Wang Lei,Wang Shaochao,Hu Weidong,et al.Application of laryngeal mask general anesthesia in pediatric percutaneous dilatational tracheostomy guided by fiberbronchoscope[J].Journal of Clinical Pediatric Surgery,2025,(02):172-178.[doi:10.3760/cma.j.cn101785-202410045-012]
喉罩全身麻醉在纤维支气管镜引导下小儿经皮扩张气管切开术的应用
- Title:
- Application of laryngeal mask general anesthesia in pediatric percutaneous dilatational tracheostomy guided by fiberbronchoscope
- Keywords:
- Laryngeal Mask Airway; Anesthesia; General; Fiberbronchoscope; Percutaneous Dilatational Tracheostomy; Child
- 摘要:
- 目的 探讨喉罩全身麻醉在纤维支气管镜(简称纤支镜)引导下小儿经皮扩张气管切开术中的应用效果。方法 回顾性分析2019年6月至2023年9月在山东大学附属儿童医院住院期间行经皮扩张气管切开术患儿的临床资料。术前经超声评估小儿甲状腺位置及颈部血管走行,选择合适的穿刺入路并标记穿刺点,全身麻醉后使用喉罩控制呼吸以保障患儿通气,喉罩置入成功后由纤支镜引导完成经皮扩张气管切开术。统计并分析患儿一般情况、麻醉方案、通气模式、手术操作、生命体征及不良事件发生情况等。结果 共40例患儿纳入分析,均安全顺利完成手术,手术时间(35±9) min,麻醉时间(41±9) min。均成功置入喉罩,患儿均采用压力控制呼吸,吸气峰压12~20 cmH2O。在纤支镜进入气道检查时气道压力有不同程度升高,潮气量略有降低,但生命体征维持稳定,围手术期不良事件发生率为15%(6/40),主要为胃肠胀气和低氧血症。结论 小儿经皮扩张气管切开术围手术期麻醉管理风险高,喉罩全身麻醉可为患儿提供有效的通气和稳定的麻醉深度,维持患儿术中生命体征平稳,确保纤支镜引导下小儿经皮扩张气管切开术安全、顺利完成,值得临床推广。
- Abstract:
- Objective To explore the efficacy of laryngeal mask general anesthesia during percutaneous dilatational tracheostomy guided by fiberbronchoscope in children. Methods Retrospective analysis of medical records was performed for 40 hospitalized children undergoing percutaneous dilatational tracheostomy at Affiliated Children’s Hospital of Shandong University from June 2019 to September 2023.Preoperative ultrasonic assessment was performed for evaluating thyroid position and following the course of anterior tracheal vessels.This aided in selecting an appropriate puncture route and marking the puncture point.After general anesthesia,a laryngeal mask was utilized for respiratory control to ensure ventilation and percutaneous dilatational tracheotomy performed guided by fiberbronchoscope after successful laryngeal mask placement.Statistical analyses were conducted for general profiles,anesthesia protocols,ventilation mode,surgical procedures,vital signs and adverse events. Results All procedures were performed smoothly and safely.The average surgical duration was (35±9) min and average anesthesia duration (41±9) min.Laryngeal masks were all successfully placed and pressure controlled breathing was achieved with peak inspiratory pressures of (12-20) cmH2O.There was a variable elevation in airway pressure and a slight declined in tidal volume during flexible bronchoscopy.Vital signs remained stable.The incidence of adverse events during perioperative period was 15%.It was primarily attributed to gastrointestinal distension and hypoxemia. Conclusions Pediatric percutaneous dilatational tracheostomy presents a high risk in terms of perioperative anesthesia management.Laryngeal mask ventilation under general anesthesia can effectively provide ventilation and maintain a stable depth of anesthesia.This approach ensures a smooth progression of the procedure while maintaining the stability of vital signs.It enhances the operative safety and is worthy of wider clinical applications.
参考文献/References:
[1] 王桂香,张丰珍,王华,等.儿童不同病因气管切开术并发症及转归分析[J].中华耳鼻咽喉头颈外科杂志,2021,56(4):356-362.DOI:10.3760/cma.j.cn115330-20200515-00418. Wang GX,Zhang FZ,Wang H,et al.Analysis of complications and outcomes of tracheotomy with different etiologies in children[J].Chin J Otorhinolaryngol Head Neck Surg,2021,56(4):356-362.DOI:10.3760/cma.j.cn115330-20200515-00418.
[2] Jabbour J,Martin T,Beste D,et al.Pediatric vocal fold immobility:natural history and the need for long-term follow-up[J].JAMA Otolaryngol Head Neck Surg,2014,140(5):428-433.DOI:10.1001/jamaoto.2014.81.
[3] Lesnik M,Thierry B,Blanchard M,et al.Idiopathic bilateral vocal cord paralysis in infants:case series and literature review[J].Laryngoscope,2015,125(7):1724-1728.DOI:10.1002/lary.25076.
[4] Funk RT,Jabbour J,Robey T.Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility[J].Int J Pediatr Otorhinolaryngol,2015,79(6):895-899.DOI:10.1016/j.ijporl.2015.03.026.
[5] 侯自明,杨俊,王浩,等.经皮扩张气管切开术在神经重症患者中的应用[J].中国医师进修杂志,2017,40(2):139-141.DOI:10.3760/cma.j.jssn.1673-4904.2017.02.012. Hou ZM,Yang J,Wang H,et al.Study on the application value of percutaneous dilation tracheostomy on the neurological intensive patients[J].Chin J Postgrad Med,2017,40(2):139-141.DOI:10.3760/cma.j.jssn.1673-4904.2017.02.012.
