Application of Laryngeal Mask Combined with Sevoflurane in Painless Fiberoptic Bronchoscopy Anesthesia in Children_West China Medical Journal

Authors：

HE Wei ,  YUAN Qinghui , LI Jianqiao , ZHANG Yonghong , XIA Qing , LI Wei

Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R.China;

Corresponding?author：

YUAN Qinghui, Email: hewei5413@163.com

Keywords：

喉罩; 氣管內; 全身麻醉; 纖維支氣管鏡檢查; 血流動力學; 小兒

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【摘要】目的 比較喉罩和氣管內插管吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查的麻醉效果、蘇醒時間、蘇醒質量。方法將2008年3月-2009年3月40例行纖支鏡檢查的患兒隨機分為喉罩組（L組，21例）和氣管內插管組（T組，19例）。兩組均采用逐漸誘導法吸入七氟烷，靜脈給予芬太尼1 μg/kg；L組置入喉罩，T組氣管插管后控制呼吸。手術中，兩組均吸入2%～5%七氟烷維持麻醉。分別記錄麻醉前（T0）、麻醉后纖支鏡進入前（T1）、進鏡至咽部（T2）、聲門部（T3）、氣管內（T4）及第15 min（T5）時的血壓（BP）、心率（HR）、MAP和動脈血氧飽和度（SPO2）。觀察纖支鏡檢查期間有無嗆咳、氣道痙攣或體動；記錄停藥至拔管的時間，蘇醒后是否再入睡及麻醉滿意度。結果兩組HR在T1、T3、T4時升高，與T0時比較，有統計學意義（P lt;0.05）；其中HR在T1時T組高于L組，組間比較有統計學意義（P lt;0.05）；MAP在T1、T2、T3、T4時，T組低于L組，組間比較有統計學意義（P lt;0.05）。兩組患兒鏡檢期間均無嗆咳、氣道痙攣或體動；L組蘇醒時間短于T組（P lt;0.05），蘇醒后再入睡率低于T組（P lt;0.05），麻醉滿意度高于T組（P lt;0.05）。結論喉罩吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查，能保證穩定的血流動力學狀態，蘇醒快速，效果滿意。
【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (P lt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (P lt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(P lt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.

Citation： HE Wei,YUAN Qinghui,LI Jianqiao,ZHANG Yonghong,XIA Qing,LI Wei. Application of Laryngeal Mask Combined with Sevoflurane in Painless Fiberoptic Bronchoscopy Anesthesia in Children. West China Medical Journal, 2010, 25(8): 1520-1522. doi: Copy

1.	Miller RD. Miller’s anesthesia[M]. 6th edition. Churchill: livingstone, 2004.
2.	Grabowska Gawe A. End-tidal sevoflurane concentrations for laryngeal mask airway insertion and tracheal intubation in children [J]. Przegl Lek, 2004, 61(7): 783-785.
3.	Pennant JH, White PF. The laryngeal mask airway: its uses in anesthesiology[J]. Anesthesiology, 1993, 79: 144-149.
4.	Cook TM, Nolan JP, Verghese C, et al. Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients [J]. Br J Anaesth, 2002, 88: 527-533.
5.	Chawathe M, Zatman T, Hal JE, et al. Sevoflurane(12% and 8%) inhalational induction in children[J]. Paediart Anaesth, 2005, 15(6): 470-475.
6.	張溪英, 郭曲練, 王江平, 等. 七氟烷用于小兒誘導及維持麻醉的臨床研究[J]. 中南大學學報(醫學版), 2007, 32(3): 503-506.
7.	彭志宏, 昌克勤, 畢好生. 七氟醚快速吸人誘導在小兒法洛四聯征手術麻醉中的應用[J]. 臨床麻醉學雜志, 2003, 11(3): 686-687.
8.	楊梵, 黃文起. 七氟醚在成人門診手術中的應用[J]. 臨床麻醉學雜志, 2006, 3(1): 239-241.
9.	Cros AM, Lopez C, Kandel T, et al. Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil, and no muscle relaxant [J]. Anaesthesia, 2000, 55(10): 965-969.
10.	Aantaa R, Takale R, Muittari P, et al. Sevoflurane EC50 and EC95 values for laryngeal mask insertion and tracheal intubation in children[J]. Br J Anaesth, 2001, 86(2): 213-216.
11.	Kathoh T, Nakajnna Y, Monwaki G, et al. Sevoflurane requirementsfor tracheal intubation with and without fentanyl[J]. Br J Anaesth, 1999, 82(4): 561-565.

1. Miller RD. Miller’s anesthesia[M]. 6th edition. Churchill: livingstone, 2004.
2. Grabowska Gawe A. End-tidal sevoflurane concentrations for laryngeal mask airway insertion and tracheal intubation in children [J]. Przegl Lek, 2004, 61(7): 783-785.
3. Pennant JH, White PF. The laryngeal mask airway: its uses in anesthesiology[J]. Anesthesiology, 1993, 79: 144-149.
4. Cook TM, Nolan JP, Verghese C, et al. Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients [J]. Br J Anaesth, 2002, 88: 527-533.
5. Chawathe M, Zatman T, Hal JE, et al. Sevoflurane(12% and 8%) inhalational induction in children[J]. Paediart Anaesth, 2005, 15(6): 470-475.
6. 張溪英, 郭曲練, 王江平, 等. 七氟烷用于小兒誘導及維持麻醉的臨床研究[J]. 中南大學學報(醫學版), 2007, 32(3): 503-506.
7. 彭志宏, 昌克勤, 畢好生. 七氟醚快速吸人誘導在小兒法洛四聯征手術麻醉中的應用[J]. 臨床麻醉學雜志, 2003, 11(3): 686-687.
8. 楊梵, 黃文起. 七氟醚在成人門診手術中的應用[J]. 臨床麻醉學雜志, 2006, 3(1): 239-241.
9. Cros AM, Lopez C, Kandel T, et al. Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil, and no muscle relaxant [J]. Anaesthesia, 2000, 55(10): 965-969.
10. Aantaa R, Takale R, Muittari P, et al. Sevoflurane EC50 and EC95 values for laryngeal mask insertion and tracheal intubation in children[J]. Br J Anaesth, 2001, 86(2): 213-216.
11. Kathoh T, Nakajnna Y, Monwaki G, et al. Sevoflurane requirementsfor tracheal intubation with and without fentanyl[J]. Br J Anaesth, 1999, 82(4): 561-565.

West China Medical Journal

Application of Laryngeal Mask Combined with Sevoflurane in Painless Fiberoptic Bronchoscopy Anesthesia in Children

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