Anghelescu Doralina L, Burgoyne Laura L, Liu Tiebin, Li Chin-Shang, Pui Ching-Hon, Hudson Melissa M, Furman Wayne L, Sandlund John T
Division of Anesthesiology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
Paediatr Anaesth. 2007 Nov;17(11):1090-8. doi: 10.1111/j.1460-9592.2007.02279.x.
The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications.
We conducted a retrospective review of 118 pediatric patients who presented with mediastinal masses. We investigated their medical records for clinical symptoms and signs at presentation and reviewed their chest radiographs, computed tomography scans, and echocardiograms and electrocardiograms when available. We then conducted analyses to identify clinical and diagnostic imaging features associated with anesthesia-related complications.
Eleven of 117 [9.4%, 95% confidence interval (CI) 4.1-14.7%] patients experienced an anesthesia-related complication. Four preoperative features were significantly associated with anesthetic complications: orthopnea (P = 0.033, odds ratio (OR) 5.31, 95% CI, 1.15-24.56), upper body edema (P = 0.035, OR 8.00, 95% CI, 1.16-55.07), great vessel compression (P = 0.037, OR 5.41, 95% CI, 1.11-26.49), and main-stem bronchus compression (P = 0.044, OR 5.11, 95% CI, 1.05-24.92). The presence of pleural effusion (P = 0.060, OR 4.53, 95% CI, 0.94-21.96) or tracheal compression (P = 0.061, OR 5.09, 95% CI, 0.93-27.81) also appeared to be risk factors. Although the rate of anesthesia-related complications detected in our cohort was comparable with that found in earlier studies, the events were less severe.
Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.
儿童纵隔肿物的存在会带来包括死亡在内的重大麻醉相关风险。为优化治疗结果，临床医生必须能够预测哪些患者发生麻醉并发症的风险最高。
我们对118例患有纵隔肿物的儿科患者进行了回顾性研究。我们调查了他们就诊时的临床症状和体征，并在有条件时查看了他们的胸部X光片、计算机断层扫描、超声心动图和心电图。然后我们进行分析，以确定与麻醉相关并发症相关的临床和诊断影像学特征。
117例患者中有11例（9.4%，95%置信区间[CI]4.1 - 14.7%）发生了麻醉相关并发症。四个术前特征与麻醉并发症显著相关：端坐呼吸（P = 0.033，优势比[OR]5.31，95%CI，1.15 - 24.56）、上身水肿（P = 0.035，OR 8.00，95%CI，1.16 - 55.07）、大血管受压（P = 0.037，OR 5.41，95%CI，1.11 - 26.49）和主支气管受压（P = 0.044，OR 5.11，95%CI，1.05 - 24.92）。胸腔积液（P = 0.060，OR 4.53，95%CI，0.94 - 21.96）或气管受压（P = 0.061，OR 5.09，95%CI，0.93 - 27.81）的存在似乎也是危险因素。虽然我们队列中检测到的麻醉相关并发症发生率与早期研究中的相当，但这些事件的严重程度较低。
出现端坐呼吸、上身水肿、大血管受压和主支气管受压的患者有发生麻醉相关并发症的风险。我们系列中并发症的低严重程度可能反映了多种因素的综合作用：使用侵入性最小的方法（如介入放射学）获取组织进行诊断、完成全面的术前评估以及最小化麻醉干预。
