Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Anesthesiology, Weill Cornell Medical Center, New York, NY, USA.
Minerva Anestesiol. 2017 Jul;83(7):712-719. doi: 10.23736/S0375-9393.17.11565-8. Epub 2017 Jan 17.
General anesthesia utilizing inhalational agents without intravenous (IV) access for minor procedures is controversial. Eliminating IV access increases efficiency and patient satisfaction; however, the ability to introduce rapid acting medications into the circulation during an unanticipated emergency becomes challenging. The objective of this study was to examine complication risk following pediatric ophthalmologic examinations under anesthesia (EUA) without IV placement.
A retrospective review of consecutive pediatric patients who underwent EUA for retinoblastoma management was performed from 2004 to 2014. The total number of anesthetics and elective IV placement were identified. Patient characteristics, length of the procedure, laryngeal mask airway (LMA) placement, and complications were also recorded. A survey of specialized ophthalmology institutions was performed in order to ascertain the state of standard practices.
Over 10 years, 5216 anesthetics were identified. The mean age and weight of the patients were 2.7±2.0 years and 14.4±6.6 kg, respectively. In all, 298 elective IVs were placed (6%) and 4918 cases (94%) were performed without IV access. A total of 1687 (32%) anesthetics were administered with a laryngeal mask airway (LMA), of which 1389 (82%) did not have IV access. There were no deaths and no unplanned admissions. There were 8/5216 complications (0.153%) which all resolved safely.
The current study shows that it is safe to perform EUA and procedures for the diagnosis and treatment of retinoblastoma in pediatric patients without securing IV access. All emergency post-complication IV placements were successful and no long-term sequelae were seen.
对于小手术，不进行静脉（IV）入路而使用吸入性麻醉剂进行全身麻醉存在争议。消除 IV 入路可以提高效率和患者满意度；然而，在意外紧急情况下，将快速作用的药物引入循环系统的能力变得具有挑战性。本研究的目的是检查在没有静脉置管的情况下进行小儿眼科麻醉检查（EUA）后的并发症风险。
对 2004 年至 2014 年间连续接受 EUA 治疗视网膜母细胞瘤的小儿患者进行回顾性研究。确定总麻醉次数和选择性 IV 置管次数。还记录了患者特征、手术时间、喉罩气道（LMA）置管和并发症。对专门的眼科机构进行了调查，以确定标准实践的现状。
在 10 年期间，共确定了 5216 例麻醉。患者的平均年龄和体重分别为 2.7±2.0 岁和 14.4±6.6 公斤。共进行了 298 次选择性 IV 置管（6%），4918 例（94%）手术无 IV 入路。总共 1687 例（32%）麻醉使用喉罩气道（LMA），其中 1389 例（82%）无 IV 入路。无死亡和非计划住院。5216 例中有 8 例（0.153%）发生并发症，均安全解决。
本研究表明，在不进行 IV 置管的情况下，对小儿患者进行 EUA 及诊断和治疗视网膜母细胞瘤的手术是安全的。所有紧急并发症后的 IV 置管均成功，无长期后遗症。
