Ji Jeong-Yeon, Kim Eun-Hee, Lee Ji-Hyun, Jang Young-Eun, Kim Hee-Soo, Kwon Seong Keun
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
Int J Pediatr Otorhinolaryngol. 2020 Jul;134:110042. doi: 10.1016/j.ijporl.2020.110042. Epub 2020 Apr 8.
In pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway.
This retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered.
The median age of the patients was 16.0 months (range: 1-215 months) and the median weight was 10.2 kg (range: 2.4-38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10-140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients.
STRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.
在小儿气道手术中，静脉麻醉联合高流量鼻导管吸氧下的自主呼吸（STRIVE Hi）尚未得到充分研究。在此，我们报告我们在小儿气道内镜评估和手术中使用STRIVE Hi的经验。
本回顾性研究基于2017年5月至2018年9月在单一机构由单一外科医生进行的45例在STRIVE Hi下进行的气道手术。麻醉诱导后，持续输注丙泊酚和瑞芬太尼以确保足够的麻醉水平，并通过鼻导管提供湿化氧气。使用经皮二氧化碳传感器和脉搏血氧仪进行监测，并测量氧储备和脑电双频指数。未使用肌肉松弛剂。
患者的中位年龄为16.0个月（范围：1 - 215个月），中位体重为10.2 kg（范围：2.4 - 38.5 kg）。自主呼吸的中位持续时间为40分钟（范围：10 - 140分钟）。气道手术包括诊断性显微喉镜检查、气管造口瘘切除、球囊扩张、声门上成形术、喉裂修复、注射式喉成形术、乳头状瘤切除和声门下囊肿切除。在这些手术过程中，STRIVE Hi有助于评估气道的动态阻塞和手术治疗的即时效果，并提供良好的手术视野。仅5例患者需要插管和终止自主呼吸。
STRIVE Hi是小儿气道手术中一种有效且可行的麻醉选择。它提供无障碍的手术通路，适用于广泛的手术。
