|Title:||Minimal Flow Nitrous Oxide in Oxygen Balanced Anesthesia for Prolonged Oral and Maxillofacial Surgery
|Keywords:||nitrous oxide;anesthetic techniques;minimal flow closed system||Issue Date:||1991||Journal Issue:||n.2||Start page/Pages:||28-34||Source:||中華民國口腔顎面外科醫學會雜誌,v.2||Abstract:||
對口腔顎面長時間手術之13個病例施行小流量笑氣氧氣均衡麻醉並測量動脈血供氧狀 態。麻醉之誘導與維持均採用最近臨床方法；在鼻孔插入氣管內管後，先给笑 氣1.5-3 L，氧氣1-2 L約6-20 min，然後流量降為笑氣2.8 ml/kg，氧氣4 ml/kg。在 管制呼吸下，輔佐以lsoflurane或Enflurane與atracurium besylate；其濃度與需要 量視臨床狀況適度調整之。動脈血氣分析取樣於高流量和小流量每小時之终點 。血液pH和PCO2調整於正常範圍值；PO2則小心追蹤並觀察供氧臨床狀況。結果發現 ，雖然有4個病例PO2高於100 mmHg達7小時，且於第5小時PO2平均值仍達189 mmHg， 但有一個病例PO2則快速於第3小時降到95 mmHg(7.7%)。此結果顯示；在第3小時以後 ，笑氣流量必須調低或使用氧氣監视器以免造成缺氧症。 Thirteen patients undergoing prolonged oral and maxillofacial surgery in balanced anesthesia with minimal flow nitrous oxide and oxygen were evaluated. The induction and maintenance were performed as current method. After nasotracheal intubation, nitrous oxide 1.5-3L and oxygen 1-2 L were given for about 6-20 minutes, then the flow rates were switched to minimal flow of nitrous oxide 2.8 ml/kg and oxygen 4 ml/kg. Under controlled ventilation, the anesthesia was supplemented with isoflurane or enflurane and atracurium besylate according to clinical need. Arterial blood gas analyses were done at the end of high flow and every hour, after the beginning of minimal flow. Blood pH and PCO2 were adjusted to normal range . PO2 were carefully followed and observed. Although in 4 cases PO2 was higher than 100 mmHg for up to 7 hours and the mean value of PO2 was 189 mmHg at the 5th hour, there was 1 case with PO2 down to 95 mmHg (7.7%) at the 3rd hour. This suggested that after the 3rd hour, the flow of nitrous oxide should be decreased or carefully monitored to prevent hypoxia and there was prominent individual difference in the uptake of nitrous oxide.
|Appears in Collections:||醫學系|
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