Mohtar Sanah, Hui Theresa W C, Irwin Michael G
Department of Anesthesia and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China.
Paediatr Anaesth. 2018 Nov;28(11):1035-1042. doi: 10.1111/pan.13502. Epub 2018 Oct 3.
Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described.
This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery.
We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed.
Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point.
One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.
在过去十年中，由于医学和美容方面的益处，电视辅助胸腔镜手术（VATS）得到了显著发展。与成人相比，小儿VATS麻醉更具挑战性，因为小儿气道尺寸小和通气问题较多。单肺通气的最佳技术尚未确立，在此情况下瑞芬太尼输注的应用也鲜有描述。
本研究探讨在接受VATS的婴幼儿中使用腔外支气管封堵器进行单肺通气以及输注瑞芬太尼的效果。
我们回顾性分析了31例小儿在七氟醚或异氟醚、氧气和空气麻醉下行择期VATS治疗先天性肺部病变时单肺通气技术及瑞芬太尼输注的血流动力学效应。从数据库中提取并分析患者在基线（麻醉诱导后）、单肺通气即刻、二氧化碳气腹期间及单肺通气结束时的心率、血压和呼气末二氧化碳。记录并分析血管升压药或右美托咪定的使用情况。
90.3%的病例（28例患者）成功在气管导管旁放置了腔外支气管封堵器，无任何严重并发症或动脉血氧饱和度下降。在VATS手术期间，即使呼气末二氧化碳浓度升高，血压和心率也无显著升高。58%的患者（18例患者）使用去氧肾上腺素以维持血压在基线值的20%以内。各时间点所有患者的心率均无显著变化。
在这组接受先天性肺部病变胸腔镜切除的幼儿中，腔外平行封堵器单肺通气有效。瑞芬太尼输注能有效减轻接受VATS的婴幼儿的手术应激。
