双管喉罩在小儿麻醉中的应用

目的探讨双管喉罩(PLMA)在小儿麻醉中应用的可行性和安全性。方法择期矫形外科手术患儿300例,随机均分为PLMA组(P组)和气管插管组(T组),经静脉麻醉诱导后,记录两组插入喉罩(导管)成功率、肺通气情况;记录插入前(T1)、插入即刻(T2)、插入后2min(T3)、拔除喉罩(拔管)前(T4)、拔除即刻(T5)、拔除后2min(T6)的HR、SBP、DBP及术后并发症。结果两组插入成功率均为100%。与T组比较,P组机械通气30min时PETCO2较高;T2、T3、T5、T6时HR较慢,SBP、DBP较低;苏醒期呛咳发生率较低(P<0.05)。结论 PLMA放置成功率高,诱导、苏醒期血流动力学平稳,术中通气情况良好,术后并发症少。     

鼻内窥镜手术患者可弯曲喉罩与一次性双管喉罩气道管理效果比较

目的 观察可弯曲喉罩(flexible laryngeal mask airway,FLMA)与一次性双管喉罩(supreme laryngeal mask airway,SLMA)在鼻内窥镜手术中的气道管理效果,并对二者进行比较. 方法 选取择期行鼻内窥镜手术患者40例.美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、年龄20岁～70岁、体重指数＜30 kg/m2.按随机数字表法随机分成两组,分别为FLMA组(F组)及SLMA组(S组),每组各20例.记录麻醉时间、手术时间、喉罩拔除时间(术毕至呼吸恢复正常可以拔除喉罩的时间)和苏醒时间(术毕至呼之睁眼的时间);术毕即刻、术后6、24、36 h咽喉疼痛发生情况;术者满意程度.统计学分析处理采用SPSS 19.0软件完成. 结果 ①两组喉罩首次成功率分别为95％、90％,差异无统计学意义(P＞0.05).②F组置入时间(10.2±1.8)s,S组置入时间(6.3±1.3)s,差异有统计学意义(P＜0.05).③气道压、气道密封压、纤维支气管镜(branchofiberoscope,FOB)检查分级、两组术后拔出喉罩即刻咽喉疼痛发生例数、术后6h咽喉疼痛发生例数差异无统计学意义(P＞0.05).④两组之间手术医生的满意度差异无统计学意义(P＞0.05),但是F组有一个上升的趋势. 结论 ①FLMA与SLMA均可应用于全身麻醉下鼻内窥镜手术的气道管理,安全可靠.SLMA比FLMA更易置入.②FLMA可适用于各类鼻内镜手术,SLMA在涉及到额窦的手术时应用受到一定限制.     

SaCo可视喉罩和Supreme喉罩用于腹腔镜手术的比较

目的 观察SaCo可视喉罩和Supreme喉罩在腹腔镜手术中的效果.方法 选择择期行全麻下腹腔镜手术患者60例,男21例,女39例,年龄18～78岁,ASAⅠ—Ⅲ级.按照随机数字表法分为两组:Supreme喉罩组(S组)和SaCo喉罩组(K组),每组30例.记录喉罩置入成功即刻、置入成功后1、2h气道密封压、置入时间、...     

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。     

插管型喉罩麻醉用于妇科腹腔镜手术中的应用

目的探讨插管型喉罩用于妇科腹腔镜手术麻醉的可行性和安全性。方法随机将78例于2013-01—2016-03间接受妇科腹腔镜手术的患者分为2组,每组39例。对照组使用气管插管麻醉,观察组采用插管型喉罩麻醉。对比2组患者气管插管或喉罩置入成功率、不同时段的气道峰压(Pmax)、气道平均压(Pmean)、SpO_2、呼气末二氧化碳分压(PETCO_2)及并发症发生率。结果2组患者各时段的SpO_2、Pmax、Pmean及PETCO_2水平,差异均无统计学意义(P0.05)。观察组患者喉罩1次成功置入率高于对照组的气管插管,并发症发生率低于对照组,术后苏醒时间短于对照组,差异均有统计学意义(P0.05)。结论插管型喉罩麻醉在妇科腹腔镜手术中一次插管置入成功率高,术中气道阻力变化及血流动力学稳定,并发症低,术后苏醒快。     

