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。     

Proseal喉罩应用于甲状腺手术麻醉

目的探讨Proseal喉罩（PLMA）应用于甲状腺手术麻醉的安全性及可行性,并与传统气管插管比较。方法40例择期行甲状腺手术患者,随机分为PLMA组及ETT（气管内插管）组。记录插管（罩）后血压、心率变化,气道压（Paw）,脉搏氧饱和度（SPO2）、呼气末二氧化碳分压（ETCO2）以及麻醉并发症的情况。结果PLMA组置罩后血压、心率无明显变化,而ETT组置管后血压、心率明显增高,P〈0．05。PLMA组苏醒期患者呛咳、体动及术后咽喉痛的发生率明显少于ETT组,P〈0,05。PLMA组术中有3例发生咽部漏气,经调整喉罩位置后无漏气,有6例Paw升高,伴ETCO2升高或降低,持续短暂无需处理。结论PLMA可安全应用于甲状腺手术麻醉,但术中应严密观察通气质量,必要时即予处理。     

改良Proseal喉罩与改良普通喉罩在无痛纤维支气管镜检查中的气道管理

目的比较改良Proseal喉罩和改良普通喉罩在无痛纤维支气管镜检查中气道管理的效果。方法选择行纤维支气管镜检查患者40例,随机均分为两组:改良Proseal喉罩组(P组)和改良普通喉罩组(L组)。全麻诱导后徒手插入喉罩,接麻醉机,控制或辅助通气。记录两组麻醉前(T0)、插入喉罩即刻(T1)、插入喉罩3min(T2)的SBP、DBP、HR和SpO2,同时记录喉罩插入时间和并发症,并进行喉罩通气评估、纤维支气管镜评估和气道密封压测定。结果两组患者喉罩插入时间及各时点的SBP、DBP、HR和SpO2差异均无统计学意义;P组气道密封压明显高于L组(P<0.01);P组喉罩通气、纤维支气管镜评分优良率均为100%,明显高于L组的85%、80%(P<0.01);术毕P组1例喉罩粘血,明显少于L组的7例(P<0.05)。结论改良Proseal喉罩在气密性、通气评估、纤维支气管镜评估等方面好于改良普通喉罩,但对血流动力学的影响两者无明显差异。     

置入食管引流型喉罩和经典喉罩对小儿伤害性刺激程度的比较

目的 比较置入食管引流型喉罩(PLMA)与经典喉罩(CLMA)对小儿伤害性刺激的程度.方法 择期全麻手术患儿47例,性别不限,年龄3-12岁,体重11-36 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患儿随机分为PLMA组(n=23)和CLMA组(n=24).采用序贯法进行试验,靶控输注异丙酚行麻醉诱导,待效应室浓度与预设的血浆靶浓度平衡后置入喉罩.PLMA组和CLMA组首例患儿异丙酚血浆靶浓度分别设为6.0和4.4 μg/ml,存在喉罩置入反应,则下一例患儿异丙酚血浆靶浓度升高1个浓度梯度,无喉罩置入反应,则下一例患儿异丙酚血浆靶浓度降低1个浓度梯度,浓度梯度为0.2 μg/ml.喉罩置入反应的标准为:下颌松弛困难无法置入、置入即刻、置往后1 min内出现呛咳、吞咽、肢体运动、屏气或喉痉挛.计算异丙酚抑制喉罩置往反应的半数有效血浆靶浓度及其95％置信区间.结果 异丙酚抑制小儿PLMA和CLMA置入反应的半数有效血浆靶浓度及其95％置信区间分别为5.87(5.62～ 6.11)和4.53(4.38 ～ 4.69)μg/ml,差异有统计学意义(P＜0.01).结论 置入PLMA对3～12岁小儿的伤害性刺激程度较CLMA增强.     

A rather unconventional use of the laryngeal mask airway

Jaw masses are often associated with difficult airway and very often anesthesiologists have to use ingenious but safe techniques to secure the airway. This report is upon awake insertion of the laryngeal mask airway in a patient with a huge jaw tumor.     

Anesthesia for postpartum tubal ligation

Postpartum tubal ligation is an elective procedure that can be performed safely shortly after delivery, provided the patient’s labor was uncomplicated, she is hemodynamically stable, and she understands the risks and alternatives to the surgery and anesthesia. Epidural, spinal, general, or local anesthesia with sedation has been used for postpartum tubal ligation. The most convenient anesthetic is reactivation or extension of an already existing epidural, and the success is increased when postpartum tubal ligation is performed within 4 to 8 hours of delivery.

Most of the physiologic changes that occur during pregnancy are still present in the postpartum period. Postpartum patients have delayed gastric emptying of solid foods and should be given some form of gastric acid prophylaxis before inducing anesthesia.

