Howath A, Brimacombe J, Keller C
Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Queensland, Australia.
Anaesth Intensive Care. 2002 Oct;30(5):624-7. doi: 10.1177/0310057X0203000514.
We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1-2 aged 18 to 80 years) were studied. The ProSeal LMA drainage tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the drainage tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17-40) cmH2O and ventilation was possible without leak in all patients at 9.5 ml x kg(-1) tidal volume. There were no drainage tube or gastric air leaks. Gastric tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.
我们测定了在弹性橡胶探条引导下插入食管引流型喉罩气道（ProSeal LMA）的成功率、心血管反应及气道并发症情况。研究对象为100例接受麻醉、未使用肌松剂的成年患者（年龄18至80岁，美国麻醉医师协会分级1至2级）。用一根充分润滑的16号弹性橡胶探条对ProSeal LMA的引流管进行准备，使弯曲端靠近近端，直端超出引流管尖端30厘米。在喉镜引导下将弹性橡胶探条的直端插入食管，移除喉镜，然后以弹性橡胶探条为引导，采用标准插入技术插入ProSeal LMA。记录以下变量：插入的难易程度、口咽漏气压、通气能力、胃管插入的难易程度、移除时探条或LMA上的血染情况以及术后气道并发症。在插入前即刻以及插入后5分钟内每分钟记录血流动力学数据。所有患者均在50秒内首次成功插入弹性橡胶探条和ProSeal LMA。心率和血压均无显著升高。口咽漏气压为33（17 - 40）厘米水柱，所有患者在潮气量为9.5毫升/千克时通气无漏气。无引流管或胃内气体泄漏。所有患者首次尝试插入胃管均成功。弹性橡胶探条移除时未发现血染，但在3%的ProSeal LMA上发现有血染。咽痛、吞咽困难和构音障碍的发生率分别为21%、9%和1%。我们得出结论，在弹性橡胶探条引导下插入ProSeal LMA成功率高，血流动力学变化极小，创伤发生率低。
