Dones Francesco, Foresta Grazia, Russotto Vincenzo
Department of Anesthesia and Intensive Care AOUP, University of Palermo, Italy.
Pediatr Rep. 2012 Apr 2;4(2):e19. doi: 10.4081/pr.2012.e19. Epub 2012 Apr 5.
Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.
哮喘是儿童慢性疾病发病的主要原因。因此，对于参与小儿外科手术围术期的麻醉医生和其他专业人员来说，处理这种疾病是很常见的。术前评估在检测围术期呼吸并发症风险增加的儿童方面起着关键作用。对于症状控制不佳或近期有呼吸道感染的儿童，如有可能，应在优化治疗后推迟择期手术。根据临床情况，局部区域麻醉是理想的选择，因为它可以避免气道插管。气道管理目标是在全身麻醉期间防止气流阻力增加，同时避免支气管痉挛的触发因素。对于哮喘儿童，当可行时，面罩通气和喉罩被认为比气管插管更可靠。七氟烷是最常用的诱导和维持麻醉剂。沙丁胺醇似乎有助于防止气管插管后气流阻力增加。机械通气应根据哮喘的病理生理学进行调整：应设置足够的呼气时间，以避免因呼气气流阻塞导致呼气末正压。如有可能，应采用局部区域麻醉技术预防和及时控制疼痛。在整个围术期，应始终考虑对药物或乳胶的潜在过敏反应。营造宁静的氛围应作为干预措施的重要组成部分，以确保为哮喘儿童提供最佳护理。
