Konrad F, Wiedeck H, Winter H, Kilian J
Universitätsklinik für Anästhesiologie, Universität Ulm.
Anasth Intensivther Notfallmed. 1990 Apr;25(2):160-3.
In a prospective, randomised trial bronchoscopy was performed either in local anaesthesia (LA) or general anaesthesia, each on 15 ventilated patients. LA was carried out with oxybuprocain-hydrochloride 1% in repeated doses injected into the trachea and main bronchi, general anaesthesia with midazolam, piritramide and vecuronium bromide. Measurements were performed before, 3 minutes after induction of anaesthesia, immediately after bronchoscopy and 15 and 60 minutes after bronchoscopy. There was no effect on cardiocirculatory function during bronchoscopy in both groups, but we found a decrease in paO2 from 97 to 80 mmHg (median) after application of LA. Subsequent bronchoscopy did not significantly influence paO2. The present study shows that in ventilation patients undergoing fibreoptic bronchoscopy, the application of LA will usually result in a decline of arterial oxygen tension. This procedure should therefore only be performed if general anaesthesia is undesirable, as e.g. in patients being weaned from ventilation.
在一项前瞻性随机试验中，对15例接受机械通气的患者分别实施局部麻醉（LA）或全身麻醉下的支气管镜检查。局部麻醉采用将1%盐酸奥布卡因反复注入气管和主支气管，全身麻醉采用咪达唑仑、匹利卡明和溴化维库溴铵。在麻醉诱导前、诱导后3分钟、支气管镜检查后即刻以及检查后15分钟和60分钟进行测量。两组在支气管镜检查期间对心脏循环功能均无影响，但我们发现局部麻醉后动脉血氧分压（PaO₂）从中位数97 mmHg降至80 mmHg。随后的支气管镜检查对PaO₂无显著影响。本研究表明，在接受纤维支气管镜检查的机械通气患者中，应用局部麻醉通常会导致动脉血氧张力下降。因此，仅在全身麻醉不可行时，如在撤机患者中，才应进行该操作。
