喉罩用于甲亢患者甲状腺手术全身麻醉的临床观察

目的 观察甲亢患者甲状腺次全切除术中应用喉罩通气行全身麻醉对血液动力学的影响。方法 40例甲亢甲状腺次全切除术患者,随机分为气管插管组（T组）与喉罩置入组（L组）,每组20例。气管插管用喉镜明视插入法,喉罩按顺行盲探置入口底。全部患者均于麻醉诱导后插管（或罩入喉罩）前（T0）、气管插管（或罩入）后即刻（T1）、1 m in（T2）、3 m in（T3）、5 m in（T4）各时间点监测SBP、MAP、HR值。术后24 h随访记录患者咽痛、声嘶的发生率。结果 L组在置入喉罩前后各时点SBP、MAP、HR无显著性变化（P〉0.05）,T组在插管后各时点与T0相比SBP、MAP、HR均明显升高（P〈0.05）。T组T1、T2、T3各时点SBP、MAP、HR均高于L组（P〈0.05）。术后24 h咽痛、声嘶副作用发生率,T组明显高于L组（P〈0.05）。结论 喉罩对血流动力学影响小、安全性高、副作用用少,比气管插管更适合于甲亢患者甲状腺手术的全麻要求。     

喉罩在新生儿腹腔镜疝囊高位结扎术中的应用

目的观察喉罩应用于新生儿腹腔镜下疝囊高位结扎术麻醉的临床效果。方法行腹腔镜疝囊高位结扎术的新生儿100例,出生2～28d,男86例,女14例,体重3.1～4.8kg,随机均分为喉罩组(L组)和气管插管组(T组)。术中吸入七氟醚维持麻醉。观察患儿入室时、插管(喉罩)时、手术开始5min和拔管(喉罩)时的HR、MAP,记录术后拔管(喉罩)时间、拔管(喉罩)后气道痉挛、恶心干呕、咽部红肿、声嘶和低SpO2等并发症的发生率;通过麻醉机电子挥发罐余量显示来计算两组患儿七氟醚消耗量。结果 L组患儿的插喉罩时、手术开始5min和拔喉罩时的HR明显快于、MAP明显低于T组(P<0.01)。L组拔喉罩时间明显短于T组(P<0.01),拔喉罩后呼吸道并发症以及七氟醚消耗量均低于T组(P<0.05)。结论喉罩应用于新生儿腹腔镜手术的麻醉安全可靠,较气管插管全麻用药少,拔管后并发症少,麻醉更为平稳。     

SLIPA喉罩用于腹腔镜手术的可行性和安全性

目的 观察SLIPA喉罩应用于全身麻醉下腹腔镜胆囊切除手术的可行性和安全性.方法 择期腹腔镜胆囊切除手术患者90例.随机均分为SLIPA喉罩组(S组)、ProSeal喉罩组(L组)和气管插管组(T组).观察麻醉诱导前(T1)、管(罩)插入成功时(T2),管罩插入后10 min(T3),管(罩)拔出前即刻(T4),管(罩)拔出后即刻(T5)MAP、HR变化.观察管(罩)一次插入成功率、麻醉时间、清醒时间、丙泊酚的用量以及术后胃胀、咽喉疼痛情况.结果 T2～T5时L组和S组MAP明显低于、HR慢于T组(P＜0.05).T组咽喉疼痛发生率明显高于S组及L组(P＜0.05),而S组咽喉疼痛发生率低于L组(P＜0.05),S组及L组在麻醉维持时间、清醒时间短于、丙泊酚用量少于T组.结论 SLIPA喉罩在临床应用中安全、可靠,操作简便,且对咽喉损伤较小,可安全用于腹腔镜手术.     

