Tang Kexiang,Xiao Ting,Fu Guangli,et al.Exploration of factors related to laryngospasm during anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy and intervention strategies[J].Journal of Clinical Pediatric Surgery,,():872-877.[doi:10.3760/cma.j.cn101785-202407069-013]
Exploration of factors related to laryngospasm during anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy and intervention strategies
- Keywords:
- Tonsillectomy; Anesthesia; General; Laryngismus; Postanesthesia Nursing; Child
- Abstract:
- Objective To observe the occurrence of laryngospasm during the anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy,analyze the causes of laryngospasm,and propose corresponding management strategies. Methods This retrospective study included 1,200 pediatric patients who underwent adenoidectomy and tonsillectomy in the Department of Otolaryngology-Head and Neck Surgery at Hunan Children’s Hospital.After surgery,patients were transferred to the anesthesia recovery room with an endotracheal tube in place.They were divided into two groups based on whether laryngospasm occurred after extubation:the laryngospasm group and the non-laryngospasm group.Clinical information was collected from both groups.Binary logistic regression was used to analyze the causes of laryngospasm after extubation,and corresponding intervention measures were formulated to observe the effect of these interventions. Results Among the 1,200 pediatric patients,48 cases of laryngospasm occurred after extubation during the anesthesia recovery period,with an incidence rate of 4%.Multivariate analysis indicated that age <6 years(OR=3.799,95%CI:1.842-7.836),supine position (OR=3.235,95%CI:1.418-7.382),recent upper respiratory tract infection within 2 weeks (OR=3.543,95%CI:1.482-8.469),and sevoflurane inhalation anesthesia duration >45 minutes (OR=3.679,95%CI:1.248-10.818) were risk factors for laryngospasm during the anesthesia recovery period in pediatric patients (P<0.05).Preoperative intranasal administration of dexmedetomidine (OR=0.295,95%CI:0.128-0.682) and postoperative placement of an analgesic pump (OR=0.526;95%CI:0.348-0.796) were protective factors against laryngospasm (P<0.05). Conclusions Age < 6 years,supine position,recent upper respiratory tract infection with 2 weeks,and sevoflurane inhalation anesthesia duration >45 minutes increase the risk of laryngospasm during the anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy.Clinicians should pay close attention and adopt targeted intervention measures to reduce the incidence of laryngospasm during the anesthesia recovery period.
References:
[1] 宋雨童,颜明.学龄前儿童麻醉后苏醒期谵妄的危险因素及防治研究进展[J].山东医药,2020,60(20):98-102.DOI:10.3969/j.issn.1002-266X.2020.20.027. Song YT,Yan M.Research progress on risk factors and prevention and treatment of delirium in preschool children during the recovery period after anesthesia[J].Shandong Med J,2020,60(20):98-102.DOI:10.3969/j.issn.1002-266X.2020.20.027.
[2] Mo XF,Zeng JQ,Wu XY,et al.Sucking lollipop after awakening from sevoflurane anesthesia reduces the degree of emergence agitation in children undergoing ambulatory surgery:a prospective randomized controlled trial[J].Medicine (Baltimore),2023,102(44):e35651.DOI:10.1097/MD.0000000000035651.
[3] Taneja S,Jain A.Systematic review and meta-analysis comparing the efficacy of dexmedetomidine to midazolam as premedication and a sedative agent in pediatric patients undergoing dental procedures[J].Oral Maxillofac Surg,2023,27(4):547-557.DOI:10.1007/s10006-022-01087-6.
[4] Namigar T,Serap K,Esra AT,et al.The correlation among the Ramsay sedation scale,Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation[J].Rev Bras Anestesiol,2017,67(4):347-354.DOI:10.1016/j.bjan.2017.03.006.
[5] Zaman B,Noorizad S,Safari S,et al.Efficacy of laryngeal mask airway compared to endotracheal tube:a randomized clinical trial[J].Anesth Pain Med,2022,12(1):e120478.DOI:10.5812/aapm.120478.
[6] Neve?[KG-1.1mm]c[DD(-1*4][HT7.]＇[HT6]anin A,Vickov J,Elezovi[KG-1.1mm]c[DD(-1*4][HT7.]＇[HT6] Baloevi[KG-1.1mm]c[DD(-1*4][HT7.]＇[HT6] S,et al.Laryngeal ma-sk airway versus tracheal intubation for laparoscopic hernia repair in children:analysis of respiratory complications[J].J Laparoendosc Adv Surg Tech A,2020,30(1):76-80.DOI:10.1089/lap.2019.0382.
