Sore throat and hoarseness after fiberoptic nasotracheal intubation

Fiberoptic nasotracheal intubation is frequently chosen for surgery involving the oral cavity. In such cases, the endotracheal tube passes through the vocal cords into the trachea blindly, which may cause laryngeal trauma. We, therefore, studied the incidence of sore throat and hoarseness after fiberoptic nasotracheal intubation (n=44) and compared the results with those after conventional oral intubation (n=35). The incidence of sore throat was lower in the fiberoptic nasotracheal intubation group than in the conventional oral intubation group but the difference was not statistically significant (25.0%s 42.8%). The incidence of hoarseness after fiberoptic nasotracheal intubation was significantly lower than that after conventional oral intubation (4.5%s 34.3%,P<0.05). This study confirms a low incidence of laryngeal trauma in fiberoptic nasotracheal intubation.     

Tracheal intubation and sore throat: a mechanical explanation

Although tracheal intubation remains a valuable tool, it may result in pressure trauma and sore throat. The evidence for an association between these sequelae is not conclusive and sore throat may be caused at the time of intubation. This hypothesis was tested in a mechanical model and the results from tracheal intubation compared with those from insertion of a laryngeal mask airway, which is associated with a lower incidence of sore throat. Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard 'Magill' curve (radius of curvature 140 +/- 20 mm) is about optimum for the average airway.     

小儿腹腔镜腹股沟斜疝手术中采用喉罩通气与气管插管麻醉效果观察

目的观察对比在小儿腹腔镜腹股沟斜疝手术中,采用喉罩通气与气管插管的麻醉效果。 方法纳入2019年5月至2020年5月于十堰市妇幼保健院确诊并进行腹腔镜腹股沟疝修补术治疗的患儿100例,按随机数字表法均分为观察组和对照组,每组患儿50例。对照组患儿接受气管插管方式进行麻醉,观察组患儿接受喉罩通气方式进行麻醉。记录所有患儿的基线资料、术中相关指标、血流动力学以及呼吸系统并发症,并进行比较。 结果2组患者临床资料比较,差异无统计学意义（P>0.05）;观察组患儿的麻醉时间、恢复时间、拔管时间[（39.15±6.88）、（4.45±1.85）、（6.15±1.56）min]均短于对照组[（44.95±8.98）、（7.96±1.86）、（13.58±3.28）min],差异均有统计学意义（P<0.05）;观察组除术前外的各时间点的各项血流动力学指标均明显优于对照组患儿（P<0.05）;观察组患儿的并发症总发生率（10.00%）明显少于对照组（34.00%）,差异有统计学意义（P<0.05）。 结论在小儿腹腔镜腹股沟斜疝手术中采用喉罩通气的方式进行麻醉是安全可行的。     

全身麻醉诱导后经多功能插管型喉罩盲探气管插管的临床观察

目的 观察全身麻醉患者经多功能插管型喉罩盲探行气管插管的可行性及安全性. 方法 选择ASA分级Ⅰ、Ⅱ级,年龄18～77岁择期行全身麻醉下手术的患者100例.麻醉诱导使用芬太尼4μg/kg、丙泊酚1.5～2.0 mg/kg、罗库溴铵0.6 mg/kg,诱导后先置入多功能插管型喉罩,通气行纤维支气管镜检查并定位后,经喉罩盲探插入配套的鹰嘴气管导管,观察放置喉罩及气管插管的次数和时间,记录诱导前、放置喉罩前后、气管插管前后的BP和HR.结果 置入喉罩和气管插管均1～2次成功,置入喉罩时间平均(11.0±3.2)s,气管插管时间平均(10.5±6.2)s,插管成功退出喉罩后即刻SBP、DBP和HR与诱导前比较,差异均无统计学意义(P＞0.05). 结论 经多功能插管型喉罩盲探气管插管,安全、快捷、有效,患者舒适、刺激小,比经典的插管型喉罩盲探插管更具有优势.     

