88岁以上老年人的手术麻醉方法与管理

目的总结88岁以上高龄患者的麻醉方法和管理体会。方法回顾性分析61例88岁以上患者的麻醉处理,采用全麻12例,硬膜外麻醉37例,静脉麻醉5例,臂丛麻醉3例,局麻4例。结果本组手术时间平均66(15～150)min,术中出血平均180(0～500)ml。1例硬膜外麻醉阻滞不全改为全身麻醉,各项生命体征平稳。硬膜外麻醉局麻药初量平均为7.3(4～11)ml,阻滞平面2例为T8,其余均控制在T10以下。所有全麻患者术毕清醒后均拔出气管导管。61例均安全度过手术期并顺利出院。结论术前准确评估和充分准备,选择恰当的麻醉方法,加强围术期监测,及时进行术中、术后并发症防治及麻醉管理,是高龄患者安全度过围术期的重要措施,可减少麻醉风险。     

超强纤维结合方丝弓托槽在外伤脱位牙固定中的应用

目的：探讨超强纤维结合方丝弓托槽在外伤脱位牙固定中的临床应用。方法：选择外伤性脱位牙患者36例,55颗牙（脱位牙≤2颗;无冠根折及牙槽骨骨折;基牙无松动、缺失或萌出不全）,随机分成两组,分别采用超强纤维结合方丝托槽树脂夹板技术、与超强纤维增强复合树脂夹板技术进行单颌固定,固定6周。记录外伤、疗效及操作时间情况。结果：在外伤脱位牙固定疗效方面,超强纤维结合方丝托槽树脂夹板技术与超强纤维增强复合树脂夹板技术相比较无显著性差异（χ2=0.02,P〉0.05）;在牙体无损伤方面,超强纤维结合方丝托槽树脂夹板技术与超强纤维增强复合树脂夹板技术相比较有显著性差异（χ2=45.6,P〈0.01）。在操作时间方面,超强纤维结合方丝托槽树脂夹板技术与超强纤维增强复合树脂夹板技术相比较有显著性差异（t=9.99,P〈0.01）。结论：超强纤维结合方丝托槽树脂夹板技术固定外伤脱位牙疗效确切,具有牙齿无损伤、临床操作时间短及简单易操作等特点。     

Assessing the Need for Anesthesia and Sedation Services in Kuwaiti Dental Practice

The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.     

全身热疗对全凭静脉麻醉下阿曲库铵肌松效应的影响

目的 观察全身热疗(whole body hyperthhermia,WBH)对晚期癌症患者全凭静脉麻醉(total intravenous anesthesia,TIVA)中阿曲库铵用量和作用时间的影响.方法 晚期癌症TIVA患者,分非高温组(24例),高温组(26例).监测两组患者的体温、心电图(ECG)、中心静脉...     

阴部神经阻滞在痔手术中的应用

目的探讨阴部神经阻滞麻醉在痔切除手术中应用的临床效果。方法对两组各25例Ⅲ、Ⅳ度痔患者分别采用阴部神经阻滞麻醉及腰部麻醉,分别观察比较两组患者手术操作时间,术中麻醉效果,术后第一次疼痛的时间,最大疼痛分级,术后继发出血、尿潴留及恶心、呕吐情况。结果两组患者在手术操作时间及术中麻醉效果的比较上无显著性差异（P〉0.05）;阴部神经阻滞组术后第一次疼痛时间13.53±1.82 h相比腰部麻醉组6.15±2.60 h明显延长（P〈0.05）;阴部神经阻滞组在各时段最大疼痛分级明显优于腰部麻醉组（P〈0.05）;阴部神经阻滞组术后尿潴留及恶心、呕吐发生率比腰部麻醉组明显减少（P〈0.05）。结论阴部神经阻滞麻醉用于痔手术,麻醉效果好,镇痛时间长,降低了常规腰部麻醉带来的痔术后并发症的发生,并为门诊手术开展提供技术支持。     

Comparison of effective inspired concentration of sevoflurane in preterm infants with different postconceptual ages

