Brimacombe J, Holyoake L, Keller C, Barry J, Mecklem D, Blinco A, Weidmann K
Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Australia.
Anaesthesia. 2000 Apr;55(4):338-43. doi: 10.1046/j.1365-2044.2000.01285.x.
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.
在本研究中,我们检验了以下假设:喉罩气道的初始套囊容积会影响苏醒特征及术后喉咽发病率。160例接受小手术的成年患者被随机分配,使用套囊完全充气的喉罩气道(高容量喉罩,LMA-High)或套囊半充气的喉罩气道(低容量喉罩,LMA-Low)进行气道管理。麻醉采用丙泊酚、氧化亚氮、氧气和异氟烷。插入喉罩后,4号尺寸(女性)的套囊充入15或30 ml气体,5号尺寸(男性)的套囊充入20或40 ml气体。手术结束时,一名不知情的观察者记录每个1分钟时段内是否出现不良气道事件(低氧、高碳酸血症、咳嗽、干呕、反流/呕吐、气道梗阻、通气不足、呃逆、咬喉、身体移动或寒战),并每5分钟记录一次心肺变量(心率、平均血压、动脉血氧饱和度、呼气末二氧化碳分压和呼吸频率),直至患者苏醒并拔除喉罩气道。在患者离开麻醉后护理单元前及术后18 - 24小时,对患者进行关于咽喉部发病率(咽痛、声音嘶哑和吞咽困难)的访谈。按时段分析显示,高容量喉罩组的部分气道梗阻情况更多,但按患者人数分析则无差异。高容量喉罩组患者进入麻醉后护理单元时心率略高,但在心肺反应方面并无其他差异。高容量喉罩组咽痛和吞咽困难更为常见。我们得出结论,一般而言,喉罩气道的苏醒特征不受用于充气套囊的空气量影响,但初始套囊容量较高时,术后咽痛和吞咽困难的发生率更高。