七氟醚吸入麻醉在小儿唇腭裂手术中的应用

目的观察七氟醚吸入麻醉用于小儿唇腭裂手术的麻醉诱导、维持及苏醒的临床效果。方法50例唇腭裂患者，ASAⅠ-Ⅱ，年龄2月-12岁。6岁以下患儿采用七氟醚快速吸入麻醉诱导，七氟醚5—8vd％＋吸入氧6L／min，待疼痛消失后，经口异型管（oral）气管插管；6岁以上患儿静注芬太尼1μg／kg，同时吸入七氟醚5—8vol％＋吸入氧6L／min，待疼痛消失后，经口异型管（oral）气管插管或喉罩（LMA）置入，待麻醉诱导完毕，术者做眶下神经阻滞。术中七氟醚维持2—3vol％，＋吸入氧1-3L／min，保持患者自主呼吸存在。记录睫毛反射消失时间，疼痛反射消失时间，术后苏醒时间，观察幼儿是否合作，诱导期患儿是否合作，有无咳嗽、屏气及喉痉挛，有无术后躁动及恶心呕吐等并发症。记录诱导前、睫毛反射消失时、气管插管时、术中、术毕各时间点MAP、HR、SpO2％、PETCO2的变化。结果睫毛反射消失时间（48．5±13．5）s，疼痛反射消失（147±23．5）s苏醒时间（3．82±1．25）min。6岁以上患儿中2例术中体动，追加异丙酚0．5mg／kg后麻醉平稳。无一例术后恶心呕吐及躁动。插管时MAP和HR稍有增快，插管后恢复诱导前水平，SpO2、PETCO2均无显著改变。结论七氟醚具有气味芬芳，诱导迅速，术中可不需肌松弛剂，麻醉维持平稳，苏醒快，不良反应少，是理想的吸入麻醉剂。

Application of sevoflurane inhalation anaesthesia in repairing of children cleft lip and palate cleft surgery

Objective To observe the clinical effects of sevoflurane inhalation anaesthesia in children lip and cleft palate surgery during anaesthesia induction,maintain and awakeness period. Methods Fifty children 2 months-12 years old,ASA Ⅰ～Ⅱ ,underwent lip and palate cleft surgery. Sevoflurane rapidly mask inhalation anaesthesia induction in below 6 years old children, 5 %- 8% Sevoflurane ＋ 6 L/min oxygen, when consciousness and analgesia, relief endotracheal intubation （ oral ）. Above 6 years old children at first intravenous Fentanyll μg/kg,meantime Sevoflorane mask inhalation anaesthesia 5% - 8% Sevoflurane ＋ 6 L/min oxygen, when consciousness and pain relief, insert LMA （laryngeal mask airway）or endotracheal tube. After induction, the surgeon make the local anaesthesia at the nerve of hypoorbital. All children breathed spontaneously during operation. The anaesthesia was maintained with 2% - 3% Sevoflurane ＋ 1 - 3 L/min oxygen. Recorded the time of losing eyelash reflex, analgesia, and awakeness. The incidence of coughing, apnoca, and laryngospasm during the induction period, and excitatory activity , nausea and vomiting in recovery. The variety of MAP,HR,SpO2 % 、PET- CO2 were recorded in the every time point of operation. Results Time to losing eyelash reflex is （48.5 ±13.5 ） s, time to analgesia is （ 147 ± 23.5 ） s, time to awakeness is （ 3.82± 1.25 ） min. Two cases had limbs movement in above 6 years old children,then injected intravenous Propofol 0.5 mg/kg, no incidence of coughing, apnoea ,and laryngospasm were found during the induction period, and excitatory activity nausea and vomiting in recovery. MAP and HR had a little increasing when inserting the tube, after that recover the ex-level. SpO2 % ,PETCO2 didn＇ t have a rapid change. Conclusion Sevoflurane has a fine smell, rapid induction and recovery, making muscle flabby,smooth and rapid anaesthesia ,little side effect. Sevoflurane is the best ideal inhalation anaesthetic.