喉罩全身麻醉复合骶管阻滞在非洲儿童手术中的应用

目的 观察喉罩全身麻醉复合骶管阻滞与单纯气管插管全身麻醉在非洲儿童手术中的应用,为儿童麻醉提供参考. 方法 4～6岁行下腹部及下肢部位择期手术的患儿60例,完全随机分为喉罩全身麻醉复合骶管阻滞麻醉组(A组)和单纯气管插管全身麻醉组(B组),每组30例.观察记录患儿麻醉诱导前(T0)、置入喉罩/气管导管前后(T1、T2)及术毕拔出喉罩/气管导管(T3)时的MAP、HR和Sp02,以及麻醉苏醒时间、术后VAS疼痛评分及副作用情况. 结果 两组患儿MAP、HR和Sp02在To和T1时比较,差异无统计学意义(P＞0.05);A组MAP和HR[(68±10) mmHg(1 mmHg=0.133 kPa)、(108±17)次/min]在T2时明显低于B组[(91±8) mmHg、(139±18)次/min] (P＜0.05);A组MAP和HR[(67±9) mmHg、(121±16)次/min]在T3时也明显低于B组[(85±9) mmHg、(141±17)次/min] (P＜0.05);A组术后VAS评分[(1.5±0.5)分]明显低于B组[(6.5±1.5)分](P＜0.05),A组苏醒时间[(5.8±2.4)min]明显短于B组[(12.2±2.8) min](P＜0.05),A组术后躁动(4例)明显低于B组(17例)(P＜0.05),术后A组啼哭和呛咳的发生率也明显低于B组(P＜0.05). 结论 喉罩全身麻醉复合骶管阻滞麻醉在患儿诱导期和苏醒期有更加平稳的血流动力学,且术后疼痛明显降低、苏醒时间明显缩短、术后副作用发生率明显降低,是非洲儿童下腹部及下肢部位手术的一种较理想的麻醉方法.     

腹腔镜腹壁切口疝修补术麻醉中喉罩通气的可行性

目的探讨食管引流型喉罩用于腹腔镜腹壁切口疝修补术麻醉中通气的可行性。方法择期全身麻醉下行腹腔镜腹壁切口疝修补术患者60例,年龄24~82岁,ASAⅠ或Ⅱ级,随机分为喉罩(LMA)组和气管导管(ETT)组,每组30例。术中采用压力控制通气(pressure controlled ventilation,PCV)模式,记录患者全身麻醉诱导后气管导管/喉罩置入前与置入完成后即刻及气管导管/喉罩拔出前及拔出后即刻患者平均动脉压(MAP)及心率(HR),RR为12次/min、I/E为1∶1.5条件下使实际潮气量(VTE)达到7 ml/kg时的预设吸气峰压(Pinspired)值以及术中胃肠减压引流瓶容量的增加。结果所有患者气管导管或喉罩置入顺利且能够满足手术通气要求。气管导管/喉罩置入后及拔出后即刻ETT组的MAP及HR明显高于LMA组(t=6.927、2.471、4.033、3.185,P=0.000、0.016、0.000、0.002),气管导管/喉罩置入后与置入前即刻及拔出后与拔出前比较仅ETT组MAP及HR明显增加(t=2.916、2.965、2.171、2.484,P=0.026、0.016、0.000、0.025);PCV模式下RR为12次/min、I/E为1∶1.5条件下,当VTE达到7 ml/kg时LMA组Pinspired值明显低于ETT组(t=3.046,P=0.004);二组患者术中胃肠减压引流瓶容量的增加无明显差异;术后24 h时咽喉疼痛不适发生率LMA组明显低于ETT组(χ2=4.32;P=0.038)。结论食管引流型喉罩较气管导管对循环影响小,通气可靠,术后并发症发生率低,可满足腹腔镜腹壁切口疝修补术麻醉的通气需要。     

腹腔镜胆囊切除术中Supreme喉罩实施气道管理的应用价值

探讨腹腔镜胆囊切除术(LC)患者采用Supreme喉罩对患者血流稳定性、麻醉药物应用及插管/拔管指标的影响。选取我院择期LC患者120例,采用随机数字表法分为喉罩组和插管组各60例,均全麻下行LC。喉罩组采用Supreme喉罩,插管组采用气管插管实施气道管理。对比两组患者平均动脉压(MAP)和心率(HR)变化、手术时间、麻醉时间,比较两组瑞芬太尼、顺阿曲库铵、丙泊酚、咪达唑仑用量,记录插管或置入喉罩时间、术后拔管或移除喉罩相关并发症发生情况。两组不同时间MAP、HR测定值比较差异具有统计学意义(P0.05),插管组MAP、HR测定值波动较喉罩组更加明显;两组手术时间、麻醉时间、咪达唑仑用量差异无统计学意义(P0.05);喉罩组瑞芬太尼、顺阿曲库铵、丙泊酚用量均低于插管组(P0.05);喉罩组一次性插入成功率高于插管组(P0.05);喉罩组患者插入时间、拔除后低氧血症发生率、呛咳发生率、喉痉挛发生率、咽痛发生率均低于插管组(P0.05)。全麻LC患者采用Supreme喉罩较采用气管插管更利于维持血流动力学稳定,减少麻醉药物用量及降低插管/拔管引起的并发症。     

