门诊及办公室耳鼻咽喉外科手术的麻醉考虑

摘要(中文译文)

门诊及日间耳鼻咽喉科手术的数量日益增加，其原因在于内镜技术、麻醉技术及围手术期管理的进步使得复杂干预得以在住院环境之外实施。本综述总结了当前门诊及日间耳鼻咽喉（ENT）手术的麻醉考量，重点阐述患者选择、围手术期风险分层及气道管理。近期文献强调，在适当进行患者选择和监测的前提下，门诊手术作为手术室干预的安全且具成本效益的替代方案，其作用正在不断扩大。术前评估应评价气道病史、解剖可及性以及肥胖和阻塞性睡眠呼吸暂停等合并症。证据支持采用阿片类药物节约型镇痛策略和选择性术后监测，以促进安全的当日出院。在鼻窦鼻腔手术中，气道保护和血流动力学管理仍是关键的麻醉考量。儿童耳鼻咽喉科手术需特别关注氧储备、气道反应性和镇静风险。在喉科学领域，共享气道手术需要外科医生与麻醉医生密切协作，而表面麻醉技术和靶向神经阻滞已改善了门诊喉部干预的耐受性。当麻醉管理根据患者及手术特异性风险进行个体化调整时，门诊及日间耳鼻咽喉科手术可以安全实施。仔细的患者选择、详细的气道评估和多学科协作对于在扩大微创耳鼻咽喉科手术可及性的同时维持安全至关重要。

Abstract

Ambulatory and office-based otolaryngologic procedures are increasingly performed as advances in endoscopic technology, anesthesia techniques, and perioperative care enable complex interventions outside the inpatient setting. This review summarizes current anesthetic considerations for ambulatory and office-based ear, nose, and throat (ENT) surgery, emphasizing patient selection, perioperative risk stratification, and airway management. Recent literature highlights the expanding role of office-based procedures as safe and cost-effective alternatives to operating room interventions when appropriate patient selection and monitoring are applied. Preoperative assessment should evaluate airway history, anatomic accessibility, and comorbid conditions such as obesity and obstructive sleep apnea. Evidence supports opioid-sparing analgesic strategies and selective postoperative monitoring to facilitate safe same-day discharge. In sinonasal surgery, airway protection and hemodynamic management remain key anesthetic considerations. Pediatric ENT procedures require particular attention to oxygen reserve, airway reactivity, and sedation risk. In laryngology, shared-airway procedures necessitate close surgeon-anesthesiologist coordination, while topical anesthesia techniques and targeted nerve blocks have improved tolerability of office-based laryngeal interventions. Ambulatory and office-based otolaryngologic surgery can be performed safely when anesthetic management is tailored to patient- and procedure-specific risks. Careful patient selection, detailed airway assessment, and interdisciplinary collaboration are essential to maintaining safety while expanding access to minimally invasive ENT procedures.

如何引用

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