显微支撑喉镜下CO_2激光手术的麻醉管理

Anesthesia Management of CO_2 Laser Surgery Under Suspension Laryngoscope

目的 总结显微支撑喉镜下CO2激光手术的麻醉管理.方法 2007年11月～2013年3月显微支撑喉镜下CO2激光治疗声带良性肿物113例,均行经鼻气管内插管全身麻醉,监测无创血压（BP）、心率（HR）、脉搏血氧饱和度（SpO2）和呼气末CO2分压（PETCO2）.结果 置入支撑喉镜即刻易出现循环波动,血压及心率较气管插管后升高,其中21例出现一过性窦性心动过缓.置入支撑喉镜后5 min循环渐趋平稳.SpO2和PETCO2正常.均在手术间拔除气管导管,安返病房.结论 术前全面评估患者全身情况及气管插管条件,完善围术期监测,加强术中管理,按需加深麻醉,及时纠正并处理危急情况,可保障显微支撑喉镜下CO2激光手术顺利进行及患者的安全.

Objective To summarize anesthesia management of CO2 laser surgery under suspension laryngoscope.Methods Retrospective analysis of 113 cases of anesthesia management of CO2 laser surgery under suspension laryngoscope from November 2007 to March 2013 in our hospital was carried out.All patients underwent nasotracheal intubation under general anesthesia,with noninvasive blood pressure,heart rate,saturation of pulse oxygen （SpO2）,and end-tidal carbon dioxide pressure （PET CO2） being monitored.Results Circulation fluctuation was observed right after suspension laryngoscope being inserted.Blood pressure and heart rate generally increased compared to baseline after tracheal intubation.However,there were 21 cases of transient sinus bradycardia.Indicators of circulation stabilized 5 minutes after suspension laryngoscope was inserted.SpO2 and PET CO2 maintained within normal range.All patients were extubated in the operation room.Conclusion Comprehensive preoperative assessments,peri-operative monitoring,and proactive anesthesia management including adjustment of anesthesia and handling of crisis situations in a timely fashion,are key elements to ensure patients＇ safety during CO2 laser surgery under suspension laryngoscope.