湿化高流量鼻导管通气全身麻醉下支撑喉镜手术后苏醒延迟1例分析

Delayed awakening after microlaryngeal surgery under general anesthesia by humidified high-flow nasal cannula: an analysis of 1 patient

目的探讨湿化高流量鼻导管通气(HFNC)用于喉显微手术的安全性和可行性。方法回顾性分析1例湿化高流量鼻导管通气全身麻醉下支撑喉镜下行会厌囊肿切除术,出现明显二氧化碳潴留和苏醒延迟患者的病史及相关检查、麻醉过程、术后苏醒情况等。结果患者预充氧时间太短(仅1 min),窒息时间太长(达20 min)是造成二氧化碳蓄积,进而导致苏醒延迟的主要原因。结论HFNC可以延长安全窒息时间,可用于喉部手术、气管异物、气管狭窄等气道内手术,临床应当遵守HFNC专家共识的建议,规范操作,HFNC预充氧时间不能太短,长时间窒息可能导致二氧化碳潴留,明显的二氧化碳潴留对意识有一定的影响,临床应用中要加以重视。

Objective To investigate the safety and feasibility of high-flow nasal cannula oxygen therapy(HFNC)for laryngeal microsurgery.Methods A case of epiglottic cyst resection using HFNC under general anaesthesia was performed.The history and related examination,anesthesia course and postoperative recovery of patient with obvious carbon dioxide retention and delayed recovery were analyzed.Results The preoxygenation time was too short(only 1 min)and the suffocation time was too long(up to 20 min)in this case were the main reasons for the accumulation of carbon dioxide and delayed recovery.Conclusion HFNC can prolong the safe asphyxia time and can be used for intra airway procedures such as laryngeal surgery,tracheal foreign body,and tracheal stenosis.Operations should standardize and follow the recommendations of HFNC expert consensus.The pre-oxygenation time of HFNC should not be too short.Long time suffocation may lead to carbon dioxide retention that has a certain effect on consciousness.These should be emphasized in clinical applications.