Chen Ching-Chi, Hung Wei-Te, Liou Cher-Ming
Department of Anesthesiology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 2002 Mar;40(1):21-4.
The purpose of this study was to evaluate whether manipulation or position change of the head during dental procedures for handicapped patients (mentally retarded) using a reinforced laryngeal mask airway for ventilation would lead to air leak.
All patients had a reinforced laryngeal mask airway inserted after induction of anesthesia; anesthesia was maintained with sevoflurane. Normal saline stained with methylene blue was instilled into the oral cavity of the patient. Then, the patient's laryngeal region was checked for blue staining with a fiberoptic bronchoscope. After dental treatment, the laryngeal region was checked again under fiberoptic bronchoscopy. The staining results were recorded and analyzed.
In one of 51 patients (1.96%), the laryngeal region was stained blue after the flexible laryngeal mask airway was inserted. In ten of 51 (19.6%) patients, the laryngeal area was stained blue after the dental procedure. One of the ten patients who had a leak because the laryngeal mask was pulled out during the dental procedure. And in another one patient endotracheal tube was placed in lieu of laryngeal mask due to severe leakage. No oxygen desaturation below 90% occurred in all patients. No major complications such as fever or aspiration pneumonia were reported.
The use of a reinforced laryngeal mask airway eliminates the complications due to endotracheal intubation and enhances the progress of the dental procedure. Although leakage may happen during dental manipulation, it usually does not raise serious problem. No serious complications such as aspiration were found in our cases. So a reinforced laryngeal mask airway may be considered to be another safe choice for maintenance of a patent airway in handicapped patients during dental procedures.
本研究的目的是评估在为残疾患者（智力迟钝）进行牙科手术时，使用加强型喉罩气道进行通气，头部的操作或位置改变是否会导致漏气。
所有患者在麻醉诱导后插入加强型喉罩气道；使用七氟醚维持麻醉。将用亚甲蓝染色的生理盐水滴入患者口腔。然后，用纤维支气管镜检查患者的喉部区域是否有蓝色染色。牙科治疗后，再次在纤维支气管镜下检查喉部区域。记录并分析染色结果。
51例患者中有1例（1.96%）在插入柔性喉罩气道后喉部区域被染成蓝色。51例患者中有10例（19.6%）在牙科手术后喉部区域被染成蓝色。10例发生漏气的患者中有1例是因为在牙科手术过程中喉罩被拔出。另有1例患者因严重漏气而放置了气管内导管代替喉罩。所有患者均未出现氧饱和度低于90%的情况。未报告发热或吸入性肺炎等重大并发症。
使用加强型喉罩气道可消除气管插管引起的并发症，并促进牙科手术的进行。虽然在牙科操作过程中可能会发生漏气，但通常不会引发严重问题。在我们的病例中未发现吸入等严重并发症。因此，加强型喉罩气道可被认为是残疾患者在牙科手术期间维持气道通畅的另一种安全选择。