[7] Liu X,Cao HY,Tan XN,et al.Comparison of the effect of laryngeal mask airway versus endotracheal tube on airway management in pediatric patients with tonsillar hypertrophy[J].J Perianesth Nurs,2021,36(2):142-146.DOI:10.1016/j.jopan.2020.06.020.
[8] 韦启清,覃春艳,韦珊珊,等.侧卧位复苏在小儿喉罩全身麻醉苏醒期中的应用效果[J].广西医学,2021,43(17):2058-2061.DOI:10.11675/j.issn.0253-4304.2021.17.08. Wei QQ,Qin CY,Wei SS,et al.Application effect of resuscitation in lateral position on children during recovery period of laryngeal mask general anesthesia[J].Guangxi Med J,2021,43(17):2058-2061.DOI:10.11675/j.issn.0253-4304.2021.17.08.
[9] 刘欢,谢叶青,胡啸玲,等.七氟醚、地氟醚和丙泊酚不同组合的全麻方式对患儿苏醒期躁动和谵妄的影响[J].临床麻醉学杂志,2021,37(4):399-402.DOI:10.12089/jca.2021.04.015. Liu H,Xie YQ,Hu XL,et al.Influence of different combinations of sevoflurane compound,desflurane and propofol in general anesthesia on emergence agitation and delirium in children[J].J Clin Anesthesiol,2021,37(4):399-402.DOI:10.12089/jca.2021.04.015.
[10] Bromfalk ?,Hultin M,Walldén J,et al.Cardiorespiratory response to sedative premedication in preschool children:a randomized controlled trial comparing midazolam,clonidine,and dexmedetomidine[J].J Perianesth Nurs,2023,38(3):454-460.DOI:10.1016/j.jopan.2022.08.009.
[11] Bromfalk ?,Myrberg T,Walldén J,et al.Preoperative anxiety in preschool children:a randomized clinical trial comparing midazolam,clonidine,and dexmedetomidine[J].Paediatr Anaesth,2021,31(11):1225-1233.DOI:10.1111/pan.14279.
[12] Bromfalk ?,Hultin M,Myrberg T,et al.Postoperative recovery in preschool-aged children:a secondary analysis of a randomized controlled trial comparing premedication with midazolam,clonidine,and dexmedetomidine[J].Paediatr Anaesth,2023,33(11):962-972.DOI:10.1111/pan.14740.
[13] 尹静,张俊丽,李媛媛,等.右美托咪定辅助用药对全身麻醉手术患儿苏醒期躁动及术后行为改变影响[J].临床军医杂志,2023,51(11):1174-1176.DOI:10.16680/j.1671-3826.2023.11.18. Yin J,Zhang JL,Li YY,et al.The effect of dexmedetomidine adjuvant therapy on agitation during the recovery period and postoperative behavioral changes in children undergoing general anesthesia surgery[J].Clin J Med Off,2023,51(11):1174-1176.DOI:10.16680/j.1671-3826.2023.11.18.
[14] 苏和升,姚嘉琦,吴悦,等.右美托咪定经直肠或经鼻给药对扁桃体/腺样体切除术患儿术前镇静效果的对比研究[J].国际麻醉学与复苏杂志,2023,44(7):710-714.DOI:10.3760/cma.j.cn321761-20230216-00837. Su HS,Yao JQ,Wu Y,et al.Comparative study of the sedative effect of dexmedetomidine by rectum or intranasal administration on children before adenotonsillectomy[J].Int J Anesthesiol Resusc,2023,44(7):710-714.DOI:10.3760/cma.j.cn321761-20230216-00837.
[15] 禹二友,赵静,童易如.小儿全身麻醉拔管时机的研究进展[J].临床小儿外科杂志,2016,15(5):502-504.DOI:10.3969/j.issn.1671-6353.2016.05.025. Yu EY,Zhao J,Tong YR.Research progress on the timing of extubation under general anesthesia in children[J].J Clin Ped Sur,2016,15(5):502-504.DOI:10.3969/j.issn.1671-6353.2016.05.025.
[16] 朱梦妤,王梦婕,童易如.小儿麻醉中喉罩拔出时机及相关并发症的研究进展[J].临床小儿外科杂志,2018,17(4):312-316,320.DOI:10.3969/j.issn.1671-6353.2018.04.016. Zhu MY,Wang MJ,Tong YR.Research progress on timing and related complications of laryngeal mask extraction during pediatric anesthesia[J].J Clin Ped Sur,2018,17(4):312-316,320.DOI:10.3969/j.issn.1671-6353.2018.04.016.
Memo
收稿日期:2024-7-30。
基金项目:湖南省卫生健康委科研计划项目(202214044031)
通讯作者:杜真,Email:meggyzhen@163.com