2 Introduction Pediatric anesthesia refers to anesthesia of children under 12 years old. /kloc-The anesthesia method of children over 0/2 years old is basically similar to that of adults, but the drug dosage is reduced accordingly. Children under 6 years old have different anatomical and physiological changes and different anesthesia management.
Anatomical and physiological characteristics of infants and preschool children. The head of infants is relatively large, and the neck is soft and short. The throat is narrow and forward. Newborns have higher glottis, which are located in cervical vertebrae 3 ~ 4 (adults are located in cervical vertebrae 4 ~ 5); The tracheal orifice is usually funnel-shaped and narrowest at cricoid cartilage. Babies' epiglottis is long and often "V"-shaped; Arytenoid cartilage accounts for about12 of the glottic area, while adults only account for 10%. The ventilation area of cricoid cartilage in newborns is only 14mm2, and mucosal swelling is 1mm, which can reduce the ventilation area of laryngeal cavity by 78%, while that in adults is only 19%, so newborns are prone to dyspnea and asphyxia. Sometimes, the baby's tonsils and adenoids proliferate, and the baby's tongue is enlarged, which can partially block the upper respiratory tract. During anesthesia, a small pillow must be placed under the shoulder to make the head lean back to keep the respiratory tract unobstructed. Neonatal trachea is 4cm long, the inner diameter is only 6mm, and the intubation is 3cm deeper than the glottis, so it is easy to enter the bronchus. Trachea size and respiration in newborns, infants and preschool children.
Infants and young children under 2 years old, due to narrow chest, transverse ribs, thin intercostal muscles, poor sternum activity, pulmonary hypoplasia, limited lung expansion and insufficient gas exchange, mainly use diaphragmatic abdominal breathing. Therefore, the respiratory frequency is high, the tidal volume is small, and the reserve capacity is poor, which is easy to cause respiratory failure after hypoxia. After 2 years old, the abdominal organs descend, and the front ends of ribs gradually move down, forming an acute angle with the spine. The respiratory muscles are gradually developed, and the anterior and posterior diameter and transverse diameter of the chest cavity are obviously increased when inhaling, and the diaphragm-abdominal breathing is gradually changed into thoracoabdominal breathing.
3. 1 neonatal lung compliance (the ability of chest wall and lung expansion to overcome elastic resistance during breathing, the elastic resistance is small, the lung expansion is good, and the resistance is large, but it is poor. The change of lung volume is called lung compliance. Generally, it is expressed by the volume change caused by the change of unit pressure, and the compliance of adult lung is 200 ml/cmH2O; The newborn's 5ml/cm H2O is lower than that of adults. If there is congestion and atelectasis in the lungs, the lung compliance will be lower. From the comparison of lung function between newborns and adults (see table), it can be seen that the functional residual gas, ineffective cavity gas, tidal volume and alveolar surface area of newborns are the same as those of adults, but the body surface area of newborns is more than 1.5 times that of adults, and the oxygen consumption is greater than that of adults. The oxygen consumption of adults at rest is 4ml/kg, and that of newborns is 6ml/kg, so newborns must increase their ventilation per minute. But the respiratory movement is enhanced and more energy is consumed. The oxygen consumption of respiratory exercise accounts for 6% of the total oxygen consumption of newborns, while that of adults only accounts for 2%. Because of the high oxygen consumption, any reason to reduce the effective area of alveoli or increase the oxygen demand will make the respiratory function difficult to meet the needs of the body. Therefore, it is very important to use auxiliary or controlled breathing to ensure effective ventilation of alveoli during neonatal anesthesia.
