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頁籤選單縮合
題名 | Anesthetic Management of the Patients with Giant Mediastinal Tumors--A Report of Two Cases=巨大前縱隔腔腫瘤之麻醉處理--二病例報告 |
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作者 | 林聖瀚; 蘇煖燕; 許淑霞; 丁乾坤; 尹彙文; 鄭慧正; 李德譽; | 書刊名 | 麻醉學雜誌 |
卷期 | 37:3 1999.09[民88.09] |
頁次 | 頁133-139 |
分類號 | 416.52 |
關鍵詞 | 縱隔腔腫瘤; 全身麻醉; 腰椎麻醉; 術中併發症; 呼吸道阻塞; Mediastinal neoplasms; Anesthesia; General; Spinal; Intraoperative complications; Airway obstruction; |
語文 | 英文(English) |
中文摘要 | 為有巨大前縱隔腔腫瘤的病人進行麻醉,是麻醉醫師極困難且富挑戰的工作。癌 病腫塊直接壓迫氣管和支氣管,會導致缺氧和心跳停止,甚至一誘導全身麻醉便發生猝死, 因此應儘可能地不進行全身麻醉或使用人工被動換氣呼吸。此款嚴重威脅生命困境,胸腔外 科醫師多能警覺,但他項外科次專科醫師,例如耳鼻喉科醫師或婦產科醫師則未必瞭然。因 此我們提出兩個分屬不同科別的患者(一是耳鼻喉科進行全身麻醉終為死亡病例,另一位為婦 科以腰椎麻醉安全完成全子宮切除患者)未說明:前縱隔腔腫瘤病患以全身麻醉誘導之危險 性;麻醉前萬全準備之重要性及無可避免之手術與麻醉安全性應如何改進,並順道說明俯臥 姿勢對換氣及氧合之影響。 |
英文摘要 | Anesthesia for patients with a huge anterior mediastinal tumor is a well-known challenge and trial to all the anesthesiologists. The tumor mass which directly compresses the trachea and bronchus induces hypoxia and asphyxia, eventuating in cardiac arrest or even fatality in the process of general anesthesia. In selection of anesthetic technique, general anesthesia is deliberately avoided if not mandatory or spontaneous respiration should be strictly preserved by all means if obligatory. Our surgical colleagues are usually not so familiar with this potentially life-threatening situation as are the anesthesiologists, and bad communications and interactions between the two may court disaster. Here we reported 2 cases: the former was an immediate mortality in a youth with a giant anterior mediastinal tumor undergoing excisional biopsy of a neck mass under general anesthesia, and the latter was a successful anesthetic management in a woman with a giant mediastinal tumor receiving abdominal total hysterectomy for cervical cancer in situ under spinal anesthesia. The hazards of general anesthesia in these patients and the importance of comprehending preanesthetic preparations were reviewed and discussed. Moreover, we address that whenever one has shot his bolt still futile to improve the respiratory crisis in a case with mediastinal tumor, try to ventilate the patient in a prone position as it has clinical importance in ventilation and oxygenation. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。