Yu Eryou,Xiang Zhen,Wu Lei,et al.Application of laryngeal mask controlled ventilation under general anesthesia in interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis[J].Journal of Clinical Pediatric Surgery,,20():1038-1041,1047.[doi:10.12260/lcxewkzz.2021.11.008]
Application of laryngeal mask controlled ventilation under general anesthesia in interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis
- Keywords:
- Bronchoscopy; Subglottic Stenosis; Interventional Surgery; Laryngeal Mask; Controlled Ventilation; Child
- CLC:
- R768.1;R767.44;R726.142
- Abstract:
- Objective To explore the anesthetic effect and surgical safety of laryngeal mask controlled ventilation under general anesthesia during interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis. Methods From January 2019 to May 2020, retrospective review was conducted for 52 children aged over 1 year old undergoing interventional surgery via fiberoptic bronchoscope for subglottic stenosis. General anesthesia was applied with laryngeal mask controlled ventilation. Clinical profiles and the changes of HR (heart rate), oxygen concentration (SpO2) and MAP (mean arterial pressure) at the timepoints of entering operating room (T1), completing induction (T2), starting operation (T3) , 15 min post-operation (T4) and end of operation (T5) were recorded. Results All procedures were completed successfully and at least one perioperative adverse event occurred in 13 cases. Mean operative duration was (63.08±31.58) min and mean anesthesia induction duration (6.93±1.06) min. No significant changes occurred in HR or MAP at the timepoints of T1-T5 (P>0.05). The level of SpO2 changed markedly (P<0.001) and peaked at T3. Conclusion During interventional surgery via fiberoptic bronchoscopy, laryngeal mask controlled ventilation under general anesthesia may improve blood oxygen reserve, enhance surgical tolerance and reduce the occurrence of adverse events with better anesthesia effect and operative safety.
References:
1 Jiao A, Liu F, Lerner AD, et al. Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy[J].Pediatr Investig, 2019, 3(1):9-16.DOI:10.1002/ped4.12113.
2 Deshmukh A, Jadhav S, Wadgoankar V, et al. Airway management and bronchoscopic treatment of subglottic and tracheal stenosis using holmium laser with balloon dilatation[J].Indian J Otolaryngol Head Neck Surg, 2019, 71 (Suppl 1):453-458.DOI:10.1007/s12070-018-1348-x.
3 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南(2018年版)[J].中华实用儿科临床杂志, 2018, 33(13):983-989.DOI:10.3760/cma.j.issn.2095-428X.2018.13.006. Talent Exchange Service Center of National Health Commission:Expert Group of Pediatric Respiratory Endoscopic Diagnostic & Therapeutic Techniques; Endoscopic Specialty Committee, Branch of Pediatricians, China Doctors Association; Pediatric Respiratory Endoscopic Specialty Committee, Branch of Endoscopic Physicians, China Doctors Association:Guideline of Pediatric Flexible Bronchoscopy in China (2018 Edition)[J].Chinese Journal of Applied Clinical Pediatrics, 2018, 33(13):983-989.DOI:10.3760/cma.j.issn.2095-428X.2018.13.006.
4 杨梅雨, 张新萍, 肖政辉, 等. 支气管镜下肺介入治疗在儿童获得性声门下狭窄中的应用[J].中国小儿急救医学, 2021, 28(3):235-237.DOI:10.3760/cma.j.issn.1673-4912.2021.03.016. Yang MY, Zhang XP, Xiao ZH, et al. Application of bronchoscopic intervention in children with acquired subglottic stenosis[J].Chinese Pediatric Emergency Medicine, 2021, 28(3):235-237.DOI:10.3760/cma.j.issn.1673-4912.2021.03.016.
