Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whe...Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.展开更多
Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsisten...Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.展开更多
背景 目前喉罩全麻是小儿斜疝手术最主要的麻醉方式,但由于手术刺激、麻醉操作及吸入性麻醉药物、术后疼痛等诸多原因会造成患儿特异性细胞免疫状态,全麻无法有效地抑制机体应激反应。骶管阻滞能够阻断手术部位传入神经冲动,骶管阻滞复...背景 目前喉罩全麻是小儿斜疝手术最主要的麻醉方式,但由于手术刺激、麻醉操作及吸入性麻醉药物、术后疼痛等诸多原因会造成患儿特异性细胞免疫状态,全麻无法有效地抑制机体应激反应。骶管阻滞能够阻断手术部位传入神经冲动,骶管阻滞复合喉罩全麻可更好地维护小儿免疫功能稳态;腹横肌(TAP)阻滞复合喉罩全麻也被证实具有较好的镇痛作用,并且可以显著降低静脉镇痛药物的使用量,提升手术的安全性。但目前两种复合麻醉手段在小儿斜疝手术治疗中的应用较少。目的 探讨骶管阻滞或TAP阻滞复合喉罩全麻对腹腔镜下斜疝手术患儿应激反应及免疫功能的影响。方法 选取2018年2月—2019年2月安徽省儿童医院收治的行腹腔镜下手术治疗的斜疝患儿90例为研究对象,依据麻醉方式的不同分为A组(30例,仅行七氟醚吸入喉罩全麻)、B组(30例,行骶管阻滞复合喉罩全麻)、C组(30例,行TAP阻滞复合喉罩全麻),记录3组患儿喉罩放置前(T0)、建立气腹后即刻(T1)、拔除喉罩后5 min(T2)时舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、去甲肾上腺素(NA)、皮质醇(COR)及血糖(GLU),记录术前,术后2、12、24 h时CD3^+、CD4^+、CD8^+、CD4^+/CD8^+,以及小儿麻醉苏醒期躁动量化评分(PAED)和并发症发生情况。结果 3组患儿T1、T2时DBP、SBP、MAP、HR、SpO2比较,差异均有统计学意义(P<0.05);其中B、C组患儿T1、T2时DBP、SBP、MAP、HR低于A组,SpO2高于A组(P<0.05)。A组患儿T1、T2时DBP、SBP、MAP、HR高于T0时,SpO2低于T0时(P<0.05);B组患儿T1、T2时SBP低于T0时,T0时MAP高于T1时、低于T2时,T1时MAP低于T2时(P<0.05);C组患儿T1、T2时SBP低于T0时,T0时MAP高于T1时、低于T2时,T1时MAP低于T2时,T0时HR高于T1时、低于T2时,T1时HR低于T2时,T1时SpO2低于T0、T2时(P<0.05)。3组患儿T1、T2时NA、COR、GLU比较,差异均有统计学意义(P<0.05);其中A组患儿T1、T2时NA、COR、GLU高于B、C组,B组患儿T1、T2时NA、COR、GLU低于C组(P<0.05)。A组患儿T1、T2时NA、COR、GLU高于T0时(P<0.05);B组患儿T1、T2时NA低于T0时、GLU高于T0时(P<0.05);C组患儿T1、T2时COR、GLU高于T0时(P<0.05)。3组患儿术后12 h CD3^+、CD4^+、CD4^+/CD8^+比较,差异均有统计学意义(P<0.05);其中A组患儿术后12 h CD3^+、CD4^+、CD4^+/CD8^+低于B组,CD3^+、CD4^+低于C组(P<0.05)。各组患儿术后12 h、术后24 h CD3^+、CD4^+、CD4^+/CD8^+低于术前,术后2 h CD3^+低于术前(P<0.05);A组患儿术后2 h CD4^+、CD4^+/CD8^+低于术前(P<0.05)。A组患儿PAED高于B组,并发症发生率高于B、C组(P<0.05)。结论 斜疝患儿行腹腔镜下手术治疗时采用骶管阻滞复合喉罩全麻可有效减轻机体应激反应,对患儿免疫功能影响较低,是腹腔镜下手术治疗患儿较好的麻醉手段。展开更多
文摘Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.
