Law-Koune Jean-Dominique, Liu Ngai, Szekely Barbara, Fischler Marc
Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France.
J Neurosurg Anesthesiol. 2004 Jan;16(1):11-3. doi: 10.1097/00008506-200401000-00003.
Airway management may be difficult in acromegalic patients. The purpose of the study was to evaluate the intubating laryngeal mask airway (ILMA) as a primary tool for ventilation and intubation in acromegalic patients. Twenty-three consenting consecutive adult acromegalic patients presenting for transsphenoidal resection of pituitary adenoma were enrolled in the study. Anesthesia was induced using propofol (1.5 mg/kg followed by 0.5-mg/kg increments); the ILMA was inserted when the bispectral index fell below 50. The ILMA was successful as a primary airway for oxygenation and ventilation at the first attempt for 21 (91%) patients, while 2 (9%) patients required a second attempt. Patient movement was noticed in five (21.7%) of the patients during ILMA insertion. An attempt at tracheal intubation through the ILMA was performed following administration of a mean 395 +/- 168-mg dose of propofol. Overall success rates for tracheal intubation were 82% (19 patients). The first-attempt success rate for tracheal intubation was 52.6% (10 patients), second- and third-attempt success rates were 42.1% (8 patients) and 5.3% (1 patient), respectively. Coughing or movement during intubation was observed in 12 (63.2%) of the patients. Direct laryngoscopy permitted intubation in three cases and blind intubation using a bougie in the fourth case. ILMA can be used as a primary airway for oxygenation in acromegalic patients (manual bag ventilation), but the rate of failed blind intubation through the ILMA precludes its use as a first choice for elective airway management.
肢端肥大症患者的气道管理可能具有挑战性。本研究的目的是评估插管喉罩气道（ILMA）作为肢端肥大症患者通气和插管的主要工具。23例连续同意接受垂体腺瘤经蝶窦切除术的成年肢端肥大症患者纳入本研究。使用丙泊酚诱导麻醉（1.5mg/kg，随后每次递增0.5mg/kg）；当脑电双频指数低于50时插入ILMA。ILMA作为初次氧合和通气的主要气道，21例（91%）患者首次尝试成功，2例（9%）患者需要再次尝试。在插入ILMA期间，5例（21.7%）患者出现身体移动。在平均给予395±168mg丙泊酚后，通过ILMA进行气管插管尝试。气管插管的总体成功率为82%（19例患者）。气管插管的首次成功率为52.6%（10例患者），第二次和第三次成功率分别为42.1%（8例患者）和5.3%（1例患者）。12例（63.2%）患者在插管期间出现咳嗽或身体移动。3例患者通过直接喉镜检查成功插管，第4例患者使用探条进行盲插。ILMA可作为肢端肥大症患者氧合的主要气道（手动气囊通气），但通过ILMA进行盲插失败的发生率使其不能作为择期气道管理的首选。
