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小儿眼科手术前常规检查的价值:一家三级医疗医院的10年经验

The Value of Routine Tests before Pediatric Eye Surgery: A 10-Year Experience at a Tertiary Care Hospital.

作者信息

Horikawa Hideyo, Matsuo Mitsuhiro, Yamazaki Mitsuaki

机构信息

Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan.

Department of Anesthesiology, Toyama Nishi General Hospital, Toyama, Japan.

出版信息

Anesth Essays Res. 2022 Jul-Sep;16(3):392-396. doi: 10.4103/aer.aer_112_22. Epub 2022 Dec 9.

Abstract

BACKGROUND

Routine tests before ophthalmologic surgery in adult patients are no longer recommended. However, there are limited data on the utility of routine preoperative tests for children.

AIMS

We aimed to describe the effect of routine preoperative tests on systemic perioperative complications by hospital discharge or by day 30 following eye surgery.

SETTINGS AND DESIGN

This was a single-center, observational, and descriptive study.

SUBJECTS AND METHODS

We examined all patients ≤ 17 years old for whom ophthalmologists consulted with anesthesiologists before eye surgery under general anesthesia in an academic teaching tertiary care hospital from January 2010 to December 2019.

RESULTS

A total of 708 pediatric patients were analyzed. The mean patient age was 8.5 ± 4.6 years. The most frequently performed procedure was strabismus surgery in 433 patients (61.2%). Following anesthetic consultations, 15 patients (2.1%) underwent surgery postponed due to abnormalities at the physical examination. Routine tests identified that the two patients (0.3%) required additional evaluations due to elevated serum creatine kinase and electrocardiographic abnormalities. However, further examinations found that these abnormalities were unremarkable. The remaining 691 patients (97.6%) underwent surgery as scheduled. Substantial intraoperative blood loss was observed only in three patients with malignant tumors or trauma. The incidence of systemic complications was 0 (0%; 95% confidence interval, 0%-0.05%).

CONCLUSIONS

These data indicated that the development of systemic perioperative complications following pediatric ophthalmic surgery is rare. Preoperative tests should be requested only if they are clinically indicated or before potentially bleeding procedures, such as malignancy or trauma surgery.

摘要

背景

不再推荐对成年患者进行眼科手术前的常规检查。然而,关于儿童术前常规检查效用的数据有限。

目的

我们旨在描述常规术前检查对眼部手术后出院时或术后30天内全身性围手术期并发症的影响。

设置与设计

这是一项单中心、观察性和描述性研究。

研究对象与方法

我们检查了2010年1月至2019年12月期间在一家学术教学三级护理医院接受全身麻醉下眼科手术前眼科医生咨询麻醉医生的所有17岁及以下患者。

结果

共分析了708例儿科患者。患者平均年龄为8.5±4.6岁。最常进行的手术是433例(61.2%)斜视手术。在麻醉咨询后,15例患者(2.1%)因体格检查异常而手术延期。常规检查发现2例患者(0.3%)因血清肌酸激酶升高和心电图异常需要进一步评估。然而,进一步检查发现这些异常并不显著。其余691例患者(97.6%)按计划进行了手术。仅在3例患有恶性肿瘤或创伤的患者中观察到术中大量失血。全身性并发症的发生率为0(0%;95%置信区间,0% - 0.05%)。

结论

这些数据表明儿童眼科手术后全身性围手术期并发症的发生很少见。仅在临床有指征时或在可能出血的手术(如恶性肿瘤或创伤手术)前才应要求进行术前检查。

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本文引用的文献

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Preoperative laboratory testing: Implications of "Choosing Wisely" guidelines.术前实验室检查:“明智选择”指南的影响
Best Pract Res Clin Anaesthesiol. 2020 Jun;34(2):303-314. doi: 10.1016/j.bpa.2020.04.006. Epub 2020 Apr 22.
2
Routine preoperative medical testing for cataract surgery.白内障手术的常规术前医学检查。
Cochrane Database Syst Rev. 2019 Jan 8;1(1):CD007293. doi: 10.1002/14651858.CD007293.pub4.
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Peri-operative adverse respiratory events in children.儿童围手术期不良呼吸事件。
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