碳酸血症和中度呼吸性酸中毒。手术和麻醉期间及术后即刻均未观察到严重并发症。因此,气道内镜干预中全身麻醉和肺通气方法的选择取决于病变部位和气道阻塞程度。

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