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笔者近十余年来对小儿上肢手术的麻醉应用锁骨上径路臂丛阻滞麻醉法,取得了良好的效果,现将麻醉处理总结如下。 临床资料:随机48例中,男32例,女16例,年龄2岁～12岁,ASA分级Ⅰ～Ⅱ级,手术种类包括手外伤、肱骨干中段以下的各类骨折内固定,神经探查、植皮、矫形等手术,手术时间20分至5小时35分。术前用药:①颠茄类药物,阿托品0.2mg/kg,对于有发热或心动过速的患儿可选用东莨菪0.015mg/kg,②神经安定及镇静药,如安定0.2～0.3mg/kg,或苯巴比妥钠2～4mg/kg肌肉内注射,对不能合用的患儿,采用臂丛神经阻滞加基础麻醉下完成,基础麻醉用药为氯胺酮或硫喷妥钠,局麻用药为1％～1.5％利多卡因6～8mg/kg,或0.25％布比卡因1.5mg/kg,均加入1:20万肾上腺素。
I nearly 10 years of pediatric upper limb surgery anesthesia using supraclavicular approach brachial plexus anesthesia, and achieved good results, the anesthesia is summarized as follows. Clinical data: A randomized 48 patients, including 32 males and 16 females, aged 2 to 12 years old, ASA grading Ⅰ ~ Ⅱ grade, surgical types including hand injuries, various types of fractures within the middle of the humeral shaft fixation, nerve exploration, Skin graft, orthopedic surgery, surgery time 20 minutes to 5 hours and 35 minutes. Preoperative medication: a belladonna drugs, atropine 0.2mg / kg, for children with fever or tachycardia may choose scopolamine 0.015mg / kg, ② neuroleptic and sedative drugs, such as diazepam 0.2 ~ 0.3mg / kg , Or phenobarbital 2 ~ 4mg / kg intramuscular injection of children can not be combined with brachial plexus block plus basic anesthesia to complete the basis of anesthesia for ketamine or thiopental, local anesthesia drug 1% ~ 1.5% lidocaine 6 ~ 8mg / kg, or 0.25% bupivacaine 1.5mg / kg, were added 1: 200000 epinephrine.