喉罩在小儿全身麻醉中拔管时机的临床观察
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摘要
目的:探讨在喉罩控制通气的小儿全身麻醉中合适拔除喉罩的时机。方法:将2017年7月至2018年2月广东省佛山市中医院麻醉科应用喉罩通气全身麻醉的40例小儿随机分为对照组和研究组,每组各20例,对照组小儿自主呼吸恢复后脱氧,经皮氧饱和度(SpO_2)>95%即拔除喉罩;研究组在对照组的基础上,出现体动后才拔除喉罩。比较两组小儿拔除喉罩后出现的最低SpO_2、拔喉罩后的并发症和在恢复室停留时间。结果:所有小儿均顺利度过麻醉苏醒期,无躁动、呕吐、咳嗽、喉痉挛及支气管痉挛的发生,对照组有5例小儿SpO_2<90%,需要辅助通气,研究组有1例小儿需要辅助通气。结论:喉罩通气的小儿全身麻醉在小儿自主呼吸恢复、出现体动后拔除喉罩是可行的。
Objective:To explore the timing of Tracheal extubation with the laryngeal mask airway in children undergeneral anesthesia. Methods:40 cases of children under general anesthesia by the laryngeal mask airway were randomlydivided into the control group and the research group from jul 2017 to Feb 2018,and each group was 20 cases. Thecontrol group was extubated the laryngeal mask airway when Sp O2>95% after oxygen supply was stopped to the childrenand spontaneous breathing recovered,while the research group was extubated the laryngeal mask airway when body move-ment appeared and Sp O2>95% after oxygen supply was stopped to the children and spontaneous breathing recovered.The changes of minimums of Sp O2,complications,residence time in recovery room were compared between the twogroups. Results:Children in all cases revived in awakening period of anesthesia,no case was observed,includingdysphoria,emesia,cough,laryngospasm,bronchus spasm. 5 children in the control group needed assisted ventilation,while 1 child in the control group needed assisted ventilation. Conclusion:It is viable that extubate the laryngeal maskairway in children after general anesthesia when body movement appear and spontaneous breathing recover.
Objective:To explore the timing of Tracheal extubation with the laryngeal mask airway in children undergeneral anesthesia. Methods:40 cases of children under general anesthesia by the laryngeal mask airway were randomlydivided into the control group and the research group from jul 2017 to Feb 2018,and each group was 20 cases. Thecontrol group was extubated the laryngeal mask airway when Sp O2>95% after oxygen supply was stopped to the childrenand spontaneous breathing recovered,while the research group was extubated the laryngeal mask airway when body move-ment appeared and Sp O2>95% after oxygen supply was stopped to the children and spontaneous breathing recovered.The changes of minimums of Sp O2,complications,residence time in recovery room were compared between the twogroups. Results:Children in all cases revived in awakening period of anesthesia,no case was observed,includingdysphoria,emesia,cough,laryngospasm,bronchus spasm. 5 children in the control group needed assisted ventilation,while 1 child in the control group needed assisted ventilation. Conclusion:It is viable that extubate the laryngeal maskairway in children after general anesthesia when body movement appear and spontaneous breathing recover.
引文
[1]杨飞,李莹莹,马宗芬,等.可弯曲喉罩应用于小儿眼科手术的评价[J].广东医学,2017,38(24):3827.
[2]Sibel O,Hacer S,Canan T,et al.Comparison of the Supreme and Pro Seal laryngeal mask airways in infants:a prospective randomised clinical study[J].BMC Anesthesiol,2017,17(1):125.
[3]Ravira j,Sunita G,David T.Tracheal extubation with a laryngeal mask airway and exchange catheter in a patient with a difficult airway[J].J Can Anesth,2013,60(12):1278.
[4]夏小萍,倪坤,汪小海,等.改良普通喉罩辅助纤维支气管镜气管插管在困难气道患者中的应用[J].临床麻醉学杂志,2016,32(12):1186.
[5]禹二友,赵静,童易如.小儿全身麻醉拔管时机的研究进展[J].临床小儿外科杂志,2016,15(5):502.
[6]龚亚红,王杰,魏伟,等.病态肥胖患者腹腔镜减肥手术后早期拔管的影响因素分析[J].临床麻醉学杂志,2015,31(1):22.
[7]Yoshitaka F,Yuhji S,Hiroyoshi T,et al.Retraction Note to:Cardiovascular responses to tracheal extubation or LMA removal in children[J].Can J Anaesth,2013,60(6):617.
[2]Sibel O,Hacer S,Canan T,et al.Comparison of the Supreme and Pro Seal laryngeal mask airways in infants:a prospective randomised clinical study[J].BMC Anesthesiol,2017,17(1):125.
[3]Ravira j,Sunita G,David T.Tracheal extubation with a laryngeal mask airway and exchange catheter in a patient with a difficult airway[J].J Can Anesth,2013,60(12):1278.
[4]夏小萍,倪坤,汪小海,等.改良普通喉罩辅助纤维支气管镜气管插管在困难气道患者中的应用[J].临床麻醉学杂志,2016,32(12):1186.
[5]禹二友,赵静,童易如.小儿全身麻醉拔管时机的研究进展[J].临床小儿外科杂志,2016,15(5):502.
[6]龚亚红,王杰,魏伟,等.病态肥胖患者腹腔镜减肥手术后早期拔管的影响因素分析[J].临床麻醉学杂志,2015,31(1):22.
[7]Yoshitaka F,Yuhji S,Hiroyoshi T,et al.Retraction Note to:Cardiovascular responses to tracheal extubation or LMA removal in children[J].Can J Anaesth,2013,60(6):617.