腹腔镜胆道手术患者双管型喉罩通气的可行性

目的 探讨双管型喉罩（PLMA）用于腹腔镜胆道手术患者通气的可行性。方法 择期行腹腔镜胆囊切除术或腹腔镜胆总管探查术患者80例，年龄21-63岁，ASAⅠ或Ⅱ级，随机分为PLMA组和气管导管（TT）组，每组40例。用纤维支气管镜观察PLMA的到位情况。记录患者插管时、插管后3min、拔管时和拔管后3min的平均动脉压和心率，间歇正压通气15min时和气腹15min时的气道峰压（Ppeak）、潮气量（Vτ）和呼气末CO2分压（PETCO2）。结果 两组的插管时间、间歇正压通气15min时和气腹15min时的Ppeak、VT、PETCO2差异无统计学意义（P〉0．05）。两组首次插管后通气成功率均为95％，纤维支气管镜确认PLMA首次正确到位率为87．5％。PLMA组插管时、插管后3min、拔管时和拔管后3min的平均动脉压和心率较TT组降低（P〈0．05或0．01）。拔管时TT组65％出现呛咳或挣扎反应，术后2、24h咽痛发生率分别为22．5％、25％，而PLMA组均无拔管反应和术后咽痛。结论 与气管导管相比，双管型喉罩操作简便，应激反应小，通气可靠，可避免术后咽喉部并发症。     

Proseal喉罩在妇科腹腔镜手术麻醉中的应用

目的观察正压通气下Proseal喉罩用于妇科腹腔镜手术的安全性、可行性。方法妇科腹腔镜择期手术病人50例,ASAⅠ~Ⅱ级,随机分为喉罩组(L组,25例)和气管插管组(T组,25例),麻醉后记录心率(HR)、平均动脉压(MAP)、气道峰压(Pmax)、气道平均压(Pmean)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、动脉血二氧化碳分压(PaCO2)的数值及插管(罩)期、拔管(罩)期、术后24h相关并发症。结果(1)HR、MAP变化:插管(罩)期和拔管(罩)期T组明显升高(P<0.05),L组无明显变化(P>0.05)。(2)两组PETCO2、PaCO2、Pmax、Pmean随麻醉、气腹的影响变化是一致的,组间比较各时间点差异无显著性(P>0.05),两组的SpO2一直保持稳定水平。(3)两组并发症比较:插管(罩)期L组有3例体动,1例呛咳,T组无体动及呛咳,差异无显著性(P>0.05);拔管(罩)期T组体动、呛咳发生率明显高于L组(P<0.05);术后24h咽痛、声嘶发生率T组明显高于L组(P<0.05)。(4)手术医师对手术条件的评价100%满意。结论本研究显示妇科腹腔镜手术中Proseal喉罩可以达到与气管插管一样满意的通气效果,且安全可靠。     

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.     

Supreme喉罩和Proseal喉罩用于腹腔镜手求患者气道管理的比较体会

目的：比较Supreme和Proseal喉罩用于腹腔镜手术患者的气道管理。方法：择期全麻下腹腔镜手术患者60例。随机分为S（Supreme喉罩）组和P（Proseal喉罩）组。记录喉罩置入时间．置入次数及胄管置入情况。分别记录置入喉罩后1min．5min及置入胃管5rain时的SpO2．SBp．DBp．Hr．气道峰压。结果;两组各时点的SpO2．SB-．DBe．Hr．PETCO2．Peak之间无统计学差异。S组置入喉罩时间短于P组喉罩置入时间．其中1次置入成功率91％．2次成功率100％。两组拔喉罩后不良反应的发生率之间无统计学差异。结论：Supreme喉罩置入快速．通气效果好．拔除后不良反应少,可安全有效地用于腹腔镜手术患者的全麻气道管理。     

喉罩在妇科腹腔镜手术中的应用

目的:探讨喉罩在妇科腹腔镜手术中的应用.方法:将50例ASAl～Ⅱ级择期行妇科腹腔镜手术的患者随机平均分两组.LAM组,为喉罩组,TT组为气管插管组.将两组作一对比分析.结果:血流动力学变化:喉罩置入后血压、心率未见明显改变(P<0.05).TT组各项指标均不同程度波动.结论:喉罩用于妇科腹腔镜手术,较气管全麻减少了血流动力学波动,是一种较好的妇科腹腔镜手术的麻醉方法.     

