腹腔镜手术患者i-gel喉罩气道管理的效果

目的 评价i-gel喉罩应用于腹腔镜手术患者气道管理的效果.方法 择期妇科腹腔镜手术及腹腔镜胆囊切除手术50例,男女不限,20-60岁,体质量50-80kg,BMI＜30kg/m2,ASAⅠ-Ⅱ级,无喉罩使用禁忌证,随机分为i-gel喉罩组(Ⅰ组)和supreme喉罩组(S组)(n=25).患者入室常规监测,麻醉诱导后按分组分别置入4号i-gel及supreme喉罩,记录喉罩置入时间,一次喉罩置入成功率,并测定最高气道密闭压.调整VT为8ml/kg,RR为10次/min,术中依据PetC02调整RR,记录气腹前后气道压及平均气道压.术后随访喉罩相关并发症.结果 两组喉罩均100％置入成功,第一次置入成功率均为92％(P＞0.05).两组患者机械通气时气道峰压在气腹后明显高于气腹前,但均低于气道密闭压(P＜0.05).两组患者气腹前后通气效果良好,无低血氧症等不良事件发生.S组有2例患者在拔去喉罩时带有血丝,两组患者术后各有1例发生咽痛.结论 与supreme喉罩相似,i-gel喉罩置入成功率高,气道密闭性可靠,术后不良反应少,可安全有效应用于腹腔镜短小手术.

Effect of laryngeal mask i-gel on airway of patients undergoing laparoscopic surgery

Objective To assess the effect of laryngeal mask i-gel(LMA i-gel) used on airway of patients undergoing laparoscopic surgery.Methods Fifty ASAⅠorⅡpatients who aged 20-60 years and weighted 50-80kg,undergoing selective laparoscopic surgery,with no contraindications for laryngeal mask on airway and with their BMI<30kg/m2,were divided into i-gel group(group I) and laryngeal mask supreme group(group S),25 in each group.After the LMA supreme and i-gel(size 4 each) were inserted into the patients of group S and group I after anesthesia.The duration of inserting LMA and the success rate of first try of insertion were recorded.The peak airway pressure was measured.Then,the VT and RR were adjusted to 8ml/kg and 10bpm,respectively.The RR was adjusted during operation according to the PetCO2.Max and mean airway pressure were recorded before and after pneumoperitoneum.The patients were followed up for LMA i-gel-related complications after operation.Results A 100% success rate for LMA insertion was achieved in the two groups and both the first insertion success rate for LMA was 92%(P>0.05).The peak airway pressure was significantly higher after pneumoperitoneum than before pneumoperitoneum during mechanical ventilation(P<0.05).However,it was lower than the airway sealing pressure in the two groups(P<0.05).The ventilation effect was good in the two groups after pneumoperitoneum with no adverse reactions occurred such as hypoxemia.The blood stain was observed on the LMA removed from 2 patients of group S and 1 patient of each group had sore throat.Conclusion The success insertion rate of LMA i-gel is as high as that of LMA supreme,with a reliable airway sealing pressure and few postoperative complications,and can thus be used in small laparoscopic operation.