Patel R I, Hannallah R S, Norden J, Casey W F, Verghese S T
Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010.
Anesth Analg. 1991 Sep;73(3):266-70.
We compared the differences in oxygen saturation and airway-related complications after tracheal extubation in pediatric patients undergoing elective strabismus surgery or adenoidectomy and/or tonsillectomy who were awake versus anesthetized. Seventy otherwise healthy patients between 2 and 8 yr of age were studied. Anesthesia was induced with halothane or thiamylal and maintained with nitrous oxide and halothane. After induction of anesthesia, the patients were randomly assigned to group 1 (awake extubation) or group 2 (anesthetized extubation). Oxygen saturation was measured continuously and recorded 10 min before extubation and at 1, 2, 3, 5, 7, 10, 15, 20, 25, and 30 min after tracheal extubation. Supplemental oxygen was administered when oxygen saturation values were less than 90% while breathing room air. Oxygen saturation levels were higher in group 2 than in group 1 at 1, 2, 3, and 5 min after extubation. There were no differences between the two groups in the number of patients requiring supplemental oxygen. The incidence of airway-related complications such as laryngospasm, croup, sore throat, excessive coughing, and arrhythmias was not different between the two groups. We conclude that the anesthesiologist's preference or surgical requirements may dictate the choice of extubation technique in otherwise healthy children undergoing elective surgery.
我们比较了接受择期斜视手术或腺样体切除术和/或扁桃体切除术的小儿患者在清醒与麻醉状态下气管拔管后氧饱和度及气道相关并发症的差异。研究了70例年龄在2至8岁之间的健康患儿。采用氟烷或硫喷妥钠诱导麻醉，并用氧化亚氮和氟烷维持麻醉。麻醉诱导后，将患者随机分为1组（清醒拔管）或2组（麻醉拔管）。在气管拔管前10分钟以及拔管后1、2、3、5、7、10、15、20、25和30分钟连续测量并记录氧饱和度。当呼吸室内空气时氧饱和度值低于90%时给予补充氧气。拔管后1、2、3和5分钟时，2组的氧饱和度水平高于1组。两组中需要补充氧气的患者数量没有差异。两组之间气道相关并发症如喉痉挛、哮吼、咽痛、过度咳嗽和心律失常的发生率没有差异。我们得出结论，对于接受择期手术的健康儿童，麻醉医生的偏好或手术要求可能决定拔管技术的选择。
