Airway management and fiberoptic tracheal intubation via the laryngeal mask in a child with Marshall–Smith syndrome
Airway management and fiberoptic tracheal intubation via the laryngeal mask in a child with Marshall–Smith syndrome
复制标题
马歇尔-史密斯综合征儿童的气道管理和通过喉罩进行纤维气管插管
DOI：
10.1111/j.1460-9592.2008.02470.x
复制
发表时间：
2008
影响因子：
1.7
通讯作者：
H. Hoeve
中科院分区：
文献类型：
--
作者：
A. Machotta;H. Hoeve
进行了蛤壳式手术切口，为手术以及必要时进行紧急心脏搭桥手术以及动脉和静脉插管提供了良好的通道。这种类型的切口还允许双侧同时肺减压。 CLE 肺气肿可能导致纵隔急性移位，导致心输出量减少并随后死亡。关于单侧先天性肺气肿患者的麻醉管理已有多种描述 (4,5)，据我们所知，这是第一次描述接受双侧 CLE 手术的儿童的麻醉管理。我们对这名患者进行麻醉时担心的是，开始正压通气会导致肺气肿叶过度充气，并损害氧合、静脉回流和心输出量。因此，我们采用吸入诱导，并在 100% 氧气中用七氟醚维持自主通气，并且仅在获得股骨和动脉导管通路后才开始正压通气。这使我们能够最大限度地缩短手术切开前正压通气的持续时间，并减少肺气肿叶过度充气的可能性。我们认为我们的方法有助于安全诱导麻醉和建立侵入性监测，避免了心肺功能受损的可能性，并允许通过蛤壳式切口单阶段切除双侧 CLE 的手术进行，没有并发症。 Francesca Iodice Fraser Harban Isabeau Walker 麻醉科，大奥蒙德街医院，大奥蒙德街，伦敦 WC 1N 3JH（电子邮件：francesca_iodice@yahoo.it）
clamshell surgical incision was performed which provided a good access for both surgery and for arterial and venous cannulation should emergency cardiac bypass be necessary. This type of incision also allows bilateral simultaneous lung decompression. CLE emphysema may produce an acute shift of the mediastinum with loss of cardiac output and subsequent death. There have been several descriptions of the anesthetic management of patients with unilateral congenital emphysema (4,5), to our knowledge, this is the first description of the anesthetic management of a child undergoing surgery for bilateral CLE. Our concerns in anesthetising this patient were that initiation of positive pressure ventilation would cause hyperinflation of the emphysematous lobes and compromise oxygenation, venous return and cardiac output. We therefore used an inhalational induction and maintained spontaneous ventilation with sevoflurane in 100% oxygen and only instituted positive pressure ventilation after femoral and arterial line access was obtained. This allowed us to minimize the duration of positive pressure ventilation prior to surgical incision and reduce the potential for hyperinflation of the emphysematous lobes. We feel our method facilitated safe induction of anesthesia and establishment of invasive monitoring, avoided the potential for cardio respiratory compromise and allowed the surgery for a single stage excision of bilateral CLE via a clamshell incision to proceed without complications. Francesca Iodice Fraser Harban Isabeau Walker Department of Anaesthetics, Great Ormond Street Hospital, Great Ormond Street, London WC 1N 3JH (email: francesca_iodice@yahoo.it)