在 COVID-19 大流行期间，小儿眼科手术中联合静脉注射氯胺酮和区域麻醉的复苏。

Resurgence of combined intravenous Ketamine and regional anesthesia in pediatric ocular surgery in COVID-19 pandemic.

机构信息

Department of Pediatric Ophthalmology and Strabismus, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.

Department of Anaestehsia, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.

出版信息

Indian J Ophthalmol. 2021 Feb;69(2):395-399. doi: 10.4103/ijo.IJO_2839_20.

DOI:10.4103/ijo.IJO_2839_20

PMID:33463598

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7933828/

Abstract

PURPOSE

The current pandemic of COVID-19 has made airway procedures like intubation and extubation, potential sources of virus transmission among health care workers. The aim of this work was to study the safety profile of combined ketamine and regional anesthesia in pediatric ocular surgeries during the COVID-19 pandemic.

METHODS

This prospective study included pediatric patients undergoing ocular surgery under general anesthesia from April to October 2020. Children were premedicated with oral midazolam (0.25-0.50 mg/kg) or intramuscular ketamine (7-10 mg/kg), ondensetron (0.1 mg/kg) and atropine (0.02 mg/kg). Anesthesia was achieved with intravenous ketamine (4-5 mg/kg) and local anesthesia (peribulbar block or local infiltration). The patient's vital signs were monitored. Serious complications and postoperative adverse reactions related to anesthesia were documented.

RESULTS

A total of 55 children (62 eyes) were operated. Lid tear was the most common surgical procedure performed [n = 18 (32.7%)]. Dose of ketamine needed ranged from 30 to 120 mg (66.67 ± 30.45). No intubation or resuscitation was needed. Four children complained of nausea and two needed an additional dose of intravenous ondansetron due to vomiting in the post-operative period. Incidence of postoperative nausea and vomiting was not affected by age, duration of surgery or dose of ketamine used (P > 0.05). There was no correlation between increase in pulse and dose of ketamine.

CONCLUSION

Combined ketamine and regional anesthesia is a safe and effective alternative to administer anesthesia in a child during ocular surgeries.

摘要

目的

COVID-19 大流行期间，气道操作（如插管和拔管）成为医护人员之间病毒传播的潜在来源。本研究旨在探讨 COVID-19 大流行期间小儿眼科手术中联合使用氯胺酮和区域麻醉的安全性。

方法

本前瞻性研究纳入 2020 年 4 月至 10 月期间在全身麻醉下接受眼科手术的小儿患者。患儿术前给予咪达唑仑（0.25-0.50mg/kg）或氯胺酮（7-10mg/kg）、昂丹司琼（0.1mg/kg）和阿托品（0.02mg/kg）口服，静脉给予氯胺酮（4-5mg/kg）和局部麻醉（球周阻滞或局部浸润）。监测患儿生命体征，记录麻醉相关严重并发症和术后不良反应。

结果

共 55 例（62 眼）患儿接受手术。最常见的手术方式为眼睑撕裂伤[18 例（32.7%）]。所需氯胺酮剂量为 30-120mg（66.67±30.45mg）。无需插管或复苏。4 例患儿诉恶心，2 例患儿因术后呕吐需追加静脉昂丹司琼。术后恶心呕吐的发生率与年龄、手术持续时间或使用的氯胺酮剂量无关（P＞0.05）。脉搏增加与氯胺酮剂量之间无相关性。