喉罩与气管插管在全麻或复合硬膜外阻滞时的心率和血压改变

目的比较喉罩与气管插管用于全麻或全麻复合硬膜外阻滞患者的HR和BP变化.方法妇科手术80例,随机分为全麻气管插管(T)组、全麻喉罩(L)组、硬膜外阻滞 全麻气管插管(ET)组、硬膜外阻滞 全麻喉罩(EL)组,每组20例.硬膜外阻滞用1%利多卡因 0.15%丁卡因.全麻诱导咪唑安定2 mg、芬太尼0.2 mg、丙泊酚1.5 mg/kg、琥珀胆碱1.5 mg/kg后插气管导管或喉罩.全麻维持50%N2O O2 异氟醚,静注阿曲库铵、芬太尼.于麻醉前(基础,入室静卧10 min后)、插管后1 min、切皮、进腹探查后5 min、拔管后1 min记录MAP、SpO2、HR、PETCO2.结果插管时HR和MAP均低于基础值,而两组喉罩HR低于插气管导管者,硬膜外复合全麻喉罩组MAP低于气管插管组.切皮时两组全麻MAP高于复合硬膜外组.探查时两组复合硬膜外者HR和MAP均低于基础值,且MAP低于单纯全麻者(P＜0.05).拔管时各组HR均显著高于基础值,MAP未复合硬膜外者显著高于基础值.结论(1)插喉罩对BP和HR的影响不如气管导管剧烈;(2)复合硬膜外阻滞时气管插管或喉罩置入应激反应轻,也可减轻探查时的BP波动.     

Supreme喉罩在神经外科手术中的应用效果

目的 观察Supreme喉罩在神经外科手术中的应用效果.方法 36例择期神经外科手术患者,随机均分为喉罩组(S组)和气管插管组(Ⅰ组).麻醉诱导后,分别插入喉罩或气管导管行机械通气,记录插入和拔出喉罩(气管导管)前后MAP、HR、围术期动脉血pH、PaCO2、气道峰压(Ppeak)、舒芬太尼和七氟醚总用量及清醒和拔管时间.结果 与Ⅰ组比较,S组插入及拔除喉罩后MAP、HR更平稳;两组围术期动脉血pH、PaCO2、Ppeak差异无统计学意义;与Ⅰ组比较,S组舒芬太尼、七氟醚用量降低(P＜0.05),清醒时间、拔管时间缩短(P＜0.05).结论 神经外科手术中应用Supreme喉罩可减轻麻醉诱导及苏醒期血流动力学反应,减少麻醉药物用量,缩短清醒和拔管时间.     

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.     

A comparison of postoperative sore throat after use of laryngeal mask airway and tracheal tube

Purpose We compared the degree of postoperative sore throat (PST) after use of a laryngeal mask airway (LMA; by two insertion techniques) and a tracheal tube (TT) in adult patients.Methods Eighty-six adult patients undergoing surgery of an extremity were randomized into three groups. The LMAs (size 4 for men, 3 for women) and TTs were lubricated with 2% lidocaine gel. After the induction of anesthesia, an LMA with the cuff deflated was inserted and then the cuff was inflated in group A, an LMA with the cuff inflated was inserted in group B, and the trachea was intubated using vecuronium in group C; staff anesthesiologists performed all these methods. LMA cuffs were inflated with the maximum recommended volume of air. TT cuffs were inflated with the minimum volume of air without gas leakage at 20cmH₂O pressure. The mode of ventilation depended on the individual anesthesiologists. Blood traces on the devices were examined after their removal. PST was rated immediately after anesthesia and on the first postoperative day, using a three-point score and a 100-mm visual analog scale, respectively.Results Most of the patients receiving an LMA breathed spontaneously and those receiving a TT underwent controlled ventilation. The ratio of positive blood traces on devices, as well as the degree of PST immediately after anesthesia, was similar in the three groups; however, on the first postoperative day, the severity of PST was greater in the LMA groups than in the TT group (P = 0.016). The severity of PST was similar with the two LMA insertion techniques.Conclusion In the conditions of our study, LMAs inserted with the cuff either fully inflated or deflated worsened PST compared with TTs.This work was presented in part at the 49th annual meeting of the Japanese Society of Anesthesiologists, Fukuoka, Japan, April 18–20, 2002     

