Rawlinson Ellen, Bagshaw Oliver
Birmingham Children's Hospital NHS Trust, Birmingham, UK.
Paediatr Anaesth. 2012 Nov;22(11):1124-31. doi: 10.1111/j.1460-9592.2012.03894.x.
To review the anesthetic management of children requiring surgical intervention for pericardial effusion, determine the nature and frequency of complications and define risk factors that predict perioperative risk.
Anesthesia in the presence of a pericardial effusion may be associated with significant hemodynamic compromise particularly during induction. However, the literature specifically concerning children is limited to a single-case report.
A retrospective case review of children undergoing general anesthesia for surgical treatment for pericardial effusion between 1999 and 2008 at a single institution.
Sixty-five children underwent 79 general anesthetics for surgical treatment for pericardial effusion. Median age was 4 years (2 weeks-16 years), and median weight 15 kg (range, 2.5-96 kg). Fifty-five children (84%) developed effusions following cardiac surgery. The commonest induction agent was ketamine (25/65, 38%), and the majority of children (52/65, 80%) were intubated and ventilated for the procedure. Seven children (11%) suffered from eight major complications, and 14 children (22%) suffered from a minor complication. Major complications were more common in children with preoperative tachypnoea (P = 0.01) and cardiac tamponade on preoperative echocardiogram (ECHO) (P = 0.001). Preoperative hypoxia had a sensitivity of 92% and a positive likelihood ratio of 5.2 (95% CI 1.5-17.5) for predicting all complications.
Anesthesia for pericardial effusion in children was associated with an adverse physiological event in one-third of children. Major complications may be predicted by preoperative tachypnoea and cardiac tamponade on preoperative ECHO, and all complications may be predicted by preoperative hypoxia. The anesthetic technique included a variety of induction agents, and we cannot recommend a particular approach.
回顾因心包积液需手术干预的儿童的麻醉管理，确定并发症的性质和发生率，并明确预测围手术期风险的危险因素。
存在心包积液时进行麻醉可能会导致显著的血流动力学损害，尤其是在诱导期。然而，专门针对儿童的文献仅限于一篇个案报告。
对1999年至2008年在单一机构接受全身麻醉进行心包积液手术治疗的儿童进行回顾性病例分析。
65名儿童接受了79次全身麻醉以进行心包积液的手术治疗。中位年龄为4岁（2周 - 16岁），中位体重为15千克（范围2.5 - 96千克）。55名儿童（84%）在心脏手术后出现积液。最常用的诱导药物是氯胺酮（25/65，38%），大多数儿童（52/65，80%）在手术过程中进行了气管插管和机械通气。7名儿童（11%）出现了8例主要并发症，14名儿童（22%）出现了轻微并发症。主要并发症在术前呼吸急促的儿童中更为常见（P = 0.01），术前超声心动图（ECHO）显示有心包填塞的儿童中也更为常见（P = 0.001）。术前低氧血症预测所有并发症的敏感度为92%，阳性似然比为5.2（95% CI 1.5 - 17.5）。
儿童心包积液麻醉与三分之一的儿童发生不良生理事件相关。术前呼吸急促和术前ECHO显示的心包填塞可预测主要并发症，术前低氧血症可预测所有并发症。麻醉技术包括多种诱导药物，我们无法推荐特定的方法。