The newborn's heart is generally well developed, weighing about 24g, which is1130 of body weight, while the adult's heart weight is 1/205 of body weight. The cardiothoracic ratio of newborns is 0.55, and that of adults is 0.5. Infants and young children have low vagus nerve excitability and sympathetic nerve is dominant, which has a weak inhibitory effect on cardiac contraction frequency and is easy to accelerate their heartbeat. When the body temperature rises by 65438 0℃, the heartbeat can be accelerated by 65438 05 ~ 20 beats/min. The neonatal pulse rate is 125 ~ 130 beats/min, while the infant pulse rate gradually drops to105 ~10 beats/min. It is normal for the pulse to increase during anesthesia. If the pulse slows down, it means that the situation is not good. The neonatal blood pressure is 80/40mmHg (with a 2.5cm wide air band), and then gradually rises, and the systolic blood pressure can reach 80 ~ 90 mmHg in the second week. From 3 to 6 years old, the circulatory compensation function is generally better than the respiratory function. Normal blood pressure is 80 ~ 90/50 ~ 60 mmHg, and pulse is 80 ~ 1 10 beats/min. The total blood volume of the newborn is 10% of the body weight, generally less than 300ml, and the blood loss of the newborn is 30ml, which is equivalent to 500ml of adult blood loss. Blood is distributed in the trunk and viscera, and there are few limbs, and the limbs are prone to chills or cyanosis. Neonatal red blood cell count is high, ranging from 5.5 million to 6 million /μl, and hemoglobin is as high as 18g/dl. The decrease of hemoglobin during anesthesia is easy to increase, so cyanosis is easy to occur, so oxygen must be given during anesthesia.
Neonatal body fluids account for about 75% of body weight, six-month-old infants account for 65%, and adults account for 60%. Extracellular fluid accounts for 45% of neonatal body fluids, while adult extracellular fluid accounts for only 20%. Newborns' water metabolism rate is much higher than that of adults, and they are prone to dehydration when vomiting, diarrhea or insufficient liquid intake. Because the renal function is not perfect, the amount and speed of fluid replacement should be as accurate as possible, otherwise it may cause excessive or insufficient supplementation. Intraoperative infusion of 5 ~ 10% glucose solution can not only replenish fluid and heat, but also prevent infantile ketosis. Except for a small amount of blood transfusion, normal saline is basically not used during the operation. Short-term superficial minor surgery, non-hot summer is generally not infusion. The intraoperative input was 5 ~ 8 ml/kg per hour.
4 Preparation before anesthesia The safety of anesthesia in children is closely related to adequate preparation before anesthesia. Preparations before anesthesia include:
4. 1 Correct dehydration and acidosis. Children with severe dehydration and acidosis at the time of admission should strive for time to correct as soon as possible. 20 ml of "2: 1" basic sodium solution (that is, 2 parts of normal saline and1part of M/6 sodium lactate) can be infused in the first hour, and then slowly dripped. Sometimes we can't wait for emergency surgery, but we can also perform surgery after partial correction and continue treatment during the operation. If conditions permit, it is hoped that the condition of the sick child can meet the following standards before operation: ① The rectal temperature is below 38.5℃. ② Heart rate returned to normal. ③ Skin elasticity improved. (4) Sick children can urinate. ⑤ More conscious.
4.2 correct anemia in order to improve the endurance of anesthesia and surgery, hemoglobin is required to be above 9 g.
4.3 Fasting In order to prevent vomiting and suffocation during anesthesia, drinking and fasting must be strictly prohibited 6 hours before anesthesia. /kloc-infants under 0/year old can be fed a small amount of sugar water 4 hours before anesthesia in order to prevent acidosis caused by hunger. Usually, the food in the stomach can be emptied in 4 hours, but under the influence of accidental trauma, pain and fear, the stomach can not be emptied for a long time. If general anesthesia is needed in emergency surgery, vomiting can be induced or gastric tube can be inserted first, and then intratracheal anesthesia can be performed after emptying the stomach contents. Even if local or epidural anesthesia is performed under basic anesthesia, there is still the possibility of vomiting and suffocation. In case of emergency, the stomach contents should be emptied.
4.4 Pre-anesthetic drugs The pre-anesthetic drugs given on the morning of the operation include analgesics, anticholinergic drugs, sleeping pills and sedatives. Their kind, dosage and usage can be determined according to the situation and weight.
5. Infants do not cooperate with anesthesia, and general basic anesthesia is combined with other anesthesia. Such as basic anesthesia combined with general anesthesia; Basic anesthesia combined with epidural anesthesia; Basic anesthesia combined with nerve block anesthesia. Although you can choose a variety of anesthesia methods, you should always be prepared for general anesthesia. The choice of anesthesia should be considered according to the development of the child, the characteristics of the disease, the general situation and the scope and requirements of the operation.
