Dolbneva E L
Anesteziol Reanimatol. 2000 Sep-Oct(5):80-4.
Choice of induction agent is the decisive factor in utilization of a laryngeal mask (LM) under spontaneous respiration, as insufficient relaxation and unwanted laryngopharyngeal reflexes deteriorate the efficiency of LM functioning during operation and anesthesia. 132 anesthesias with LM were performed, 86 of these for laparoscopic cholecystectomies (LCE) (group 1) and 42 for saphenectomies (group 2). Control group consisted of 60 patients anesthetized for LCE by means of an endotracheal tube (ETT). Combined induction intravenous anesthesia with ketamine, barbiturates, and diprivan was used in group 1 and controls. In group 2 induction anesthesia was based on ketamine and diprivan. Group 1 and control group were matched for demographic characteristics and concomitant diseases. All groups were divided into subgroups, depending on anesthesia. In all groups pipecuronium bromide (0.06 mg/kg) was administered before insertion of EET or LM after injection of induction agents. In total myoplegia, installation of LM was simple, involving no untoward laryngo-pharyngeal reflexes. LM was correctly installed from the first attempt in 98.7% cases. In combined intravenous ketamine-based anesthesia, pressor reaction to LM installation consisted in an increase of heart rate by 5.6% (1K group--control), by 10.2% in 2K group (fractionated ketamine (1.5-2 mg/kg) + diazepam (0.1 mg/kg) and fentanyl (2.6 micrograms/kg); after barbiturates heart rate increased by 6.7% in 1B group (control), after diprivan it did not increase in 1D group (control), while the mean arterial pressure in 2D group (fractionated diprivan (1 mg/kg) + ketamine (25-50 mg), diazepam (0.08 mg/kg) and fentanyl (2.6 micrograms/kg) increased by 10% and heart rate by 6.6%. Reaction to tracheal intubation was pronounced in all types of induction anesthesia. No regurgitation or aspiration was observed in any case. Hence, use of total myoplegia in installation of LM allows the use of various modern anesthetics in optimal doses and notably simplifies the utilization of LM.
在自主呼吸下使用喉罩（LM）时，诱导药物的选择是决定性因素，因为肌肉松弛不足和不必要的喉咽反射会降低手术和麻醉期间LM的功能效率。共进行了132例使用LM的麻醉，其中86例用于腹腔镜胆囊切除术（LCE）（第1组），42例用于大隐静脉切除术（第2组）。对照组由60例通过气管内插管（ETT）进行LCE麻醉的患者组成。第1组和对照组采用氯胺酮、巴比妥类药物和丙泊酚联合诱导静脉麻醉。第2组诱导麻醉以氯胺酮和丙泊酚为基础。第1组和对照组在人口统计学特征和伴随疾病方面相匹配。所有组根据麻醉方式分为亚组。在所有组中，在注射诱导药物后插入ETT或LM之前给予溴哌库铵（0.06mg/kg）。在完全肌松状态下，插入LM很简单，未出现不良喉咽反射。98.7%的病例首次尝试就正确插入了LM。在以氯胺酮为基础的联合静脉麻醉中，插入LM时的升压反应表现为心率增加5.6%（1K组——对照组），2K组（分次给予氯胺酮（1.5 - 2mg/kg）+地西泮（0.1mg/kg）和芬太尼（2.6μg/kg））心率增加10.2%；巴比妥类药物后，1B组（对照组）心率增加6.7%，丙泊酚后，1D组（对照组）心率未增加，而2D组（分次给予丙泊酚（1mg/kg）+氯胺酮（25 - 50mg）、地西泮（0.08mg/kg）和芬太尼（2.6μg/kg））平均动脉压增加10%，心率增加6.6%。在所有类型的诱导麻醉中，气管插管反应都很明显。在任何情况下均未观察到反流或误吸。因此，在插入LM时使用完全肌松可允许以最佳剂量使用各种现代麻醉药，并显著简化LM的使用。
