射频消融术治疗小儿快速心律失常的麻醉体会

Anesthetic experiences of radiofrequency catheter ablation in children with tachyarrhythmia

目的探讨射频消融术治疗小儿快速心律失常的麻醉处理方法。方法 60例室上性心动过速接受射频消融术患儿,术前禁食6 h,麻醉前30～45 min肌注东莨菪碱0.01 mg/kg、咪唑安定0.1 mg/kg。入室后面罩给氧,持续监测呼吸、心率、血压、ECG、SpO2等;静注杜冷丁、咪唑安定和异丙酚并辅以充分局麻下完成手术。结果 2例患儿因无法诱导出心动过速导致手术失败,其余全部患儿在局麻复合非气管内插管静脉麻醉下完成手术,效果满意。结论使用杜冷丁、咪唑安定和异丙酚等药为基础麻醉,在加用局麻的情况下用于小儿射频消融术,具有起效快、对呼吸循环影响小、麻醉管理方便、病人苏醒快的特点,是一种安全有效的麻醉方法。

Objective To investigate the anesthetic methods for radiofrequency catheter ablation （RFCA）in children with tachyarrhythmia. Methods 60 children with supraventricular taehycardia all fast for 6 h before RFCA, and then intramuscularly injected with scopolamine at 0.01 mg/kg and midazolam at 0.1 mg/kg 30 - 45 min pre - anesthesia. Mask oxygen inhalation was performed after they were delivered into operation room. Their respiration, heart rate, blood pressure, ECG and SpO2 were continuously monitored. RFCA was done under basal anesthesia by intravenous injection of pethidine, midazolam and propofol combined with local infiltration anesthesia. Results RFCA in two eases was failed due to no induction of tachycardia. The others were successful under local and intravenous anesthesia without intratracheal intubation. There were no significant differences in mean arterial pressure and heart rate between pre - anesthesia and post - anesthesia. Conclusion Basic anesthesia using pethidine, midazolam and propofol combined with local anesthesia is a safe and effective anesthetic method for RFCA in children. It has many advantages such as rapid work,little influence on respiratory and circulation systems, convenient management and fast postanaesthetic recovery.