预期困难气道患者喉罩辅助纤维支气管镜引导气管插管的研究

目的 探讨在预期困难气道患者中采用喉罩辅助纤维支气管镜(fiberoptic bronchoscope,FOB)引导气管插管的应用价值. 方法 择期经口气管插管全身麻醉手术预测困难气道患者24例,ASA Ⅰ或Ⅱ级,入选患者达到以下1种或几种条件为预期困难气道:1.5 cm＜张口度＜3 cm,甲颏间距＜6 cm,头颈活动度＜80°,Mallampati分级Ⅲ、Ⅳ级.采用随机数字表法分为喉罩辅助FOB组(F组)和直接喉镜组(L组),每组12例.F组采用喉罩辅助FOB引导下气管插管;L组在直接喉镜暴露下经口气管插管,3次试插未成功者改行F组方法试插.记录两组患者的气道评估情况、气管插管前(基础值)和插管后3 min的MAP和HR、成功插管的次数及术后的并发症的发生情况. 结果 插管前两组气道评估差异无统计学意义(P＞0.05).与插管前相比,L组患者插管后MAP和HR显著增加,差异有统计学意义(P＜0.05).两组插管后的MAP和HR比较,差异有统计学意义(P＜0.05).F组气管插管一次成功率为75％,3次以内插管合计总成功率为100％;L组气管插管一次成功率为25％,3次以内插管合计总成功率为50％;6例L组患者直接喉镜3次插管不成功后改为喉罩辅助FOB插管,2例1次成功,4例2次成功;F组一次插管成功率和3次插管总成功率均显著高于L组,两组比较差异有统计学意义(P＜0.05).与L组插管时间(161±26)s比较,F组插管时间(81±9)s明显缩短,差异有统计学意义(P＜0.05).F组有2例术后轻度咽喉疼痛,L组有6例术后咽喉疼痛明显和轻度声嘶、2例轻度咽痛. 结论 对术前预期为困难气道的患者采用喉罩辅助FOB引导气管插管可显著提高插管的成功率,降低直接喉镜反复试插引起的术后并发症,具有一定的临床应用价值.     

喉罩与气管插管麻醉用于妇科腹腔镜手术的护理观察

目的 比较喉罩与气管插管通气对妇科腹腔镜手术患者血流动力学及并发症的影响,并探讨相应的护理方法.方法 将60例择期妇科腹腔镜手术患者随机分为喉罩组与气管插管组各30例,分别置入喉罩与气管插管.比较两组麻醉诱导期血流动力学变化,观察术中反流误吸,术毕呛咳,术后咽痛、声音嘶哑、恶心、呕吐、肺部感染等并发症发生率.结果 两组麻醉诱导期SpO2比较,差异无统计学意义(P>0.05),气管插管组插管后即刻MAP、HR较喉罩组显著升高(均P<0.05);喉罩组术后咽痛发生率显著低于气管插管组(P<0.05).结论 喉罩组插管应激反应小于气管插管组;喉罩与气管插管麻醉患者术中、术后的护理各有侧重,前者侧重于防止术中反流误吸,后者侧重于气管护理以及预防感染等并发症的发生.     

椎管内麻醉与全身麻醉对关节置换术效果的Meta分析

目的通过Meta分析的方法评价椎管内麻醉与全身麻醉对关节置换术的效果。方法计算机检索Pubmed、Web of Science、Cochrane Library、中国知网、中国生物医学数据库,检索中华系列杂志相关文献,收集所有评价椎管内麻醉与全身麻醉对关节置换术效果的随机对照试验(RCT),筛选出符合的文献,并严格评价纳入研究的方法学质量。统计学软件采用Cochrane协作网提供的RevMan 5.3。结果最终纳入21篇符合标准的RCT,共包含1 874例患者。Meta合并分析显示:与全身麻醉比较,椎管内麻醉可明显减少关节置换术术中出血量(WMD=-97.52ml,95%CI=-173.60~-21.44,P=0.01),明显降低关节置换术深静脉血栓发生率(RR=0.68,95%CI=0.48~0.95,P=0.02)、肺栓塞发生率(RR=0.58,95%CI=0.35~0.91,P=0.03)、术后恶心呕吐发生率(RR=0.74,95%CI=0.60~0.92,P=0.008)。亚组分析显示,未使用抗凝药时椎管内麻醉可明显降低深静脉血栓发生率(RR=0.51,95%CI=0.38~0.69,P0.001)和肺栓塞发生率(RR=0.34,95%CI=0.18~0.65,P=0.001)。结论椎管内麻醉在关节置换术中可有效改善患者术中情况,降低术后不良反应发生率。     