Anesthesiologists should keep away from the head to observe the head and neck maxillofacial surgery; In order to prevent blood from flowing into trachea during oral surgery, intratracheal anesthesia is the first choice. The removal of tracheal foreign bodies mostly advocates that under general anesthesia, after artificial control of breathing, bronchoscope can be inserted to control breathing for surgery. Foreign bodies in the esophagus should be intubated first to prevent dyspnea caused by esophageal endoscope pressing the larynx. Intrathoracic surgery requires endotracheal anesthesia; Although thoracic wall surgery does not require tracheal intubation, it should be closely observed. Once there is pleural injury, oxygen should be given through the mask or tracheal intubation. Selective abdominal surgery can use basic anesthesia plus continuous epidural anesthesia or general anesthesia. If it is an acute abdomen with high abdominal pressure, it is necessary to guard against reflux and aspiration of gastric contents, and intratracheal anesthesia is appropriate. In addition to the above methods, the lower abdomen, pelvic cavity, perineum and lower limbs of school-age children can be anesthetized by subarachnoid block. Upper limb surgery is mainly based on brachial plexus block or general anesthesia, and local infiltration anesthesia can also be used.
6 basic anesthesia When children are anesthetized, they are generally afraid of surgery and do not cooperate well except for older children. Basic anesthesia must be used first, and all kinds of anesthesia can be implemented smoothly. Children can use local anesthesia methods applied by adults. The dosage of alkaline * * * should be limited to not inhibiting respiration and circulation, and alkaline * * * should never be relied on as the main analgesic means, otherwise drug overdose will inevitably occur, resulting in inhibition of respiration and circulation.
Commonly used alkaline substances are sodium γ hydroxybutyrate, thiopental and ketamine. The dose of γ -hydroxybutyrate for intravenous injection is 60 ~ 100 mg/kg. The dosage of thiopental sodium for infants is15 ~ 20 mg/kg; 1 ~ 3 years old children were given 2.5% solution, and 3 ~ 6 years old children were given 3 ~ 5% solution for deep intramuscular injection; /kloc-children under 0/year old are prohibited to prevent respiratory depression. Ketamine can be injected intramuscularly at 2.5 ~ 6 mg/kg. Older children who can cooperate can be injected with pethidine alone at a dose of 2mg/kg to eliminate fear and tension. Newborns can drink and sleep as a basic anesthesia. Generally, a few milliliters of wine is enough, soaked in sterilized cotton balls and sucked by newborns.
Inhalation anesthesia and intravenous anesthesia are the most commonly used general anesthesia.
7. 1 Inhalation anesthesia mainly uses ether, halothane, methoxyhalothane, enflurane and nitrous oxide. There are many ways to induce. Generally, basic anesthesia is used first, and then inhaled after the sick child falls asleep. The depth of anesthesia can be judged according to pupil size and masticatory muscle tension. The latter can be placed between the upper and lower gums of the baby with one finger, and the masticatory muscles can be clenched when anesthesia is shallow; When the anesthesia is deep, the masticatory muscles relax. After general anesthesia, muscle relaxants can be given and tracheal intubation can be performed for head, maxillofacial, oral, thoracic surgery and long-term abdominal surgery. Intubation should be gentle, so as not to damage the larynx and cause edema and obstruction. Tracheal catheters for newborns and infants. Cole catheter has small resistance, thin front end and thick back end, which is slightly funnel-shaped to prevent the catheter from entering the trachea too deeply and inserting into one side of the bronchus. Although the enlarged part increases the dead space, it is still better than the general tracheal catheter. The thickness and length of the selected conduit can be calculated according to the following formula:
Tracheal catheter length (cm) Age × 1/2+ 12
Tracheal catheter diameter (legal catheter number) Age+18
Children's tracheal intubation is usually inserted through the mouth under bright vision. A few oropharyngeal operations need to be inserted through the nasal cavity. Anesthesia devices after tracheal intubation include reciprocating closed absorption device and semi-closed device.
Anesthesia can also be maintained by using T-device (Yali device) or Y-device, or adding a breathing bag on T-device or Y-device to facilitate breathing. Baln ring devices can also be used.
