小儿脑立体定向术麻醉应注意的几个问题

本文对我院１９８８～１９９６年６月１０５例脑立体定向手术患儿（ＡＳＡⅠ～Ⅱ，平均年龄９．７９±３．６８岁，男／女：６１／４４）的麻醉资料进行了分析。结果表明，所有患儿均在局麻（０．５％普鲁卡因）基础上进行手术（手术时间１．２～４．５ｈ）．其中辅用镇静剂（安定、氟哌啶）或基础麻醉（肌注氯胺酮或哌替啶）５４例（５１．４％）、静脉麻醉４６例（４３．８％）和气管内麻醉５例（４．８％）。术中最常见的并发症为恶心呕吐（２４例）、窦性心动过速（１０例）／过缓（２４例）和不同程度的呼吸困难（２９例）。为提高手术麻醉的安全性，对围手术麻醉期应注意的几个问题，如术前用药、术中并发症处理、术中监测等进行了讨论。

Problems about anesthesia of pediatric patients during cerebral stereotactic opera-tions

In this article,a nine-year,s date(1988 to June 1996)about anesthesia of 105 pediatric patientsunderwent cerebral stereotastic operations was anaiysed.The results showed that all children (ASA I-II,2-14yr,M/F:61/44),anesthetilized basically by local anesthesia with 0.5%procaine, were also needed tobe combined with one other different anesthetic method during procedures,such a8 54 cases(51.6%) withsedative(diazepam or droperidol)or basical anesthesia(ketamine or pethidine I.M.),46 cases(43.8%)with intravenous anesthesia(ketamine, r-OH, fentanyl or thiopental I.V,)and 5 cases(4.8%)with trachealintubation. The commonnest complications during operations were nausea, vomiting,bradycardia andtachycardia as well as dyspnea in various degrees. In conclusion,we suggested that, in order toincreasethe safety during pediatric anesthesia and stereotartic operation, anesthetists should attend followingproblems:(1)preparing the pediatric patients preopratively,including history,physical examination,premedication and or so;(2) choosing anesthetic techniques and anesthetics reasonably for earh case;(3)positioning proppJrly for airway manapement and preventing vomiting or regurigitation with subsequentpulmonary aspiration of stomaich content during anesthesia,and(4)monitoring SBP, DBP,MAP,ECGand SpO2.