文摘Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.
文摘背景 目前喉罩全麻是小儿斜疝手术最主要的麻醉方式,但由于手术刺激、麻醉操作及吸入性麻醉药物、术后疼痛等诸多原因会造成患儿特异性细胞免疫状态,全麻无法有效地抑制机体应激反应。骶管阻滞能够阻断手术部位传入神经冲动,骶管阻滞复合喉罩全麻可更好地维护小儿免疫功能稳态;腹横肌(TAP)阻滞复合喉罩全麻也被证实具有较好的镇痛作用,并且可以显著降低静脉镇痛药物的使用量,提升手术的安全性。但目前两种复合麻醉手段在小儿斜疝手术治疗中的应用较少。目的 探讨骶管阻滞或TAP阻滞复合喉罩全麻对腹腔镜下斜疝手术患儿应激反应及免疫功能的影响。方法 选取2018年2月—2019年2月安徽省儿童医院收治的行腹腔镜下手术治疗的斜疝患儿90例为研究对象,依据麻醉方式的不同分为A组(30例,仅行七氟醚吸入喉罩全麻)、B组(30例,行骶管阻滞复合喉罩全麻)、C组(30例,行TAP阻滞复合喉罩全麻),记录3组患儿喉罩放置前(T0)、建立气腹后即刻(T1)、拔除喉罩后5 min(T2)时舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、去甲肾上腺素(NA)、皮质醇(COR)及血糖(GLU),记录术前,术后2、12、24 h时CD3^+、CD4^+、CD8^+、CD4^+/CD8^+,以及小儿麻醉苏醒期躁动量化评分(PAED)和并发症发生情况。结果 3组患儿T1、T2时DBP、SBP、MAP、HR、SpO2比较,差异均有统计学意义(P<0.05);其中B、C组患儿T1、T2时DBP、SBP、MAP、HR低于A组,SpO2高于A组(P<0.05)。A组患儿T1、T2时DBP、SBP、MAP、HR高于T0时,SpO2低于T0时(P<0.05);B组患儿T1、T2时SBP低于T0时,T0时MAP高于T1时、低于T2时,T1时MAP低于T2时(P<0.05);C组患儿T1、T2时SBP低于T0时,T0时MAP高于T1时、低于T2时,T1时MAP低于T2时,T0时HR高于T1时、低于T2时,T1时HR低于T2时,T1时SpO2低于T0、T2时(P<0.05)。3组患儿T1、T2时NA、COR、GLU比较,差异均有统计学意义(P<0.05);其中A组患儿T1、T2时NA、COR、GLU高于B、C组,B组患儿T1、T2时NA、COR、GLU低于C组(P<0.05)。A组患儿T1、T2时NA、COR、GLU高于T0时(P<0.05);B组患儿T1、T2时NA低于T0时、GLU高于T0时(P<0.05);C组患儿T1、T2时COR、GLU高于T0时(P<0.05)。3组患儿术后12 h CD3^+、CD4^+、CD4^+/CD8^+比较,差异均有统计学意义(P<0.05);其中A组患儿术后12 h CD3^+、CD4^+、CD4^+/CD8^+低于B组,CD3^+、CD4^+低于C组(P<0.05)。各组患儿术后12 h、术后24 h CD3^+、CD4^+、CD4^+/CD8^+低于术前,术后2 h CD3^+低于术前(P<0.05);A组患儿术后2 h CD4^+、CD4^+/CD8^+低于术前(P<0.05)。A组患儿PAED高于B组,并发症发生率高于B、C组(P<0.05)。结论 斜疝患儿行腹腔镜下手术治疗时采用骶管阻滞复合喉罩全麻可有效减轻机体应激反应,对患儿免疫功能影响较低,是腹腔镜下手术治疗患儿较好的麻醉手段。
