Zhonghua yi xue za zhi · 2013
[Anesthetic management for pediatric congenital laryngomalacia].
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Zhu Zhi-rui, Gai Chun-an, Hu Zhi-yong, Jiang Yi-lei, Sun Yue-feng
Аннотация
OBJECTIVE: To explore our experience of anesthetic management for pediatric congenital laryngomalacia operation.
METHODS: A total of 27 pediatric patients with congenital laryngomalacia were treated at our hospital between December 2010 and November 2012. All patients were anesthetized by intravenous anesthesia of propofol-remifentanil and spontaneous breathing. Oxygen was insufflated at a rate of 4 L/min through an endotracheal tube near glottis. Propofol was set at a constant rate of 100 µg · kg(-1) · min(-1). The initial dose of remifentanil at 0.05 µg·kg(-1)·min(-1) was adjusted in 0.05 µg·kg(-1)·min(-1) increments to titrate a 50% reduction in baseline respiratory rate. Heart rate (HR), mean arterial pressure, pulse oxygen saturation (SpO2), respiratory rate (RR), operation time, anesthesia time and remifentanil rate were recorded. Adverse events and interventions were also examined.
RESULTS: Comparison with induction of anesthesia, HR and RR changed significantly intraoperatively (P < 0.05). MAP, SpO2 were no significantly change during operation (P > 0.05). The induction time was 9-12 min and the highest remifentanil rate stood at (0.18 ± 0.03) µg·kg(-1)·min(-1). Body movements occurred in 3 (11%) patients and a bolus of propofol was administered. Desaturation below 95% occurred in 2 (7%) patients in which interventions were offered by decreasing the remifentanil infusion rate. No complications such as cough, hypoxemia, laryngospasm or bronchospasm, nausea or vomiting, arrhythmia were observed.
CONCLUSION: Key points of anesthetic management for pediatric congenital laryngomalacia include sufficient preoperative evaluation, spontaneous respiration anesthesia technique with total intravenous anesthesia, suitable anesthesia depth and intensive intraoperative monitoring.
METHODS: A total of 27 pediatric patients with congenital laryngomalacia were treated at our hospital between December 2010 and November 2012. All patients were anesthetized by intravenous anesthesia of propofol-remifentanil and spontaneous breathing. Oxygen was insufflated at a rate of 4 L/min through an endotracheal tube near glottis. Propofol was set at a constant rate of 100 µg · kg(-1) · min(-1). The initial dose of remifentanil at 0.05 µg·kg(-1)·min(-1) was adjusted in 0.05 µg·kg(-1)·min(-1) increments to titrate a 50% reduction in baseline respiratory rate. Heart rate (HR), mean arterial pressure, pulse oxygen saturation (SpO2), respiratory rate (RR), operation time, anesthesia time and remifentanil rate were recorded. Adverse events and interventions were also examined.
RESULTS: Comparison with induction of anesthesia, HR and RR changed significantly intraoperatively (P < 0.05). MAP, SpO2 were no significantly change during operation (P > 0.05). The induction time was 9-12 min and the highest remifentanil rate stood at (0.18 ± 0.03) µg·kg(-1)·min(-1). Body movements occurred in 3 (11%) patients and a bolus of propofol was administered. Desaturation below 95% occurred in 2 (7%) patients in which interventions were offered by decreasing the remifentanil infusion rate. No complications such as cough, hypoxemia, laryngospasm or bronchospasm, nausea or vomiting, arrhythmia were observed.
CONCLUSION: Key points of anesthetic management for pediatric congenital laryngomalacia include sufficient preoperative evaluation, spontaneous respiration anesthesia technique with total intravenous anesthesia, suitable anesthesia depth and intensive intraoperative monitoring.