Griffith E R, Melampy C N
Arch Phys Med Rehabil. 1977 Apr;58(4):154-7.
This study reviews a nearly three-year experience of intramuscular neurolysis in children with spasticity. Thirteen children aged 3 to 11 years received general anesthesia during 16 procedures. Ten were cerebral palsy patients, one a congenital hydrocephalic, one a familial spastic paraplegic, and one a brain-injured child. Types of preoperative medications, induction and maintenance anesthetic agents are described, with indications for the particular choices of each type of drug. The principal and side effects of these agents during and after the 16 procedures are summarized. A combination of agents such as chloral hydrate; atropine if endotracheal intubation is necessary; pentothal, halothane, or cyclopropane for induction, and halothane-nitrous oxide for maintenance is our current choice of drugs to produce a light surgical plane of anesthesia. Advantages and disadvantages of the operating room method are considered. An overnight hospital stay was sufficient for all but two children, who required an additional evening of observation as the result of anesthetic side effects. No major complications were encountered in any of these elective procedures. The presence of a pediatric anesthesiologist during the procedure is perhaps to most reassuring aspect of the operating room-general anesthesia method.
本研究回顾了近三年来对痉挛性儿童进行肌肉内神经松解术的经验。13名年龄在3至11岁的儿童在16次手术过程中接受了全身麻醉。其中10名是脑瘫患者，1名是先天性脑积水患儿，1名是家族性痉挛性截瘫患者，1名是脑损伤儿童。描述了术前用药类型、诱导和维持麻醉剂，并说明了每种药物特定选择的适应症。总结了这些药物在16次手术过程中及术后的主要作用和副作用。目前我们选择的药物组合是：水合氯醛等；必要时使用阿托品进行气管插管；诱导时使用硫喷妥钠、氟烷或环丙烷，维持时使用氟烷-氧化亚氮，以达到浅麻醉手术平面。考虑了手术室方法的优缺点。除两名儿童外，其他儿童在医院过夜观察就足够了，这两名儿童因麻醉副作用需要额外观察一晚。在这些择期手术中均未出现重大并发症。手术过程中有小儿麻醉医生在场可能是手术室全身麻醉方法最让人安心的方面。
