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紧急手术中的静脉全麻醉:一个叙述性回顾

Andrew W Smith¹, Claire C Nestor¹, Michael G Irwin²

¹Department of Anaesthesiology, Tallaght University Hospital, Dublin, Republic of Ireland.

|December 3, 2025

概括

全静脉麻醉 (TIVA) 在紧急手术中的使用是有限的,因为缺乏具体的指导方针和证据. 快速序列诱导的实施失败造成了损害,突出了培训和协议的需要.

科学领域:

麻醉学麻醉学
紧急医疗紧急医疗
手术护理手术护理

背景情况:

静脉内全麻醉 (TIVA) 在选择性手术中已经确立,但在紧急情况下未得到充分利用,特别是用于快速序列诱导.
实施方面的挑战和缺乏紧急具体指导方针阻碍了TIVA在重症监护中的采用.
国家审计和报告显示,在紧急程序中,TIVA存在困难和安全问题.

研究的目的:

审查使用TIVA在紧急手术中的证据基础.
检查TIVA在紧急情况下的药理学方面,诱导技术,安全数据和实施障碍.
识别知识上的差距,指导未来的研究和实践.

主要方法:

关于TIVA在紧急手术中的现有文献的叙事综述.
对药理学考虑,快速序列诱导技术和来自国家审计的安全数据的分析.
检查在紧急情况下的实施挑战和改变患者生理学的情况.

主要成果:

没有随机试验直接比较TIVA与紧急手术中的吸入麻醉.
国家审计显示,与剂量和输送问题相关的快速序列诱导过程中的TIVA错误可能造成可预防的伤害.
对诱导速度和缺乏指导方针的担忧导致只有四分之一的麻醉科医生使用TIVA进行快速序列诱导.

结论:

目前在紧急情况下的TIVA实践依赖于从选择性手术中推断出来的数据,其有效性不确定.
在国家审计中记录的可预防伤害强调了培训不足和TIVA在紧急情况下缺乏指导方针.
结构化的协议,全面的培训和明确的团队角色对于在紧急情况下安全实施TIVA至关重要;需要进行前性试验.

关键词:

紧急手术是紧急手术.患者安全患者安全快速序列的感应感应.目标控制输注 (TCI) 的目标控制输注 (TCI)完全静脉内麻醉 (TIVA) 的方法

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