1例小儿颞骨巨大横纹肌肉瘤3次手术的麻醉管理

Anesthetic management of three surgeries in child with huge temporal bone rhabdomyosarcoma: A case report and literature review

  • 摘要: 目的 探讨小儿头颈部巨大肿瘤所致困难气道的麻醉与管理。 方法 回顾2014年6月14日收入我院的1例2岁小儿颞骨巨大横纹肌肉瘤3次手术麻醉的临床资料,文献回顾并分析小儿头颈部巨大肿瘤导致困难气道的麻醉管理特点及处理原则。 结果 患儿于2014年6月24日、7月15日、9月4日行3次手术,其中第2次全身麻醉下行输液港置入手术时,因肿瘤巨大并凸入口咽部无法建立人工气道,临时改变手术方案,在面罩吸入七氟醚并辅以局部麻醉下行右锁骨下大静脉穿刺置管术,手术麻醉过程均顺利。 结论 对于颈部及口内巨大肿物患儿,不能盲目采用快速诱导实施气管插管,术前应充分评估气道,麻醉实施宜循序渐进,并制订安全可行的麻醉手术应急预案。

     

    Abstract: Objective To study the anesthetic management of difficult airway caused by huge head and neck neoplasms in children. Methods Clinical data about three surgeries of a 2-year old child with temporal bone rhabdomyosarcoma who was hospitalized on June 14, 2014 were reviewed and the anesthetic features and clinical treatment principles of difficult airway caused by huge and neck neoplasms in children were retrospectively analyzed. Results The patient underwent three surgeries successively on June 24, July 15 and September 4 in 2014.Because of difficult airway resulting from huge and pharynx oralis-involved tumor, the operation plan was changed from implantable venous-access ports under general anesthesia to right subclavian vein catheterization under local anesthesia with inhalation anesthesia of sevoflurane in the second surgery.Three operations were all uneventful. Conclusion It suggests that children with huge head and neck neoplasms cannot adopt rapid induction and tracheal intubation blindly, anesthesia procedure should be undertaken gradually and make viable and secure anesthesia program.

     

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