Short-term, simple surgery can also be anesthetized by opening the mask, but it is forbidden for people who are not ready to fast. A small or medium-sized steel wire mask covered with 6 ~ 8 layers of gauze is covered on the nose of the sick child, and volatile substances are dripped. Commonly used are ether, trichloroethylene and chloroethane. This method can also be used to induce anesthesia.
7.2 Intravenous anesthesia and intravenous compound anesthesia Preschool and school-age children can also use intravenous anesthesia or intravenous compound anesthesia. Commonly used drugs are ketamine, sodium γ-hydroxybutyrate, thiopental and neuroleptics. Ketamine has the advantage of good analgesic effect and is beneficial to the circulatory system, but its disadvantage is that it can increase intracranial pressure, intraocular pressure and venous pressure, so it is forbidden for children with increased intracranial pressure, glaucoma or heart failure. The usual dose is 2mg/kg, which can maintain anesthesia 15 minutes. The dosage and usage of sodium γ -hydroxybutyrate are the same as those of basic anesthesia. Because of its poor analgesic effect, it is often used in combination with other drugs. As intravenous anesthesia, the dilution concentration of thiopental sodium should not exceed 2.5%, and the anesthetic effect is rapid and short-lived, which is a good induction for superficial minor surgery. Diazepam analgesics are composed of droperidol or haloperidol 5mg and fentanyl 0. 1mg, with a ratio of 50: 1. They are often used as an auxiliary method for other anesthesia, and the dosage is 0. 1ml/kg.
7.3 Application of muscle relaxants Muscle relaxants are mostly used for tracheal intubation induced by anesthesia in infants and young children, but not used much in surgery. Infants and young children are sensitive to non-depolarizing muscle relaxants. 0.3 ~ 0.5 mg/kg D- curcumol can often make respiratory paralysis last for a long time, so it should be used with caution. Infants and young children have strong tolerance to depolarizing muscle relaxants, but they should be injected in small amounts in several times, not by intravenous drip for a long time. Infants, especially those with poor conditions, are prone to "biphasic effect" after using depolarization muscle relaxants (that is, depolarization first, then non-depolarization block), which should be paid attention to. The usual dosage of succinylcholine is 0.5 ~ 2 mg/kg for intramuscular injection, 0.5 ~ 1 mg/kg for intravenous injection, and the supplementary dosage is 0.25mg/kg. Prepare tracheal intubation, mask, laryngoscope, anesthesia machine and other appliances before use.
The types of muscle relaxants used in preschool and school-age children during general anesthesia are basically the same as those used in adults, but the indications are more stringent. Children should pay attention to the recovery of breathing after using muscle relaxants. Attention should be paid to the changes of heart rhythm after the application of succinylcholine. It is reported in the literature that arrhythmia and even cardiac arrest are caused by the increase of blood potassium.
8 Local anesthesia and nerve block anesthesia Babies can also be operated under local infiltration anesthesia, and the sick children can be fixed on a "big" wooden frame for easy operation. This anesthesia is suitable for critically ill and weak infants or short-term minor operations, and sick children can be given basic anesthesia first. Commonly used local infiltration substances are 0.25 ~ 0.5% procaine or lidocaine solution. In the first hour, the dose of procaine should not exceed 8 mg/kg, and the dose of lidocaine should not exceed 4 mg/kg, so as to be painless at low concentration and low dose. Nerve block commonly used in children includes infraorbital nerve block, axillary or intermuscular groove brachial plexus block, etc. When toxic reaction occurs due to improper application of local anesthetic, the drug should be stopped immediately; Oxygen inhalation was given according to the severity of the disease, and diazepam 3 ~ 5 mg or 1.25 ~ 2.5% thiopental sodium 2 ~ 3ml； was injected intravenously quickly; If the dyspnea does not improve after the above treatment, tracheal intubation should be performed to assist breathing.
Intraspinal anesthesia can be divided into subarachnoid block anesthesia (spinal anesthesia), epidural block anesthesia and sacral block anesthesia.
