下肢神经阻滞复合喉罩全麻在高危老年患者全髋置换术中的应用

目的 评价下肢神经阻滞复合喉罩全麻用于老年全髋置换术患者的优缺点.方法 择期75岁以上高危老年全髋置换术患者72例随机均分为四组:A组(气管插管全麻).B组(下肢神经阻滞复合气管插管全麻),C组(喉罩全麻),D组(下肢神经阻滞复合喉罩全麻).记录麻醉前(T1)、气管插管/置入喉罩时(T2)、骨膜剥离时(T3)、术毕(T4)、拔管/取出喉罩时(T5)的MAP、HR;记录清醒和拔出导管或喉罩时间、麻醉药用量及术中知晓情况.结果 T2、T5时A、B组MAP、HR明显高于T1时(P<0.05);T3时A、C组MAP、HR明显高于T1(P<0.05).术毕至拔气管导管或取出喉罩时间:A组(35.4±10.9)min,B组(21.3±6.8)min,C组(27.8±7.7)min.均明显长于D组的(11.2±4.3)min(P<0.01).结论 下肢神经阻滞复合喉罩全麻用于高危老年患者全髋置换术,患者血流动力学稳定,全麻药用量减少,恢复快.     

喉罩通气联合硬膜外阻滞在普通外科手术麻醉中的应用

目的：探讨喉罩通气联合硬膜外阻滞在普通外科手术麻醉中的作用。
方法：91例手术患者采用喉罩通气全麻联合硬膜外阻滞（联合组）,以同期采用气管插管全麻（插管组）和单纯喉罩通气全麻（喉罩组）作为对照,观察比较3种麻醉方式对于普通外科手术中患者血液循环的影响和不良反应。
结果：喉罩组与联合组在麻醉诱导、置入/取出喉罩时MAP和HR的波动明显小于插管组。联合组手术过程中MAP,HR的波动显著小于插管组和喉罩组（P＜0.05,P＜0.01）。喉罩组和联合组拔除喉罩时更为顺利,较少出现呛咳,无呕吐现象,术后也较少出现咽喉疼痛症状。
结论：喉罩通气全麻联合硬膜外阻滞兼具喉罩通气和硬膜外阻滞的优点,对于手术中患者的干扰较其他两组少。

     

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.     

喉罩通气全麻应用于老年人腹部手术的临床观察

目的 探讨气管捕管和喉罩通气道用于老年全身麻醉对血液动力学的影响.方法 将40例老年全麻腹部手术患者随机分为2组.喉罩组(L组):全麻诱导后置入喉罩;插管组(M组):全麻后喉镜下气管插管维持通气.分别记录诱导前(T0)、簧喉罩或气管导管前(T1).喉罩置人或气插管即刻(T2),之后2min(T3),4min(T4),6...     

可弯曲喉罩与加强型气管导管在老年高血压患者甲状腺手术中的应用

目的比较Flexible喉罩与加强型气管导管用于老年高血压患者甲状腺手术的效果。方法择期全麻下行甲状腺手术,且术前合并高血压的老年患者60例,年龄65~75岁,ASAⅡ或Ⅲ级,随机均分为两组:Flexible喉罩组(F组)和加强型气管导管组(R组)。静注咪达唑仑0.04mg/kg、芬太尼3μg/kg、丙泊酚1.3~1.8mg/kg、罗库溴铵0.6mg/kg行麻醉诱导。记录麻醉诱导前(T0)、插入Flexible喉罩或气管导管即刻(T1)、插入后1min(T2)、5min(T3)、拔除喉罩或气管导管前(T4)、拔除后1min(T5)、5min(T6)的MAP和HR;测定T0~T3时血浆肾上腺素和去甲肾上腺素浓度;监测术中气道峰压(Ppeak)、PETCO2、F组气道密封压及拔除喉罩或气管导管后不良反应。结果 T1、T2时R组MAP明显高于,HR明显快于T0时和F组,T3时两组MAP明显低于T0时(P0.05)。T1、T2时R组肾上腺素及去甲肾上腺素浓度明显高于T0时和F组(P0.05)。F组气道密封压为(28±3)cm H2O,两组Ppeak及PETCO2组间组内差异无统计学意义。与F组比较,R组拔除气管导管时呛咳反应及拔管后咽喉痛的发生率均明显升高(P0.05)。结论 Flexible喉罩可安全用于老年高血压患者的甲状腺手术,且麻醉相关应激反应及并发症较气管插管低。     

