Berger T M, Stocker M
Neonatologische und pädiatrische Intensivpflegestation, Kinderspital Luzern, Schweiz.
Anaesthesist. 2004 Aug;53(8):690-701. doi: 10.1007/s00101-004-0708-y.
Anaesthesiologists must be familiar with the particularities of the respiratory physiology of newborns and infants when providing perioperative care to these patients. Even brief periods of inadequate respiratory support can cause atelectatrauma and volutrauma which in turn can have deleterious cardiorespiratory consequences and accentuate pre-existing lung disease. A variety of respirators and respiratory support strategies are available and should be selected to meet a patient's particular needs. Optimal PEEP and normal tidal volumes during conventional ventilation, high volume strategy during high frequency ventilation, and permissive hypercapnia are the corner stones of a lung protective strategy. Using an interdisciplinary approach, surgery in the intensive care unit using total intravenous anaesthesia with the uninterrupted use of the ICU equipment is an attractive option for the most vulnerable patients in this age group.
麻醉医生在为新生儿和婴儿提供围手术期护理时,必须熟悉这些患者呼吸生理学的特殊性。即使是短暂的呼吸支持不足也可能导致肺不张创伤和容积伤,进而产生有害的心肺后果,并加重已有的肺部疾病。有多种呼吸机和呼吸支持策略可供选择,应根据患者的具体需求进行选择。传统通气时的最佳呼气末正压(PEEP)和正常潮气量、高频通气时的高容量策略以及允许性高碳酸血症是肺保护策略的基石。采用跨学科方法,在重症监护病房进行手术,使用全静脉麻醉并持续使用重症监护病房设备,对于该年龄组中最脆弱的患者来说是一个有吸引力的选择。