Monrigal J P, Granry J C, Rezzadori G, Rialland X, Loisel D, Delhumeau A
Unité d'Anesthésie et de Réanimation Polyvalente de l'enfant, CHU, Angers.
Ann Fr Anesth Reanim. 1995;14(2):225-9.
Due to the action of the drugs and the position of the patient, general anaesthesia in a child with a mediastinal tumor can complete the obstruction of the trachea and/or the main bronchi and possibly result in irreversible respiratory failure. The risk is directly linked to the degree of lumen amputation of the trachea, usually evaluated by CT-scan: there is a risk of accident if the degree of lumen amputation is greater than 30%. The case reports underline the value of the flexible fibreoptic bronchoscopy under local anaesthesia. This examination, as well as the CT-scan, allows to evaluate the degree of tracheal compression. Moreover, it carries a lower risk than the CT-scan which requires, in a small child, either general anaesthesia or heavy premedication which could lead to asphyxia. Total obstruction most often occurs with anterior mediastinal tumors. However, even posterior or lateral tumors can extend to an anterior position, especially in the young child. If the obstruction of the lumen is greater than 30% and if general anaesthesia is required, the fibreoptic bronchoscopy allows endotracheal intubation under local anaesthesia before general anaesthesia. We report 5 cases which illustrate the risk of tracheal compression during general anaesthesia in patients with a mediastinal tumor and substantiate the advantages of a flexible fibreoptic bronchoscope in the management of these patients before and during general anaesthesia.
由于药物的作用和患者的体位，纵隔肿瘤患儿进行全身麻醉可能会导致气管和/或主支气管梗阻，进而可能引发不可逆的呼吸衰竭。这种风险与气管管腔截断程度直接相关，通常通过CT扫描评估：当管腔截断程度大于30%时存在意外风险。病例报告强调了局部麻醉下可弯曲纤维支气管镜检查的价值。该检查以及CT扫描可用于评估气管受压程度。此外，它的风险低于CT扫描，因为在幼儿中进行CT扫描需要全身麻醉或深度术前用药，这可能导致窒息。完全梗阻最常发生在前纵隔肿瘤患者中。然而，即使是后纵隔或侧纵隔肿瘤也可能延伸至前位，尤其是在幼儿中。如果管腔梗阻大于30%且需要全身麻醉，纤维支气管镜可在全身麻醉前于局部麻醉下进行气管插管。我们报告了5例病例，这些病例说明了纵隔肿瘤患者在全身麻醉期间气管受压的风险，并证实了可弯曲纤维支气管镜在这些患者全身麻醉前和麻醉期间管理中的优势。
