Fishbaugh D F, Wilson S, Preisch J W, Weaver J M
Ohio State University, Columbus, USA.
Pediatr Dent. 1997 May-Jun;19(4):277-81.
A previous report suggested that airway compromise without self-correction may occur in pediatric dental patients sedated with chloral hydrate (CH) and nitrous oxide (N2O) and may be interpreted as "deep" sedation. The purpose of this institutionally approved study was to determine 1) the association between the size of the tonsils and 2) the degree of expired carbon dioxide (CO2) and oxygen saturation (SaO2) changes to simulated airway obstruction using the Moore head-tilt maneuver for 30 sec or less. Thirty healthy children (ASA I), aged 22-40 months, were evaluated for tonsil size and sedated with CH (50 mg/kg) and hydroxyzine (2 mg/kg) and supplemented with N2O. Pulse oximetry and capnography were used to monitor the child. During the restorative phase when the patient appeared asleep, the head was rolled forward with the chin touching the chest for a period of 30 sec. Changes in SaO2 and CO2 waveform were observed during this period. The results indicated that seven children who had enlarged tonsils had blocked airways (as determined by capnography) lasting approximately 15 sec. The remaining children did not have enlarged tonsils and continued to exchange air appropriately. O2 levels did not change during this period. The results suggest that the likelihood of airway blockage increases with enlarged tonsils. In children without airway blockage, ventilation occurs unimpeded, and attempts to readjust the head may not occur. The association between airway blockage and patient responsiveness is discussed in relation to sedation levels.
先前的一份报告表明，在使用水合氯醛（CH）和一氧化二氮（N₂O）镇静的儿科牙科患者中，可能会出现气道受压且无法自行纠正的情况，这可能被解释为“深度”镇静。这项经机构批准的研究的目的是确定：1）扁桃体大小与2）使用穆尔头部倾斜动作持续30秒或更短时间模拟气道阻塞时呼出二氧化碳（CO₂）和氧饱和度（SaO₂）变化程度之间的关联。对30名年龄在22至40个月的健康儿童（ASA I级）进行扁桃体大小评估，并用CH（50mg/kg）和羟嗪（2mg/kg）进行镇静，并补充N₂O。使用脉搏血氧饱和度仪和二氧化碳描记法监测儿童。在恢复阶段，当患者看起来入睡时，将头部向前滚动，使下巴接触胸部，持续30秒。在此期间观察SaO₂和CO₂波形的变化。结果表明，7名扁桃体肿大的儿童气道阻塞（通过二氧化碳描记法确定）持续约15秒。其余儿童扁桃体未肿大，继续正常换气。在此期间氧气水平没有变化。结果表明，扁桃体肿大时气道阻塞的可能性增加。在没有气道阻塞的儿童中，通气不受阻碍，可能不会尝试重新调整头部位置。结合镇静水平讨论了气道阻塞与患者反应性之间的关联。
