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159 cases of ketamine anesthesia in pediatric dental care


To prevent anesthesia accidents,[link widoczny dla zalogowanych], ensure the operation safety. 20, 2003 a total of 159 patients in our hospital maxillofacial surgery under ketamine anesthesia in children with surgery. Will now be described below with ketamine anesthesia care. 1 clinical data from 2002 to 2003 our department ketamine anesthesia in 159 cases the surgery, neck surgery submental mass 3l cases, cleft lip, transverse facial cleft reconstructive surgery 118 patients, the other l0 cases. Aged 3 months to 3 years old. Of these, 141 patients with stable anesthesia, oxygen saturation normal, accounting for 88.68%, which l7 cases were promptly taken measures to restore normal oxygen saturation, 10.7%,[link widoczny dla zalogowanych], 1 case was ineffective emergency, urgent tracheal After intubation, oxygen saturation returned to normal, accounting for 0.62%. 2 former nurse anesthesia anesthesia with 2.1 parents of children must be asked in detail about the ban diet, which normally takes fasting 6h, forbidden to drink 4ho weight, to prepare for narcotic medication, carefully check the situation before surgery injections. General preoperative 30rain with atropine 0.02 ~ o / kg. 2.2 anesthetist anesthesia to help calm and secure children, to help anesthetists connected oxygen saturation, heart rate monitoring. I ketamine S ~ o / kg intramuscularly. Children with sleep after opening the scalp vein needle or catheter. As required by the intravenous injection during anesthesia, thus maintaining venous flow is the key to successful anesthesia. Puncture after the success of switches for connecting links and intraoperative intravenous infusion of pushing drugs. Children with a thin pillow shoulder pad to keep the airway open. It normally takes ketamine anesthesia plus local anesthesia in order to ensure good results. Infraorbital nerve block in children with cleft lip taken, columella anesthesia. Surgery to take the rest of local anesthesia. Surgery nurses to strengthen the observation, fixed limbs. Once the d, JL a restless,[link widoczny dla zalogowanych], should be immediately reported to the anesthesiologist, timely tonic. Generally each bolus of ketamine 1 ~ 2-rlcg. Also, children should be closely observed looking, breathing, heart rate, oxygen saturation, and peripheral circulation situation. 3 Nursing 3.1d, JL condition changes rapidly during ketamine anesthesia, the nurse can not be deserting the patient, strengthening observation, get ready emergency medicine and the use of materials. 3.2 Intraoperative keep warm, at room temperature to 24 ~ 26 ℃ is appropriate, necessary, temperature monitoring to adjust the room temperature. 3.3 ensure the smooth infusion, throughout the anesthesia period, without rendering the needle slide vein, if found local swelling, leakage is required to re-puncture, in order to ensure venous flow. Amount of intraoperative fluid infusion, the infants of dehydration, blood loss, poor tolerance, d,[link widoczny dla zalogowanych], JL transfusion have caused too much too fast the risk of pulmonary edema and heart failure, so the amount of intraoperative fluid replacement should be. For children with weight less than l0lcg, rehydration about 4ml / i ~. h, l0 ~ 2olcg body weight in children, rehydration about 2m1.1cg-1 · h. 1. ... 3.4 to ensure airway patency. Surgery such as surgical instruments or the surgeon found that children with thoracic and abdominal pressure should be corrected in time, pay attention to operative position and posture is good, and hard objects to avoid distortion of body position on the respiration of oppression. Because ketamine anesthesia in our hospital for many children with cleft lip, the entire surgical process, not the wound caused by aspiration of blood into the pharynx, to remind doctors to stop bleeding and to attract, and close observation of children with or without respiratory depression. Respiratory depression may be due to ketamine injected too fast, causing too much can also be due to aspiration and intraoperative stimulation of throat secretions,[link widoczny dla zalogowanych], and bronchospasm, which, although rare, but more dangerous. About 11.3% of the children of intraoperative oxygen desaturation can occur, cyanotic lips, and you should immediately cease operations, hold fast to the mandibular angle in children, pull the tongue to give high flow oxygen inhalation, to be children increase in oxygen saturation before and without reoxygenation to continue operation. After emergency treatment, most children's blood oxygen saturation quickly returned to normal. If the above does not work, should actively cooperate with the anesthesiologist for emergency intubation. Intubation to deal with serious respiratory depression is the most effective measures. 159 cases of ketamine anesthesia in our hospital, only 1 patient had oxygen to emergency intubation after failed situation. 3.5-10min before the end of surgery discontinuing medication. Net absorption of surgery in children with oral secretions, remove the stuffing cotton balls to remind doctors and other foreign matter, keep the airway open, observe the children to fully awake, stable oxygen saturation of 98% be sent to the ward.