This article reports the management of thirty elderly patients of septic shock during anesthesia. Twenty-four of them received continious epidural anesthesia, five of them were under intravenous general anesthesia with endotracheal intubation, and onr patients recerived intravenous ketamine anesthesia. The effects of these patients on enesthesia wer satisfactory. Twenty-four patients recouverd after roperation. Six patients died. The authors atresses the high risk of anesthetic management in these patients. Experiences are introduced in per-anesthetic preparation and medication selection and maintenance of anesthesia, monitoring and treatment during anesthesia and postoperative care of septic shock of the elderly.
目的:本文回顾性分析总结32例心脏瓣膜置换术同期改良迷宫术患者的麻醉处理。方法:32例瓣膜病合并心房颤动患者,ASA分级Ⅱ-Ⅳ级,心功能ⅢⅣ级,采用以芬太尼为主的全身麻醉,术中以硫酸镁和艾司洛尔调控应激反应,复温后多联合使用多巴胺或(和)多巴酚丁胺5～10μg/kg·min、硝酸甘油或硝普钠0. 5～5μg/kg·min等血管活性药物以达到扩张血管增强心肌收缩力、降低心脏负荷、维持循环稳定的目的。停机后预防性安置心外膜起搏导线,使用异丙肾上腺素后心率仍慢者,及时运用临时起搏,保证有效的心肌收缩和稳定的心率。结果:射频消融时间为32±5分钟,主动脉阻断时间89±12分钟; 体外循环时间109±20分钟。心脏自动复跳29例, 电除颤复跳3例, 32例患者术后均为窦性心律。5例患者使用临时起搏器。结论:完善的术前准备和围术期重视心肺功能的支持治疗, 合理调控应激反应等措施是手术成功的重要基础。
ObjectiveTo discuss the anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients. MethodsWe selected 8 patients with long QT syndrome classified American Society of Anesthesiologists Ⅱ-Ⅲ who were going to undergo left thoracic sympathectomy under thoracoscope between July 2011 and October 2014 as our study subjects. They were given a moderate amount of beta blockers before operation, inducted with 0.1 mg/kg midazolam, 3-6 μg/kg fentanyl, 2-4 mg/kg propofol, 0.3-0.6 mg/kg cis-atracurium, and maintained with propofol 1-4 mg/(kg·h) combined with 0.025-2.000 μg/(kg·min) fentanyl. We recorded the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and airway peak pressure, and end-tidal carbon dioxide before anesthesia induction (T0), at endotracheal intubation (T1), during artificial lung-collapse when surgery initiated (T2), 5 minutes after surgery initiation (T3), 15 minutes after surgery initiation (T4), during artificial lung-collapse at the end of surgery (T5) and during extubation (T6). ResultsWhen compared with T0, T2 got a higher MAP, T3 and T4 had a slower HR (P<0.05), but all were within a normal range. All the patients showed little change in airway peak pressure and end-tidal carbon dioxide during the surgery with no statistically significant difference (P>0.05). ConclusionProper anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients can reduce the incidence of perioperative malignant arrhythmia.