Kemper Melanie E, Buehler Philipp K, Schmitz Achim, Gysin Claudine, Nicolai Thomas, Weiss Markus
Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
Department of Pediatric Intensive Care, Dr. von Hauner Children's Hospital Ludwig-Maximilians-University, Munich, Germany.
Acta Anaesthesiol Scand. 2020 Jan;64(1):41-47. doi: 10.1111/aas.13473. Epub 2019 Oct 10.
To determine whether bag-mask ventilation between induction of anaesthesia and tracheal intubation in children with post-tonsillectomy bleeding reduces the incidence of hypoxaemia and difficult direct laryngoscopy without increasing perioperative respiratory complications.
Medical records, anaesthesia protocols and vital sign data were analysed from February 2005 to March 2017 for patients undergoing anaesthesia for surgical revision of bleeding tonsils. Type of rapid sequence induction and intubation (RSII; classical, ie, apnoeic, vs controlled, ie, with gentle bag-mask ventilation) was noted. Primary outcomes were incidence of moderate and severe hypoxaemia, grade of direct laryngoscopic views as well as occurrence of noted tracheal intubation difficulties. Haemodynamic alterations during RSII and perioperative adverse events such as noted gastric regurgitation, pulmonary aspiration and perioperative pulmonary morbidity were also recorded.
A classical RSII was performed for 22 surgical revisions in 22 children and a controlled RSII was used for 88 surgical revisions in 81 children. Patients undergoing controlled RSII had less incidence of severe hypoxaemia (1 vs 3; P = .025), better direct laryngoscopic views (P = .048) and less hypertension (5 vs 9; P < .001) than those patients managed by classical RSII. No tracheal intubation difficulties occurred. There was no significant perioperative pulmonary morbidity reported in either group.
Controlled RSII had advantages over classical RSII in children with post-tonsillectomy bleeding and may become a strategic option in these patients to avoid hypoxaemia, difficult laryngoscopy and hypertension during induction of anaesthesia and tracheal intubation. Bag-mask ventilation in patients with bleeding tonsils did not lead to pulmonary morbidity.
确定扁桃体切除术后出血患儿在麻醉诱导至气管插管期间进行面罩通气是否能降低低氧血症的发生率和直接喉镜检查困难的发生率，同时不增加围手术期呼吸并发症。
分析2005年2月至2017年3月期间接受扁桃体出血手术修复麻醉患者的病历、麻醉方案和生命体征数据。记录快速顺序诱导插管（RSII）的类型（经典型，即窒息型；或控制型，即轻柔面罩通气型）。主要结局为中度和重度低氧血症的发生率、直接喉镜检查视野分级以及气管插管困难的发生情况。还记录了RSII期间的血流动力学改变以及围手术期不良事件，如观察到的胃反流、肺误吸和围手术期肺部疾病。
22例儿童的22次手术修复采用了经典RSII，81例儿童的88次手术修复采用了控制型RSII。与接受经典RSII的患者相比，接受控制型RSII的患者严重低氧血症的发生率更低（1例对3例；P = 0.025），直接喉镜检查视野更好（P = 0.048），高血压发生率更低（5例对9例；P < 0.001）。未发生气管插管困难。两组均未报告有显著的围手术期肺部疾病。
在扁桃体切除术后出血的儿童中，控制型RSII比经典RSII更具优势，可能成为这些患者在麻醉诱导和气管插管期间避免低氧血症、喉镜检查困难和高血压的策略性选择。扁桃体出血患者的面罩通气未导致肺部疾病。
