Kaplan Andrew, Crosby Gregory J, Bhattacharyya Neil
Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
Laryngoscope. 2004 Apr;114(4):652-5. doi: 10.1097/00005537-200404000-00010.
OBJECTIVES/HYPOTHESIS: The objective was to compare the laryngeal mask airway and endotracheal tube for airway protection from blood during sinonasal surgery.
Nonrandomized, controlled, prospective clinical trial.
Patients scheduled to undergo sinonasal surgery (septoplasty and/or endoscopic sinus surgery) were prospectively enrolled and grouped according to type of airway during general anesthesia with choice of airway device based on the anesthesiologist's preference. Clinical data were tabulated by case including airway device, patient age, weight, estimated blood loss, airway pop-off pressure, and emergence quality. At the conclusion of surgery, the airway was examined through the laryngeal mask airway or endotracheal tube with a flexible fiberoptic bronchoscope to determine the amount of blood present on the vocal cords or in the trachea. The airway device was also evaluated postoperatively for the presence of blood.
Seventy-six adult patients were initially enrolled; two were excluded because fiberoptic evaluation of the airway could not be completed. Of the remaining 74 patients, an endotracheal tube and laryngeal mask airway were used in 31 and 43 patients, respectively. The two groups did not differ with respect to age, weight, estimated blood loss during surgery, pop-off pressure, or emergence quality (all P >.05). Patients managed with an laryngeal mask airway were significantly less likely to have blood staining the airway (glottis or trachea) than patients with an endotracheal tube (19.5% vs. 84.8%, chi test [P <.001]). However, the endotracheal tube provided better protection than the laryngeal mask airway against distal tracheal blood contamination (3.2% vs. 14.6%, respectively [P =.110]).
The laryngeal mask airway provides better protection of the upper airway from blood contamination during sinonasal surgery than a standard endotracheal tube, but there is a higher incidence of distal tracheal contamination. The laryngeal mask airway is a reasonable alternative to endotracheal intubation for airway management in sinonasal surgery.
目的/假设：目的是比较在鼻窦手术中喉罩气道和气管内导管对气道的血液保护作用。
非随机、对照、前瞻性临床试验。
前瞻性纳入计划接受鼻窦手术（鼻中隔成形术和/或鼻内镜鼻窦手术）的患者，并根据全身麻醉期间的气道类型进行分组，气道装置的选择基于麻醉医生的偏好。临床数据按病例列表，包括气道装置、患者年龄、体重、估计失血量、气道逸气压力和苏醒质量。手术结束时，通过喉罩气道或气管内导管使用柔性纤维支气管镜检查气道，以确定声带或气管内的血液量。术后还对气道装置进行血液存在情况的评估。
最初纳入76例成年患者；2例因无法完成气道的纤维光学评估而被排除。在其余74例患者中，分别有31例和43例使用了气管内导管和喉罩气道。两组在年龄、体重、手术期间估计失血量、逸气压力或苏醒质量方面无差异（所有P>.05）。与使用气管内导管的患者相比，使用喉罩气道管理的患者气道（声门或气管）被血液染色的可能性显著降低（19.5%对84.8%，卡方检验[P<.001]）。然而，气管内导管比喉罩气道对远端气管血液污染提供了更好的保护（分别为3.2%对14.6%[P =.110]）。
在鼻窦手术中，喉罩气道比标准气管内导管能更好地保护上呼吸道免受血液污染，但远端气管污染的发生率更高。喉罩气道是鼻窦手术气道管理中气管内插管的合理替代方案。