Objective: Screening examination for retinopathy of prematurity (ROP) is stressful and painful to the neonate. Sevoflurane has been used successfully in anesthesia for full‐term and premature neonates and has been recently used for pediatric outpatient procedures. In this study, we examined the effective inspired concentration of sevoflurane to prevent movement in response to stimulation of examination in 50% of patients (EIC50) of sevoflurane, as well as the response of sevoflurane to age in the preterm outpatients undergoing fundus examination. Methods: Preterm pediatric outpatients at different postconceptual ages (duration from the mother’s last menstrual period to the date when the examination for ROP was performed) with <44 weeks (group A) and 44–64 weeks (group B) undergoing fundus examination were included. SpO₂ and ECG were monitored in operation room. In the process of anesthetic induction, the oxygen flow rates were 3 l·min^?1, and subjects spontaneously breathed 6% sevoflurane by mask. The time to loss of movement was recorded as induction time. Six percent sevoflurane was inhaled continuously for the same duration, and then the inspired concentration of sevoflurane was adjusted to maintenance concentration. When no movement or crying was observed, the speculums were used to keep the eyelids open, and then the eye examinations were performed by the same ophthalmologist. During induction time and maintenance time, the occurrence of coughing, clenching, gross purposeful movement, breath holding or desaturation to SpO₂ < 95% was recorded. After completion of the procedure, patients were observed in the same room until spontaneous eye opening or verbalization occurred. Up and down method was used to determine subsequent maintenance concentration in each group. The initial maintenance concentration was 3%. The gradient of increase or decrease was 0.5%. If the preceding subject had not moved, the sevoflurane concentration was decreased by 0.5%; if the preceding subject had moved, the concentration was increased by 0.5%. When at least six independent alternations from no‐movement to movement were observed, test was terminated. Results: Twenty‐four pediatric outpatients completed the investigation in group A. The effective inspired concentration prevented movement in response to stimulation of examination in 50% of patients (EIC50) of sevoflurane was 2.5% in group A. Twenty‐seven patients completed the investigation and EIC50 values of sevoflurane were 3.0% in group B. The induction time in group A was significantly lower than that in group B. The gestational ages, anesthesia time, and awake time were similar in two groups. Conclusion: Anesthesia with inhaled sevoflurane by a face mask can be accomplished in preterm outpatients undergoing fundus examination without intubation and i.v. accession. The EIC50 is lower, and the induction time is shorter in smaller aged patients compared with those in older ones.     

嗜酒者丙泊酚静脉全麻药量及效应的临床观察

目的 观察嗜酒对丙泊酚用药量和麻醉效果的影响.方法 嗜酒者与非饮酒者各40例,静注芬太尼0.002 mg/kg后继以4 mg·kg-1·min-1的速度缓慢静注丙泊酚,直至睫毛反射消失.记录丙泊酚用量、意识恢复时睁眼、对答和自行离去时间、各监测指标及不良反应.结果 两组丙泊酚用量[(1.88±0.36)mg/kg与(1.59±0.35)mg/kg]、自行离去时间[(24.43±5.55)min与(27.78±4.65)min]、RR[(9.13±1.27)次/分与(10.88±1.40)次/分]、SpO2[(96.93±2.08)%与(97.90±0.98)%],差异均有统计学意义(P<0.01).嗜酒者的咳嗽反应、舌根后坠、检查时肢体运动的比例较高,但恶心、呕吐的发生率低.结论 嗜酒者丙泊酚诱导剂量显著增加,恢复时间短,呼吸抑制增强,恶心呕吐发生率低.     

Anesthetic management of children with pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications, including pulmonary hypertensive crisis and cardiac arrest. Several mechanisms of hemodynamic deterioration, including acute increases in pulmonary vascular resistance (PVR), alterations of ventricular contractility and function and coronary hypoperfusion can contribute to morbidity. Anesthetic drugs exert a variety of effects on PVR, some of which are beneficial and some undesirable. The goals of balanced and cautious anesthetic management are to provide adequate anesthesia and analgesia for the surgical procedure while minimizing increases in PVR and depression of myocardial function. The development of specific pulmonary vasodilators has led to significant advances in medical therapy of PAH that can be incorporated in anesthetic management. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan and be prepared to treat a pulmonary hypertensive crisis.     

Laryngeal mask airway insertion in children: comparison between rotational, lateral and standard technique

Background:  The purpose of the study was to compare the success and ease of insertion of three techniques of laryngeal mask airway (LMA) insertion; the standard Brain technique, a lateral technique with cuff partially inflated and a rotational technique with cuff partially inflated.
Methods:  One hundred and sixty-eight ASA I and II children aged 6 months to 6 years undergoing short elective surgical procedures lasting 40–60 min were included in the study. A standard anesthesia protocol was followed for all patients. Patients were randomly allocated into one of the three groups i.e. standard (S), rotational (R) and lateral (L). The primary outcome measure of the study was success rate at the first attempt using three techniques of LMA insertion. Secondary outcomes measures studied were overall success rate, time before successful LMA insertion, complications and maneuvers used to relieve airway obstruction.
Results:  Successful insertion at the first attempt was significantly higher in group R (96%) compared with group L (84%) and group S (80%) ( P  =   0.03). Overall success rate (i.e. successful insertion with two attempts) was 100% for group R, 93% for group L and 87% for group S ( P  =   0.03). Time for successful insertion was significantly lower in group R compared with group L and S ( P  <   0.001). The incidence of complications was lower in group R.
Conclusions:  A rotational technique with partially inflated cuff is associated with the highest success rate of insertion and lowest incidence of complications and could be the technique of first choice for LMA insertion in pediatric patients.     

Risk factors for laryngospasm in children during general anesthesia

Background:  Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children.
Material and Methods:  The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case–control study.
Results:  No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P  =   0.022) and the presence of an airway anomaly (OR   =   3.35, P  =   0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly ( P  =   0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls ( P  =   0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort.
Conclusions:  In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.