Han T H, Brimacombe J, Lee E J, Yang H S
Department of Anesthesiology Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea.
Can J Anaesth. 2001 Dec;48(11):1117-21. doi: 10.1007/BF03020379.
To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia.
Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N(2)O and 50% O(2) and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO(2) <94%, or end-tidal CO(2) >45 mmHg. Postdelivery, vecuronium and fentanyl were administered.
An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO(2) <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were >/=7 after five minutes.
We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.
报告在1067例连续选择全身麻醉的ASA I-II级患者中，喉罩气道（LMA）用于择期剖宫产的情况。
有咽反流、孕前体重指数>30或已知/预测有困难气道的患者被排除。患者禁食6小时，并给予雷尼替丁/枸橼酸钠。采用硫喷妥钠和琥珀胆碱进行快速顺序诱导。由经验丰富的使用者插入LMA。用N₂O和50% O₂及一种挥发性麻醉剂维持麻醉。环状软骨压迫一直维持到分娩，但如果插入/通气困难则放松。如果在90秒内未获得有效气道、或SpO₂<94%、或呼气末CO₂>45 mmHg，则对患者进行气管插管。产后给予维库溴铵和芬太尼。
1060例（99%）患者获得有效气道，1051例（98%）首次尝试成功，9例（1%）在第二次或第三次尝试成功。22例（21%）患者发生漏气或部分气道梗阻，7例（0.7%）患者需要气管插管。没有发生低氧血症（SpO₂<90%）、误吸、反流、喉痉挛、支气管痉挛或胃胀气事件。手术条件满意，5分钟后所有阿氏评分均≥7分。
我们得出结论，对于健康、经过筛选的患者，由经验丰富的LMA使用者操作时，LMA用于择期剖宫产是有效的且可能是安全的。
