一位幼兒放置喉頭面罩時發生嚴重支氣管痙攣之病例報告

Severe Bronchospasm during Laryngeal Mask Airway Placement in an Infant

一個三十五天大的幼兒接受二側腹股溝疝氣門診手術。手術前病人沒有呼吸道方面的問題，也沒有感冒的現象。在麻醉誘導，放置喉頭面罩之後，病人馬上發生閉氣的現象。當嘗試經由面罩給予正壓呼吸，發現病人的呼吸道壓力相當高。移除喉頭面罩仍無法有效改善病人的呼吸狀況。懷疑發生喉頭痙攣，故給予肌肉鬆弛劑並放置氣管內管。雖然確認氣管內管的位 置無誤，但病人的呼吸道壓力仍然相當高。進行正壓呼吸時，並無法看到病人的胸廓起伏，潮氣末二氧化碳濃度儀也無法測得二氧化碳。血氧濃度迅速下降並發生心律變慢的現象。懷疑因喉頭面罩的置放引發嚴重的支氣管痙攣。因放置喉頭面罩誘發支氣管痙攣的致病機轉與危險因子將於本文中討論。

A 35-day-old male infant was scheduled for bilateral inguinal herniorrhaphy. No history of recent upper airway infection or other reactive respiratory disease was noted before anesthesia. Breath holding was noted immediately after laryngeal mask airway (LMA) insertion. Removal of the LMA and positive pressure ventilation via face mask did not solve the problem. On suspicion of laryngospasm, tracheal intubation facilitated by muscule relaxant was performed. However, when the patient was ventilated, high airway pressure, absence of chest wall movement and elevated end-tidal C02 were noted. Despite visual confirmation of correct placement of tracheal tube, oxygen desaturation and bradycardia developed rapidly. After deepening the inhalational anesthesia of sevoflurane and concomitant administration of intravenous lidocaine, the patient's respiratory condition turned for the better and became compilable. Respiratory dysfunction may be caused by severe bronchospasm induced by placement of the LMA. The pathophysiology and risk factors of bronchospasm related to the LMA placement are discussed in the text.