不同麻醉方法在小儿腹腔镜手术中的应用体会

目的:对比分析不同麻醉方法对小儿腹腔镜手术患者插管及拔管前后心率、并发症情况的影响。方法:随机将56例腹腔镜手术患儿分为骶管复合气管插管全麻组(A组)、骶管复合喉罩全麻组(B组)、单纯喉罩全麻组(C组)、单纯气管插管全麻组(D组),每组14例。患儿10个月~5岁,体重9.5~21 kg。分别于麻醉插管后即刻、拔管前1 min、拔管后即刻记录心率变化,观察拔管时有无喉痉挛、呼吸道分泌物情况,术中记录心率、血氧饱和度、呼气末二氧化碳分压及BIS值。术后2 h内观察有无咽喉部疼痛不适、声音嘶哑、哭闹、咳嗽、呼吸异常及意识恢复情况。结果:B组插管后即刻、拔管后即刻对心率的影响较其他三组小,患儿术后清醒时咽喉部疼痛、咳嗽、喉痉挛、呼吸道分泌物明显减少,耐受的BIS指数更高。拔除喉罩患儿呼吸更平稳、清醒更彻底。结论:小儿腹腔镜手术行骶管复合喉罩全麻患儿麻醉前后心率的变化波动较小,术后患儿清醒更彻底,并发症更少。     

气管插管与喉罩对非颅脑手术患者视神经鞘直径影响的比较

目的应用经眼眶超声测量视神经鞘直径(ONSD),比较气管插管与喉罩对全麻非颅脑手术患者ONSD的影响。方法选择全身麻醉下行择期非颅脑手术患者45例,男26例,女19例,年龄18～80岁,随机分为三组:气管插管组(A组),气管内表麻+气管插管组(B组)和喉罩组(C组)。分别在麻醉诱导前5 min(T_0)、插入气管导管或喉罩前(T_1)和插入气管导管或喉罩后1 min(T_2)、5 min(T_3)、10 min(T_4),应用床旁超声经眼眶测量眼球后3 mm处ONSD,并随访术后头痛、头晕、恶心呕吐的发生情况。结果与T_0时比较,T_2—T_3时A组双侧ONSD均明显增加,且明显大于B组和C组(P0.05);B组和C组双侧ONSD变化差异无统计学意义。三组患者在术后24 h内无一例头痛,头晕、PONV发生率差异无统计学意义。结论喉罩置入对ONSD的影响较气管插管小,气管内表麻可以减轻气管插管引起的ONSD升高。     

Use of laryngeal mask airway in children with upper respiratory tract infection,compared with face mask: Randomized,single blind,clinical trial

ObjectiveThe incidence of postoperative cough (primary outcome) and adverse respiratory events (secondary outcome) in children who received anesthesia by laryngeal mask airway (LMA) with children who received anesthesia by face mask (FM) was compared in a blind randomized trial with uncomplicated upper respiratory track infection (URI) undergoing general anesthesia. Previous studies of pediatric patients with URI receiving anesthesia by endotracheal tube have reported a greater number of anesthetic complications; however reports concerning adverse effects in pediatric patients with URI receiving anesthesia by LMA or FM are scanty.MethodFor the present trial, 150 children with uncomplicated URI and requiring general anesthesia for ophthalmic procedures were enrolled. Once the severity of preoperative URI symptoms was stratified, the children were randomized to receive general anesthesia by FM or LMA. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen (N₂O in O₂). Respiratory adverse events were evaluated peri- and post-operatively.ResultsThe two groups did not differ in age, weight, American Society of Anesthesiologists (ASA) physical status, sex, duration of surgery or severity of URI symptoms. The incidences of cough (19% in LMA vs. 42% in FM), vomiting (4% in LMA vs. 12% in FM) and intervention to maintain the patency of the airway were statistically higher in the FM group (p < 0.05). There were no differences between the two groups with respect to the incidences of apnea, laryngospasm, desaturation, bronchospasm, readmission and sore throat.ConclusionIn children with uncomplicated URI, the administration of inhalation anesthetics in general anesthesia by LMA is likely to cause fewer adverse events than the use of FM.     

