Department of Anaesthesia and Pain Management, Perth Children's Hospital.
Medical School, The University of Western Australia.
Curr Opin Anaesthesiol. 2019 Jun;32(3):377-383. doi: 10.1097/ACO.0000000000000729.
This review summarizes the current evidence available to guide anaesthetists along the decision-making process between inhalational and intravenous anaesthesia when caring for paediatric patients.
A recent large randomized controlled trial in children with risk factors demonstrated a significant benefit of intravenous induction over inhalational induction with regards to respiratory adverse events. This difference is particularly pronounced in those with respiratory symptoms.
For children scheduled for elective surgery, intravenous induction has significant advantages with regards to reduced respiratory adverse events and for less postoperative behavioural disturbances, it may be associated with more anxiety at the time of induction. The anaesthetist in charge of the patient needs to weigh up the balance between the clinical risk of respiratory adverse events, the 'veins on offer', the level of anxiety and previous experiences of the child and his/her parents.
本综述总结了目前可用于指导麻醉师在为儿科患者提供护理时，针对吸入麻醉与静脉麻醉决策的现有证据。
最近一项针对存在危险因素的儿童的大型随机对照试验显示，静脉诱导在呼吸不良事件方面显著优于吸入诱导。在有呼吸系统症状的儿童中，这种差异更为明显。
对于择期手术的儿童，静脉诱导在降低呼吸不良事件方面具有显著优势，且术后行为紊乱较少，但诱导时可能与更高的焦虑相关。负责患者的麻醉师需要权衡呼吸不良事件的临床风险、“可提供的静脉”、焦虑程度以及儿童及其父母的既往经验之间的平衡。