Postpartum tubal ligation (PPTL) produces moderate to severe pain of short duration, so one must provide some form of postoperative pain relief. Although there is controversy regarding the use of ketorolac, a nonsteroidal anti-inflammatory medication, in breast-feeding mothers, the American Academy of Pediatrics considers it safe. Other oral opioid and nonopioid pain medications are also effective in treating postoperative pain.     

A comparison of the Proseal laryngeal mask to the standard laryngeal mask on anesthesized,non-relaxed patients

It was our goal to compare the Proseal-laryngeal mask airway (PLMA) with the classical laryngeal mask airway (LMA) in a german multicenter trial. Handling of the instruments and application criteria were to be tested. 7 anaesthesia departments were able to take part in this study. 280 patients could be investigated after approval of the ethics committee of the medical faculty of the university of Goettingen. 145 patients received the PLMA and 135 the LMA. The surgical interventions were small to moderate procedures with a duration of at least 20 minutes in the sections general surgery, trauma/orthopedic surgery, urology, vascular surgery, gynecology, ENT-surgery and ophthalmology. There was equivalence of the two instruments PLMA and LMA concerning duration and ease of insertion, endoscopic position check, observations on emergence, potential for injury and some postoperative complaints. This equivalence could be confirmed statistically. Laryngospasm was observed in three, Bronchospasm in two patients with the PLMA, in no one with the LMA. In one case of laryngospasm and another of bronchospasm a mechanism of supraglottic laryngeal stenosis has been involved which may occur in rare instances with the PLMA. This mechanism is due to the double cuff of the PLMA with the instruments proximity to the laryngeal inlet. The seal pressure in both groups differs significantly (p = 0.001). The mean value for the seal pressure was 29,3 +/- 0,21 mbar for the PLMA and 20,9 +/- 0,21 mbar for the LMA. In the PLMA the gastric tube could be positioned with the first attempt in 118 patients, with the second attempt in 17 cases. In 10 patients the gastric tube could not be placed. Contrary to the LMA the tip of the PLMA cuff may be bent in some cases with loss of airway safety and positioning of the gastric tube. The symptoms sore throat and painful swallowing on the first postoperative day were more frequent with LMA application. These differences could be confirmed statistically (sore throat p = 0.01, painful swallowing p = 0.04). They may be explained by the more rigid LMA compared to the PLMA and by the fact that the LMA in this study was older than the PLMA, loosing plasticizer. The drainage tube within the PLMA offers safety from aspiration in patients with no primary aspiration risk, additional reassurance for a correct position and a better stability of the airway. Our data may support a wider indication range for the PLMA compared with the LMA. The PLMA may be applied in laparoscopies and lower abdominal surgical interventions. Careful clinical observation will show, if the minimal invasiveness of the PLMA offers an advantage for these patients. The PLMA should not be applied in patients with increased aspiration risk.     

A randomized study to compare ProSeal laryngeal mask airway with classic laryngeal mask airway in anesthetized patients

BackgroundTo overcome the problem of gastric content regurgitation, a device with drain tube and better airway sealing has been made: the ProSeal laryngeal mask airway (PLMA). We aimed to compare the clinical performance of the classic LMA with the PLMA. Several studies comparing these two devices have been done.Our study was designed to compare ease of insertion, airway sealing pressure, and fiber-optic assessment of positioning in adult patients, and we hopes to prove that PLMA is better to LMA in all these aspects. We hypothesized that PLMA would have a better leak pressure than the CLMA and minimum difference in leak pressure of 20% between them was considered clinically significant.Material and methodsOne hundred adult patients of either sex between age group of 18–65 years scheduled for elective surgery were included in the study. Patients were randomly allocated to two groups of 50 patients each. In group I CLMA and in group II PLMA were used. The number of attempts, ease of insertion, time of insertion, and failure if occurred were noted down. Hemodynamic changes, airway sealing pressure, and the fiber-optic were also recorded.ResultsData thus compiled showed that insertion was successful in first attempt in 94% cases with LMA as well as PLMA. The time taken for successful placement of LMA and - PLMA was 15 and 17 s, respectively. Sealing pressure was higher for group II at all cuff volumes. More number of patients (89%) in group II had a fiber optic score of I and II as compared to group I which had 81% patients with score I and II.ConclusionWe conclude that PLMA is easy to insert with a short insertion time, high success of placement at first attempt, and capable of achieving a more effective seal than LMA.     

