- 期刊
高頻率噴氣及全靜脈麻醉在喉內顯微手術之應用
High-Frequency Jet Ventilation and Total Intravenous Anesthesia in Endolaryngeal Microsurgery
摘要
在喉部病灶的診斷與治療上，喉內顯微手術是不可或缺的一環。然而喉內顯微手術時喉部需要保持穩固而沒有阻礙；在所有麻醉技術中，高頻率噴氣麻醉已被證實頗能提供如此情況。從1991年5至7月，台中榮總耳鼻喉科與麻醉科合作，採用高頻率噴氣於喉內顯微手術上。一共26名患者施行了27次手術，其中男性17例，女性10例。患者平均年齡46.85±14.4歲，平均手術花費時間是25.5±13.3分鐘。術後甦醒時間平均是10.4±6.5分鐘。其中延遲甦醒有6例（超過15分鐘），都是因麻藥過量所致。術後患者呼吸困難有2例：1例是喉部水腫，噴了腎上腺素就好轉；另1例是喉癌患者，作完切片後有呼吸道阻塞的現象，我們予以氣管插管。有4例在術後有二氧化碳滯留的現象。所有患者術中的血壓、脈搏及血氧飽和度都很平穩，沒有任何嚴重的併發症發生。
並列摘要
Endolaryngeal microsurgery (ELM) is mandatory in the diagnosis and treatment of laryngeal lesions. However. ELM requires an unobstructed larynx which must be shared by the anesthesiologist and otolaryngologist. Many techniques have been used for ventilation during microlaryngosurgery. Among these, high frequency jet ventilation has been proved satisfactory in ELM and many other major operations. Twenty-seven procedures were performed in 26 cases (M/F = 17/10) between April and July in 1991. The average age of these cases was 46.85 (20-76 y/o). The average operative time was 25.5 minutes (9-65 min) and average awake time was 10.4 minutes (3-25 min). There were 6 cases of delay awake (＞15 min) due to overdosage of anesthesic agents. There were two cases of post-operative respiratory difficulty. One was laryngeal edema which subsided after inhalation of epinephrine. The other was a case of laryngeal cancer with post-operative airway obstruction. Intubation was performed without any sequela. There were four cases with post-operative hypercarbia. Intra-operative arterial oxygen saturation, pulse and blood pressure monitored were stable. No severe complications such as pneumothorax or pneumomediastinum happened.
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