Hanslik Andreas, Moysich Axel, Laser K Thorsten, Mlczoch Elisabeth, Kececioglu Deniz, Haas Nikolaus A
Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria,
Pediatr Cardiol. 2014 Feb;35(2):215-22. doi: 10.1007/s00246-013-0762-9. Epub 2013 Jul 30.
Interventional cardiac catheterization in children and adolescents is traditionally performed with the patient under general anesthesia and endotracheal intubation. However, percutaneous closure of atrial septum defect (ASD) without general anaesthesia is currently being attempted in a growing number of children. The study objective was to evaluate the success and complication rate of percutaneous ASD closure in spontaneously breathing children under deep sedation. Retrospective single centre cohort study of consecutive children undergoing percutaneous ASD closure at a tertiary care pediatric cardiology centre. Transesophageal echocardiography (TEE) and percutaneous ASD closure were performed with the patient under deep sedation with intravenous bolus of midazolam and ketamine for induction and propofol continuous infusion for maintenance of sedation in spontaneously breathing children. One hundred and ninety-seven patients (median age 6.1 years [minimum 0.5; maximum 18.8]) underwent TEE and ASD balloon sizing. Percutaneous ASD closure was attempted in 174 patients (88 %), and device implantation was performed successfully in 92 %. To achieve sufficient deep sedation, patients received a median ketamine dose of 2.7 mg/kg (0.3; 7) followed by a median propofol continuous infusion rate of 5 mg/kg/h (1.1; 10.7). There were no major cardiorespiratory complications associated with deep sedation, and only two patients (1 %) required endotracheal intubation due to bronchial obstruction immediately after induction of sedation. Seventeen patients (8 %) had minor respiratory complications and required frequent oral suctioning or temporary bag-mask ventilation. TEE and percutaneous ASD closure can be performed safely and successfully under deep sedation in spontaneously breathing children of all ages.
传统上，儿童和青少年的介入性心导管插入术是在全身麻醉和气管插管下进行的。然而，目前越来越多的儿童正在尝试在不进行全身麻醉的情况下经皮闭合房间隔缺损（ASD）。本研究的目的是评估在深度镇静下自主呼吸的儿童中经皮ASD闭合术的成功率和并发症发生率。在一家三级护理儿科心脏病中心，对连续接受经皮ASD闭合术的儿童进行回顾性单中心队列研究。在自主呼吸的儿童中，通过静脉推注咪达唑仑和氯胺酮诱导并持续输注丙泊酚维持镇静，在深度镇静下对患者进行经食管超声心动图（TEE）检查和经皮ASD闭合术。197例患者（中位年龄6.1岁[最小0.5岁；最大18.8岁]）接受了TEE检查和ASD球囊尺寸测量。174例患者（88%）尝试了经皮ASD闭合术，其中92%成功植入了封堵器。为了达到足够的深度镇静，患者接受的氯胺酮中位剂量为2.7mg/kg（0.3；7），随后丙泊酚的中位持续输注速率为5mg/kg/h（1.1；10.7）。深度镇静未出现重大心肺并发症，仅有2例患者（1%）在镇静诱导后因支气管阻塞需要气管插管。17例患者（8%）出现轻微呼吸并发症，需要频繁经口吸痰或临时面罩通气。在所有年龄段自主呼吸的儿童中，TEE检查和经皮ASD闭合术在深度镇静下均可安全、成功地进行。
