Upper airway closure: A primary source of difficult ventilation with sufentanil induction of anesthesia
Upper airway closure: A primary source of difficult ventilation with sufentanil induction of anesthesia
复制标题
DOI：
10.1097/00000539-199609000-00034
复制
发表时间：
1996-09-01
影响因子：
5.7
通讯作者：
Storella, RJ
中科院分区：
文献类型：
--
作者：
Abrams, JT;Horrow, JC;Storella, RJ
大剂量阿片类药物麻醉诱导会导致通过面罩进行呼吸困难。呼吸顺应性差(VC)可能继发于“僵硬”的胸壁和腹壁肌肉结构、声门关闭或上呼吸道阻塞。这项双盲研究通过舒芬太尼麻醉对接受心脏手术的患者(M组)或经纤维气管插管的患者(E组)实施舒芬太尼麻醉，评估了上呼吸道对低VC的贡献。M组(n=17)和E组(n=23)分别于麻醉诱导前(T)=0min至T=2时以3 mg/kg舒芬太尼诱导后，连续测定VC和拇收肌(AP)的收缩张力。在肌松药(哌库溴铵或多沙库铵)用药前，E组的VC(46mL/cmH2O[39-55个四分位数范围(IQR)])明显好于M组(19mL/cmH2O[7-24 IQR])。肌松药对VC的作用先于AP。在T=9时AP完全松弛后，两组的VC相似。舒芬太尼麻醉诱导期间呼吸困难在于声门水平或以上。通过气管内插管绕过这些结构，克服了通常降低的VC。
Large-dose opioid induction of anesthesia can lead to difficult ventilation via a mask. Poor ventilatory compliance (VC) may be secondary to ''rigid'' chest and abdominal wall musculature, glottic closure, or upper airway obstruction. This double-blind study assessed the contribution of the upper airway to poor VC by inducing sufentanil anesthesia in patients undergoing cardiac surgery who are ventilated via a mask (Group M) or endotracheal tube fiberoptically inserted (Group E). After induction of anesthesia with sufentanil 3 mu g/kg from time (T) = 0 min to T = 2 in Group M (n = 17) or Group E (n = 23), VC and adductor pollicis (AP) twitch tension was measured continuously. Immediately prior to muscle relaxant (pipecuronium or doxacurium) administration at T = 3, Group E demonstrated significantly better VC (46 mL/cm H2O [39-55 interquartile range (IQR)]) than Group M (19 mL/cm H2O [7-24 IQR]). The effect of muscle relaxant administration on VC preceded its effect at the AP. After complete relaxation of the AP at T = 9, both groups had similar VC. Difficult ventilation during sufentanil induction of anesthesia lies at the level of the glottis or above. Bypassing these structures with an endotracheal tube overcomes the usual decreased VC.