Induction and maintenance characteristics of anesthesia with desflurane and nitrous oxide in infants and children.
Induction and maintenance characteristics of anesthesia with desflurane and nitrous oxide in infants and children.
复制标题
婴儿和儿童地氟烷和一氧化二氮麻醉的诱导和维持特征。
DOI：
10.1097/00000542-199203000-00009
复制
发表时间：
1992
期刊：
影响因子：
8.8
通讯作者：
D. R. Cook
中科院分区：
文献类型：
--
作者：
M. Zwass;Dennis M. Fisher;L. Welborn;Charles J. Coté;Peter J. Davis;Miles Dinner;R. Hannallah;Letty M. P. Liu;J. Sarner;Willis A. McGill;J. K. Alifimoff;P. Embree;D. R. Cook
为了确定地氟烷在儿科患者中的诱导和维持特征，作者使用氧化亚氮+地氟烷和/或氟烷在氧气中麻醉了206名1个月至12岁的婴儿和儿童。将患者分配至4组中的一组：1）术前给予哌替啶、地西泮和阿托品口服复方制剂后，使用地氟烷诱导和维持麻醉; 2）使用地氟烷诱导和维持麻醉; 3）使用氟烷诱导并使用地氟烷维持麻醉;或4）使用氟烷诱导并维持麻醉。非盲观察者记录至意识丧失（眼睑反射）的时间、至插管的时间以及麻醉诱导和维持的临床特征。在地氟烷麻醉诱导期间经常发生中度至重度喉痉挛（49%）和中度至重度咳嗽（58%）;术前用药未改变这些事件的发生率。相比之下，在氟烷麻醉诱导期间，喉痉挛和咳嗽罕见。在未术前用药的患者中，地氟烷组（2.4 ± 1.2 min）和氟烷组（2.1 ± 0.8 min）至眼睑反射丧失的时间（平均值± SD）相似。麻醉诱导期间，喉镜检查和插管前，氟烷组平均动脉压低于基线的80%更常见;地氟烷组心率和平均动脉压高于基线的120%更常见。术中，地氟烷组心率大于基线的120%更常见;两种麻醉剂的血压相似。作者得出结论，地氟烷麻醉诱导期间气道并发症的高发生率限制了其在儿科患者吸入诱导中的应用。如果使用不同的麻醉剂诱导，地氟烷可以安全地维持麻醉。
To determine the induction and maintenance characteristics of desflurane in pediatric patients, the authors anesthetized 206 infants and children aged 1 month to 12 yr with nitrous oxide plus desflurane and/or halothane in oxygen. Patients were assigned to one of four groups: anesthesia was 1) induced and maintained with desflurane after premedication with an oral combination of meperidine, diazepam, and atropine; 2) induced and maintained with desflurane; 3) induced with halothane and maintained with desflurane; or 4) induced and maintained with halothane. An unblinded observer recorded time to loss of consciousness (lid reflex), time to intubation, and clinical characteristics of the induction and maintenance of anesthesia. Moderate-to-severe laryngospasm (49%) and moderate-to-severe coughing (58%) occurred frequently during induction of anesthesia with desflurane; the incidence of these was not altered by premedication. In contrast, laryngospasm and coughing were rare during induction of anesthesia with halothane. In unpremedicated patients, time to loss of lid reflex (mean +/- SD) was similar for desflurane (2.4 +/- 1.2 min) and halothane (2.1 +/- 0.8 min). During induction of anesthesia, before laryngoscopy and intubation, mean arterial pressure less than 80% of baseline was more common with halothane; heart rate and mean arterial pressure greater than 120% of baseline were more common with desflurane. Intraoperatively, heart rate greater than 120% of baseline was more common with desflurane; blood pressures were similar for the two anesthetics. The authors conclude that the high incidence of airway complications during induction of anesthesia with desflurane limits its utility for inhalation induction in pediatric patients. Anesthesia can be safely maintained with desflurane if induced with a different anesthetic.