Miyamoto Yoshihisa, Ka Koui
Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama 232-8555.
Masui. 2013 Sep;62(9):1034-44.
Fever and upper respiratory tract infections (URI) are frequently-encountered preoperative comorbidities. Whether or not to proceed with anesthesia for a child with common cold is still a continuing dilemma for anesthesiologists. We, anesthesiologists often feel uncomfortable in making a decision whether or not to proceed because URI is associated with perioperative respiratory adverse events (PRAEs) and there are no definite rules to proceed with or postpone a case. Most of PRAEs are easily managed by experienced hands; however, laryngospasm or bronchospasm without early detection and immediate treatment would probably result in serious sequelae. Although several factors (e. g., asthma, infancy, endotracheal intubation, airway surgery, parental smoking, and parental confirmation of a URI, etc.) related to PRAEs have been elucidated to date, no one can guess correctly which child will suffer from adverse events. Moreover, because children per se are vulnerable to PRAEs, we cannot reduce the risk to zero even without a URI. Therefore, we should be familiarized with how to cope with PRAEs. In making a decision to proceed with or postpone the case, it is important to take various factors together into account, and the decision ultimately depends on whether or not we feel "Yes, we can".
发热和上呼吸道感染(URI)是术前常见的合并症。对于患有普通感冒的儿童是否进行麻醉,一直是麻醉医生面临的难题。我们麻醉医生在决定是否继续进行麻醉时常常感到不安,因为URI与围手术期呼吸不良事件(PRAEs)相关,而且对于继续进行还是推迟手术并没有明确的规则。大多数PRAEs由经验丰富的人员很容易处理;然而,喉痉挛或支气管痉挛如果没有早期发现和及时治疗可能会导致严重的后遗症。尽管迄今为止已经阐明了一些与PRAEs相关的因素(例如哮喘、婴儿期、气管插管、气道手术、父母吸烟以及父母确认的URI等),但没有人能正确猜出哪个孩子会发生不良事件。此外,由于儿童本身就容易发生PRAEs,即使没有URI我们也无法将风险降至零。因此,我们应该熟悉如何应对PRAEs。在决定继续进行还是推迟手术时,综合考虑各种因素很重要,而最终的决定取决于我们是否觉得“是的,我们可以”。