Page 40 - CASA Bulletin of Anesthesiology Vol 9 (4) 2022 (3)
P. 40
CASA Bulletin of Anesthesiology
复旦大学附属眼耳鼻喉科医院对于小儿术前焦虑处理的流程如下:
(1) 根据年龄，对于不能配合开放静脉的患儿首选术前 30min 经鼻滴入右美托咪定 2-
3ug/kg，或口服咪达唑仑 0.5mg/kg 混合高糖 1：1 配比术前 30min 口服，待患儿安静后再次
尝试开放静脉。
(2) 初步镇静后仍然不能合作开放静脉的，我们选择父母陪同下吸入诱导。
(3) 对于能合作开放静脉但不接受亲子分离的患儿，给予咪达唑仑 0.05-0.1mg/kg 或艾司氯
胺酮 0.3-0.5mg/kg 静脉推注，然后进行亲子平稳分离。在应用药物镇静期间，应常规生命体征
监测，避免患儿因术前镇静引发的呼吸抑制、低氧等问题，并准备好通气支持和复苏的设备。
患儿的围麻醉期管理既是一门科学，也是一门艺术。术前焦虑和暴力的麻醉诱导会对患儿产
生长期的行为不良后果和心理问题。麻醉医生需要了解儿童心理学，并与儿童建立良好的关系。
术前访视期间，使用合适的临床评估工具来识别有术前焦虑风险的患儿，采取适合各个年龄组的
术前抗焦虑预防措施，并在合适的时间点进行干预。术前镇静药的选择应符合患儿的年龄和气
质。总之儿童平静的与父母分离和顺利的麻醉诱导需要病房护士、手术室护士、麻醉医生、外科
医生等多个方面的医护人员共同努力。
References
1. Zainal Abidin H, Omar SC, Mazlan MZ, et al. Postoperative Maladaptive Behavior, Preoperative Anxiety and
Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review. Glob Pediatr Health.
2021;8:2333794X211007975. Published 2021 Apr 7. doi:10.1177/2333794X211007975
2. Dave NM. Premedication and Induction of Anaesthesia in paediatric patients. Indian J Anaesth. 2019;63(9):713-
720. doi:10.4103/ija.IJA_491_19
3. Chow CHT, Rizwan A, Xu R, et al. Association of Temperament With Preoperative Anxiety in Pediatric Patients
Undergoing Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(6):e195614. Published
2019 Jun 5. doi:10.1001/jamanetworkopen.2019.5614
4. Mathias EG, Pai MS, Guddattu V, Bramhagen AC. Non-pharmacological interventions to reduce anxiety among
children undergoing surgery: A systematic review [published online ahead of print, 2022 Jan 31]. J Child Health
Care. 2022;13674935211062336. doi:10.1177/13674935211062336
5. Uusalo P, Guillaume S, Siren S, et al. Pharmacokinetics and Sedative Effects of Intranasal Dexmedetomidine in
Ambulatory Pediatric Patients. Anesth Analg. 2020;130(4):949-957. doi:10.1213/ANE.0000000000004264
6. Lu X, Tang L, Lan H, Li C, Lin H. A Comparison of Intranasal Dexmedetomidine, Esketamine or a
Dexmedetomidine-Esketamine Combination for Induction of Anaesthesia in Children: A Randomized Controlled
Double-Blind Trial. Front Pharmacol. 2022;12:808930. Published 2022 Jan 27. doi:10.3389/fphar.2021.808930
7. Mathias EG, Pai MS, Guddattu V, Bramhagen AC. Non-pharmacological interventions to reduce anxiety among
children undergoing surgery: A systematic review [published online ahead of print, 2022 Jan 31]. J Child Health
Care. 2022;13674935211062336. doi:10.1177/13674935211062336
P a g e 39 | 65
