Flaishon Ron, Sotman Alexander, Friedman Alan, Ben-Abraham Ron, Rudick Valery, Weinbroum Avi A
Anesthesiology and Critical Care Department and Outpatient Surgery and Post-Anesthesia Care Units, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Anesthesiology. 2004 Feb;100(2):267-73. doi: 10.1097/00000542-200402000-00014.
Mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The laryngeal mask airway is part of the difficult airway algorithm. The authors evaluated the success rate and the time to secure airways by mask by anesthetists, surgeons, and novices when wearing either surgical attire or full antichemical protective gear that included butyl rubber gloves and a filtering antigas mask.
Twenty anesthetists and 22 surgeons with 2-5 yr of residency inserted a laryngeal mask airway in 84 anesthetized patients, and 6 novices repetitively inserted masks in 57 patients under both conditions in a prospective, randomized, crossover manner. The duration of insertion was measured from the time the device was first grasped until a normal capnography recording was obtained.
Anesthetists needed 39 +/- 14 s to insert the masks when wearing surgical attire and 40 +/- 12 s with protective gear. In contrast, surgery residents needed 64 +/- 40 and 102 +/- 40 s (P = 0.0001), respectively. Anesthetists inserted masks in a single attempt, whereas the surgeons needed up to four attempts with no hypoxia or failure associated. The initial attire-wearing novices' insertions took as long as the surgeons'; three of them then reached the mean performance time of the anesthetists after four (protective gear) and two (surgical attire) trials, with only one occurrence of hypoxia and a failure rate similar to that of the surgeons.
Anesthesia residents insert laryngeal mask airways at a similar speed when wearing surgical attire or limiting antichemical protective gear and two to three times faster than surgical residents or novices wearing either outfit. Novices initially perform at the level of surgical residents, but their learning curve was quick under both conditions.
大规模伤亡情况给气道管理带来特殊困难，即使对于经验丰富的医护人员也是如此。喉罩气道是困难气道处理流程的一部分。作者评估了麻醉医生、外科医生和新手在穿着手术服或全套防化防护服（包括丁基橡胶手套和过滤式防毒面具）时通过面罩确保气道安全的成功率和所需时间。
20名麻醉医生和22名有2至5年住院医师经历的外科医生，以前瞻性、随机、交叉方式，在84例麻醉患者中插入喉罩气道，6名新手在57例患者中在两种情况下重复插入面罩。插入持续时间从首次握住设备到获得正常的二氧化碳波形图记录开始测量。
麻醉医生穿着手术服时插入面罩需要39±14秒，穿着防护服时需要40±12秒。相比之下，外科住院医师分别需要64±40秒和102±40秒（P = 0.0001）。麻醉医生单次尝试即可插入面罩，而外科医生最多需要四次尝试，且未出现缺氧或失败情况。最初穿着服装的新手插入时间与外科医生一样长；其中三人在经过四次（防护服）和两次（手术服）试验后达到了麻醉医生的平均操作时间，仅出现一次缺氧情况，失败率与外科医生相似。
麻醉住院医师在穿着手术服或有限的防化防护服时插入喉罩气道的速度相似，比外科住院医师或穿着任何一种服装的新手快两到三倍。新手最初的表现与外科住院医师相当，但在两种情况下他们的学习曲线都很快。
