Wei W, Li X, Xu X Y, Zhuang Y, Cai Y R
Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.
Zhonghua Yi Xue Za Zhi. 2022 Jun 7;102(21):1584-1589. doi: 10.3760/cma.j.cn112137-20220117-00112.
To investigate the effects of high-flow nasal oxygen (HFNO) combined with early extubation on the incidence of respiratory adverse events (RAE) during emergence from general anesthesia in children undergoing adenoid-tonsillectomy. From December 2021 to January 2022, 40 pediatric patients [21 males, 19 females, with a median age of 4 (4, 5) years] undergoing tonsillectomy and/or adenoidectomy in Eye & ENT Hospital of Fudan University were randomly divided into two groups: HFNO-assisted early extubation group (Group H, =20) and conventional extubation group (Group C, =20) by using a random number table. After entering the post-anesthesia care unit (PACU), the patients in group H received humidified and heated oxygen (flow rate: 25 L/min) through a nasal cannula until their consciousness regained. After patient's spontaneous breathing resumed for 10 min, the oral endotracheal tube was removed. Patients in group C did not receive HFNO. The oral endotracheal tube was removed after the patient's spontaneous breathing resumed for at least 10 min with signs of tube intolerance, or 20 min without signs of tube intolerance. During the PACU stay, the incidence of RAE, the incidence of cough, the application rate of intensive care strategy, the time to extubation, the duration of PACU stay, and vital signs at spontaneous breathing resuming and extubation in each group were recorded. In Group H, the total incidence of RAE [30% (6/20) vs 65% (13/20), =0.027], the incidence of cough [10% (2/10) vs 45% (9/20), =0.031] and the application rate of intensive care strategy [20% (4/20) vs 55% (11/20), =0.048] during PACU stay was significantly lower, compared with those of Group C. Likewise, the time to extubation was significantly shorter [(33.4±4.5) min vs (42.7±5.3) min, <0.001]. However, there was no statistically significant difference in the duration of PACU stay, the vital signs at the time of spontaneous breathing resuming and extubation between the two groups (>0.05), except that the end-tidal carbon dioxide partial pressure (PCO) at the time of extubation in group H was significantly higher than group C [(52.9±9.4) mmHg vs (48.9±3.1) mmHg (1 mmHg=0.133 kPa), <0.001]. HFNO combined with early extubation can significantly reduce the incidence of RAE in children undergoing adenoid-tonsillectomy during the emergence from general anesthesia.
探讨高流量鼻导管吸氧（HFNO）联合早期拔管对腺样体扁桃体切除术患儿全身麻醉苏醒期呼吸不良事件（RAE）发生率的影响。2021年12月至2022年1月，40例在复旦大学附属眼耳鼻喉科医院接受扁桃体切除术和/或腺样体切除术的儿科患者[男21例，女19例，中位年龄4（4，5）岁]，采用随机数字表法随机分为两组：HFNO辅助早期拔管组（H组，=20）和传统拔管组（C组，=20）。进入麻醉后监护病房（PACU）后H组患者通过鼻导管接受湿化加热氧气（流速：25 L/min）直至意识恢复。患者自主呼吸恢复10分钟后拔除气管导管。C组患者未接受HFNO。患者自主呼吸恢复至少10分钟且出现不耐管征象或未出现不耐管征象20分钟后拔除气管导管。记录PACU停留期间两组患者RAE发生率、咳嗽发生率、重症监护策略应用率、拔管时间、PACU停留时间以及自主呼吸恢复和拔管时的生命体征。H组在PACU停留期间RAE总发生率[30%（6/20）比65%（13/20），=0.027]、咳嗽发生率[10%（2/20）比45%（9/20），=0.031]和重症监护策略应用率[20%（4/20）比55%（11/20），=0.048]均显著低于C组。同样，H组拔管时间显著缩短[（33.4±4.5）分钟比（42.7±5.3）分钟，<0.001]。然而，两组间PACU停留时间、自主呼吸恢复和拔管时的生命体征差异无统计学意义（>0.05），但H组拔管时呼气末二氧化碳分压（PCO）显著高于C组[（52.9±9.4）mmHg比（48.9±3.1）mmHg（1 mmHg = 0.133 kPa），<0.001]。HFNO联合早期拔管可显著降低腺样体扁桃体切除术患儿全身麻醉苏醒期RAE的发生率。
