Sozen Reiko, Kayashima Kenji, Yoshino Hiroomi, Imai Keiko
Department of Anesthesiology, Kyushukoseinenkin Hospital, Kitakyushu 806-8501.
Masui. 2013 Oct;62(10):1179-83.
Although the use of cuffed tracheal tubes (CTT) in children less than 8 years of age has increased, the criteria for selecting CTTs of appropriate sizes have not been determined.
To study the criteria for choosing tubes of appropriate sizes (internal diameter: 4.0, 4.5, 5.0, or 5.5mm), we intubated 51 children aged 2-8 years under general anesthesia using an original protocol. We excluded 2 patients who received 4.0-mm tubes; thus, the outcomes in 48 patients were analyzed statistically.
A larger CTT was replaced with a smaller one in 1 patient, and a CTT was replaced with an uncuffed tracheal tube (UTT) in another patient (excluded from analysis). No tube changes were required in 49 patients. Post-extubation stridor was observed in 3 patients. The 4.5-mm tubes seemed appropriate in 12 cases because average airway leakage in these cases was > 10%; 5.0- and 5.5-mm tubes did not seem appropriate in 17 and 19 cases, respectively, because the leakage was < 10% of the tidal volume.
We recommend the pediatric use of CTTs because of the very low tube-exchange ratio and the acceptable incidence of stridor. However, the protocol may require modification.
尽管8岁以下儿童使用带套囊气管导管（CTT）的情况有所增加，但合适尺寸CTT的选择标准尚未确定。
为研究选择合适尺寸导管（内径：4.0、4.5、5.0或5.5mm）的标准，我们采用原始方案对51例2至8岁儿童进行全身麻醉下插管。我们排除了2例接受4.0mm导管的患者；因此，对48例患者的结果进行了统计分析。
1例患者将较大的CTT换成了较小的CTT，另1例患者将CTT换成了无套囊气管导管（UTT）（排除在分析之外）。49例患者无需更换导管。3例患者拔管后出现喘鸣。12例中4.5mm导管似乎合适，因为这些病例的平均气道漏气量>10%；17例和19例中，5.0mm和5.5mm导管似乎不合适，因为漏气量<潮气量的10%。
由于导管更换率极低且喘鸣发生率可接受，我们建议儿科使用CTT。然而，该方案可能需要修改。