9. 1 subarachnoid block anesthesia can be used for perineum, lower limbs, lower abdomen and other operations in preschool or school-age children. Babies use it less. Basic anesthesia must be improved during operation, otherwise the liquid injected into subarachnoid space will easily spread, and the anesthesia level will be difficult to control because the child is crying or struggling. Preschool children's lumbar puncture points are mostly in 4 ~ 5 lumbar intervertebral spaces, and the puncture needle thickness is 24 ~ 25g. The commonly used drug is 5% procaine glucoepinephrine solution with a large specific gravity (its specific gravity is about 1.020, which is heavier than cerebrospinal fluid, so it is convenient to adjust the plane with * * * *), and the dosage of procaine is calculated as 2mg/kg. The serious accident of subarachnoid block anesthesia is that the blocking plane is too high after anesthesia, which causes blood pressure drop, dyspnea, vomiting and even asphyxia, so attention should be paid to prevention. In recent years, this kind of anesthesia has been gradually used less.
9.2 Epidural block anesthesia is suitable for abdominal and lower limb surgery, and its advantages are stable anesthesia and muscle relaxation. Continuous epidural anesthesia is often used. Children's ligamentum flavum is elastic, and there is obvious sense of sudden disappearance of resistance during puncture. When the needle tip is proved to be in the epidural space by gas injection resistance disappearance method or capillary method, a special catheter is placed. The location of puncture point was selected according to the surgical site: the space between chest 12 and waist 1 was selected for upper abdominal surgery; Lumbar space1~ 2 was selected for middle and lower abdomen operation; Insert the catheter into the epidural space 2 ~ 3 cm away from the head end. Lumbar spine 1 ~ 2 gap puncture was selected for lower limb surgery, with the oblique mouth of needle end facing the tail end and the depth of catheter insertion at the tail end as before. Children over 3 years old commonly use 1 ~ 1.5% lidocaine solution, 6 ~ 8 mg/kg. The types and concentrations of administration for infants and young children are shown in the table. When the liquid medicine mistakenly enters the subarachnoid space, the lower limbs collapse at first and the abdominal muscles are extremely relaxed. If the plane is high, respiratory depression will appear soon, and these changes can happen instantly, so we should pay close attention to them. Attention should be paid to the change of complexion and the presence or absence of small muscle twitching on the face, which are all symptoms of substance poisoning. The main complications of epidural anesthesia are spinal cord and spinal nerve root injury, epidural infection and catheter rupture. Sterile technology and careful operation should be strictly followed.
9.3 Sacral canal block anesthesia is suitable for children's perineal and pelvic surgery. Although the operation of sacral canal block is simple, there are many anatomical variations of sacral canal, which affects the success rate to some extent. At present, 7 ~ 8 short kissing needles are often used, and the feeling of penetrating sacrococcygeal ligament is obvious. In addition to anatomical variation, the main reasons for failure are insufficient dose, slow injection or too high surgical site and insufficient anesthesia level.
10 management and observation of general anesthesia 10. 1 judgment of anesthesia depth: children's eyeball changes are the same as those of adults. When anesthesia enters the third and second stages, the eyeball is fixed in the center. Children's pupils respond quickly to the depth of anesthesia, and when the depth of anesthesia is large, the pupils will enlarge. Therefore, continuous observation of pupil changes can prevent deep anesthesia as soon as possible.
10.2 respiratory management keeping the respiratory tract unobstructed from beginning to end is the primary task of pediatric anesthesia management. Even among fasting children, vomiting and aspiration during anesthesia are inevitable. During anesthesia, if the breathing fluctuates smoothly, it is mainly abdominal, which is similar to that during sleep, indicating that the anesthesia depth is appropriate and the respiratory tract is unobstructed. On the other hand, if there is a noise in the larynx when breathing, the inhalation is short and laborious or assists the movement of respiratory muscles, and there are "three depressions" when the nose flaps, breathes up or inhales; There must be airway obstruction, so be sure to check the cause and correct it in time.
10.3 the effect of circulatory management, the influence of anesthesia depth, the disorder of autonomic nervous system and insufficient ventilation will all cause the change of circulatory power. The most sensitive thing to reflect the change of circulatory power is the change of heart rate. Arterial palpation (three-step pulse pressure method) can be used to judge the changes of circulatory power during anesthesia. The common carotid artery is grade one, the superficial temporal artery is grade two, and the anterior frontal branch of the superficial temporal artery is grade three. When the circulatory function is good, three pulses can be obviously felt; The weakening or disappearance of the frontal branch indicates that the circulatory power begins to deteriorate; The disappearance of superficial temporal artery pulse suggests that shock has come; Once the common carotid artery pulse disappears, it is an important sign of cardiac arrest. In addition, the stethoscope can be placed in the precordial area or observed with an esophageal stethoscope.
