Liu Hua, Le Chengjin, Chen Jing, Xu Heng, Yu Hui, Chen Lin, Liu Henry
Department of Anesthesiology, Hubei Women & Children's Hospital, Wuhan, China.
Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
Transl Pediatr. 2021 Aug;10(8):2035-2043. doi: 10.21037/tp-21-265.
Advances in medical techniques and equipment have enabled the thoracoscopic repair of certain congenital abnormalities in neonates including congenital esophageal atresia/tracheoesophageal fistula (EA/TEF) and congenital diaphragmatic hernia (CDH). A retrospective analysis was conducted to examine the anesthetic management of neonates (7 days or younger) undergoing thoracoscopic surgery in our hospital department, and to determine the efficacy of anesthetic management in neonates.
Clinical data from 45 neonates who underwent thoracoscopic surgery in our hospital from December 2015 to March 2020 were retrospectively analyzed. A total of 25 patients underwent repair of CDH and 20 underwent repair of an EA/TEF.
All patients received general anesthesia with endotracheal intubation, standard ASA monitoring, and arterial blood gas (ABG) analysis. All patients survived the surgery. A total of 14 patients experienced decreases in SpO, pH, PaO, and increases in PCO and PaCO 30 minutes after CO insufflation. Our anesthetic management protocols are outline and analyzed.
Thorough preoperative preparation is critical for a desirable outcome in neonates undergoing a thoracoscopic repair of CDH or EA/TEF. In our cohort, intraoperative ventilation strategies included pressure control ventilation with peak airway pressure maintained at 15-25 cmHO, a respiratory rate of 35-55 breaths/minute, a fraction of inspired oxygen (FiO) of 60-80%, an inspiratory/expiratory ratio (I:E) of 1:1-1.5, and careful airway suctioning to clear secretions. Postoperatively, maintaining normovolemia and hemodynamic stability are critical for successful weaning of ventilatory support and extubation.
医学技术和设备的进步使得新生儿某些先天性异常的胸腔镜修复成为可能，包括先天性食管闭锁/气管食管瘘（EA/TEF）和先天性膈疝（CDH）。进行了一项回顾性分析，以检查我院科室中接受胸腔镜手术的7日龄及以下新生儿的麻醉管理，并确定麻醉管理对新生儿的效果。
回顾性分析了2015年12月至2020年3月在我院接受胸腔镜手术的45例新生儿的临床资料。其中25例患者接受了CDH修复，20例接受了EA/TEF修复。
所有患者均接受气管插管全身麻醉、标准ASA监测及动脉血气（ABG）分析。所有患者均手术存活。共有14例患者在二氧化碳气腹30分钟后出现SpO、pH、PaO降低，PCO和PaCO升高。我们概述并分析了麻醉管理方案。
对于接受CDH或EA/TEF胸腔镜修复的新生儿，充分的术前准备对于获得理想结果至关重要。在我们的队列中，术中通气策略包括压力控制通气，气道峰值压力维持在15 - 25 cmH₂O，呼吸频率为35 - 55次/分钟，吸入氧分数（FiO₂）为60 - 80%，吸呼比（I:E）为1:1 - 1.5，并仔细进行气道吸引以清除分泌物。术后，维持血容量正常和血流动力学稳定对于成功撤机和拔管至关重要。