Comparison of the LMA-ProSeal and LMA-Classic in children

Background. The LMA-ProSeal^TM is a new laryngeal mask airwaywith a rear cuff and drainage tube that allows a higher sealpressure than the LMA-Classic^TM for the same intra-cuff pressure,and it permits drainage of gastric secretions and access tothe alimentary tract. The LMA-ProSeal can be used in childrenbut it does not have a rear cuff. This study compared the LMA-ProSealand the LMA-Classic in children for ease of insertion, airwaysealing pressure and fibre-optic visualization. Methods. Sixty ASA I–II children undergoing herniorrhaphy,orchiopexy or myringotomy were included. The patients were randomlyassigned to size 2 LMA-Classic^TM or size 2 LMA-ProSeal groupsfor airway management. We assessed success rates at first attemptof insertion, airway sealing pressure, fibre-optic position,success rates of gastric tube placement and postoperative bloodstaining of the device, tongue–lip–dental traumaand hoarseness. Results. There was no statistical difference between the twogroups for the success rates at first attempt of insertion,airway sealing pressure and fibre-optic position. Gastric tubeinsertion was successful in 90% of cases in the LMA-ProSealgroup. The LMA-Classic had a higher rate of postoperative bloodstaining, but there was no tongue–lip–dental traumaor hoarseness in either group. Conclusion. We conclude that ease of insertion and airway sealingpressure are similar between the LMA-ProSeal and the LMA-Classicin children.     

LMA-Classic™ and LMA-ProSeal™ are effective alternatives to endotracheal intubation for gynecologic laparoscopy

PURPOSE: To compare the laryngeal mask airways (LMA), LMA-Classic(TM) (LMA-C) and LMA-ProSeal(TM) (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy. METHODS: We stratified 209 women, aged > or = 18 yr, ASA physical status I-III, by body mass index as non-obese (< or = 30 kg x m(-2)) or obese (> 30 kg x m(-2)) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL x kg(-1)). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure. RESULTS: There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO(2,) P(ET)CO(2) or airway pressure before or during peritoneal insufflation in short (< or = 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant. CONCLUSION: A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.     

Clinical study of the laryngeal mask in paediatric. Comparison of the LMA-ProSeal and LMA-classic

OBJECTIVES: To compare the Classic laryngeal mask airway (MLC) and the ProSeal LMA (MLP), size 2 and 2.5 in terms of ease of insertion, leak pressure and side effects during insertion and extraction in the recovery room. STUDY TYPE: Randomised prospective. MATERIAL AND METHOD: All children between 10 and 30 kg scheduled for general anaesthesia with laryngeal mask (ML) were included. There was no imposed protocol for the anaesthesia. The ML size was determined according to the child's weight. The MLC was inserted using the standard technique. The MLP was inserted following the recommendations, with or without the handle according to the operator's choice. The data analysed were: insertion type, ease of insertion of the mask, of the nasogastric tube (SG), number of attempts of mask insertion, complications, gastric leaks. RESULTS: One hundred (and) twenty children were included. There was no statistical difference in terms of difficulty of insertion, number of failed attempts, leak pressure or side effects. The use of the handle did not make insertion easier. Insertion of a nasogastric tube was possible in 92% cases. CONCLUSION: MLP is as easy to use in children as the MLC. MLP has the advantage of allowing rapid access to the stomach. It seems that the MLP is safer since its correct position is confirmed by easy gastric tube insertion.     

第三代喉罩用于腹腔镜胆囊切除手术患者的效果

目的 探讨第三代喉罩（PLMA）用于腹腔镜胆囊切除手术患者的效果。方法 腹腔镜胆囊切除手术患者80例，年龄35～65岁，男35例，女45例，ASAⅠ～Ⅲ级。静脉注射咪达唑仑0．1mg／kg、异丙酚1．5～2mg／kg、芬太尼0．1mg、维库溴铵0．1mg／kg麻醉诱导。采用弹性树脂探条引导法置入PLMA，观察PLMA置入前即刻、置入后1、3、5、10min、气腹后5、10、20、30min时血液动力学指标及呼气末二氧化碳分压（PETCO2）、脉搏血氧饱和度（SpO2），同时观察PLMA通气罩在不充气、充气10、20、30ml时分别在气道压20、30、40cmH2O头正中位、屈曲位、过伸位、侧位的气道密封效果，应用纤支镜插入通气管，检查PLMA的位置，插入引流管检查置入胃管的通畅性并放置胃管。结果 PLMA置管成功率100％，血液动力学、PET，CO2及SpO2稳定，喉罩气囊不充气，气道压20cmH2O时，80％不漏气；充气10ml气道压20cmH2O时，90％不漏气；充气20ml气道压30cmH2O时，95％不漏气；充气30ml气道压30cmH2O时，95％不漏气，气道压40cmH2O时5例少量漏气。各种头位不影响气道密封效果。97．5％患者胃管一次置入成功，纤支镜证实PLMA位置好，引流管通畅，术后无不良反应。结论 PLMA可安全用于腹腔镜胆囊切除手术。     

Comparison of atracurium and alcuronium in day-case gynaecological surgery

Alcuronium and atracurium were used on a randomised basis as part of the anaesthetic technique for out-patient gynaecological laparoscopy. Conditions for intubation and relaxation were similar but there was a marked decrease in the incidence of minor postoperative sequelae in the atracurium group.