The estimation of intraoperative blood loss, blood transfusion and fluid replacement are particularly important for children. Whether the infusion volume is sufficient depends not only on whether the output is consistent with the input, but also on the recovery and stability of the circulating power. Central venous pressure measurement and hematocrit examination can guide the quantity and speed of blood transfusion and rehydration, and are worth using in some operations.
10.4 observation of thermoregulation: the thermoregulation function of children is easy to be lost during anesthesia, and the intraoperative body temperature can rise and fall with external factors. In summer or in the operating room, the temperature is high, the operating lights are too hot, the air is not circulating, there are too many towels and so on. During the operation, the child's body temperature can continue to rise above 40℃, which increases the metabolic rate, aggravates the heart load and makes the body tissue need more oxygen. So it is easy to cause hypoxia. During anesthesia, we should not only pay attention to the change of heart rate, but also measure the body temperature at any time to prevent the complications of high fever, especially malignant high fever. If necessary, you can use ice or ice water to physically cool down as soon as possible, so that your child's body temperature can quickly drop to normal. In the cold winter or operating room, the temperature is not enough, especially for infants under 6 months, and the body temperature often drops during the operation. You can use hot water bottles, electric blankets, baking lamps, etc. to prevent the body temperature from dropping.
Calculation and evaluation of body mass index index of human body surface area calculator safety period calculator expected date of delivery calculator Normal weight gain during pregnancy Drug safety classification (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet suggestion Clinical biochemical common unit conversion basal metabolic rate calculation Sodium supplement calculator Iron supplement calculator prescription common Latin abbreviations Quick check Pharmacokinetics common symbols Quick check Effective plasma osmotic pressure calculator Alcohol intake calculator.
Encyclopedia of medicine, count now!
1 1 The most common anesthesia accident is respiratory accident:
1 1. 1 Respiratory obstruction can be divided into upper respiratory obstruction and lower respiratory obstruction. The former is mostly caused by secretion, vomit, tongue drop, tonsil enlargement and glottic spasm. To suck out secretions and vomit immediately, lift your chin forward and pressurize oxygen. The latter is mainly due to the reflux of gastric contents, which mistakenly attracts bronchial obstruction and is difficult to handle. Once it happens, the intubation should be lightly anesthetized and the respiratory tract should make it cough to suck out the inhalant in the bronchiole.
1 1.2 respiratory arrest is due to the decrease of carbon dioxide tension due to deep anesthesia, drug inhibition or artificially controlled breathing for too long. According to different reasons, such as reducing light anesthesia, establish spontaneous breathing.
1 1.3 Alveolar rupture is mainly caused by ignorance of anesthesia device, incorrect installation or excessive pressure during operation. Alveolar inflation can cause serious complications, such as tension pneumothorax or mediastinal emphysema. Thoracic puncture or underwater drainage should be performed immediately.
Ether burn of respiratory tract
Rarely seen. Because the ether in the ether volatilization bottle exceeds * * *, the oxygen flow is too large, and liquid ether is blown into the respiratory tract.
1 1.4 Pulmonary edema is mainly caused by excessive blood transfusion. The respiratory tract can have more pink secretions with foam; When auscultating, the lungs are covered with tiny moist rales, and there are varying degrees of cyanosis and dyspnea. Pressurized oxygen should be given immediately to assist breathing and alcohol inhalation, cardiotonic agent should be applied and blood transfusion and infusion should be stopped.
1 1.5 central nervous system accidents such as ether convulsions and symptoms of local anesthetic poisoning. All patients can be rescued according to the treatment method of local anesthetic poisoning.
Hypotension and arrhythmia hypotension are often caused by insufficient blood transfusion. The younger the child, the lower the tolerance for blood loss. In good preoperative condition, blood loss during operation is less than 5% of the whole body blood volume, so blood transfusion is not necessary; When the blood loss exceeds 5%, it should be supplemented. Blood loss as high as 20% often leads to obvious shock, accelerated pulse, decreased blood pressure and even arrhythmia, which should be rescued as soon as possible. The amount of blood loss can be calculated according to the amount of blood sucked out from surgical incision, surgical towel, gauze, operating table and ground area, with reference to central venous pressure and blood routine results, and can be replenished in time, otherwise it will cause serious consequences.
