Narayanasamy Suryakumar, Adler Elena, Mahmoud Mohamed, Burkley Meghan, Lim Foong-Yen, Subramanyam Rajeev
Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Anesthesiology, Le Bonheur Children's Hospital, Memphis, TN.
Paediatr Anaesth. 2019 Aug;29(8):808-813. doi: 10.1111/pan.13648. Epub 2019 May 27.
Anesthestic management of congenital pulmonary airway malformation has not been well described in the literature. It is not clear whether one-lung ventialtion is indicated during thoracoscopic lobectomy and if so, what is the best technique achieve it.
We describe the variables with the two commonly performed surgical techniques, thoracoscopic lobectomy and open thoracotomy, from our institutional database to assess the role of lung isolation and the preferable method of lung isolation technique for congenital pulmonary airway malformation resections.
After institutional review board approval, fetal center records were reviewed retrospectively from January 2010 to July 2016 for patients who underwent congenital pulmonary airway malformation resection. The primary goal was to describe the anesthesia induction-airway management techniques with emphasis on one-lung ventilation techniques.
Among the 65 resections, one-lung ventilation was performed in 30 resections (46%) and was primarily achieved by endobronchial intubation in most cases (80%). One-lung ventilation was performed in a greater number of resections with thoracoscopic lobectomy (96%) compared to open thoracotomies.
From our institution cohort, one-lung ventilation was more commonly used during thoracoscopic resections and was most commonly achieved with endobronchial intubation. Most patients were induced with inhalational anesthesia (sevoflurane), nondepolarizing neuromuscular blocker, and gentle positive pressure ventilation for intubation.
先天性肺气道畸形的麻醉管理在文献中尚未得到充分描述。目前尚不清楚在胸腔镜肺叶切除术中是否需要进行单肺通气，如果需要，最佳的实现技术是什么。
我们从机构数据库中描述两种常用手术技术（胸腔镜肺叶切除术和开胸手术）的相关变量，以评估肺隔离的作用以及先天性肺气道畸形切除术的最佳肺隔离技术方法。
经机构审查委员会批准，对2010年1月至2016年7月在胎儿中心接受先天性肺气道畸形切除术的患者记录进行回顾性研究。主要目的是描述麻醉诱导-气道管理技术，重点是单肺通气技术。
在65例切除术中，30例（46%）进行了单肺通气，大多数情况下（80%）主要通过支气管内插管实现。与开胸手术相比，胸腔镜肺叶切除术中进行单肺通气的切除例数更多（96%）。
根据我们机构的队列研究，胸腔镜切除术中更常用单肺通气，最常用的方法是支气管内插管。大多数患者采用吸入麻醉（七氟醚）、非去极化神经肌肉阻滞剂诱导，并在插管时采用轻柔的正压通气。
