新型冠状病毒肺炎流行期间小儿麻醉相关规范

Pediatric anesthesia-related specification during coronavirus disease 2019 epidemic

新型冠状病毒肺炎传染性强,人群普遍易感。儿童作为一个特殊群体,是各种呼吸道感染性疾病的易感人群,由于需要更多的人员照顾和护理,交叉感染风险明显增加。在新型冠状病毒肺炎流行期间如何保障患儿和医护人员自身安全,避免交叉感染,减少麻醉相关并发症,加速患儿康复,是目前亟待解决的问题。基于以上问题,本文将从以下几方面进行逐一介绍:(1)围术期处理:涉及到术前会诊评估、手术的必要性、手术室内安排、手术过程中的注意事项、患儿及医护人员的防护以及运输路线规划;(2)麻醉流程:患儿转运、术前镇静、麻醉方式选择、麻醉诱导、困难气道的鉴别和处理、术中管理以及气管拔管相关问题;(3)术后地表、物表、空气、医疗器械的消毒问题,术后患儿登记和随访;(4)手术室外气管插管术的防护和准备、气管插管操作和注意事项以及气管插管后的判断;(5)中心静脉穿刺置管术的防护和准备、置管选择、麻醉管理以及置管的相关注意事项;(6)门诊镇静中心舒适化诊疗过程中医护人员的防护、镇静方案以及镇静流程;(7)特殊疫情时期患儿院内诊疗操作时的家属签字问题。

Coronavirus disease 2019 is highly infectious and generally susceptible to all human beings.Pediatric patients,as a special group which is prone to various respiratory infectious diseases,need more people to nurse and care and may cause a higher risk of cross-infection.Therefore,greater attention should be paid to this group.During the prevention and control of coronavirus disease 2019,it is an urgency to ensure the safety of children and medical staff,avoid cross-infection,reduce anesthesia-related complications,and accelerate the rehabilitation of pediatric patients.The article introduces the following aspects based on the problem mentioned above:(1)perioperative treatment of surgery,involving preoperative consultation and assessment,necessity of surgery,arrangement of operating room,precautions during surgery,protection of children and medical staff,and the transportation route planning;(2)anesthesia process,including pick-up of the pediatric patient,preoperative sedation,choice of anesthesia method,anesthesia induction,identification and management of difficult airways,intraoperative management,as well as problems related to the extubation;(3)the disinfection of the ground,air and medical equipment after surgery,and registration and follow-up of the children;(4)protection and preparation of emergency tracheal intubation,selection and performance of intubation,precautions in intubation and judgement after intubation outside the operating room;(5)protection and preparation of central vein catheterization,selection of the catheter,anesthesia management of the central vein catheterization and relevant precautions;(6)protection of medical staff,sedation program and sedation procedure during the comfort treatment in outpatient sedation center;(7)problems of family signature of the in-hospital treatment for pediatric patients during special epidemic period.