An case of hypotherchronic circulation in children with in vitro circulation interval repair surgery anaesthetic management

Case patients, female, 3 years old, Han, weight 10kg, height 86 cm, ASAIII gradeBecause of the "discovery of congenital heart disease 3 years" hospital admission, to be in the whole hemp circulation downward "room interval defect repair." No history of infectious diseases, no history of surgery, trauma, pregnancy 35 weeks and 4 days premature baby, after birthdiagnosis"throat softening", without treatment;preoperative blood routine, liver and kidney function and water electrolyte did not see obvious abnormalities; otolaryngology consultation line nasal endoscopy examination: sound door and will not see obvious abnormalities; heart color super: congenital heart disease, room gap defect, lower cavity type, secondary hole type, about 1.6 cm, left to right shunt, PASP40mmHg; Anestheticmanagement: fasting 8h before surgery, 2h for drinkingThe ward with the right upper extremities peripheral vein into the room, followed by ECG, SPO2, no invasive blood pressure, line left artery puncture tube and continuous monitoring of IBPInduction pre-IBP96/60mmHg, HR128bpm, SPO2 100%anaesthetic-induced pre-mystine-injection of ethyl ethyl ether 0.1 mgMask saespressi-induced after nitrogen supply: intravenous midazolam 1mg, propofol 25mg, Shun adecuku ammonium 1mg, Shufentani 20 mg, normal laryngology downstream trachea intubation, ID: 4.5 Mm, depth of 12.5 cm, hearing double lung breathing sound symmetry, set the anaesthetic machine for PCV mode: PINSP15 cmH2O, RR30 times / minute, maintain PETCO2 35 to 45mmHgDuring the in vitro circulation, the mouth temperature was maintained at 30 to 35 degrees Canaesthetic maintenance: continuous pump injection of aquukamon 1 sg.kg-1 h-1, shufentani 2?g-kg-1 h-1, right-metomiquine 1?g-kg-1-h-1, and 1% heptafluorane continuous inhalation, during the pump injection of polypamine and milinon (adjusted blood pressure dose) to maintain circulation stabilityThe operation was smooth, hemodynamics were smooth, the operation time was 147min, the in vitro circulation time was 43minSurgical, the child's sinus heart rate 108bpm, IBP85/55mmHg, anaesthetic is not awake, with trachea intubation transferred to icu to continue monitoring treatmentPostoperative condition: after the 1d at 09:55 am successful removal of trachea intubation, breathing circulation is stableAfter surgery, the 2d was transferred back to the general ward, and was treated with active internal environmental regulation, maintenance of circular stability, nutritional support, etc., and was discharged from the hospital after 17d rehabilitationdiscussioncerebral palsy referred to as cerebral palsy, refers to a chronic irreversible lesions of brain tissue caused by ischemic hypoxia,infection, abnormal delivery, etc.,clinicalas central motor impairment and posture abnormalities, accompanied by low intelligence,epilepsy, visual impairment and behavioral abnormalitiesIf there is a myelin dysfunction, it can also lead to the disappearance of normal respiratory protective reflexes in children, resulting in chronic misabsorption, repeated episodes of pneumonia, reactive airway damage and pulmonary lesionsthe child's young age, light weight, poor level of health, drinking water prone to cough, poor cough reflection, easy to produce secretion retention, and proposed congenital heart disease correction, postoperative lung incontinence and lunginfectionthe chance is higher, so before surgery to give anti-choline is necessaryChildren with cerebral palsy are often accompanied by abnormal psychological behavior, in order to better implement anesthesia, ensure the safety of perioperative period and reduce related adverse reactions, before anesthesia to give a moderate amount of sedatives can reduce the induction process of spasmsaquukamonis in the liver by esterase hydrolysis and Hofmann elimination, short action time, decomposition product no muscle loose action, in children with cerebral palsy in selective spinal nerve seishydges in the rational use can maintain the normal muscle response to electrical stimulation Shun aquku ammonium is one of the isomers of aquku ammonium, and in this case, we choose Shunaquu ammonium as a muscle pine medicine Heptafluerane is a new type of inhaled anesthetic, has been widely used in clinical anesthesia, because of the small respiratory inflammation, anesthesia induction and rapid awakening and so on, especially suitable for polio intoxicated Huang Jiansheng and other research results that heptafluorane inhalation anesthesia in pediatric cerebral palsy orthopaedic surgery safe and reliable, simple and convenient, the case of continuous inhalation of 1% heptafluorane, not only played the analgesic effect of heptafluorane, but also conducive to the control of the depth of anesthesia Children's cerebral palsy is often accompanied by systemic muscle tone and muscle strength, it is generally believed that reducing the occurrence of full hemp wake-up period of children means that the quality of wake after anesthesia improved, easy to management after surgery right-metoride is a new type of high-selective alpha 2 epinephrine receptor agonists, with certain sedative, analgesic, anti-anxiety and other effects, not only can reduce the amount of heptafluorane, but also reduce the occurrence and degree of heptafluorane anaesthetic resonating in children with cerebral palsy, has been widely used in the anesthesia of children with cerebral palsy For children with cerebral palsy, intravenous and inhalation compound anesthesia can play a synergy, easy to ensure and regulate the depth of anesthesia in surgery, thereby reducing the body's stress response to surgery, so it can better meet the needs of this type of surgery However, children with cerebral palsy should avoid using anaesthetic drugs such as amber choline and ketamine to avoid adverse reactions such as muscle complications, restlessness and delirium some children with cerebral palsy are reported to have epilepsy, most narcotic drugs have anticonvulsive effect, but some drugs such as anfluoretherine, relying on cesteres, etc may induce seizures, generally not used In view of the lack of combined cases of congenital heart disease surgery in children with cerebral palsy, more reporting and research is needed on how to provide reasonable administration of inoperative anaesthetic in such children