可视喉罩与可视喉镜用于困难气管插管的比较

目的 比较可视喉罩和可视喉镜用于困难气管插管患者的效果。

方法 选择气管插管全麻手术患者90例,男27例,女63例,年龄18～64岁,BMI<30 kg/m²,ASA Ⅰ或Ⅱ级,根据术前简化气道风险指数（SARI）筛选困难气管插管患者（SARI评分≥3分）。采用随机数字表法将患者分为两组：可视喉罩组（S组）和可视喉镜组（C组）,每组45例。S组使用可视喉罩引导气管插管,C组使用可视喉镜完成气管插管。记录声门暴露分级、声门暴露时间、气管插管时间、总插管时间、插管成功例数,插管前、插管即刻、插管后3 min和拔管前、拔管即刻、拔管后3 min的HR和MAP、术后插管并发症（声音嘶哑、咽喉痛）的发生情况。

结果 与C组比较,S组声门暴露时间［Ｓ组（18.2±7.6）s vs C组（14.1±2.8）s］明显延长（P＜0.05）,S组插管即刻和拔管即刻HR明显减慢,MAP明显降低（P＜0.05）。两组声门暴露分级、气管插管时间、总插管时间、插管成功率和术后插管并发症发生率差异无统计学意义。

结论 在困难气管插管的患者中,使用可视喉罩与可视喉镜均能快速有效地完成气管插管,与可视喉镜比较,使用可视喉罩声门暴露时间延长,插管与拔管即刻血流动力学波动幅度较小。     

喉罩与气管插管用于全麻乳腺癌根治术的比较

目的 比较喉罩和气管插管用于全麻乳腺癌根治术对患者血流动力学、呼吸功能和应激激素的影响。方法 40例ASAⅠ或Ⅱ级在全麻下实施乳腺癌根治术的患者,随机均分为喉罩组和气管内插管组。在麻醉诱导前（T0）、插入喉罩／气管导管前（T1）、插入喉罩／气管导管后即刻（T2）、插入喉罩／气管导管后5min（T3）、10min（T4）、15min（T5）和乳腺癌根治术切皮时（T6）、拔管后即刻（T7）记录SBP、DBP、HR。应用BICORE呼吸功能监测仪监测呼吸功能16项指标,选择T0、T3、T4、T5、T7时记录吸气潮气量（VT1）、呼气潮气量（VTE）、分钟通气量（VE）、吸气峰流速（PIFR）、呼气峰流速（PEFR）、吸气峰压（PIP）和平均气道阻力（RAWM）。每组随机抽取10例患者于T0、T1、T2、T6、T7时应用高效液相色谱分析法测定血浆肾上腺素（AE）、去甲肾上腺素（NE）、多巴胺（DA）水平。结果 气管插管组T2时SBP、DBP、HR显著高于喉罩组（P〈0．05）;VT1、VTE、VE、PIFR、PEFR、PIP和RAWM组间差异无统计学意义,AE、NE、DA在T2、T7时均显著高于喉罩组（P〈0．05）。结论 全麻喉罩通气用于乳腺癌根治术患者优于气管插管,易于维持血流动力学稳定,应激反应轻微,全麻后恢复平稳。     

A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways

Tracheal intubation with the intubating laryngeal mask airway or the Bonfils intubation fibrescope was performed in 80 patients with predicted difficult airways. Mallampati score, thyromental distance, mouth opening and mobility of the atlanto-occipital joint were used to predict difficult airways. The overall success rate, time to the first adequate lung ventilation and time taken for the successful placement of the tracheal tube were recorded, as well as a subjective assessment of the handling of the device and the incidence of postoperative sore throat and hoarseness. The median [range] time to the first adequate ventilation was significantly shorter with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (28 [6-85] s vs. 40 [23-77] s, p < 0.005). Tracheal intubation was significantly slower with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (76 [45-155] s vs. 40 [23-77] s, p < 0.0001. Patients in the Bonfils group suffered less sore throat and hoarseness than those in the other group.     

