Keeri-Szanto M
Can Anaesth Soc J. 1978 Mar;25(2):147-50. doi: 10.1007/BF03005074.
A three-hour operation on the maxilla of a woman with an unrecognized large left diaphragmatic defect using narcotic-supplemented nitrous oxide anaesthesia resulted in near-complete compression of her left lung. The condition remained asymptomatic until post-operative shivering increased the patient's metabolic requirements, leading to signs of air hunger. Aspiration of large amounts of gas from the stomach promptly relieved all symptoms in spite of significant residual X-ray findings. It is important to keep in mind that the early post-operative period is usually one of intense metabolic activity rather than of rest. Patients who are unlikely to cope with such demand should be identified pre-operatively and supported prophylactically by ventilatory assistance, ample supply of metabolic substrates and judicious sedation.
一名患有未被识别的巨大左侧膈肌缺损的女性，在使用补充了麻醉剂的氧化亚氮麻醉进行了长达三小时的上颌骨手术过程中，其左肺几乎完全被压缩。该情况在术后一直无症状，直到术后颤抖增加了患者的代谢需求，导致出现空气饥饿的迹象。尽管X线检查仍有明显残留表现，但从胃中抽出大量气体后迅速缓解了所有症状。必须牢记，术后早期通常是代谢活动剧烈的时期，而非休息期。术前应识别出那些不太可能应对这种需求的患者，并通过通气辅助、充足的代谢底物供应和合理的镇静进行预防性支持。