喉罩在颅内动脉瘤介入手术麻醉中的效果观察

目的观察20例喉罩在颅内动脉瘤介入手术麻醉中的应用效果。方法将40例行颅内动脉瘤介入手术患者依据麻醉给药途径分为喉罩组(置入普通型喉罩)和插管组(喉镜引导下经口明视插入内径7.5 mm气管导管),各20例。记录两组患者麻醉诱导前,插管(罩)即刻、插管(罩)后3 min、拔管(罩)即刻、拔管(罩)后3 min的MAP、HR,同时记录术中丙泊酚和瑞芬太尼的用量以及苏醒时间。结果插管组(除麻醉诱导前)各时间点的HR、MAP均较喉罩组明显升高(P0.05)。插管组术中丙泊酚、瑞芬太尼用量明显多于喉罩组。插管组术后苏醒时间明显长于喉罩组,差异具有统计学意义(P0.05)。结论喉罩用于全麻下颅内动脉瘤介入手术通气效果好、安全可靠,且较气管插管有血流动力学平稳、用药少、苏醒快等优点。     

SLIPA喉罩与气管插管在老年全麻手术中的应用比较

目的 比较应用SLIPA喉罩与气管插管对老年患者全麻手术中血流动力学的影响.方法 腹腔镜胆囊手术96例,年龄65～81岁.随机均分为喉罩组(S组)和气管插管组(G组).记录入室后(T0)、麻醉诱导时(T1)、置入喉罩或气管导管即刎(T2)、置入喉罩或气管导管后3 min(T3)、气腹后20 min(T4)、拔除喉罩或气管导管前(T5)、拔除喉罩或气管导管后即刻(T6)的SBP、DBP、HR、SpO2、气道峰压(Paw);观察拔除喉罩(导管)后并发症的发生情况.结果 与T0时比较,两组T1时SBP、DBP均下降,HR减慢(P＜0.05);与T1时比较,G组T2时SBP、DBP明显升高,HR增快(P＜0.05);与T5时比较,G组T6时SBP、DBP明显升高,HR增快(P＜0.05).G组发生呛咳、躁动、喉痛及声嘶的患者明显多于S组.结论 全麻腹腔镜胆囊手术中使用SLIPA喉罩控制血流动力学平稳、安全性好、并发症少.     

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喉罩和气管插管全麻在腹腔镜胆囊手术中的应用比较

目的 观察SLIPA喉罩与气管插管对患者血流动力学和气道阻力的影响.方法 择期全麻下腹腔镜胆囊手术患者60例,随机均分为SLIPA喉罩组(A组)和气管插管组(B组),记录插入喉罩/气管导管前(T0)、插入喉罩/气管导管后1 min(T1)、3 min(T2)和拔喉罩/气管导管前(T3)、拔喉罩/气管导管后1 min(T4)、3 min(T5)的SBP、DBP、HR和SpO2,同时在8 ml/kg潮气量下监测T1～T3时的平均气道压(Pmean)、气道峰压(Ppeak)和PETCO2,并观察有无反流误吸情况及术后咽喉部并发症.结果 与T0时相比,B组T1、T3、T4时SBP、DBP明显升高,HR明显增快,且相应时点均高于A组(P＜0.05);A组在T1、T2时的Pmean、Ppeak低于B组(P＜0.05);术后咽部不适患者B组(9例)明显多于A组(2例)(P＜0.05).结论 SLIPA喉罩通气用于腹腔镜胆囊手术时,患者应激反应小,术后咽喉部并发症少.     

喉罩过渡对双腔气管导管拔管期应激反应的影响

目的研究喉罩过渡法对支气管内麻醉中双腔气管导管拔管期应激反应的影响。方法选择全身麻醉并行双腔气管导管插管手术患者90例,随机分为A、B、C组,每组30例。A组在手术结束后直接拔除双腔气管导管,B组术后深麻醉下更换单腔气管导管,C组在术后深麻醉下更换喉罩。分别记录手术结束时(T0)、拔除气管导管(喉罩)前1 min(T1)、拔除后1 min(T2)、5 min(T3)的MAP、HR、心率收缩压乘积(RPP)。观察三组呛咳、躁动等不良反应发生情况。结果与T0时比较,T1~T3时A、B组MAP、RPP明显升高,HR明显增快(P0.01或P0.05)。与A组比较,T1~T3时B、C组MAP、RPP明显降低,HR明显减慢(P0.05)。C组严重呛咳、躁动例数均明显低于A、B组(P0.05)。结论在双腔气管插管麻醉苏醒期使用喉罩过渡法可以减少苏醒期血流动力学波动,降低拔管期应激反应。     

