麻醉科R1杨美惠.pptVIP

Different ways to reduce the incidence of laryngospasm in children after Tonsillectomy and Adenoidectomy 麻醉科R1楊美惠 指導醫師 劉漢平 醫師 Laryngospasm May induced by blood or secretion accumulated around pharyhx or any kind of stimulation during emergence It is particularly frequent in children after upper airwy surgery(e.g. adenotonsillectomy)~about 21-24% Laryngospasm is essentially a protective reflex which acts to prevent foreign material entering the tracheaobronchial tree. This glottic reflex to inspiration and expiration causes hypercarbia and hypoxia and may be life-threatening. Current methods Deep versus awake extubation IV or aerosolized lidocaine IV magnesium “No Touch” extubation Emergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients. Anesth Analg Patel RI, Hannallah RS, Norden J, et al. 1991;73:266-70 Patients: 70 children undergoing either elective strabismus surgery or adenoidectomy and/or tonsillectomy. Methods: Awake extubation group: Extubation at end-tidal halothane concentrations of less than 0.15% Deep extubation group: end-tidal halothane concentrations of greater than 0.8% Results: At 1, 2, 3, and 5 min after extubation, patients extubated deep had significantly higher oxyhemoglobin saturations than patients extubated awake (SpO2 97.6% +/- 3.7% to 99.8% +/- 0.5% vs 93.7% +/- 4.8% to 98.6% +/- 2.5%). Oxygen saturation values were similar thereafter. The incidence of postoperative laryngospasm, excessive coughing, breath holding, airway obstruction requiring positive pressure ventilation after extubation, or arrhythmias was not statistically different between patients extubated awake or deep. These investigators concluded that for healthy children undergoing elective surgery, clinical conditions or the preference of the anesthesiologist should dictate the choice of extubation technique. Deep extubation Lidocaine via IV route Baraka A. Intravenous lidocaine controls extubatio