5 卓海珍, 何海燕.喉罩全身麻醉用于小儿纤维支气管镜检查中的效果及安全性[J].临床肺科杂志, 2020, 25(3):431-433.DOI:10.3969/j.issn.1009-6663.2020.03.024. Zhuo HZ, He HY.Effect and safety of general anesthesia with laryngeal mask for fiber bronchoscopy in children[J].Journal of Clinical Pulmonary Medicine, 2020, 25(3):431-433.DOI:10.3969/j.issn.1009-6663.2020.03.024.
6 Mir GA, Neira V, Ufholz LA, et al. A systematic review and meta-analysis of acute severe complications of pediatric anesthesia[J].Paediatr Anaesth, 2015, 25(11):1093-1102.DOI:10.1111/pan.12751.
7 Dohrmann T, Muschol NM, Sehner S, et al. Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses:A retrospective cohort study[J].Paediatr Anaesth, 2020, 30(2):181-190.DOI:10.1111/pan.13787.
8 Porter LL, Blaauwendraad SM, Pieters BM.Respiratory and hemodynamic perioperative adverse events in intravenous versus inhalational induction in pediatric anesthesia:A systematic review and meta-analysis[J].Paediatr Anaesth, 2020, 30(8):859-866.DOI:10.1111/pan.13904.
9 Ramgolam A, Hall GL, Zhang G, et al. Inhalational versus intravenous induction of anesthesia in children with a high risk of perioperative respiratory adverse events:a randomized controlled trial[J].Anesthesiology, 2018, 128(6):1065-1074.DOI:10.1097/ALN.0000000000002152.
10 Li L, Zhang Z, Yao Z, et al. The impact of laryngeal mask versus other airways on perioperative respiratory adverse events in children:A systematic review and meta-analysis of randomized controlled trials[J].Int J Surg, 2019, 64:40-48.DOI:10.1016/j.ijsu.2019.02.020.
11 Schweiger T, de Faria SRI, Roesner I, et al. Laryngeal mask as the primary airway device during laryngotracheal surgery:data from 108 patients[J].Ann Thorac Surg, 2020, 110(1):251-257.DOI:10.1016/j.athoracsur.2019.11.064.
12 段效军, 黄建宝, 王江平, 等. 经纤维支气管镜介入治疗儿童获得性声门下狭窄[J].临床小儿外科杂志, 2020, 19(7):631-635.DOI:10.3969/j.issn.1671-6353.2020.07.014. Duan XJ, Huang JB, Wang JP, et al. Interventional treatment of acquired subglottic stenosis in children by fiberoptic bronchoscopy[J].J Clin Ped Sur, 2020, 19(7):631-635.DOI:10.3969/j.issn.1671-6353.2020.07.014.
13 黄伟坚, 李永乐, 陈佩玲, 等. 保留自主呼吸喉罩全身麻醉在婴儿声门下狭窄钬激光消融术中的应用[J].临床小儿外科杂志, 2019, 18(4):319-322.DOI:10.3969 /j.issn.1004-647X.2018.19.118. Huang WJ, Li YL, Chen PL, et al. Application of laryngeal mask airway with spontaneous breathing under general anesthesia during holmium laser ablation for infantile subglottic stenosis[J].J Clin Ped Sur, 2019, 18(4):319—322.DOI:10.3969 /j.issn.1004—647X.2018.19.118.
14 许煊, 祝彬, 石苗茜, 等. 喉罩下经支气管镜钬激光联合氩气刀和二氧化碳冷冻治疗儿童获得性重度声门下狭窄[J].中华实用儿科临床杂志, 2015, 30(19):1479—1482.DOI:10.3760/cma.j.issn.2095—428X.2015.19.011. Xu X, Zhu B, Shi MQ, et al. Treatment of tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser plus argon plasma coagulation and cryotherapy under bronchoscopy[J].Chinese Journal of Applied Clinical Pediatrics, 2015, 30(19):1479—1482.DOI:10.3760/cma.j.issn.2095—428X.2015.19.011.
Memo
收稿日期:2020-09-14。
基金项目:湖南省自然科学基金青年基金项目（编号：2019JJ50295）
通讯作者:王江平,Email:hneywjp@163.com