喉罩用于隆胸手术患者气道管理的效果

[摘要]目的观察喉罩通气全凭静脉麻醉用于隆胸术的临床效果。方法选择ASAI～Ⅱ级女性隆胸手术患者40例,年龄23—42岁;体重45—67kg;随机分为气管内插管组（A组,n=20）与喉罩组（B组,n=20）两组,A组静脉注射芬太尼0．2mg、丙泊酚2．0—2．5mg／kg、阿曲库铵0．15mg／kg诱导,插入气管导管;B组静脉注射芬太尼0．1mg、丙泊酚2．0～2．5mg／kg诱导,插入普通型喉罩,两组均接麻醉机行IPPV模式控制呼吸,两组均以微量泵持续泵入丙泊酚6～9tLg／（kg·min）,瑞芬太尼0．1—0．15μg/（kg·min）维持麻醉,A组间断静脉注射阿曲库铵,手术结束前10min停止用药,待受术者呼之能应,呼吸良好时拔除气管导管或喉罩。观察记录两组患者气管内插管和喉罩置入时间及置人情况、监测病人麻醉前（11D）、插管（插喉罩）后即刻（T1）、分离胸部肌肉时（他）、植入假体时（T3）、喉罩和气管导管拔除后即刻（T4）时的MAP、HR及SpO：的变化、通气状态以及操作时及术后的相关不良反应。结果A组1次成功完成气管内插管率与B组1次成功置入喉罩率无显著性差异（P〉0．05）;A组诱导时芬太尼用量显著多于B组（P〈0．05）;A组气管内插管后即刻（T1）以及拔管后即刻（rr4）的MAP及HR较诱导前显著升高（P〈0．05）,分离胸部肌肉时（T2）与植入假体时（T3）SBP、DBP、MAP和HR值均低于麻醉前,而B组T1、T2、T3时均较诱导前低（P〈0．05）;T4与诱导前相比无明显差异（P〉0．05）。A组插管时发生口腔粘膜出血及术后发生咽喉疼痛及呛咳的患者明显多于B组（P〈0．05）。结论与气管内插管全麻相比,喉罩通气全凭静脉麻醉施行隆胸手术,麻醉效果更满意、循环更稳定、并发症更少,术后恢复更舒适。     

Effect of tracheal intubation or laryngeal mask airway insertion on intraocular pressure using balanced anesthesia with sevoflurane and remifentanil.

STUDY OBJECTIVES: To study the effect of tracheal intubation or laryngeal mask airway (LMA) insertion on intraocular pressure (IOP) in strabismus patients undergoing balanced anesthesia with sevoflurane and remifentanil. DESIGN: Open, prospective, randomized study. SETTING: Tertiary care academic medical institution. PATIENTS: 40 adult ASA physical status I and II patients scheduled for elective strabismus surgery. INTERVENTION: Patients were randomized to receive either tracheal intubation or LMA insertion following mask induction with sevoflurane in combination with IV remifentanil. MEASUREMENTS: Intraocular pressure, mean arterial pressure (MAP), and heart rate (HR) were measured before induction, immediately following induction, and after airway insertion. MAIN RESULTS: Intraocular pressure after tracheal intubation or LMA insertion did not differ significantly from preoperative baseline values. Mean arterial pressure and HR did not significantly differ between groups at any time point. CONCLUSIONS: Remifentanil and sevoflurane are not associated with an increase in IOP response during tracheal intubation or LMA insertion above baseline in healthy patients undergoing ophthalmic surgery.     

RETRACTED ARTICLE: Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients

The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. In both normotensive and hypertensive patients, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product increased after tracheal intubation or LMA insertion compared with base-line (P < 0.05). The haemodynamic changes were greater after intubation than after LMA insertion (P < 0.05). Following intubation of the trachea or insertion of the LMA, HR increased more markedly in hypertensive patients than in normotensive patients (P < 0.05). Plasma adrenaline and noradrenaline concentrations after tracheal intubation or LMA insertion increased compared with baseline values (P < 0.05) in normotensive and hypertensive patients. The increase in noradrenaline concentration after tracheal intubation was greater than that after LMA insertion (P < 0.05). No patient revealed ECG evidence of myocardial ischaemia. We conclude that insertion of LMA is associated with less circulatory responses than tracheal intubation in both normotensive and hypertensive patients.     

