哮喘联盟

   摘要
   目的：哮喘是一种常见的疾病，尤其在儿童中多发，麻醉师越来越多的为需要择期手术并控制良好以及控制不良或未确诊需要紧急手术的哮喘儿童提供麻醉。这两部分综述的第二部分对贯穿于普通围手术期的药物和通气处理作了详细介绍，并且对哮喘患儿的急性支气管痉挛和哮喘发作的围手术期管理也作了详细介绍。
   近期发现：多重观察性试验对健康和哮喘患儿在围手术期发生的呼吸道不良事件进行了评估，这可以为风险降低策略获得确定提供依据。主要是，动物实验和小范围内的临床数据已经提高了我们对麻醉剂如何影响支气管平滑肌张力和反射性支气管收缩的理解水平。在大量证据支持的基础上，麻醉之外的哮喘治疗已经被很好的建立。围手术期的预防策略越来越多地被研究。然而，包括机械通气策略在内的对哮喘患儿围手术期的管理，这方面的证据仍然是单一的，需要进一步研究。
   小结：为了最大限度地减少哮喘患儿在围手术期发生呼吸道不良事件的巨大风险，围手术期的管理应基于两个主要方面：哮喘治疗的术前优化（请参阅由两部分组成的本综述的第一部分）和本综述的第二部分所关注的关于麻醉管理的优化，麻醉管理的优化是为了优化围手术期的肺功能和减少围手术期支气管高反应性。
 

（林江涛 审校）
Curr Opin Anaesthesiol. 2014 Mar 29. [Epub ahead of print]

 

Anesthesia and ventilation strategies in children with asthma: part II - intraoperative management.
 

Regli A1, von Ungern-Sternberg BS.
 

Abstract
PURPOSE OF REVIEW: As asthma is a frequent disease especially in children, anesthetists are increasingly providing anesthesia for children requiring elective surgery with well controlled asthma but also for those requiring urgent surgery with poorly controlled or undiagnosed asthma. This second part of this two-part review details the medical and ventilatory management throughout the perioperative period in general but also includes the perioperative management of acute bronchospasm and asthma exacerbations in children with asthma.
RECENT FINDINGS: Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk reduction strategies. Mainly, animal experiments and to a small extent clinical data have advanced our understanding of how anesthetic agents effect bronchial smooth muscle tone and blunt reflex bronchoconstriction. Asthma treatment outside anesthesia is well founded on a large body of evidence.Perioperative prevention strategies have increasingly been studied. However, evidence on the perioperative management, including mechanical ventilation strategies of asthmatic children, is still only fair, and further research is required.
SUMMARY: To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, perioperative management should be based on two main pillars: the preoperative optimization of asthma treatment (please refer to the first part of this two-part review) and - the focus of this second part of this review - the optimization of anesthesia management in order to optimize lung function and minimize bronchial hyperreactivity in the perioperative period.
 

Curr Opin Anaesthesiol. 2014 Mar 29. [Epub ahead of print]