呼气末二氧化碳分压反映患儿置入喉罩机械通气时动脉血二氧化碳分压的准确性

目的 评价PETCO2反映患儿置入喉罩机械通气时PaCO2的准确性.方法 拟在全身麻醉下行骨科手术患儿52例,ASA分级Ⅰ级,年龄2～9岁,体重10～30 kg.采用分层随机法,将患儿随机分为2组(n=26):喉罩组(LMA组)和气管导管组(ETT组).常规麻醉诱导后行机械通气,待血液动力学稳定后,采集桡动脉血样测定PaCO2,同时记录PETCO2.结果 两组间PETCO2和PaCO2比较差异无统计学意义(P＞0.05);LMA组PETCO2与PaCO2比较差异无统计学意义(P＞0.05).结论 患儿置入喉罩机械通气时,PETCO2可反映PaCO2,用于指导调整机械通气参数.

Abstract：

Objective To investigate the accuracy of end-tidal carbon dioxide (PETCO2) in reflecting arterial carbon dioxide (PaCO2) during mechanical ventilation via laryngeal mask airway (LMA) in children. Methods Fifty-two ASA Ⅰ patients, aged 2-9 yr, weighing 10-30 kg, undergoing orthopaedic surgery under general anesthesia, were randomized into 2 groups (n = 26 each) : LMA group and endotracheal tube (ETT) group. After anesthesia was induced with fentanyl, propofol and succinycholine, LMA or ETT was inserted and the children were mechanically ventilated. After the hemodynamics was stable, arterial blood samples were obtained to detect PaCO2, and PETCO2 was recorded simultaneously. Results There was no significant difference in PaCO2 and PCT CO, between groups LMA and ETT ( P ＞ 0.05) . There was no significant difference between PaCO2 and PETCO2 in LMA group (P ＞ 0.05). Conclusion When mechanical ventilation is performed via LMA in children, PETCO2 can reliably reflect PaCO2 and guide the regulation of ventilatory parameters.     

Prospective Randomized Controlled Trial on the Use of Flexible Reinforced Laryngeal Mask Airway (LMA) During Total Thyroidectomy: Effects on Postoperative Laryngopharyngeal Symptoms

Background

Sore throat, hoarseness, dysphagia, and cough are common laryngopharyngeal discomforts after thyroidectomy. The incidence and severity of laryngopharyngeal symptoms after the use of a flexible reinforced laryngeal mask airway (LMA) were compared with those that occur after the use of a plain endotracheal tube in patients after thyroidectomy.

Methods

Seventy-six patients scheduled for total thyroidectomy were randomized into a plain endotracheal tube group (group E) or a flexible reinforced LMA group (group L). Total intravenous anesthesia (propofol and remifentanil) was used for maintenance of anesthesia. Hemodynamic variables were recorded during induction of anesthesia. The incidence and severity (100-point numerical rating scales) of laryngopharyngeal symptoms, including sore throat, hoarseness, dysphagia, and cough, were assessed at 1, 24, and 48 h after surgery.

Results

All patients were placed successfully with an endotracheal tube or a flexible reinforced LMA. The postoperative incidence and severity of sore throat (25 vs. 33 at 24 h, p = 0.035, 17 vs. 28 at 48 h, p = 0.017; 50 [0–100] vs. 80 [20–100] at 1 h, p = 0.002; 30 [0–80] vs. 50 [0–100] at 24 h, p < 0.001; 0 [0–40] vs. 30 [0–90] at 48 h, p < 0.001) and hoarseness were lower in group L than in group E. At 48 h postoperatively, dysphagia (p = 0.005) and cough (p = 0.028) occurred less frequently in group L than in group E patients.

Conclusion

A flexible reinforced LMA placed during surgery decreases the incidence and severity of laryngopharyngeal symptoms and is a feasible anesthetic tool compared with a conventional endotracheal tube for thyroidectomy.     