内镜面罩与双管喉罩在老年患者无痛纤维支气管镜检查中的应用

目的 研究适合于无痛纤维支气管镜检查(fibreoptic bronchoscopy,FB)麻醉的气道管理手段.方法 选择无痛FB老年患者60例,用信封法随机分为3组(每组20例),Ⅰ组鼻导管吸氧;Ⅱ组患者应用内镜面罩;Ⅲ组患者插入双管喉罩Supreme(Laryngeal Mask Supreme,塞舌尔),经面罩、...     

Emergence characteristics and postoperative laryngopharyngeal morbidity with the laryngeal mask airway: a comparison of high versus low initial cuff volume

In this study we tested the hypothesis that the initial cuff volume of the laryngeal mask airway influences emergence characteristics and postoperative laryngopharyngeal morbidity. One hundred and sixty adult patients undergoing minor surgery were randomly assigned for airway management with the laryngeal mask airway with either a fully inflated cuff (LMA-High) or a semi-inflated cuff (LMA-Low). Anaesthesia was with propofol, nitrous oxide, oxygen and isoflurane. Following insertion, the cuff was inflated with either 15 or 30 ml for the size 4 (females) and 20 or 40 ml for the size 5 (males). At the end of surgery, a blinded observer documented the presence or absence of adverse airway events (hypoxia, hypercapnea, coughing, retching, regurgitation/vomiting, airway obstruction, hypoventilation, hiccupping, biting, body movement or shivering) during every 1 min epoch and cardiorespiratory variables (heart rate, mean blood pressure, arterial oxygen saturation, end-tidal carbon dioxide and respiratory rate) every 5 min until the patient was awake and the laryngeal mask airway removed. Patients were interviewed about pharyngolaryngeal morbidity (sore throat, dysphonia and dysphagia) immediately before leaving the postanaesthesia care unit and 18-24 h following surgery. Analysis by epoch showed more partial airway obstruction in the LMA-High group, but analysis by patient numbers revealed no difference. Heart rate was slightly higher in the LMA-High group upon arrival in the postanaesthesia care unit, but otherwise there were no differences in cardiorespiratory responses. Sore throat and dysphagia were more common in the LMA-High group. We conclude that, in general, emergence characteristics with the laryngeal mask airway are not influenced by the volume of air used to inflate the cuff, but that postoperative sore throat and dysphagia are more likely at high initial cuff volumes.     

Supreme喉罩用于高血压病老年患者气道管理的效果

目的 评价Supreme喉罩用于高血压病老年患者气道管理的效果.方法 选择高血压病老年患者40例,年龄65～ 75岁,体重45 ～ 70 kg,BMI＜ 35 kg/m2,ASA分级Ⅱ或Ⅲ级,高血压病程＞1年,采用随机数字表法,将患者随机分为2组(n=20):气管插管组(T组)与Supreme喉罩组(S组).静脉注射芬太尼、丙泊酚、维库溴铵行麻醉诱导,下颌松弛后,S组置入Supreme喉罩,T组置入气管导管,行机械通气.七氟醚,丙泊酚和维库溴铵维持麻醉.于入手术室、置入喉罩/气管导管即刻、1、2、5min、切皮、拔除喉罩/气管导管即刻(T0-6)时记录SP、DP、HR、SpO2;于T0-4,6时采集右颈内静脉血样4ml,测定血浆肾上腺素(AE)、去甲肾上腺素(NE)和多巴胺(DA)浓度;记录插管反应和拔管反应的发生情况、置入时间、置入次数;置入喉罩/气管导管后测定肺顺应性、气道峰压、气道密封压、平台压;记录拔除后咽部不良反应的发生情况.结果 与T组比较,S组SP、HR、插管反应、拔管反应和咽部不良反应的发生率、血浆NE、AE和DA的浓度降低,置入时间缩短(P＜0.05).与T0时比较,S组T2时血浆NE浓度升高,T组T1～46时血浆NE浓度升高,T1～3时血浆AE和DA浓度升高(P＜0.05).结论 Supreme喉罩用于高血压病老年患者气道管理的效果优于气管插管,Supreme喉罩置入和拔除反应小,咽部不良反应少.     

