喉罩通气全麻在腹腔镜手术中的应用

目的:观察腹腔镜手术中喉罩(laryngeal mask,LAM)置入后患者血流动力学的变化及呕吐、返流、损伤等情况。方法:选择ASAI～II级的腹腔镜手术患者680例,应用表面麻醉和少量镇静镇痛药,以减少LAM置入时的反应。LAM置入后,通气罩内充气压至60cmH2O后,记录1～5min SBP、DBP和HR的变化情况,观察有无漏气、置入前后及麻醉期间呼吸并发症和呼吸道损伤情况。结果:LAM首次插入后血流动力学基本无变化,未发现憋气、喉痉挛、呼吸道梗阻、恶心呕吐、返流误吸损伤等并发症。结论:LAM具有很好的密封性,能很好地进行肺通气,是全身麻醉患者安全有效的呼吸道管理工具之一。

The clinical application of general anesthesia with laryngeal mask ventilation in laparoscopic surgery

Objective:To observe the changes of hemodynamics,nausea and vomiting,gastric reflux and injury after general anesthesia with the laryngeal mask (LAM) ventilation in laparoscopic surgery.Methods:We selected 680 patients with ASA level Ⅰ-Ⅱ for laparoscopy under general anesthesia.We applied surface anesthesia and small amounts of sedative to reduce reaction during insertion of LAM.The intracuff pressure was set at 60cm H2O.The change of SBP,DBP and HR were recorded from 1 to 5min after the pressure was set.Whether there was air leakage,respiratory complications and injury or not before and after mask insertion and during anesthesia was observed.Results:After the first attempt of LAM insertion,satisfactory lung ventilation was achieved.There were no change of the hemodynamics,and no complications such as breath holding,laryngospasm,respiratory tract obstruction,nausea and vomiting,and the back-streaming aspiration injury.Conclusions:LAM can achieve good seal effect and provide adequate lung ventilation.LAM is a safe and effective airway management device for patients undergoing general anesthesia during laparoscopic surgery.