Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
BMC Anesthesiol. 2020 Jun 2;20(1):135. doi: 10.1186/s12871-020-01052-4.
There is very little published literature and none that discussed care in a neonate regarding anesthetic risk and management of neonate with congenital bronchobiliary fistula during thoracoscopy and thoracotomy. This article analyzes related risk factors and literature review from perioperative ventilation, circulation and other aspects of management.
A neonate diagnosed as congenital bronchobiliary fistula combined with severe chemical pneumonia, consolidation of the lungs, and infection was facing the risk of anaesthesia under thoracoscopy exploration surgery, who experiened more than 20 days diagnostic period before operation. Many risk factors have led to conversion from minimally invasive surgery to thoracotomy, including persistent hypoxemia, hypercapnia, difficult surgical exposure and extremly difficulty of intraoperative ventilation management. Anesthesia maintenance after conversion to open access remained problematic. Fortunately the patient showed no sign of any adverse CNS effects after 4 months of follow-up.
The most prominent anesthesia challenges are hypoxemia, increased airway resistance, impaired ventilation, and the risk of metabolic acidosis. Close cooperation among the entire neonatal medical team is the key factors in successful management of this rare case.
目前发表的相关文献很少，也没有文献讨论过在胸腔镜和开胸手术中，对患有先天性支气管胆管瘘的新生儿进行麻醉风险评估和管理。本文从围手术期通气、循环等方面分析了相关的危险因素和文献回顾。
一名新生儿被诊断为先天性支气管胆管瘘，合并严重化学性肺炎、肺部实变和感染，面临着胸腔镜探查手术麻醉的风险，在手术前经历了超过 20 天的诊断期。许多风险因素导致微创手术转为开胸手术，包括持续低氧血症、高碳酸血症、手术暴露困难以及术中通气管理极度困难。转为开放手术后的麻醉维持仍然存在问题。幸运的是，患者在随访 4 个月后没有出现任何中枢神经系统不良反应的迹象。
最突出的麻醉挑战是低氧血症、气道阻力增加、通气受损和代谢性酸中毒的风险。整个新生儿医疗团队的密切合作是成功管理这一罕见病例的关键因素。
