Oohata H, Takada M, Ishizawa Y, Akamatsu S, Shimonaka H, Dohi S
Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Japan.
Masui. 1996 Apr;45(4):458-63.
We describe a mentally retarded child with obstructive sleep apnea syndrome (OSAS) in whom it was difficult to maintain upper airway in the perioperative period. The child underwent awake intubation, because the preanesthetic evaluation of the airway with a direct fiberoptic visualization revealed a very narrow airway. Also we considered that if we used an anesthetic agent, a perioperative airway management would be very troublesome. Postoperatively we continuously monitored for apnea and arrhythmias. When the child was sleeping, we found frequently that her thoratic movements were getting weak and percutaneous oxygen saturation went down to about 70 percent. The preoperative direct fiberoptic visualization of the upper airway is effective for the evaluation of the degree of airway obstruction in this child. We also recommend the continuous intensive postoperative monitorings including pulse oximetry, ECG, and apnea monitor which are very important to avoid life-threatening complications such as upper airway obstruction and serious arrhythmias in patients with obstructive sleep apnea syndrome.
我们描述了一名患有阻塞性睡眠呼吸暂停综合征（OSAS）的智力发育迟缓儿童，其在围手术期难以维持上呼吸道通畅。该患儿接受了清醒插管，因为术前通过直接纤维喉镜可视化评估气道发现气道非常狭窄。此外，我们认为如果使用麻醉剂，围手术期气道管理将非常麻烦。术后我们持续监测呼吸暂停和心律失常。当患儿睡觉时，我们经常发现她的胸廓运动变弱，经皮血氧饱和度降至约70%。术前对上呼吸道进行直接纤维喉镜可视化检查，对于评估该患儿气道阻塞程度是有效的。我们还建议术后持续进行强化监测，包括脉搏血氧饱和度监测、心电图监测和呼吸暂停监测，这对于避免阻塞性睡眠呼吸暂停综合征患者出现危及生命的并发症（如气道阻塞和严重心律失常）非常重要。