[6] Emigh B,Zaunbrecher RD,Trust MD,et al.A safer placement technique for percutaneous dilatational tracheostomy[J].Am J Surg,2021,222(5):913-915.DOI:10.1016/j.amjsurg.2021.03.050.
[7] 王超,张新村,孟晨,等.可弯曲支气管镜联合颈部超声在婴幼儿经皮扩张气管切开术中的临床应用[J].中华实用儿科临床杂志,2022,37(19):1464-1468.DOI:10.3760/cma.j.cn101070-20220426-00456. Wang C,Zhang XC,Meng C,et al.Clinical application of flexible bronchoscopy and neck ultrasound in percutaneous dilatational tracheotomy in infants[J].Chin J Appl Clin Pediatr,2022,37(19):1464-1468.DOI:10.3760/cma.j.cn101070-20220426-00456.
[8] 姚忠岩,娄宁,齐曼曼,等.超声引导喉上神经阻滞联合静脉麻醉用于纤维支气管镜诊疗术患儿的改良效果[J].中华麻醉学杂志,2023,43(10):1197-1200.DOI:10.3760/cma.j.cn131073.20230604.01009. Yao ZY,Lou N,Qi MM,et al.Efficacy of ultrasound-guided superior laryngeal nerve block combined with intravenous anesthesia for improving pediatric fiberoptic bronchoscopy[J].Chin J Anesthesiol,2023,43(10):1197-1200.DOI:10.3760/cma.j.cn131073.20230604.01009.
[9] 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. Expert Group of Pediatric Respiratory Endoscopy,Talent Exchange Service Center of National Health Commission; Endoscopy Committee,Pediatric Section of Chinese Medical Doctor Association; Pediatric Respiratory Endoscopy Committee,Endoscopists Section of Chinese Medical Doctor Association,et al.Guideline of Pediatric Flexible Bronchoscopy in China (Edition 2018)[J].Chin J Appl Clin Pediatr,2018,33(13):983-989.DOI:10.3760/cma.j.issn.2095-428X.2018.13.006.
[10] Bermede O,Sar?cao?lu MC,Bayta? V,et al.Percutaneous ultrasound-guided versus bronchoscopy-guided dilatational tracheostomy after median sternotomy:a case-control study[J].Turk Gogus Kalp Damar Cerrahisi Derg,2021,29(4):457-464.DOI:10.5606/tgkdc.dergisi.2021.21951.
[11] Sar?ta? A,Kurnaz MM.Comparison of bronchoscopy-guided and real-time ultrasound-guided percutaneous dilatational tracheostomy:safety,complications,and effectiveness in critically ill patients[J].J Intensive Care Med,2019,34(3):191-196.DOI:10.1177/0885066617705641.
[12] Trouillet JL,Collange O,Belafia F,et al.Tracheotomy in the intensive care unit:guidelines from a French expert panel[J].Ann Intensive Care,2018,8(1):37.DOI:10.1186/s13613-018-0381-y.
[13] 禹二友,向珍,吴磊,等.全身麻醉喉罩通气在小儿声门下狭窄纤维支气管镜介入手术中的应用研究[J].临床小儿外科杂志,2021,20(11):1038-1041,1047.DOI:10.12260/lcxewkzz.2021.11.008. Yu EY,Xiang Z,Wu L,et al.Application of laryngeal mask controlled ventilation under general anesthesia in interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis[J].J Clin Ped Sur,2021,20(11):1038-1041,1047.DOI:10.12260/lcxewkzz.2021.11.008.
[14] 赵鑫,赵保建,谢泽敏,等.纤维支气管镜在经皮扩张气管切开术中的应用[J].临床麻醉学杂志,2022,38(11):1147-1151.DOI:10.12089/jca.2022.11.005. Zhao X,Zhao BJ,Xie ZM,et al.Application of fiberoptic bronchoscope during percutaneous dilatation tracheotomy[J].J Clin Anesthesiol,2022,38(11):1147-1151.DOI:10.12089/jca.2022.11.005.
[15] 李宏亮,田野,马燕娟,等.经皮扩张气管切开术标准操作流程在神经重症患者中的应用[J].中华重症医学电子杂志(网络版),2021,7(3):219-227.DOI:10.3877/cma.j.issn.2096-1537.2021.03.005. Li HL,Tian Y,Ma YJ,et al.Application of standard operating procedure of percutaneous dilatation tracheotomy in patients with severe neuropathy[J].Chin J Crit Care Intensive Care Med (Electronic Edition),2021,7(3):219-227.DOI:10.3877/cma.j.issn.2096-1537.2021.03.005.
[16] Lerner AD,Yarmus L.Percutaneous dilational tracheostomy[J].Clin Chest Med,2018,39(1):211-222.DOI:10.1016/j.ccm.2017.11.009.
[17] 黄伟坚,李永乐,陈佩玲,等.保留自主呼吸喉罩全麻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.1671-6353.2019.04.014. 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].DOI:10.3969/j.issn.1671-6353.2019.04.014.
[18] Easterday TS,Moore JW,Redden MH,et al.Percutaneous tracheostomy under bronchoscopic visualization does not affect short-term or long-term complications[J].Am Surg,2017,83(7):696-698.
[19] Apfelbaum JL,Hagberg CA,Connis RT,et al.2022 American Society of Anesthesiologists Practice guidelines for management of the difficult airway[J].Anesthesiology,2022,136(1):31-81.DOI:10.1097/ALN.0000000000004002.
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备注/Memo
收稿日期:2024-10-18。
基金项目:济南市卫生健康委员会科技计划项目(2023-2-152)
通讯作者:王少超,Email:330876630@qq.com