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目的研究在脑电双频指数(BIS)指导下,对七氟醚麻醉的儿童拔出喉罩的时机进行研究。方法 45例ASAⅠ级、年龄4～6岁、拟在全身麻醉下行择期手术的患儿,随机分为3组,每组15例。七氟醚诱导成功后置入喉罩,术中采用七氟醚和O2维持麻醉。手术结束后停止吸入七氟醚,Ⅰ组在BIS值65～60时拔出喉罩,Ⅱ组在BIS值60～55时拔出喉罩,Ⅲ组在BIS值55～50时拔出喉罩,拔出喉罩同时记录呼气末七氟醚浓度。拔出喉罩时或拔出后1min内患儿出现咳嗽、牙齿咬紧致拔管困难、有目的性的肢体运动、屏气、喉痉挛、低氧血症(SpO2<95%)都认为拔出喉罩不满意;无上述现象则视为拔出喉罩满意。结果 3组满意度分别为40%(6/15)、80%(12/15)、20%(3/15);拔出喉罩时,七氟醚浓度分别为(1.03±0.11)%、(1.31±0.12)%、(1.51±0.14)%;Ⅱ组患儿的拔出喉罩情况更能满足实际需要。结论在BIS55～60之间可以减少拔出喉罩过程中潜在的并发症,提高麻醉安全。
Objective To study the timing of pull-out of laryngeal mask in sevoflurane-anesthetized children under the guidance of bispectral index (BIS). Methods Forty-five ASA Ⅰ patients, aged 4 to 6 years old, who underwent elective surgery under general anesthesia were randomly divided into 3 groups (n = 15 each). Sevoflurane induction into the laryngeal mask after surgery, intraoperative sevoflurane and O2 to maintain anesthesia. Sevoflurane was stopped after the operation was over. Group Ⅰ was pulled out of laryngeal mask at BIS value of 65 ~ 60, group Ⅱ was laryngeal mask removed at BIS value of 60 ~ 55, and laryngeal mask was removed at group B of 55 ~ 50 , Pull out the laryngeal mask while recording end-sevoflurane concentration. When the laryngeal mask is pulled out or within 1 min after the pull-out, the child coughs and the teeth are bitten and the extubation is difficult. Expected limb movements, breath holding, laryngospasm and hypoxemia (SpO2 <95% Laryngeal mask is not satisfied; None of the above phenomenon is considered to be satisfied with pulling out the mask. Results The satisfaction rates of the three groups were 40% (6/15), 80% (12/15) and 20% (3/15), respectively. The concentrations of sevoflurane were (1.03 ± 0.11)% (1.31 ± 0.12)% and (1.51 ± 0.14)%, respectively. The situation of pull-out laryngeal mask in group Ⅱ was more able to meet the actual needs. Conclusions Between BIS55 and C60 can reduce the potential complications of pulling out the laryngeal mask and improve the safety of anesthesia.