ProSeal喉罩用于体外循环心内直视术患儿气道管理的效果

目的 评价ProSeal喉罩用于体外循环心内直视术患儿气道管理的效果.方法 择期拟行心内直视术患儿76例,年龄3月～8岁,体重3.3～34.5 kg,性别不限,ASA分级Ⅱ级,心功能分级Ⅰ或Ⅱ级,随机分为2组(n=38):气管导管组(T组)和ProSeal喉罩组(P组).麻醉诱导后,T组置入气管导管,P组置入ProSeal喉罩,行机械通气.记录气管导管和喉罩的置入情况、置入时间、最高气道压、术中低氧血症、心动过速、心动过缓、低血压和高血压的发生情况、术后喉头水肿、吞咽困难、呛咳、呼吸困难、声音嘶哑的发生情况.结果 气管导管和ProSeal喉罩全部置入成功.两组术中均未见低氧血症、心动过速、心动过缓、低血压和高血压的发生.与T组比较,P组置入时间缩短,喉头水肿和吞咽困难的发生率降低(P＜0.05),最高气道压、呛咳、呼吸困难和声音嘶哑的发生率差异无统计学意义(P＞0.05).结论ProSeal喉罩置入简单易行,可有效保证通气,对咽喉部刺激较小,用于体外循环心内直视术患儿的气道管理安全可靠.     

针刺联合止吐药防治全麻术后恶心呕吐效果的Meta分析

目的 系统评价针刺(手针、电针)防治全麻术后恶心呕吐的效果。方法 计算机检索Embase、PubMed、Cochrane、中国知网、维普、中国生物医学文献数据库、万方医学等数据库，纳入有关针刺联合止吐药防治全麻术后恶心、呕吐的随机对照试验(RCT),检索年限为建库至2022年9月，采用RevMan 5.3进行统计分析。结果 共纳入15篇文献，患者1 493例，其中止吐药组741例，针刺联合止吐药组752例。与止吐药组比较，针刺联合止吐药组术后恶心发生率明显降低(OR=0.43, 95%CI 0.34～0.54,P<0.001),术后呕吐发生率明显降低(OR=0.55, 95%CI 0.45～0.66,P<0.001)。结论 与单用止吐药比较，采用针刺(手针、电针)联合止吐药患者术后恶心和呕吐的发生率更低。     

Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway

A prototype armoured laryngeal mask airway (LMA) was compared with tracheal intubation (ETT) for anaesthesia for adenotonsillectomy. Fifty-five children were randomised into the LMA group and 54 into the ETT group. During insertion of the LMA, peripheral oxyhaemoglobin desaturation (SpO₂) < 94% occurred in ten patients (18.2%) and in seven patients (13%) during tracheal intubation (NS). After opening the Boyle-Davis gag, airway obstruction occurred in ten patients (18.2%) in the LMA group and in three patients (6%) in the ETT group (P = 0.07). In five patients (9%) the LMA was abandoned in favour of tracheal intubation. In all others (91%), when the need for adequate depth of anaesthesia was realized, a satisfactory airway was achieved more rapidly than with tracheal intubation (P < 0.001), and maintained throughout surgery. Manually assisted ventilation was required in all patients in the ETT group, mean duration 373 ± 385 sec, and in 26 patients (52%) in the LMA group, mean duration 134 ± 110 sec, P < 0.001. Mean end-tidal CO₂ (PetCO₂) was 45.5 ± 6.21 mmHg in the ETT group and 46.6 ± 6.09 in the LMA group (NS). The LMA did not limit surgical access. Heart rate, MAP and blood loss in the LMA group were 110 ± 21, 74 ± 9 mmHg and 1.92 ± 1.22 ml · kg^?1 respectively, compared with 143 ± 13 (P < 0.001), 85 ± 12 mmHg (P < 0.001) and 2.62 ± 1.36 ml · kg^?1 (P < 0.05) with tracheal intubation. Fibreoptic laryngoscopy at the end of surgery in 19 patients in the LMA group revealed no blood in the larynx. In the LMA group postintubation stridor and laryngospasm occurred in five and three patients respectively, compared with 14 (P < 0.05) and six patients respectively (NS) with tracheal intubation. SpO₂ on admission to the PACU in the LMA group was 95.9 ± 2.21, and 93.5 ± 4.53 (P < 0.05) after tracheal intubation. Our study demonstrated that the LMA is a safe alternative to tracheal intubation for adenotonsillectomy. Control of airway reflexes by ensuring sufficient depth of anaesthesia is essential for successful use of the LMA in children.     

