Taste disturbance after general anesthesia with classic laryngeal mask airway (CLM)

A 27-year-old man underwent the right knee joint operation under general anesthesia with CLM. After the operation, he complained of taste disturbance of the left side of the tongue. We measured electrical taste threshold and the serum level of zinc, copper and iron. The taste threshold was elevated in the two nerve areas of the left side of the tongue (chorda tympani, N. glossopharyngeus) and the serum levels of zinc and iron were low. We concluded that he had been short of zinc and iron and the insertion of CLM had triggered taste disturbance.     

Regurgitation and aspiration of gastric contents in a child during general anaesthesia using the laryngeal mask airway

We present a case report of a child who underwent general anaesthesia for elective surgery in whom regurgitation and aspiration of gastric contents were associated with the use of the laryngeal mask airway (LMA). Bronchospasm developed but mechanical ventilation was not required. The possible mechanisms causing regurgitation are discussed.     

喉罩全麻白内障患儿手术苏醒期拔管时机的探讨

目的 降低惠儿全麻苏醒期喉罩拔出后呼吸道并发症的发生率,为患儿喉罩拔管时机的选择提供临床依据.方法 采用计算机随机将择期喉罩全麻下行白内障手术的患儿60例分为镇静状态喉罩拔管组(镇静组,33例)和清醒状态喉罩拔管组(清醒组,27例).在麻醉后恢复室观察并记录两组患儿拔出喉罩后呼吸道并发症发生率.结果 手术苏醒期,镇静组无一例发生呛咳,清醒组13例出现呛咳,两组比较,差异有统计学意义(P＜0.01).结论 患儿镇静状态下拔出喉罩能降低拔管后呛咳发生率,以保证患儿安全渡过全麻苏醒期.     

食管引流型与标准型喉罩通气道在全身麻醉患者的应用

目的比较食管引流型喉罩通气道(PLMA)和标准型喉罩通气道(SLMA)在全身麻醉患者的应用。方法ASAⅠ~Ⅱ级择期整形外科手术患者60例,随机均分为PLMA组和SLMA组,常规麻醉诱导后,分别插入PLMA或SLMA,并将通气罩充气至60cmH2O。评价两种喉罩通气道的插入特征、气道密封压和漏气部位,记录麻醉诱导前后、喉罩插入时和喉罩插入后5min内SBP、DBP和HR的变化情况。记录麻醉期间发生的呼吸并发症和呼吸道损伤情况。结果PLMA组首次插入即获得满意肺通气的例数高于SLMA组,但PLMA组操作时间明显长于SLMA组(P<0·05)。PLMA组通气罩充气量和气道密封压明显高于SLMA组(P<0·05)。两组插入操作所致的血液动力学反应相似,而且均非常轻微。结论与SLMA相比,PLMA可达到更好的气道密封性,并可提供良好的胃管插入通路,是全身麻醉患者安全有效的呼吸道管理工具之一。     

Continuous ventilation technique for laryngeal mask airway (LMA) removal after fiberoptic intubation in children

BACKGROUND: Fiberoptic tracheal intubation through the laryngeal mask airway (LMA) is a simple technique to establish a safe airway in neonates and infants with a difficult airway. The technique, however, is complicated by the removal of the laryngeal mask from the patient's mouth because of the similarity in length of the LMA and the tracheal tube. METHODS: Several solutions have been presented to stabilize the tracheal tube within the trachea during withdrawal of the LMA. With all these techniques ventilation of the patient is interrupted. RESULTS: We present a modified technique, using a double tube assembly, which allows uninterrupted ventilation of the patient during withdrawal of the LMA from the patient's mouth. CONCLUSIONS: The technique is simple and safe, can be performed without hurry and carries potential advantages for neonates and children with limited cardiorespiratory reserve.     

The size 1.5 laryngeal mask airway (LMA) in paediatric anaesthetic practice

BACKGROUND: The recently introduced size 1.5 laryngeal mask airway (LMA) is specifically designed for use in children weighing 5-10 kg. METHODS: We prospectively evaluated its use in 68 patients, mean age 8.7 months, who were undergoing a variety of routine surgical procedures. RESULTS: The overall incidence of complications was high (42%) and was significantly more common in younger patients. Most of these related to poor positioning of the LMA, or airway problems such as obstruction or laryngospasm. Critical incidents occurred in seven patients, and all but one of these was related to the use of an LMA. CONCLUSIONS: The size 1.5 LMA is a useful addition to the range available, although the overall complication rate is considerable and is inversely related to the age of the child.     

Apparent sialadenopathy of the sublingual glands after general anesthesia with placement of laryngeal mask airway

Sialadenopathy, inflammation of the salivary glands, is a rare anesthetic complication. This case conference describes a patient who developed sialadenopathy of the sublingual glands after placement of a laryngeal mask airway during a brief surgical procedure. The patient's history is detailed, the surgical and anesthetic procedures are described, and a discussion follows, which describes the different causes of this inflammatory process. In the comment, the physiology of the salivary glands is described in detail.     

