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目的探讨国人小儿麻醉时七氟烷吸入、丙泊酚TCI在喉罩置入时的最适浓度,并比较在最适浓度时两种方法的优缺点。方法择期腹股沟手术80例,年龄1-10岁,ASAⅠ-Ⅱ级,体重10-30kg。不用术前用药,常规禁食禁饮。基础麻醉采用阿托品0.02mg/kg+氯胺酮2mg/kg臀部肌肉注射。七氟烷组(S组,n=40)采用七氟烷吸入,按照有无基础麻醉分为SA组(n=20)和SB组(n=20)。丙泊酚组采用效应室浓度靶控输注,按照有无基础麻醉分为PA组(n=20)和PB组(n=20)。4组根据Dixon序贯法来确定喉罩置入时的合适浓度。在咽喉反射消失、下颌松弛、睫毛反射消失时用反转法置入。观察入室时、喉罩置入前和置入后的心率、呼吸频率、PETCO2、SPO2及异常情况。结果 SA组喉罩置入时呼末七氟烷浓度的ED50为1.60%,SB组喉罩置入时呼末七氟烷浓度的ED50为2.09%;PA组喉罩置入时丙泊酚效应室浓度的ED50为4.05μg/ml,PB组喉罩置入时丙泊酚效应室浓度的ED50为3.70μg/ml。结论丙泊酚靶控输注置入喉罩更适用于已行基础麻醉小儿,而未做基础麻醉的小儿则用七氟烷吸入诱导后置入喉罩较为合适。
Objective To investigate the optimal concentrations of sevoflurane inhalation and propofol TCI in laryngeal mask in pediatric anesthesia and to compare the advantages and disadvantages of the two methods at optimal concentration. Methods Ten patients underwent inguinal surgery, aged 1-10 years, ASA Ⅰ-Ⅱ grade, weighing 10-30kg. No preoperative medication, regular fasting ban. The basis of anesthesia with atropine 0.02mg / kg + ketamine 2mg / kg intramuscular injection. Sevoflurane (group S, n = 40) was inhaled with sevoflurane and divided into SA group (n = 20) and SB group (n = 20) according to the presence or absence of basic anesthesia. Propofol group with target-controlled infusion of target concentration, according to the presence or absence of basic anesthesia was divided into PA group (n = 20) and PB group (n = 20). Group 4 according to Dixon sequential method to determine the appropriate concentration of laryngeal mask placement. In the disappearance of the throat reflex, the mandibular relaxation, eyelash reflex disappear with reverse method. The heart rate, respiratory rate, PETCO2, SPO2 and anomalies were observed before and after laryngeal mask placement. Results The ED50 of ephedrine sevoflurane concentration in SA group was 1.60% when placed in laryngeal mask and 2.09% in SB group when laryngeal mask was placed in SB group. The propofol effect The ED50 of room concentration was 4.05μg / ml. The ED50 of propofol concentration in PB group was 3.70μg / ml. Conclusion Propofol target-controlled infusion into the laryngeal mask is more suitable for basic anesthesia in children, but not for basic anesthesia in children induced by sevoflurane induced laryngeal mask after induction is more appropriate.