Intubation via LMA in pediatric patients with difficult airways

PURPOSE: To report two cases of successful tracheal intubation in difficult pediatric airways using a conventional laryngeal mask airway (LMA) with an extended polyvinyl chloride (PVC) tube after laryngeal assessment with a fibreoptic device. CLINICAL FEATURES: Two cases, Dandy-Walker and Pierre Robin syndromes, were scheduled for surgery. They were premedicated with 0.5 mg x kg(-1) promethazine p.o. 90 min before surgery. Both patients arrived in the operating room sedated, with dry mouth, and without evidence of increased intracranial tension or airway obstruction. Inhalational induction with isoflurane 0.5-3% was commenced. Conventional tracheal intubation was impossible in both cases. In each an LMA was inserted to maintain ventilation, anesthesia, and to facilitate intubation. Fibreoptic bronchoscopy was used to assess the larynx, followed by blind intubation via the LMA using extended PVC tracheal tube (TT). Anesthesia was maintained during intubation using Mapleson F anesthesia circuit attached to a connector with fibreoptic bronchoscope adapter. CONCLUSION: This report describes the assessment of the airway with fibreoptic bronchoscopy after LMA insertion facilitated blind tracheal intubation in two children with difficult airways.     

Comparative effects of laryngeal mask airway and endotracheal tube insertion on intraocular pressure in children.

Intraocular pressure (IOP) measurements in children are frequently performed under halothane-nitrous oxide anesthesia; however, anesthesia face masks may limit access to the eyes, and tracheal intubation is associated with transient increases in IOP. Use of the laryngeal mask airway (LMA) permits the maintenance of a patent airway without the need for laryngoscopy and tracheal intubation. In a randomized study of 41 children, we compared the IOP, hemoglobin oxygen saturation, and hemodynamic responses to the insertion of an LMA or tracheal tube during a standardized steady-state anesthetic technique consisting of 1 MAC halothane and 66% nitrous oxide. Baseline measurements of IOP, hemoglobin oxygen saturation, heart rate, and arterial blood pressure were recorded and repeated within 15-30 s after insertion of the airway device and at 1-min intervals for 5 min. Insertion of the LMA required significantly less time (26 +/- 16 vs 39 +/- 17 s [mean +/- SD]) and was associated with higher hemoglobin oxygen saturation values compared with the tracheal intubation. The LMA did not increase IOP, heart rate, or arterial blood pressure above baseline values. In contrast, tracheal intubation was associated with significant increases of IOP, heart rate, and arterial blood pressure. We concluded that the laryngeal mask offers advantages over tracheal intubation and the face mask for airway management in patients undergoing IOP measurements.     

Comparison of laryngeal mask airway with tracheal tube for ophthalmic surgery in paediatric patients

This study of sixty ASA grade 1 or 2 children, aged 1 to 12 years, undergoing elective ophthalmic procedures, compared the use of the laryngeal mask airway (LMA) with that of an endotracheal tube. Changes in intraocular pressure and haemodynamic parameters, and intraoperative and postoperative complications were measured Patients were randomly allocated into two groups of 30 patients. In group 1, the airway was secured with an LMA and in group 2 with an endotracheal tube. A standard technique of general anaesthesia incorporating positive pressure ventilation was used in both groups. The changes in intraocular pressure, heart rate (HR) and mean arterial pressure (MAP) were observed before and after insertion of the airway device, two minutes after insertion, and pre and post removal of the device. The incidence of airway complications was also noted. There was no significant change in mean intraocular pressure after insertion of the LMA, but removal caused a significant increase to 19.3 +/- 7.6 mmHg (from a baseline of 13.9 +/- 4.3 mmHg). In the endotracheal tube group, intubation increased the mean intraocular pressure significantly to 19.9 +/- 7.3 mmHg (from a baseline of 13.1 +/- 4.0 mmHg) and extubation caused an increase to 24.6 +/- 10.4 mmHg which was clinically as well as statistically significant. The incidence of postoperative coughing was lower in the LMA group, but the incidence of vomiting higher. Two patients had displacement of the LMA during the procedure. We conclude that the use of an LMA is associated with less increase in intraocular pressure than the use of an endotracheal tube in children.     

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。     

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.