Alegret N, Serra P, Pessas J P, Curià X, Vidal J, Valero R
Servicio de Anestesiología y Reanimación, Institut Guttmann, Badalona, Barcelona, España.
Servicio de Anestesiología y Reanimación, Institut Guttmann, Badalona, Barcelona, España.
Rev Esp Anestesiol Reanim (Engl Ed). 2019 Dec;66(10):497-505. doi: 10.1016/j.redar.2019.10.005. Epub 2019 Nov 20.
The diaphragm pacemaker (DP) has proven its utility in replacing mechanical ventilation in patients with chronic spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). The DP improves patient quality of life and reduces morbidity and mortality and their associated health care costs. The anesthetic management of these patients and the particularities of the surgical procedure are challenging. The aim of our study is to analyze anesthetic management and intraoperative complications in patients undergoing DP placement in our hospital.
We performed a chart review of patients treated between December 2007 and July 2017, recording the patients' preoperative status, anesthetic management and intraoperative complications.
The study included 16 patients (5 pediatric) undergoing DP implantation for chronic SCI (63%), ALS (25%) and other neurologic conditions (12%). Abdominal laparoscopy was performed under general anesthesia, with intravenous (87%) or inhalational (13%) induction and maintenance using total intravenous (50%) or balanced (50%) anesthesia. Rocuronium was administered in one case to permit airway management. Complications included: hypotension (50%), difficulties in mechanical ventilation during laparoscopy (31%), pneumothorax (12.5%) and autonomic dysreflexia (6%).
DP placement under general anesthesia is a safe intervention in both adult and pediatric patients. Complications derived from both the underlying disease and the surgical technique may appear, and must be rapidly identified and treated to obtain a satisfactory surgical outcome.
膈神经起搏器（DP）已在慢性脊髓损伤（SCI）和肌萎缩侧索硬化症（ALS）患者中证明其在替代机械通气方面的效用。DP可改善患者生活质量，降低发病率和死亡率及其相关的医疗保健成本。这些患者的麻醉管理以及手术过程的特殊性具有挑战性。我们研究的目的是分析在我院接受DP植入患者的麻醉管理和术中并发症。
我们对2007年12月至2017年7月期间接受治疗的患者进行了病历审查，记录患者的术前状况、麻醉管理和术中并发症。
该研究包括16例患者（5例儿科患者），因慢性SCI（63%）、ALS（25%）和其他神经系统疾病（12%）接受DP植入。在全身麻醉下进行腹部腹腔镜检查，采用静脉诱导（87%）或吸入诱导（13%），并使用全静脉麻醉（50%）或平衡麻醉（50%）进行维持。1例患者使用罗库溴铵以利于气道管理。并发症包括：低血压（50%）、腹腔镜检查期间机械通气困难（31%）、气胸（12.5%）和自主神经反射异常（6%）。
全身麻醉下的DP植入对成人和儿科患者都是一种安全的干预措施。可能会出现由基础疾病和手术技术引起的并发症，必须迅速识别并治疗，以获得满意的手术结果。