Vomiting during the use of the laryngeal mask airway

Journal of Anesthesia -     

A comparison of the laryngeal tube-S and Proseal laryngeal mask during outpatient surgical procedures

BACKGROUND AND OBJECTIVE: The Laryngeal Tube Sonda (LTS) and the ProSeal Laryngeal Mask Airway (PLMA) are two new devices introduced for maintaining the airway during controlled ventilation under general anaesthesia. The present investigation compared their performance in a randomized controlled study. METHODS: One hundred ASA I-II patients, aged 18-60 yr undergoing elective minor surgery, were randomized to receive either an LTS (n = 50) or PLMA (n = 50) for airway management. After induction of general anaesthesia, the devices were inserted, its correct placement was verified and airway leak pressure was measured. Ease of insertion, quality of airway seal, fibre-optic view and postoperative pharyngeal morbidity were examined. RESULTS: There were no differences in patient characteristics for both groups. First-time and second-time success rates were comparable for both groups (86 vs. 88% and 96 vs. 98% in LTS and PLMA groups, respectively). The airway of one patient in each group could not be managed with these devices after three attempts. Time until delivery of first tidal volume for LTS and PLMA was 24.5 +/- 6.9 and 28.8 +/- 10.3 s. Fixation and manipulation time was 54.9 +/- 15.2 and 73.2 +/- 25 s, respectively (P < 0.05). Airway seal pressure (cm H(2)O) for LTS and PLMA was 20 +/- 8.6 and 24.1 +/- 10.8, respectively (P = 0.04). Patients were questioned on a variety of postoperative pharyngeal morbidities. Only hoarseness was more frequent in the LTS group. CONCLUSIONS: Both devices provide a secure airway, are similar in clinical utility and are easy to insert. Better airway seal was detected in the PLMA group.     

Laryngo-pharyngeal complaints after use of the laryngeal mask airway

PURPOSE: To compare the incidence of dysphagia, dysphonia and sore throat following anesthesia, using the laryngeal mask airway (LMA), among patients receiving intermittent positive-pressure ventilation (IPPV) and those breathing spontaneously (SV) and with two different concentrations of nitrous oxide (N2O) in oxygen. METHODS: In a prospective trial, 120 patients (ASA I-III, 16-70 yr, > 60 kg) undergoing minor peripheral surgery were randomised into four groups with respect to type of ventilation and N2O concentration (50% or 66%) received. Cuff pressure measurements were monitored continuously. Twenty-four hours after surgery, patients were questioned for sore throat, dysphagia and dysphonia. RESULTS: At 30 min post-LMA insertion, increases in cuff pressure were 35.2+/-17.1 mmHg (22.8%) vs 50.1+/-16.3 mmHg (32.7%) in patients breathing 50 and 66% N2O, respectively (P < 0.01). There were no differences in cuff pressure increment between patients in the SV and IPPV groups. Cuff pressure values at the end of surgery depended on the duration of surgery and on the concentrations of N2O. The overall incidence of postoperative discomfort at 24 hr was dysphagia 11%, dysphonia 11% and sore throat 28.8%. Only two patients reported sore throat as more than mild. There was no relationship between cuff pressure and laryngo-pharyngeal complaints. The incidence of dysphonia in the groups receiving IPPV was higher than that in the groups with spontaneous ventilation (17.2 vs 5%, P < 0.05). CONCLUSION: Post-operative discomfort is related to the type of ventilation but not to variation in LMA cuff pressure.     

Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation

Background: Out-of-hospital airway management is a critical skill, demandingexpert knowledge and experience. The intubating laryngeal maskairway (ILMA) is a ventilatory and intubating device which maybe of value in this arena. We evaluated the ILMA for out-of-hospitalmanagement of the difficult airway. Methods: Twenty-one anaesthesia-trained emergency physicians (EPs) completeda training programme and used the ILMA in patients with difficult-to-manageairways. Indications for use of the ILMA included patients withdifficult laryngoscopy, multiple intubation attempts, limitedaccess to the patient’s head, presence of pharyngo-laryngealtrauma, and gastric fluids or bleeding obscuring the view ofthe vocal cords. Results: During the study period, 146 of 2513 patients underwent trachealintubation or alternate rescue airway insertion. In 135 patients,laryngoscopy was performed and Cormack–Lehane view wasrecorded as grade I in 72 (53.3%), II in 45 (33.3%), III in10 (7.4%), and IV in 8 (5.9%). EPs encountered 11 patients (7.5%)with difficult-to-manage airways. ILMA insertion and ventilationwas possible in 10 patients in the first and one patient inthe second attempt. ILMA-guided tracheal intubation was successfulin all patients, in 10 after the first and in 1 after two attempts. Conclusions: In this study, ventilation and intubation with ILMA was successfulin all patients with difficult-to-manage airways. Our data supportthe use of the ILMA as rescue device for out-of-hospital airwaymanagement by staff who have appropriate airway skills and havereceived appropriate training.