- 期刊
The Anesthetic Management of a Preterm Infant Weighing 500 Grams Undergoing Ligation of Patent Ductus Arteriosus-A Case Report
體重五百公克早産兒開放性動脈導管結紮手術之麻醉處理－病例報告
摘要
早産兒開放性動脈導管是一常見問題，若其無法自行關閉，可用藥物或手術處理。然而一旦需要手術結紮，由於通常都有併發其他主要器官的疾病，因此對於麻醉醫師是一項挑戰。本文報告一位二十八週出生之早産兒，女嬰出生時體重只有五百公克，出生後就發現有呼吸窘迫症並住進新生兒加護病房，隨後發現在開放性動脈導管，由於左至右之血液分流很大，可能引發肺出血與心臟衰竭，而且因其腎功能不全，無法以藥物治療，因此決定以手術結紮，爲避免於轉送過程中發生意外，因此選擇在新生兒加護病房中進行麻醉與手術。全身麻醉使用的藥物爲atropine 0.01mg, pancuronium 0.1mg, fentany 12μg,及ketamine 0.15mg。除了心電圖、動脈血氧飽和度與體溫的監測外，動脈導管與中央靜脈導管也是重要的臨測指標，中央靜脈導管還可作爲輸液之用，更可做爲大量失血時之緊急輸血用。本文探討了早産兒開放性動脈導管手術結紮時之麻醉處理，並回顧相關文獻。
並列摘要
PDA (patent ductus arteriosus) is a common congenital heart disease. Usually surgical intervention through left thoracotomy or recently through video assisted thoracoscopy will be recommended if the preceding or intent medical treatment fails or is contraindicated. However, once surgical intervention is decided, various complications are still a real fear in the mind of the surgeon and the anesthesiologist, particularly if the infant is premature or very sick. Here we report an anesthetic management in a female preterm infant weighing 500 grams, who underwent PDA ligation. She was born at gestation age of 28 weeks at our hospital, and since her birth she was noted to have infant respiratory distress syndrome associated with renal dysfunction. She was admitted to the neonatal intensive care unit (NICU) straightaway. After thorough examination, a severe PDA was disclosed. The possibility of pulmonary hemorrhage and heart failure could be predicted in view of the large left to right shunt. Worst of all was that her poor renal function contradicted a medical treatment. So we decided to carry out the ligation procedure at once although she was premature and only 5 days old. The NICU was chosen as the operation theater for transferring concerns. General anesthesia was induced and maintained by atropine 0.01 mg, pancuronium 0.1mg, fentanyl 2μg, and ketamine 0.15mg intravenously. Supplemental oxygen was given throughout the operation. The PDA was ligated through left thoracotomy and blood loss was minimal. The pen-operative course was uneventful. The patient recovered well following surgery and anesthesia.
延伸閱讀
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