Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Eur J Anaesthesiol. 2010 Nov;27(11):930-4. doi: 10.1097/EJA.0b013e32833d69ad.
Foreign body aspiration is a life-threatening condition, with children under 3 years of age most at risk. This study was designed to compare the clinical characteristics of sevoflurane volatile induction/maintenance anaesthesia (VIMA) and propofol-remifentanil total intravenous anaesthesia (TIVA) for children undergoing rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal.
Sixty-four children undergoing rigid bronchoscopy were allocated randomly to receive sevoflurane (Group VIMA; n = 32) or propofol-remifentanil (Group TIVA, n = 32) between 2007 and 2009. Respiratory rate, heart rate and mean blood pressure were compared at the time points including baseline level (T 0); laryngoscopy (T lary); insertion of rigid bronchoscope (T bron); 5, 10 and 20 min during procedure (T 5 min, T 10 min, T 20 min); the end of procedure (Tend) and discharge (T dis). Induction time, emergence time, intubating condition scores and the incidence of adverse events were compared.
Time for loss of consciousness (Group VIMA 95.6 ± 15.2 s vs. Group TIVA 146.2 ± 26.9 s, P < 0.05), time of Bispectral Index value decreased to 40 (Group VIMA 115.3 ± 16.5 s vs. Group TIVA 160.4 ± 25.8 s, P < 0.05) and emergence time (Group VIMA 10.5 ± 2.6 min vs. Group TIVA 16.9 ± 3.1 min, P < 0.05) in Group VIMA were significantly shorter than those in Group TIVA. Intubating condition scores between the two groups were comparable (8.1 ± 0.9 in Group VIMA vs. 8.1 ± 1.0 in Group TIVA). The incidence rates of breath holding (Group VIMA 6.25% vs. Group TIVA 31.25%, P < 0.05) and desaturation (Group VIMA 15.63% vs. Group TIVA 37.50%, P < 0.05) in Group VIMA were significantly lower than those in Group TIVA. Heart rate, mean blood pressure and respiratory rate were significantly higher in Group VIMA than in Group TIVA.
Compared with propofol-remifentanil TIVA, sevoflurane VIMA provides more stable haemodynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal under spontaneous breathing.
异物吸入是一种危及生命的情况，3 岁以下儿童的风险最高。本研究旨在比较七氟醚挥发性诱导/维持麻醉（VIMA）和丙泊酚-瑞芬太尼全静脉麻醉（TIVA）在儿童自主呼吸下进行硬性支气管镜检查以清除气管/支气管异物时的临床特征。
2007 年至 2009 年期间，将 64 例接受硬性支气管镜检查的儿童随机分为接受七氟醚（VIMA 组，n = 32）或丙泊酚-瑞芬太尼（TIVA 组，n = 32）。比较呼吸频率、心率和平均血压在以下时间点的变化：基础水平（T0）；喉镜检查（T lary）；插入硬性支气管镜（T bron）；手术期间的 5、10 和 20 分钟（T5 min、T10 min、T20 min）；手术结束时（Tend）和出院时（T dis）。比较诱导时间、苏醒时间、插管条件评分和不良事件发生率。
VIMA 组意识丧失时间（95.6 ± 15.2 s 比 TIVA 组 146.2 ± 26.9 s，P < 0.05）、BIS 值降至 40 的时间（VIMA 组 115.3 ± 16.5 s 比 TIVA 组 160.4 ± 25.8 s，P < 0.05）和苏醒时间（VIMA 组 10.5 ± 2.6 min 比 TIVA 组 16.9 ± 3.1 min，P < 0.05）均明显短于 TIVA 组。两组插管条件评分无差异（VIMA 组 8.1 ± 0.9 比 TIVA 组 8.1 ± 1.0）。VIMA 组的屏气发生率（6.25%比 TIVA 组 31.25%，P < 0.05）和低氧血症发生率（VIMA 组 15.63%比 TIVA 组 37.50%，P < 0.05）明显低于 TIVA 组。VIMA 组心率、平均血压和呼吸频率明显高于 TIVA 组。
与丙泊酚-瑞芬太尼 TIVA 相比，七氟醚 VIMA 可为自主呼吸下进行气管/支气管异物清除术的患儿提供更稳定的血流动力学和呼吸，更快的诱导和恢复，以及更高的兴奋发生率。
