Edomwonyi N P, Ekwere I T, Egbekun R, Eluwa B
Department of Anaesthesia, University of Benin Teaching Hospital, Edo State, Nigeria.
Middle East J Anaesthesiol. 2006 Jun;18(5):915-27.
Careful preoperative assessment and adequate planning of an appropriate anesthetic are the cornerstones safe pediatric anesthetic practice. A prospective study was carried out in pediatric surgical patients to identify and quantitate both intra-operative and post anesthesia recovery room complications, management and outcome.
Two hundred and seventy children, aged day 1-16 years who had surgery over twelve months period were recruited in the study. There were 151 males (56%) and 119 females (44%). There were 15 neonates (5.5%), 69 infants below 1 year (25%), 99 (36.7%) toddlers and younger children (1-5 years); older children >5 years were 87 (32.2%). Anesthetists managing the patients were free to use drugs and technique they considered appropriate for each patient. A standardized form was used to collect patient's details, type of surgery, technique of anesthesia, duration of anesthesia and surgery. The incidence of intra-operative and post-anesthesia recovery room complications was determined.
Twenty five intraoperative complications were recorded in 14 (5.1%) patients while forty postoperative complications were recorded in 25 (9.25%) patients. The incidence of intraoperative complications was 9.3% while that of postoperative complications was 14.8%. There were no statistically significant differences. P = 0.0635, Odds ratio = 0.5867, 95% CI: 0.3449 - 0.9981. Intraoperative adverse events were mainly cardiovascular and respiratory. After cardiovascular complication, pain was the second commonest postoperative complication observed in the recovery room. Occurrence of complication was not related to ASA physical status but the outcome of management of complications was directly related to ASA status. Three preterm infants weighing 1.6 kg, 1.9 kg and 2 kg respectively were transferred to Intensive Care Unit for ventilatory support. Neonates and infants < below 12 months old had the highest rate of adverse events both intraoperatively and in the postanesthesia recovery room. There were two cases of cardiac arrest. Mortality rate was 0.34%.
Preterm infants are more prone to developing respiratory complications. Anesthesia-related morbidity and mortality can either be minimized or avoided with early identification and prompt management of any complication.
术前仔细评估并合理规划合适的麻醉方案是小儿麻醉安全实施的基石。一项前瞻性研究在小儿外科手术患者中开展，以识别和量化术中及麻醉后恢复室的并发症、处理情况及结局。
招募了270名年龄在1天至16岁之间、在12个月内接受手术的儿童。其中男性151名（56%），女性119名（44%）。有15名新生儿（5.5%），69名1岁以下婴儿（25%），99名（36.7%）学步儿童及幼儿（1至5岁）；5岁以上大龄儿童有87名（32.2%）。负责管理患者的麻醉医生可自由使用他们认为适合每位患者的药物和技术。使用标准化表格收集患者详细信息、手术类型、麻醉技术、麻醉及手术持续时间。确定术中及麻醉后恢复室并发症的发生率。
14名（5.1%）患者记录了25例术中并发症，25名（9.25%）患者记录了40例术后并发症。术中并发症发生率为9.3%，术后并发症发生率为14.8%。两者无统计学显著差异。P = 0.0635，比值比 = 0.5867，95%可信区间：0.3449 - 0.9981。术中不良事件主要为心血管和呼吸系统事件。心血管并发症之后，疼痛是在恢复室观察到的第二常见术后并发症。并发症的发生与美国麻醉医师协会（ASA）身体状况无关，但并发症的处理结果与ASA状况直接相关。3名分别重1.6千克、1.9千克和2千克的早产儿被转至重症监护病房接受通气支持。12个月以下的新生儿和婴儿在术中及麻醉后恢复室的不良事件发生率最高。有2例心脏骤停。死亡率为0.34%。
早产儿更容易发生呼吸系统并发症。通过早期识别并及时处理任何并发症，可将麻醉相关的发病率和死亡率降至最低或避免。
