论著

喉罩与气管插管在小儿眼科全身麻醉中的对比研究

Laryngeal mask and endotracheal intubation in pediatric ophthalmic general anesthesia: A comparative study

:700-706
 
目的:对比喉罩与气管插管在小儿眼科全身麻醉中的应用情况,选取小儿全身麻醉的适宜气道管理方式。方法:选取2019年6月至2021年4月在天津市眼科医院进行眼科全身麻醉手术的86例患儿为研究对象,根据全身麻醉诱导后置入气管导管或喉罩分为插管组与喉罩组,每组43例。麻醉诱导后插入气管导管或喉罩后实施容量控制通气。通过回顾收集麻醉记录单查询麻醉诱导前(T0)、麻醉诱导后(T1)、插入气管导管或喉罩时(T2)、手术开始时(T3)、手术结束时(T4)、移除喉罩或气管导管时(T5)检测心率、平均动脉压,以及插管后5、10、20 min时的平均气道压和呼气末CO2分压。根据麻醉记录单查询每例患者气管插管或喉罩置入的次数、苏醒期呛咳及躁动的发生情况。比较2组麻醉时间、置管/喉罩首次成功率、拔管/撤罩时间、自主呼吸恢复时间、麻醉复苏时间。观察2组患者并发症(呛咳、躁动发生情况)的发生情况。结果:在T2、T3和T5时,插管组心率明显高于喉罩组,差异有统计学意义(P<0.05);在T2、T3、T4和T5时,插管组平均动脉压明显高于喉罩组,差异有统计学意义(P<0.05)。插管后5、10和20 min时,插管组平均气道压均高于喉罩组,差异有统计学意义(P<0.05)。2组不同时间点呼气末CO2分压的比较,差异无统计学意义(P<0.05)。喉罩组麻醉复苏期间呛咳和躁动的发生率明显低于插管组,差异有统计学意义(P<0.05)。结论:喉罩具有操作简单、对气道刺激较小等优点,用于小儿眼科全身麻醉时对血流动力学的影响较小,气道反应性低,并发症较少,值得在临床推广使用。
Objective: To select the appropriate airway management mode for children under general anesthesia by comparing the application of laryngeal mask and endotracheal intubation in pediatric ophthalmology. Methods: A total of 86 children who underwent ophthalmic general anesthesia surgery in our hospital in June 2019 and April 2021 were selected as the study subjects, and the tracheal catheter or laryngeal mask was placed after induction of general nesthesia, and the group of 43 cases were divided into intubation group and laryngeal mask group. Volumecontrolled ventilation is performed after induction of anesthesia after insertion of a tracheal catheter or laryngeal mask. Heart rate and mean arterial pressure were detected by retrospectively collecting anesthesia records alone before anesthesia induction (T0), after anesthesia induction (T1), when a tracheal catheter or laryngeal mask was inserted (T2), at the beginning of surgery (T3), at the end of surgery (T4), and when the laryngeal mask or tracheal catheter was removed (T5). As well as the average airway pressure and end-expiratory CO2 partial pressure at 5, 10, and 20 min after intubation. The number of endotracheal intubations or laryngeal hoods, the occurrence of cough during awakening, and agitation in each patient was queried according to the anesthesia record. The timing of anesthesia, the first success rate of catheterization/laryngeal mask, the time of extubation/uncommissioning, the time of spontaneous breathing recovery, and the time of anesthesia resuscitation were compared between the 2 groups. The occurrence of complications (choking cough, agitation) in both groups of patients was observed. Results: At T2, T3 and T5, the heart rate in the intubation group was significantly higher than that in the laryngeal mask group (P<0.05), and at T2, T3, T4 and T5, the mean arterial pressure in the intubation group was significantly higher than that in the laryngeal mask group(P<0.05). At 5, 10, and 20 min after intubation, the mean airway pressure in the intubation group was higher than that in the laryngeal mask group, and the difference was statistically significant (P<0.05). There was no statistical difference in the partial pressure of CO2 at the end of expiratory breath at different time points between the 2 groups (P<0.05). The incidence of choking cough and agitation during anesthesia resuscitation in the laryngeal mask group was significantly lower than that in the intubation group, and the difference was statistically significant (P<0.05). Conclusion: The laryngeal mask has the advantages of simple operation and less stimulation of the airway, and when used for pediatric ophthalmic general anesthesia, it has less hemodynamic effect, low airway responsiveness and fewer complications, and is worth promoting in clinical practice
论著

喉罩复合七氟醚麻醉在小儿门诊全身麻醉眼底荧光素造影检查中的应用

Application of inhaled sevoflurane via laryngeal mask airway in children undergoing outpatient fundus fluorescein angiography with general anesthesia

:695-699
 
目的:观察喉罩通气吸入七氟醚麻醉在小儿眼底荧光素造影检查(fundus fluorescein angiography,FFA)期间眼位情况、眼球运动的发生率和丙泊酚调整眼位的有效率。方法:回顾性分析2018年6月至2019年12月七氟醚麻醉下接受FFA的儿童的病例资料,记录检查开始时眼位分级、检查中眼球运动发生率、丙泊酚调整眼位的有效率、麻醉后恢复自主活动时间以及不良事件。结果:纳入1~9岁患儿54例,检查开始时42.6%(23/54)的患者眼位1级,51.9%(28/54)的患者眼位2级,5.6%(3/54)的患者眼位3级,检查中眼球运动发生率为61.1%(33/54)。13%(7/54)的患儿需丙泊酚干预,丙泊酚1 mg/kg纠正眼位的有效率为100%。患儿麻醉后恢复正常活动的平均时间为24.4 min,未发生不良事件。结论:喉罩复合七氟醚的麻醉可为门诊小儿眼底荧光造影提供相对满意的麻醉质量,患者在麻醉后可迅速恢复日常活动,丙泊酚可迅速纠正检查中眼位不正。
Objective: To observe the eye position, the incidence of eye movement and the efficacy of propofol on correcting eccentric eyeball position in children undergoing examination of outpatient fundus fluorescein angiography (FFA) with inhaled sevoflurane via laryngeal mask airway. Methods: Children undergoing FFA with sevoflurane anesthesia from June 2018 to December 2019 were retrospectively reviewed. Eye position at the beginning of examination, incidence of eye movement during examination, the efficiency of propofol on correcting eccentric eyeball position during procedure, the time to resume normal activities, and adverse events were recorded. Results: Fifty-four children aged 1–9 years were included in this study. The rates of eye position from grade one to grade three at the beginning of examination were 42.6% (23/54), 51.9% (28/54), and 5.6% (3/54), respectively. The incidence of eye movement during examination was 61.1% (33/54). 13% (7/54) of children with unsatisfactory eye-position needed intervention with propofol. The efficacy of propofol (1 mg/kg) in correcting eye position was 100%. The mean time to return normal activities was 24.4 min. There were no any adverse events during the peri-anesthetic period. Conclusion: Inhaled sevoflurane via LMA can provide appropriate anesthesia for outpatient FFA in children. Children can resume daily activities soon after anesthesia. Propofol can return the incorrect eye position during examination
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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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