Effect of laryngeal mask airway on esophageal motility during general anesthesia

STUDY OBJECTIVES: To determine whether the Laryngeal Mask Airway (LMA) triggers the pharyngo-esophago-gastric reflex during general anesthesia by comparing the esophageal motility of patients with the LMA and endotracheal tube (ETT) in place. DESIGN: Randomized clinical trial. SETTING: Operating room and recovery room of a tertiary-care referral hospital. PATIENTS: 50 adult ASA physical status I and II patients scheduled for elective orthopedic surgery. INTERVENTIONS: All patients received a standardized general anesthetic technique, then were allocated randomly to the LMA (n = 30) or ETT (n = 20) groups. MEASUREMENTS AND MAIN RESULTS: The esophageal manometric inputs were recorded continuously using an ambulatory esophageal manometric recorder and divided into five perioperative phases (preanesthesia, induction, surgery, LMA, or ETT rejection and arousal phase). The LMA or ETT was removed at the end of the surgery, when the patient was awake. An awake state was defined as the presence of the following clinical signs: swallowing, bucking, struggling, straining, and restlessness. The esophageal peristaltic wave percent and esophageal contraction frequency were significantly decreased during induction, surgery, and the LMA or ETT rejection and arousal phases compared with the preanesthetic phases in both the LMA and ETT groups. However, there were no significant group differences in any corresponding perioperative phases. CONCLUSION: During the general anesthetic period before the arousal phase in this study, a LMA does not provoke significantly different esophageal peristalsis compared with an ETT. Thus, the LMA is unlikely to stimulate the pharyngo-esophago-gastric reflex during that period.     

Unilateral negative pressure pulmonary edema during anesthesia with a laryngeal mask airway

PURPOSE: To present a case of unilateral pulmonary edema after upper airway obstruction. CLINICAL FEATURES: In a 21-yr-old man, anesthesia was induced with propofol and maintained with N2O/O2/isoflurane via an LMA. After being placed in the lateral position, he had an episode of upper airway obstruction while breathing spontaneously. Hypoxemia (SpO2 80-83%) refractory to the administration of oxygen (F1O2 1.0) ensued following relief of the obstruction. Chest X-ray showed edema of the dependent lung. Treatment consisted of placing the patient in the sitting position and supplemental oxygen. The situation resolved over a few hours. CONCLUSION: If airway obstruction occurs in the lateral position, development of negative pressure pulmonary edema (NPPE) in the dependent lung is favoured by hydrostatic forces and possibly the elevated resting position of the dependent hemidiaphragm.     

The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent

We describe a new laryngeal mask airway (LMA) that incorporatesa second tube placed lateral to the airway tube and ending atthe tip of the mask. The second tube is intended to separatethe alimentary and respiratory tracts. It should permit accessto or escape of fluids from the stomach and reduce the risksof gastric insufflation and pulmonary aspiration. It can alsodetermine the correct positioning of the mask. A second posteriorcuff is fitted to improve the seal. A preliminary crossovercomparison with the standard mask in 30 adult female patientsshowed no differences in insertion, trauma or quality of airway.At 60 cm H₂O intracuff pressure, the new LMA gave twice theseal pressure of the standard device (P<0.0001) and permittedblind insertion of a gastric tube in all cases. It is concludedthat the new device merits further study.     

Vomiting and aspiration pneumonitis with the laryngeal mask airway

We report a case of severe aspiration pneumonitis in the dependent lung of a 74-yr-old man following Austin-Moore arthroplasty. A laryngeal mask airway provided a clear airway until anaesthesia became too light during manipulation of the fractured femoral head. Active vomiting occurred and gastric contents were "reflected" back into the trachea. Tracheal intubation and suction were immediately performed but the patient required postoperative ventilatory and inotropic support for three days.     

Thyroplasty under general anesthesia using a laryngeal mask airway and fibreoptic bronchoscope

Purpose

To report the management of a patient, with unilateral vocal cord paralysis, undergoing thyroplasty, under general anesthesia.

Clinical Features

A 25-yr-old man developed hoarseness and occasional episodes of pulmonary aspiration, caused by unilateral vocal cord paralysis. He was scheduled for thyroplasty, in an attempt to ease phonation and to decrease or prevent further episodes of pulmonary aspiration. He refused local anesthesia with sedation and it was therefore decided to attempt the procedure under general anesthesia. The paralysed vocal cord was displaced inwards by a wedge inserted through a window in the thyroid cartilage. We assessed the ideal position of the wedge by using a fibreoptic bronchoscope and laryngeal mask airway during general anesthesia, instead of phonation.

Conclusion

We describe the successful use of a general anesthetic for a thyroplasty, a procedure normally done under local anesthesia with or without sedation, in a patient who was keen to have surgery, but who refused local anesthesia with sedation.     

喉罩通气道全麻用于超低出生体重儿视网膜病变激光光凝术的麻醉处理

报道1例胎龄27+4周,现月龄1月27 d,体重1.67 kg的超低出生体重伴双眼早产儿视网膜病变(retinopathy of prematurity,ROP)的早产儿在喉罩通气道全麻下行双眼激光光凝术治疗.