Malherbe Stephan, Whyte Simon, Singh Permendra, Amari Erica, King Ashlee, Ansermino J Mark
Department of Anesthesia, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada.
Paediatr Anaesth. 2010 May;20(5):434-8. doi: 10.1111/j.1460-9592.2010.03290.x. Epub 2010 Mar 11.
Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration.
We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO(2) (TcCO(2)), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded.
Forty-one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 micro-laryngobronchoscopies, including 18 LASER treatments, were performed. The mean (sd) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO(2) recorded during the procedures was 62.8 +/- 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed.
TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children.
传统上，小儿气道内镜检查采用吸入麻醉并保留自主呼吸。吸入麻醉在维持足够麻醉深度方面存在潜在困难，且手术环境存在麻醉污染，这是该技术的显著缺点。我们报告了我们机构使用全静脉麻醉（TIVA）和自主呼吸的经验。
我们前瞻性研究了41例接受52次气道内镜检查和气道手术的儿科患者。麻醉诱导后，根据脑电双频指数（BIS）将丙泊酚输注量滴定至临床适当的麻醉水平，并根据呼吸频率滴定瑞芬太尼输注量。记录心电图、血压、脉搏血氧饱和度、BIS水平、经皮二氧化碳分压（TcCO₂）、呼吸频率和药物输注速率。还记录了不良事件及其应对措施。
41名儿童接受了52次气道手术；其中包括17例硬质支气管镜检查和35例微喉镜检查，其中18例进行了激光治疗。平均（标准差）年龄为6.9（5.8）岁，体重为26.9（21.2）kg。平均诱导时间为13（6）分钟，麻醉持续时间为49（30）分钟。手术过程中记录的平均最高TcCO₂为62.8±15.3 mmHg。14例（27%）患者出现咳嗽，其中3例需要追加表面麻醉，4例需要推注丙泊酚或瑞芬太尼，1例需要拔出支气管镜。10例（19%）患者出现血氧饱和度低于90%；只有3例需要以临时辅助通气（2例）或吸入支气管扩张剂（1例）的形式进行干预。未观察到喉痉挛、喘鸣或心律失常。
TIVA和自主呼吸是小儿气道内镜检查和手术麻醉管理的有效技术。
