Gharavi-Fard Mohamad, Taghavi-Gilani Mehryar, Kazemi Samira, Razavi Majid
Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Science , Mashhad, Iran.
Iran J Pediatr. 2014 Apr;24(2):179-83.
Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy.
One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography.
Totally, 31 (20.7%) cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven (18%) apnea cases occurred in recovery room in infants with gestational age (GA) of 35.64±2.73 weeks, while only four (2.6%) patients of GA 36.02±2.0 weeks developed delayed apnea).
In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients.
术后呼吸暂停是接受手术的婴儿的一个主要问题。在本研究中，我们评估了孕龄小于60周的婴儿在疝修补术后发生术后呼吸暂停的发生率及相关因素。
2012年，对150例孕龄（PCA）小于60周且接受择期疝修补术的婴儿进行了为期8个月的研究。采用七氟醚诱导全身麻醉，瑞芬太尼、阿曲库铵和60%的氧化亚氮维持麻醉。术后，在恢复室对他们进行2小时监测，在病房使用脉搏血氧饱和度仪和鼻二氧化碳描记法进行10小时监测。
共报告31例（20.7%）术后呼吸暂停病例。通过对患者进行比较，与术后呼吸暂停相关的因素包括孕龄、出生体重以及呼吸暂停史、氧疗、代谢疾病、黄疸或心脏病史。27例（18%）呼吸暂停病例发生在孕龄（GA）为35.64±2.73周的婴儿的恢复室，而GA为36.02±2.0周的患者中只有4例（2.6%）出现延迟性呼吸暂停。
在我们的研究中，PCA小于60周的婴儿在全身麻醉下进行腹股沟疝修补术后呼吸暂停的发生率为20.7%，这一发生率相当可观。我们建议对这些有术后呼吸暂停高风险的婴儿在恢复室进行更长时间的监测。随后应评估危险因素，以确定将高风险患者转入重症监护病房进行长期监测的指征。
