Burrows F A, Taylor R H, Hillier S C
Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
Can J Anaesth. 1992 Dec;39(10):1041-4. doi: 10.1007/BF03008372.
To investigate the role of anaesthetic management in early extubation of the trachea in children after closure of a secundum-type atrial septal defect (ASD II), a retrospective chart review for a two-year period was performed. We identified 36 children who underwent surgical repair of an isolated ASD II. In 19 children (53%) the tracheas were extubated in the operating room immediately after surgery and in 17 patients (47%) the tracheas remained intubated and the lungs were ventilated in the Intensive Care Unit. There was no difference in age (69.5 +/- 33.8 vs 72.9 +/- 45.0 mo) or weight (19.5 +/- 8.1 versus 20.5 +/- 12.7 kg) between the two groups (mean +/- SD). Children in the extubated group had a shorter duration of cardiopulmonary bypass (43.4 +/- 7.8 min) than those remaining intubated (31.7 +/- 12.7 min) (P < 0.05). The children whose tracheas were extubated early received a lower perioperative fentanyl dose (5.9 +/- 6.4 micrograms.kg-1) than those remaining intubated (35.1 +/- 8.5 micrograms.kg-1). Those children in the extubated group had a lower hourly requirement for morphine by infusion (13.6 +/- 5.7 vs 18.2 +/- 5.4 micrograms.kg-1.hr-1) and a shorter stay (20.5 +/- 3.7 versus 29.0 +/- 11.2 hr) in the Intensive Care Unit. Re-intubation of the trachea was not required in any of the children and no deaths occurred. Early extubation after ASD II repair is safe and, given the results of this study, may offer certain advantages over prolonged intubation and ventilation in these children.
为了研究麻醉管理在继发孔型房间隔缺损（ASD II）修补术后儿童早期气管拔管中的作用，我们进行了一项为期两年的回顾性病历审查。我们确定了36例接受单纯ASD II手术修补的儿童。19例儿童（53%）术后在手术室立即拔管，17例患者（47%）气管仍保留插管，在重症监护病房进行肺通气。两组在年龄（69.5±33.8 vs 72.9±45.0个月）或体重（19.5±8.1 vs 20.5±12.7千克）方面无差异（平均值±标准差）。拔管组儿童的体外循环时间（43.4±7.8分钟）比仍保留插管的儿童（31.7±12.7分钟）短（P<0.05）。早期拔管的儿童围手术期芬太尼剂量（5.9±6.4微克·千克⁻¹）低于仍保留插管的儿童（35.1±8.5微克·千克⁻¹）。拔管组儿童每小时吗啡输注需求量较低（13.6±5.7 vs 18.2±5.4微克·千克⁻¹·小时⁻¹），在重症监护病房的住院时间较短（20.5±3.7 vs 29.0±11.2小时）。所有儿童均无需再次气管插管，也未发生死亡。ASD II修补术后早期拔管是安全的，根据本研究结果，与这些儿童延长插管和通气相比可能具有某些优势。
