Azma Toshiharu, Kawai Kazumi, Okida Motoichi, Okada Kuniko, Tamura Hideki
Department of Anesthesia, Hiroshima Red Cross & Atomic Bomb Survivors Hospital, Hiroshima 730-8619, Japan.
Hiroshima J Med Sci. 2002 Dec;51(4):89-92.
The laryngeal mask airway (LMA) is selected as an alternative to the endotracheal tube (ETT) when rapid recovery from general anesthesia is considered. However, the clinical significance of this airway for abdominal surgery is unclear. Thus, we evaluated whether the LMA, in combination with regional anesthesia, facilitates the induction of and emergence from general anesthesia in patients undergoing elective colorectal surgery. Anesthesia-controlled time in a ETT/Epidural Anesthesia (EA) group [n = 11; general anesthesia, combined with epidural anesthesia, was maintained by sevoflurane (< 3%) supplemented with a fixed rate of propofol (3 mg/kg/h) under controlled ventilation using the ETT] was compared with that in a LMA/Combined Spinal-Epidural Anesthesia (CSEA) group [n = 10; in combination with spinal-epidural anesthesia, general anesthesia was maintained as the same protocol as the ETT/EA under spontaneous ventilation using the LMA]. Time for airway placement in the LMA/CSEA group was significantly shorter than that in the ETT/EA group. Intervals from the end of surgery until the removal of the airway or the decision to exit the operating room in the LMA/CSEA group were shorter than those in the ETT/EA group. No practical sign of aspiration pneumonia and/or atelectasis was found in patients in either group. Under the circumstance of regional anesthesia being requested for post-surgical pain management, we concluded that the LMA facilitated the emergence from as well as the induction of anesthesia without any practical complication when used for patients in colorectal surgery.
当考虑全麻快速恢复时,喉罩气道(LMA)被选作气管内插管(ETT)的替代方案。然而,这种气道在腹部手术中的临床意义尚不清楚。因此,我们评估了LMA联合区域麻醉是否有助于择期结直肠手术患者的全麻诱导和苏醒。将气管内插管/硬膜外麻醉(EA)组[ n = 11;采用气管内插管在控制通气下,通过七氟醚(<3%)并辅以固定速率的丙泊酚(3mg/kg/h)维持全麻联合硬膜外麻醉]的麻醉控制时间与喉罩气道/腰麻-硬膜外联合麻醉(CSEA)组[ n = 10;采用喉罩气道在自主通气下,联合腰麻-硬膜外麻醉,按照与气管内插管/EA组相同的方案维持全麻]进行比较。喉罩气道/CSEA组的气道放置时间显著短于气管内插管/EA组。喉罩气道/CSEA组从手术结束到气道移除或决定离开手术室的间隔时间短于气管内插管/EA组。两组患者均未发现吸入性肺炎和/或肺不张的实际迹象。在要求区域麻醉进行术后疼痛管理的情况下,我们得出结论,对于结直肠手术患者,LMA用于麻醉诱导和苏醒时,无任何实际并发症,且有助于麻醉苏醒。