Anesthesia management in children undergoing direct laryngoscopy and bronchoscopy under total intravenous anesthesia

FU Dayong; ZHANG Ruidong

doi:10.3969/j.issn.1674-3806.2024.04.03

Abstract：Objective To explore the anesthesia management in children of different ages with spontaneous breathing and undergoing direct laryngoscopy and bronchoscopy under total intravenous anesthesia.Methods A total of 71 pediatric patients with airway malformation who were admitted to Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from May 2022 to January 2023 were selected.The pediatric patients were classified by the American Society of Anesthesiologists(ASA)as grade Ⅱ-Ⅲ,with ages ranging from 1 month to 10 years old.According to the ages,the pediatric patients were divided into younger than 1 year group(group A,25 cases),older than or equal to 1 year and younger than 4 years group(group B,23 cases)and older than or equal to 4 years group(group C,23 cases).Anesthesia was induced by intravenous infusion of lidocaine,sufentanil and dexmedetomidine combined with intravenous drip of propofol,and maintained by pump infusion of propofol at 10-12 mg/(kg·h).Vocal cord surface anesthesia was performed with 2.4％lidocaine aerosol.The pediatric patients'incidence rates of apnea,laryngeal spasm,choking cough and hypoxemia after anesthesia were compared among the three groups.The pediatric patients'indicators of vital signs were recorded at awake state(T0),rigid laryngoscope insertion(T,)and direct laryngoscopy and bron-choscopy(T2).Results After anesthesia,there were no significant differences in the pediatric patients'incidence rates of apnea,laryngeal spasm and choking cough among the three groups(P＞0.05).The dose of propofol used for inducing anesthesia in the pediatric patients of group A was significantly reduced compared with that in the pediatric patients of group B and the pediatric patients of group C,while the incidence rate of hypoxemia in the pediatric patients of group A was significantly higher than that in the pediatric patients of group C(P＜0.05).In the pediatric patients of group A,heart rate(HR)at T,and T2 time points was significantly lower than that at T0 time point,and in the pediatric patients of group B,HR at T2 time point was significantly lower than that at T0 time point(P＜0.05).Systolic blood pressure(SBP)and diastolic blood pressure(DBP)at T,and T2 time points were significantly lower than those at T0 time point in the three groups(P＜0.05).Conclusion The technique of total intravenous anesthesia with the patients'spontaneous breathing preserved can be used for direct laryngoscopy and bronchoscopy in children,but it should be noted that the incidence rate of hypoxemia in infants under 1 year of age is higher than that in children aged 1 year and above.