Routine use of the intubating laryngeal mask airway results in increased upper airway morbidity

PURPOSE: The classic laryngeal mask airway (LMA) has a soft, silicone tube and the intubating laryngeal mask airway (ILM) has a rigid, silicone-coated steel tube. We compare postoperative pharyngolaryngeal morbidity in patients randomised to receive either device. METHODS: Sixty-five female patients (ASA physical status class I or II, aged 18-80 yr) undergoing balanced regional anesthesia for gynecological laparotomy expected to last one to two hours were randomly assigned for airway management with the LMA or ILM. Intracuff pressure was maintained at 60 cm H20. Postoperative pharyngolaryngeal morbidity (sore throat, difficulty swallowing, sore mouth, sore neck/jaw, hoarseness) was assessed at two, 24 and 48 hr by blinded investigators. RESULTS: The number of insertion attempts and duration of anesthesia was similar between groups. Sore throat was more common for the ILM at two hours (44 vs 15%, P=0.01), 24 hr (59 vs 21%, P=0.008) and 48 hr (34 vs 3%, P=0.005). Sore mouth was more common for the ILM at two hours (16 vs 0%, P=0.02) and 24 hr (12 vs 0%, P=0.04), but not at 48 hr (6 vs 3%). Difficulty swallowing was more common for the ILM at two hours (25 vs 0%, P=0.04), but not at 24 hr (31 vs 3%) and 48 hr (12 vs 9%). There were no differences in the incidence of sore jaw/neck (ILM, 3-12%; LMA, 0-3%) and hoarseness (ILM, 12-31%; LMA, 16-18%). There was no correlation between postoperative pharyngolaryngeal morbidity and duration of anesthesia. CONCLUSION: Pharyngolaryngeal morbidity is more common with the ILM than the LMA following anesthesia lasting one to two hours.     

Propofol causes less postoperative pharyngeal morbidity than thiopental after the use of a laryngeal mask airway

The insertion of a laryngeal mask airway (LMA) may result in postoperative sore throat. The choice of induction drug on airway morbidity after LMA insertion may be important. We performed this study to compare the incidence of postoperative pharyngeal morbidity after the insertion of a LMA in 340 patients administered either 2 mg/kg propofol (group P) or thiopental 5 mg/kg (group T) for induction of anesthesia. Patients were maintained at 1-2 minimum alveolar anesthetic concentration sevoflurane in 50% oxygen/air. Spontaneous or assisted spontaneous ventilation was maintained. An investigator blinded to group allocation visited patients at 2, 12, and 24 h postoperatively. Adverse responses were noted (yes/no) at each time point including sore throat, sore mouth, sore jaw, hoarseness, dysphonia, and dysphagia. At 2 h postoperatively, the incidence of sore throat, dysphagia, and postoperative nausea and vomiting in group T was higher than in group P (24% vs 13% for sore throat, 15% vs 3% for dysphagia, 20% vs 11% for nausea, 14% vs 6% for vomiting, P < 0.05). The number-needed-to-treat to prevent sore throat and dysphagia was 10 and 8, respectively (95% confidence intervals, 5-43). We concluded that, when propofol, rather than thiopental, is used for the induction of anesthesia, it results in a lower incidence of early pharyngeal morbidity and postoperative nausea and vomiting after the insertion of a LMA.     

A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults

In a prospective, randomized study, we investigated the incidence of successful insertion of laryngeal mask airway (LMA) at the first attempt and the incidence of side effects after LMA insertion using the combination of sevoflurane and propofol as compared with either sevoflurane or propofol alone for induction of anesthesia. Eighty-three unpremedicated ASA physical status I-II patients were anesthetized with a single vital capacity breath (VCB) of sevoflurane 8% supplemented with IV propofol 1.5 mg/kg, a single VCB of sevoflurane 8%, or IV propofol 3 mg/kg. The coinduction technique was associated with the most frequent incidence of successful LMA insertion at the first attempt (93.5%) than either sevoflurane alone (46%) or propofol alone (61.5%) (P < 0.001). Propofol-induced induction of anesthesia allowed the fastest insertion of LMA and was associated with the least frequent incidence of postoperative nausea and vomiting. However, this advantage of propofol was offset by a frequent incidence of pain on injection (69%) and the occurrence of movements during insertion of the LMA (50% in the propofol group versus 19% and 26% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.05), as well as a more frequent incidence of apnea (84% in the propofol group versus 7% and 16% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.001). The report shows that induction of anesthesia with sevoflurane-propofol combined provides a frequent incidence of successful LMA insertion at the first attempt that is associated with an infrequent incidence of apnea.