Xu Jing, Yao Zheng, Li Shaoqing, Chen Lianhua
Department of Anesthesiology, Eye Ear Nose and roat Hospital, Fudan University, Shanghai 200031, China.
Clin Invest Med. 2013 Jun 1;36(3):E151-7. doi: 10.25011/cim.v36i3.19726.
The most important consideration for administration of anesthesia in upper airway surgery is maintenance of a patient's airway for optimal surgical exposure, adequate ventilation and sufficient depth of anesthesia. The tubeless anesthetic techniques, including total intravenous anesthesia with a combination of propofol and remifentanil or inhalation anesthesia with the insufflation of anesthetic gas, are considered experimental in many countries.
Fifteen pediatric (8 to 60 months) and 16 adult (23 to 55 years) patients were included in the study. Anesthesia (gas insufflation) was induced into the pediatric patients by inhalation of 8% sevoflurane in 8 L/min oxygen flow. An endotracheal tube, inserted through the nasal or oral cavity with its tip in the laryngopharynx, was used to maintain anesthesia with 3%-6% sevoflurane in 4 L/min oxygen flow. Total intravenous anesthesia was induced in adult patients by inhalation, 8% sevoflurane in 8 L/min oxygen flow, combined with intravenous injections of propofol (1.5-2 mg/kg) and fentanyl (1.5-2 μg/kg). Assisted ventilation was maintained by use of a face or laryngeal mask. Propofol infusion at 200-300 μg/kg/min, combined with remifentanil infusion at 0.06-0.2 μg/kg/min, was used for maintaining anesthesia.
All patients had surgery under tubeless anesthesia with steady spontaneous respiration. The mean time from induction of anesthesia to unconsciousness was 16±3 s and 36±14 s in pediatric and adult groups, respectively. The average times from induction of anesthesia to the attainment of necessary anesthetic level for surgery while keeping steady spontaneous respiration was 4.17±0.96 min and 8.69±3.17 min in pediatric and adult groups, respectively. The frequency and extent of respiration and heart rate were maintained within the normal range; SpO2 was > 98%. None of the patients developed complications.
Tubeless anesthesia with spontaneous ventilation induced in patients can provide both an interference-free operative field and continuous observation of airway activity, which may provide an effective approach in excellent surgical conditions for the actual airway operation.
在上气道手术中实施麻醉时，最重要的考虑因素是维持患者气道，以实现最佳手术视野、充足的通气和足够的麻醉深度。在许多国家，无管麻醉技术，包括丙泊酚和瑞芬太尼联合的全静脉麻醉或麻醉气体吹入的吸入麻醉，都被视为试验性的。
本研究纳入了15名儿科患者（8至60个月）和16名成年患者（23至55岁）。通过在8 L/min氧气流中吸入8%七氟醚对儿科患者进行麻醉诱导（气体吹入）。通过鼻腔或口腔插入一根气管导管，其尖端位于喉咽部，以4 L/min氧气流中3%-6%的七氟醚维持麻醉。成年患者通过在8 L/min氧气流中吸入8%七氟醚并静脉注射丙泊酚（1.5-2 mg/kg）和芬太尼（1.5-2 μg/kg）诱导全静脉麻醉。使用面罩或喉罩维持辅助通气。以200-300 μg/kg/min的丙泊酚输注联合0.06-0.2 μg/kg/min的瑞芬太尼输注维持麻醉。
所有患者均在无管麻醉下进行手术，自主呼吸平稳。儿科组和成年组从麻醉诱导到意识丧失的平均时间分别为16±3秒和36±14秒。在保持自主呼吸平稳的情况下，儿科组和成年组从麻醉诱导到达到手术所需麻醉水平的平均时间分别为4.17±0.96分钟和8.69±3.17分钟。呼吸和心率的频率及幅度维持在正常范围内；脉搏血氧饱和度>98%。所有患者均未发生并发症。
对患者实施自主通气的无管麻醉可提供无干扰的手术视野并持续观察气道活动，这可能为实际气道手术创造良好手术条件提供一种有效方法。
