对于前端中质量患者的麻醉管理的演变
Mona Sarkiss1, Carlos A Jimenez2
1Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Mediastinum (Hong Kong, China)
|June 1, 2023
概括
对于中质的麻醉是具有挑战性的. 最近的研究表明,全身麻醉和正压通风改善了呼吸道口径,挑战了当前的做法.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 呼吸机械学 呼吸机械
背景情况:
- 中质量由于潜在的气道压缩,造成了显著的麻醉挑战.
- 传统的管理强调吸入诱导和自发通风,以避免气道崩和血液动力学损害.
- 在全身麻醉后患者死亡的病例报告加强了这些谨慎的方法.
研究的目的:
- 审查有关中质的麻醉管理的现有文献.
- 介绍有关麻醉和通风期间呼吸道机械学的新研究成果.
- 根据新的证据提出修订后的麻醉技术.
主要方法:
- 历史文献和当前麻醉实践的审查.
- 分析最近的研究测量气道口径和气流 (高峰吸气流和高峰呼气流) 在患者中枢骨质.
- 在各种条件下对呼吸道机制的评估:清醒,麻醉,自发通风,正压通风,有/没有肌肉放松.
主要成果:
- 随着或没有肌肉放松的全身麻醉,不会恶化由中质引起的先前存在的气道狭窄.
- 积极压力通风,PEEP和肌肉松可以改善这些患者的气道口径和空气流量.
- 新的数据挑战了人们长期以来的信念,即自发通风是强制性的.
结论:
- 目前对于中质的麻醉实践可能过于保守.
- 新的研究表明,通用麻醉与机械通风可以安全和有益.
- 为了更安全的患者管理,建议采用综合这些发现的修订麻醉方法.
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