Welborn L G, Rice L J, Hannallah R S, Broadman L M, Ruttimann U E, Fink R
Department of Anesthesiology, Children's National Medical Center, Washington, D.C. 20010.
Anesthesiology. 1990 May;72(5):838-42. doi: 10.1097/00000542-199005000-00012.
Thirty-six former preterm infants undergoing inguinal hernia repair were studied. All were less than or equal to 51 weeks postconceptual age at the time of operation. Patients were randomly assigned to receive general or spinal anesthesia. Group 1 patients received general inhalational anesthesia with neuromuscular blockade. Group 2 patients received spinal anesthesia using 1% tetracaine 0.4-0.6 mg/kg in conjunction with an equal volume of 10% dextrose and 0.02 ml epinephrine 1:1000. In the first part of the study, infants randomized to receive spinal anesthesia also received sedation with im ketamine 1-2 mg/kg prior to placement of the spinal anesthetic (group 2 A). The remainder of group 2 patients did not receive sedation (group 2 B). Respiratory pattern and heart rate were monitored using an impedance pneumograph for at least 12 h postoperatively. Tracings were analyzed for evidence of apnea, periodic breathing and/or bradycardia by a pulmonologist unaware of the anesthetic technique utilized. None of the patients who received spinal anesthesia without ketamine sedation developed postoperative bradycardia, prolonged apnea, or periodic breathing. Eight of nine infants (89%) who received spinal anesthesia and adjunct intraoperative sedation with ketamine developed prolonged apnea with bradycardia. Two of the eight infants had no prior history of apnea. Five of the 16 patients (31%) who received general anesthesia developed prolonged apnea with bradycardia. Two of these five infants had no prior history of apnea. When infants with no prior history of apnea were analyzed separately, there was no statistically significant increased incidence of apnea in children receiving general versus spinal anesthesia with or without ketamine sedation. Because of the small numbers of patients studied, and the multiple factors that may influence the incidence of postoperative apnea (e.g., prior history of neonatal apnea), standard postoperative respiratory monitoring of these high-risk infants is still recommended following all anesthetic techniques.
对36名接受腹股沟疝修补术的 former preterm infants 进行了研究。所有患儿在手术时的孕龄均小于或等于51周。患者被随机分配接受全身麻醉或脊髓麻醉。第1组患者接受全身吸入麻醉并使用神经肌肉阻滞剂。第2组患者使用1%丁卡因0.4 - 0.6 mg/kg 联合等量的10%葡萄糖和0.02 ml 1:1000肾上腺素进行脊髓麻醉。在研究的第一部分，随机接受脊髓麻醉的婴儿在放置脊髓麻醉剂之前还接受了1 - 2 mg/kg的氯胺酮静脉镇静（第2A组）。第2组其余患者未接受镇静（第2B组）。术后至少12小时使用阻抗式呼吸描记器监测呼吸模式和心率。由一名不了解所采用麻醉技术的肺科医生对记录进行分析，以寻找呼吸暂停、周期性呼吸和/或心动过缓的证据。未接受氯胺酮镇静的脊髓麻醉患者均未出现术后心动过缓、长时间呼吸暂停或周期性呼吸。接受脊髓麻醉并在术中使用氯胺酮辅助镇静的9名婴儿中有8名（89%）出现了伴有心动过缓的长时间呼吸暂停。这8名婴儿中有2名既往无呼吸暂停病史。接受全身麻醉的16名患者中有5名（31%）出现了伴有心动过缓的长时间呼吸暂停。这5名婴儿中有2名既往无呼吸暂停病史。当分别分析既往无呼吸暂停病史的婴儿时，接受全身麻醉与接受脊髓麻醉（无论是否使用氯胺酮镇静）的儿童呼吸暂停发生率在统计学上没有显著增加。由于研究的患者数量较少，以及可能影响术后呼吸暂停发生率的多种因素（如新生儿呼吸暂停既往史），无论采用何种麻醉技术，仍建议对这些高危婴儿进行标准的术后呼吸监测。
