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目的观察利用周围神经刺激器辅助定位,罗比卡因臂丛神经阻滞复合氯胺酮静脉麻醉在小儿上肢手术中应用,对呼吸循环功能以及术后恢复情况的影响。方法30例行上肢手术患儿随机分为两组:臂丛神经阻滞复合氯胺酮静脉麻醉组(A组),氯胺酮基础麻醉后,应用神经刺激器辅助定位臂丛阻滞成功后注入0.25%罗比卡因0.5ml/kg;单纯氯胺酮静脉麻醉组(B组),术中氯胺酮1～2mg/(kg.h)间断静脉注射。结果术中A组循环、呼吸功能较B组稳定;肢体不良自主运动,喉痉挛等不良反应较B组少,A组氯胺酮用量明显少于B组;术后A组苏醒较快且平稳,恢复期精神症状少,与B组比有显著差异。结论臂丛神经阻滞复合氯胺酮静脉麻醉应用于小儿上肢手术,可减少氯胺酮用量从而减少其不良反应,使患儿在麻醉手术期间呼吸循环更平稳,家长及医护人员满意度明显提高。
Objective To observe the effect of peripheral nerve stimulator-assisted localization (RNSA) on the respiratory function and postoperative recovery of upper limbs in pediatric upper limb surgery with ropivacaine brachial plexus block combined with ketamine intravenous anesthesia. Methods Thirty patients with upper extremity surgery were randomly divided into two groups: brachial plexus block combined with ketamine intravenous anesthesia group (A group), ketamine base anesthesia, neurostimulator assisted positioning brachial plexus success after injection of 0.25% 0.5ml / kg of bupivacaine, simple ketamine intravenous anesthesia group (group B), intraoperative ketamine 1 ~ 2mg / (kg.h) intermittent intravenous injection. Results In group A, the circulatory and respiratory functions were more stable than those in group B. Adverse reactions such as limb dysfunction and laryngospasm were less than those in group B. The dosage of ketamine in group A was less than that in group B. The recovery was faster and more stable in group A Psychiatric symptoms less, compared with the B group were significantly different. Conclusions Brachial plexus block combined with ketamine intravenous anesthesia applied to pediatric upper extremity surgery can reduce the amount of ketamine to reduce its adverse reactions, so that children during the anesthesia respiratory cycle more stable, significantly increased satisfaction with parents and health care workers.