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題名 | Anesthetic Management of a Parturient Undergoing Cesarean Section with a Tracheal Tumor and Hemoptysis=合併呼吸道腫瘤及咳血的產科麻醉處理 |
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作者姓名(中文) | 伍乙棠; 劉偉明; 余振翔; 謝敬儒; 鍾志豪; | 書刊名 | 長庚醫學 |
卷期 | 26:1 2003.01[民92.01] |
頁次 | 頁70-75 |
分類號 | 417.372 |
關鍵詞 | 硬脊膜外麻醉; 孕婦; 呼吸衰竭; 咳血; Epidural anesthesia; Parturient; Respiratory failure; Hemoptysis; |
語文 | 英文(English) |
中文摘要 | 合併呼吸衰竭及肺癌侵犯氣管咳血的剖婦產麻醉是非常困難的,麻醉醫師應明瞭病患本身的主要病灶並未在此手術中改善,正如同心臟病患接受非心臟手術的危險性,手術過程中麻醉醫師也必須致力於保護產婦與嬰兒的安全。但選圛適當的麻醉方法(全身麻醉或半身麻醉)卻誤麻醉醫師傷透腦筋。誠然全身麻醉提供母子足夠的氧氣,但大量的咳血與插管可能引致腫瘤出血及擴散卻是麻醉醫師也需考量難題。延遲拔除氣管內管也會影響肺癌的治療;喉頭罩雖可考慮但也有吸入性肺炎的危險。高濃度吸入性麻醉藥可影響子宮收縮,且給予的肌肉鬆弛劑也會改變病患的呼吸型及生理。單純的半身麻醉方法,病患不一定能忍耐,咳嗽力量的降低、呼吸力量的衰竭及過度換氣會危害產婦及嬰兒的生命,在此我提供報告-以硬脊膜外麻醉合併氧罩輔助式輕度正壓給氧方法來解決與一般孕婦麻醉過程中自行呼吸的不同,以硬脊膜外麻醉藥物給予2%苦息樂卡因18ml加入7%碳酸氫納2ml及01.mg動腎上腺素,再以半平躺方式有效控制麻醉高度,成功成完成剖婦產,並扲續肺腫瘤療程。 |
英文摘要 | Anesthetic management of a parturient with respiratory failure associated with hemoptysis, dyspnea, and orthopnea is difficult. An anesthesiologist should realize that the patient’s major problem is not solved during the surgery. This circumstance is similar to a patient with associated cardiac disease scheduled for non-cardiac surgery. General anesthesia with endortracheal intubation can provide safe oxy8genation for tboth the parturient and the fetus, but with possible unexpected massive hemoptysis and tumor seeding. Prolonged intubation may delay the patient’s pulmonary treatment course. Laryngeal mask anesthesia canprovide an airway, but must not be secured due to the risk of aspiration. The need of high doses of inhalation drugs mauy hinder uterine contractions. The addion of a muscle relaxant will change the patient’s respiratory patterns and physiology. Regional anesthesia alone might not be tolerated. A decrease in cough strength, as well as dyspnea, orthopnea, and hyperventilation may be harmful to both the parturient and the fetus. However, we successfully manged this case using epidural anesthesia combined with assisted mask ventilation instead of spontaneous breathing usually provided by a simple mask in almost all American Society of Anesthesiology (ASA) class I-II parturients durng sesarean section. The anesthetic level was maintained at T8 with 18 ml of 2% Xylocatine mixed with 2ml of 7% sodium bicarbonate with 1:200.000 epinephrine epiduarlly and with the patient in a supine spoition with the head up at 30° prevent cephalic spreading and to ensure better pulmonary ventilation. |
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