Setzer Nancy, Saade Edouard
Driscoll Children's Hospital, Department of Anesthesiology, University of Texas, Medical Branch Galveston Corpus Christi, TX, USA.
Paediatr Anaesth. 2007 Apr;17(4):321-6. doi: 10.1111/j.1460-9592.2006.02128.x.
Obesity is present in a significant proportion of children presenting for anesthesia. Although it is perceived that obese adults have more frequent complications, the incidence of complications in obese children is unknown. Because of anticipated difficulties with mask ventilation, anesthesia is most frequently induced intravenously in obese adults, whereas inhalation induction is usually preferred in uncooperative children with few visible veins. The purpose of this study was to examine and compare anesthetic related complications in obese children undergoing dental surgery with a similar group of nonobese individuals.
The charts of 1133 American Society of Anesthesiology (ASA) physical status I and II children less than 12 years old who underwent general anesthesia for dental outpatient procedures in 2003 were retrospectively examined for patient height, weight, preoperative evaluation, anesthetic course and postoperative course. Body mass index was calculated and compared with international normative data to identify those children who were obese. Method of induction and perioperative complications were noted.
A total of 100 obese and 1033 nonobese children were identified. Demographically the two groups were comparable. Inhalation induction was used in the vast majority of obese (99%) and nonobese (99.7%) patients. Overall complication rate was low. Minor respiratory complications were more frequently noted in the obese group. These consisted primarily of a higher incidence of intraoperative oxygen desaturation (2% vs 0.19%) and higher requirements for unexpected overnight hospitalization (2% vs 0.19%). The only complication related directly to inhalation induction was noted in a nonobese child who vomited and aspirated on induction.
Our study demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia. Inhalation induction was not associated with an increase in adverse events in this population.
在接受麻醉的儿童中，相当一部分存在肥胖问题。尽管人们认为肥胖成人并发症更常见，但肥胖儿童的并发症发生率尚不清楚。由于预计面罩通气会有困难，肥胖成人麻醉诱导最常采用静脉注射，而对于静脉不易看见且不合作的儿童，通常首选吸入诱导。本研究的目的是检查和比较接受牙科手术的肥胖儿童与一组类似的非肥胖个体的麻醉相关并发症。
回顾性检查2003年接受牙科门诊全身麻醉的1133名12岁以下美国麻醉医师协会（ASA）身体状况为I级和II级儿童的病历，了解患者的身高、体重、术前评估、麻醉过程和术后过程。计算体重指数并与国际标准数据进行比较，以确定肥胖儿童。记录诱导方法和围手术期并发症。
共确定了100名肥胖儿童和1033名非肥胖儿童。两组在人口统计学上具有可比性。绝大多数肥胖（99%）和非肥胖（99.7%）患者采用吸入诱导。总体并发症发生率较低。肥胖组更常出现轻微呼吸系统并发症。主要包括术中氧饱和度下降发生率较高（2%对0.19%）以及意外过夜住院需求较高（2%对0.19%）。唯一与吸入诱导直接相关的并发症发生在一名非肥胖儿童身上，该儿童在诱导时呕吐并误吸。
我们的研究表明，接受麻醉的肥胖儿童轻微呼吸系统并发症略有增加。吸入诱导在该人群中并未增加不良事件的发生。