1 1.7 Malignant hyperthermia is a serious complication in pediatric anesthesia. Anyone who has shortness of breath, tachycardia and cyanosis during general anesthesia has a sharp rise in body temperature, as high as 4 1 ~ 42℃, or even 43 ~ 44℃, accompanied by muscle tension and stiffness, suggesting malignant high fever. Laboratory examination showed that creatinine phosphokinase in blood increased, and blood potassium and blood phosphorus also increased, suggesting that there was serious muscle injury, and the reasons were often unknown. We should immediately reduce the temperature, correct respiratory and metabolic acidosis, treat hyperkalemia, prevent and treat brain edema with hormones, treat myotonia with dantraline sodium and give calcium, otherwise the prognosis will be poor and the mortality rate will reach 65%.
1 1.8 Cardiac arrest is an extremely serious complication in pediatric anesthesia, which is often induced by many factors, but hypoxia and shock are still the main causes. After cardiac arrest occurs during surgery and anesthesia, we should first strive for early cardiopulmonary resuscitation, effective cardiac resuscitation and artificial respiration, and then further resuscitation treatment, with the prevention and treatment of hypoxic brain damage as the main goal (see "cardiopulmonary resuscitation").
12 Post-anesthesia treatment Children's post-anesthesia treatment is similar to that of adults, with emphasis on observation and treatment of respiration, circulatory system and awakening.
12. 1 respiratory anesthesia is affected by * * *, muscle relaxants, surgery and * * *, and breathing may cause inhibition; However, due to the close observation and treatment of anesthesiologists during the operation, its influence has been corrected. Once the operation is over, if you think that the influence of anesthesia will be eliminated, you will relax your observation and monitoring; In fact, * * * may still be at its peak, and muscle relaxants still have residual effects and may be poisoned again; Pain caused by surgical trauma can cause poor breathing, weak cough, and even accumulation of secretions in trachea and bronchus, causing bronchitis and even atelectasis. In addition, if the gastric emptying is not satisfactory during the operation, or because of abdominal distension, or because of reflux, vomiting, or subglottic edema after tracheal intubation is removed, respiratory depression will be aggravated. Therefore, although the operation has ended, the risk factors have not been eliminated after anesthesia, and the patient should be carefully observed and treated until he is fully awake, his cough reflex recovers, his breathing is normal and his respiratory tract is unobstructed. Children with partial respiratory insufficiency, heart failure or after heart surgery, high fever, hyperthyroidism and anemia should be given oxygen; Combined with arterial blood gas analysis, blood routine examination and chest X-ray examination, the relationship between inhaling a certain concentration of oxygen or mechanical ventilation and the improvement of general condition was observed. For subglottic edema, 1μl particles can be inhaled under the pressure of warm and humidified air oxygen fog. Sedatives should be used with caution, and adrenaline and antibiotics can be added if necessary.
12.2 children's circulatory system is generally sound, but after major surgery or multiple injuries and bleeding, a large amount of body fluids may remain in the extracellular space within 36 hours after surgery, which will cause hypovolemia and shock if not replenished in time. Therefore, the monitoring of circulatory system after anesthesia should include: ① maintaining normal circulating blood volume. ② Maintain normal cardiac output. ③ Prevention of anemia, hypoproteinemia, acid-base imbalance and electrolyte disorder. ④ Prevent pulmonary edema caused by excessive infusion. The monitoring items include peripheral blood perfusion, blood pressure, heart rate and rhythm, pulse, respiration, body temperature (especially the temperature difference between peripheral tissue and central tissue), blood loss, routine blood examination, urine volume (at least 1ml/kg/ hour), routine urine examination, electrocardiogram, etc. When conditions permit, arterial blood gas analysis, arterial pressure, central venous pressure and pulmonary capillary retention pressure (PCWP) can be done. According to the examination results, combined with the symptoms of sick children, analyze the possible changes and make corresponding treatments.
12.3 awakening situation