小儿气管后路手术的麻醉。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Carlos J Muñoz, Frederick H Kuo, Michael R Hernández, Walid Alrayashi, Cornelius A Sullivan, Jue T Wang, Russell W Jennings
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引用次数: 0

摘要

气管支气管畸形是指呼气时气管和/或支气管异常过度塌陷。在儿童群体中,气管支气管畸形越来越被认为是发病和死亡的原因之一。一直以来,内科治疗和外科干预的选择都很有限,患者的治疗效果也很差。在过去的十年中,美国一些儿科机构投入了大量资源,建立了专门的外科和麻醉团队,并开发了新技术,成功地识别、评估和手术矫正了高度复杂的儿科气管支气管畸形。密切的沟通、合作以及麻醉技术的不断发展,满足了新手术过程的独特要求,大大提高了患者的安全性并优化了治疗效果。美国两家儿科医疗机构已使用这些技术完成了 800 多例手术。本文回顾了后气管成形术,这是一种较新但越来越常见的手术,旨在解决气管支气管畸形问题,并概述了相关的麻醉注意事项和独特的挑战。此外,本文还介绍了专为促进气管支气管畸形的最佳诊断和后气管成形术及类似气道手术的术中管理而开发的新型麻醉技术。这些技术包括安全地进行三相硬质动态支气管镜检查以准确诊断气管支气管畸形的方法、在颈部和胸部手术解剖过程中监测喉返神经的方法、在气道重建过程中进行连续术中支气管镜检查以获得实时图像的方法,以及术中评估气道修复的充分性以确保成功矫正气管支气管畸形的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anesthesia for Posterior Tracheopexy in Pediatric Patients.

Tracheobronchomalacia refers to an abnormally excessive collapse of the trachea and/or bronchi during exhalation. In the pediatric population, tracheobronchomalacia is increasingly recognized as a cause of morbidity and mortality. Historically, options for medical management and surgical intervention were limited, and patient outcomes were poor. Over the last decade, select US pediatric institutions have devoted significant resources to the establishment of dedicated surgery and anesthesia teams and the development of novel techniques for the successful identification, assessment, and surgical correction of tracheobronchomalacia in a highly complex subset of the pediatric population. The close communication, collaboration, and evolution of anesthesia techniques to meet the unique requirements of new surgical procedures have greatly improved patient safety and optimized outcomes. More than 800 cases have been performed across 2 US pediatric institutions using these techniques. This article reviews the posterior tracheopexy procedure, a newer but increasingly common surgery designed to address tracheobronchomalacia, and provides an overview of related anesthesia considerations and unique challenges. In addition, this article describes novel anesthesia techniques developed specifically to facilitate optimal diagnosis of tracheobronchomalacia and intraoperative management of posterior tracheopexy and similar airway surgeries. These include methods to safely enable 3-phase rigid dynamic bronchoscopy for accurate tracheobronchomalacia diagnosis, recurrent laryngeal nerve monitoring during cervical and thoracic surgical dissection, continuous intraoperative bronchoscopy to enable real-time images during airway reconstruction, and intraoperative assessment of airway repair adequacy to ensure successful correction of tracheobronchomalacia.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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