From the Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (EH-K, JH-L, YE-J, SH-J, SA-C, JT-K, HS-K).
Eur J Anaesthesiol. 2021 Oct 1;38(10):1012-1018. doi: 10.1097/EJA.0000000000001400.
Hypoxaemia occurs frequently in infants during anaesthetic induction.
We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants.
Randomised controlled trial.
Tertiary care children's hospital, single centre, from November 2018 to October 2019.
We included patients under 1 year of age receiving general anaesthesia.
We assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg-1 atropine, 5 mg kg-1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg-1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg-1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants' trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%.
The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound.
Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2).
Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants.
www.clinicaltrials.gov, NCT03540940.
在麻醉诱导过程中，婴儿经常会出现低氧血症。
我们评估麻醉诱导时给予呼气末正压对婴儿非缺氧性呼吸暂停时间的影响。
随机对照试验。
2018 年 11 月至 2019 年 10 月，三级儿童保健医院，单中心。
我们纳入了接受全身麻醉的 1 岁以下患者。
我们将婴儿分为 7cmH2O 或 0cmH2O 呼气末正压组。麻醉诱导采用 0.02mg/kg 阿托品、5mg/kg 硫喷妥钠和 3%至 5%七氟醚，并采用 0.6mg/kg 罗库溴铵进行神经肌肉阻滞。此后，通过容量控制通气给予 6ml/kg 潮气量的 100%氧气，采用 7cmH2O 或无呼气末正压。通气 3 分钟后，婴儿的气管被插管，但与呼吸回路断开，当脉搏血氧饱和度达到 95%时恢复通气。
主要结局是非缺氧性呼吸暂停时间，定义为从停止通气到脉搏血氧仪读数达到 95%的时间，次要结局是通过肺部超声评估的显著肺不张（肺实变评分≥2）的发生率。
最终有 60 名患者纳入了最终分析。7cmH2O 呼气末正压组的呼吸暂停时间（105.2s）较对照组（92.1s）增加（P=0.011，平均差异 13.0s，95%CI，3.1 至 22.9s）。所有未给予呼气末正压的患者均出现显著肺不张，66.7%给予 7cmH2O 呼气末正压的患者出现显著肺不张（P=0.019，95%CI，1.7 至 563.1，优势比 31.2）。
面罩通气麻醉诱导时给予呼气末正压可延长婴儿非缺氧性呼吸暂停时间。
