Small dose Sufentanil used in Neonatal III type esophageal atresia and correcting surgery before ligation esophageal tracheal fistula with spontaneous breath

Abstract

Objective To conclude the better anesthetic method and ventilation method in Neonatal Ⅲ type esophageal atresia and correcting surgery before ligation esophageal tracheal fistula, slow induction by small dose Sufentanil with spontaneous breath and fast induction using Remifentanil with intermittent positive pressure mechanical ventilation,on the funtion of respiratory and circulation. Methods Eighty cases of neonatal Ⅲ esophageal atresia of both sexes,aged 1 -6 days,weighing 1. 75-2. 8 kg,scheduled for pyloromyotomy,were randomly divided into R group and S group（ n =40 ）. After making the children quiet by inhaling 1% -5% Sevoflurane（ oxygen flow 2 L/min）,patients in group R received intravenous injection of Remifentanil 1 -2 μg/kg,rocuronium 0. 45 mg/kg,then control the respiratory by intermittent positive pressure mechanical ventilation pressure control mode （ PCV） after endotracheal intubation,and patients in group S received slow intravenous injection of Sufentanil 0. 1-0. 2 μg/（kg·min）with spontaneous breath after endotracheal intubation,then used SIMV﹢PSV pattern after thoracotomy. According to the situation of children with spontaneous breathing, rocuronium 0. 45 mg/kg was injected after ligation of esophageal tracheal fistula,then change the patten to PCV,Remifentanil 0. 1-0. 2 μg/（kg·min）was used at the same time. The two group patients inhaled sevoflurane continuously,MAC value was controled at 0. 8. Monitor arterial blood gas at the points of preoperative,after endotracheal intubation,before and after Ligation fistula,before the end of the op-eration. The blood gas analysis index（PO2,PCO2,SO2,pH）,and respiratory monitoring indicators （ HR,MAP,PetCO2 ,SPO2 ）between group R and S was compared. Results Circulation：the HR and MAP of group S during T1 -T3 was more stable than those of group R（ P﹤0 . 01 ）. Respiratory：compared with group R ,the SPO2 of group S during T1 -T2 was higher（ P﹤0 . 05 ）,the Pet-CO2 of group S during T1 -T3 was lower（ P﹤0 . 05 ）. Arterial blood gas：compared with group R, the PaCO2 of group S during T1 -T4 was lower,T2 ,T4 significantly lower（ P ﹤0 . 01 ）,PaO2 , SO2 ,pH at T1 ,T2 point was higher（ P﹤0 . 05 ）. Postperation：compared with group R,the respirator treatment time and hospital days of group S was shorter,the pulmonary complications of group S were less（ in group R,6 patients with atelectasis,2 cases pneumothorax;no pulmonary complications in group S）. Conclusions In NeonatalⅢ type esophageal atresia and correcting surgery,the method,slow induction using small dose Sufentanil with spontaneous breath before ligation esophageal tracheal fistula,is an ideal anesthetic and ventilation method,because it has smaller effect on phisiological function of children,during surgery the patients have more stable circulation and respiratory,less pulmonary complications. Key words: Infant; Newborn; Sufentanil; General anesthesia; Type Ⅲ esophageal atresia; Spontaneous breath