腰硬联合阻滞复合喉罩麻醉与气管插管全麻在腹腔镜阑尾炎手术中的应用对比

目的：对比腰麻联合硬膜外阻滞（combined spinal and epidural anesthesia, CSEA）复合喉罩麻醉与气管插管全身麻醉在腹腔镜阑尾切除术（laparoscopic appendectomy,LA）中的麻醉效果。方法：选择240例ASA分级I或Ⅱ级的LA患者,随机分为两组,每组120例,复合组采用CSEA复合喉罩通气,全麻组采用静脉复合插管全麻。记录两组患者MAP、HR、PETCO2、镇痛情况、血糖、麻醉费用等相关指标。结果：全麻组术中血糖高于复合组（P〈0．05）;复合麻醉组镇痛满意度更高,麻醉费用更低。结论：与单纯全麻相比,CSEA复合喉罩可更好地抑制IA术中患者的应激反应,全麻药物用量减少,术后镇痛效果好,费用低,是基层医院LA术中麻醉的理想选择。     

可弯曲喉罩、普通喉罩和双管喉罩用于全麻乳腺手术的临床研究

目的对可弯曲喉罩、普通喉罩以及双管喉罩用于全麻乳腺手术的安全性进行随机对照研究。方法拟行全麻乳腺手术的患者60例,美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级,年龄27岁～77岁,参照随机数字表法将患者随机分为3组（每组20例）：可弯曲喉罩组（A组）、普通喉罩组（B组）及双管喉罩组（C组）。常规麻醉诱导后,经口置入喉罩,记录麻醉诱导前（基础值）、喉罩置入前即刻、喉罩置入即刻及喉罩置入后1、2、3、5、10min的心率（heart rate,HR）、血压（blood pressure,BP）和脑电双频指数（bispectral index,BIS）,观察患者的血流动力学变化及其并发症。结果3组患者均顺利完成喉罩置入,一次置入成功率均高于90％,插管时间短（均〈1min）。麻醉诱导后,3组患者BIS均显著降低[A组（93±5）VS（39±7）,B组（96±3）vs（39±9）,C组（95±5）vs（39±9）,P〈0．05],A组BP显著降低[收缩压（systolic blood pressure,SBP）（134±13）mmHgVS（109±12）mmHg（1mmHg=0．133kPa）,舒张压（diastolic blood pressure,DBP）（77±10）mmHg vs（64±9）mmHg,平均动脉压（mean artery pressure,MAP）（90±11）mmHg vs（74±9）mmHg,P〈0.05],B组患者HR和BP均未显著降低,C组患者HR和BP均显著降低[HR（77±10）次／min vs（68±9）次／min,SBP（127±28）mmHg vs（107±15）mmHg,DBP（72±14）mmHg vs（58±11）mmHg,MAP（85±15）mmHg vs（70±10）mmHg,P〈0．05]。在喉罩置入和拔除期间,血流动力学平稳。麻醉诱导、喉罩置入期间,3组各项指标差异无统计学意义,但是A组患者术后并发症发生率低。结论普通喉罩、双管喉罩和可弯曲喉罩插管成功率高、血流动力学平稳,能够有效地减轻插管及拔管的血流动力学反应。较之普通喉罩和双管喉罩,可弯曲喉罩可以降低插管及拔管并发症。