支撑喉镜下CO2激光治疗小儿喉乳头状瘤的麻醉管理

本院2003年5月-2007年5月支撑喉镜下CO2激光治疗喉乳头状瘤患儿28例,男性19例,女性9例,年龄lO个月～3.5岁,体重8～15 kg,无喉阻塞患儿17例,喉阻塞Ⅰ度患儿7例,喉阻塞Ⅱ度或Ⅲ度息儿4例.术前对全身和喉部病变情况进行评估,根据不同喉阻塞程度选用不同的麻醉方法,纠正术前呼吸系统感染、脱水、电解质紊乱等合并症后行手术.麻醉诱导:无喉阻塞患儿肌肉注射氯胺酮5mg/kg,入睡后静脉注射咪达唑仑0.1 mg/kg、氯胺酮1～2 mg/kg或芬太尼2μ g/kg和琥珀胆碱1.5 mg/kg后气管插管;喉阻塞Ⅰ度患儿肌肉注射氯胺酮5 mg/kg,保留自主呼吸充分给氧,l%地卡因充分表面麻醉后气管插管;喉阻塞Ⅱ度或Ⅲ度患儿1%地卡因充分表面麻醉后气管插管;所有患儿均在喉镜直视下插入较正常小1号的气管导管,行辅助通气或机械通气.麻醉维持:间断静脉注射维库溴铵0.05-0.1 mg/kg和氯胺酮1～2 mg/kg,静脉输注异丙酚3～5 mg·kg-1·h-1,维持HR 110～150次/min,MAP 70～90 mm Hg.术毕时均静脉注射地塞米松0.2-0.3 mg/kg.待患儿清醒、吸空气维持SpO2≥96%时拔除气管导管.除喉阻塞Ⅰ度患儿中1例麻醉诱导时行紧急气管切开外,其余患儿麻醉诱导平稳,麻醉效果满意,血液动力学稳定,术后自主呼吸恢复平稳,均顺利完成手术.激光治疗中未见气管导管损伤及燃烧等情况发生,术中及术后未见窒息、喉痉挛及支气管痉挛等并发症发生.

Anesthetic management for CO2 laser treatment of laryngeal papilloma under self-retaining laryngoscope in children

Twenty-eight children with laryngeal papilloma aged 10 months -3.5 yr weighing 8-15 kg received CO2 laser treatment under serf-retaining laryngoscope from May 2003 to May 2007. There were 17 patients without laryngeal obstruction, 7 patients with 1st degree laryngeal obstruction and 4 patients with 2rid or 3rd degree laryngeal obstruction. Different techniques of anesthesia were used for patients with different degrees of laryngeal obstruction. In patients without laryngeal obstruction anesthesia was induced with intramuscular ketamine 5 mg/kg. After the patients lost consciousness midazolam 0.1 mg/kg, ketamine 1-2 mg/kg or fentanyl 2 μg/kg was given iv. Tracheal intubation was facilitated with succinyl-cboline 1.5 mg/kg. In patients with 1st degree laryngeal obstruction, ketamine 5 mg/kg was given ira. The patients kept spontaneous breathing. Tracheal intubaiion was pedormed under topical anesthesia with 1% tetracaine. In patients with 2nd and 3rd degree laryngeal obstruction tracheal intubation was performed awake without any premedication under topical anesthesia with 1% tetracaine. The trachea was intubated with the tracheal tube 1 size smaller than the regular size. Anesthesia was maintained with propofol 3-5 mg·kg1·h-1 and intermittent iv boluses of ketamine 1-2 mg/kg and vecuronium 0.05-0. 1 mg/ kg. Dexamethasone 0.2-0.3 mg/kg was given iv at the end of operation. The patients were extubated when the patients regained consciousness and SpO2≥ 96% on air. In one patient with Ist degree laryngeal obstruction emergency tracheotomy was performed during induction of anesthesia. Anesthesia was otherwise smooth and recovery was uneventful.