Lonnqvist Per-Arne, Morton Neil S
Department of Anaesthesia, Astrid Lindgrens Children's Hospital, Stockholm, Sweden.
Curr Opin Anaesthesiol. 2006 Dec;19(6):617-21. doi: 10.1097/ACO.0b013e3280101dab.
More surgery on children is being carried out on a day-case basis and we review the anaesthetic management. Selection of appropriate patients and procedures is vital and careful preparation of children and families minimizes fear and anxiety and streamlines the organizational aspects of care. Simple, noninvasive general-anaesthetic techniques with modern agents are recommended. Good analgesia is important and is based upon local or regional blockade, nonsteroidal antiinflammatory drugs and paracetamol, with opioids being reserved for rescue analgesia. Omission of opioids helps to minimize postoperative emesis. Discharge home is facilitated by clear instructions about activities, dressings, wound care and continuing pain control.
Oral clonidine premedication, new, safer local anaesthetic agents, ultrasound guidance for blocks and prolongation of single-injection caudal blocks with clonidine or ketamine are recent developments. Guidelines for safe sedation and analgesia for procedures are available. Behavioural and cognitive changes can be seen in children after anaesthesia and surgery and parents should be informed of this possibility.
Children benefit particularly from day care and recent advances in anaesthesia and pain management have allowed a huge expansion of this modality of care with a consequent reduction in the need for children to be in hospital.
越来越多的儿童手术在日间进行，我们对其麻醉管理进行综述。选择合适的患儿和手术方式至关重要，对儿童及其家庭进行精心准备可将恐惧和焦虑降至最低，并简化护理的组织工作。推荐使用简单、无创的全身麻醉技术及现代麻醉药物。良好的镇痛很重要，应以局部或区域阻滞、非甾体类抗炎药和对乙酰氨基酚为基础，阿片类药物仅用于补救镇痛。避免使用阿片类药物有助于减少术后呕吐。关于活动、敷料、伤口护理和持续疼痛控制的明确指示有助于患儿出院回家。
口服可乐定进行术前用药、新型更安全的局部麻醉药、超声引导下阻滞以及用可乐定或氯胺酮延长单次注射骶管阻滞是最近的进展。有手术安全镇静和镇痛的指南。麻醉和手术后儿童可能会出现行为和认知改变，应告知家长这种可能性。
儿童尤其受益于日间护理，麻醉和疼痛管理方面的最新进展使这种护理模式得到了极大扩展，从而减少了儿童住院的需求。
