Hemmerling Thomas M, Beaulieu Pierre, Jacobi Klaus E, Babin Denis, Schmidt Joachim
Department of Anesthesiology, Université de Montréal, Hôtel-Dieu, 3840 St. Urbain, Montréal, Québec H2W 1T8, Canada.
Can J Anaesth. 2004 Aug-Sep;51(7):728-32. doi: 10.1007/BF03018434.
Positive pressure ventilation using a laryngeal mask airway (LMA) has gained increased popularity. This study examined the influence of neuromuscular blockade on the incidence and severity of pharyngolaryngeal discomfort after positive pressure ventilation using a LMA.
130 patients were included in this prospective, double-blind, randomized two-centre study. Anesthesia was induced with remifentanil and propofol and maintained using remifentanil and sevoflurane in 30% oxygen and 70% air. Patients were mechanically ventilated at 15 breaths.min(-1) with tidal volumes to maintain Petco(2) 30-40 mmHg. Patients were randomly assigned to receive no neuromuscular blocking agent (NOBLOCK group) or cisatracurium prior to LMA insertion (BLOCK group). Prior to the end of surgery, morphine 3 to 5 mg iv were injected. The ease of insertion of the LMA, cuff pressure, and inspiratory pressure were recorded. Patients were asked immediately after two hours, and 24 hr after surgery to rate sore throat, dysphonia, or dysphagia as absent, minimal, moderate or severe. Continuous and categorical data were compared using t test and Chi-squared test, respectively.
68 and 62 patients were randomized to the NOBLOCK and BLOCK groups, respectively. Successful insertion on first attempt were 89% and 92% in the NOBLOCK and BLOCK groups, respectively. Mean intracuff and inspiratory pressures were 85 +/- 35 mmHg and 13 +/- 3 mmHg for the NOBLOCK group, and 96 +/- 34 mmHg and 15 +/- 2 mmHg for the BLOCK group. The immediate, two and 24 hr postoperative incidences and severity of sore throat, dysphonia, and dysphagia did not differ significantly between the two groups.
Neuromuscular blockade does not influence the ease or rate of success of LMA insertion nor the incidence and severity of pharyngolaryngeal discomfort after positive pressure ventilation using a LMA.
使用喉罩气道（LMA）进行正压通气越来越普遍。本研究探讨了神经肌肉阻滞对使用LMA进行正压通气后咽喉部不适的发生率和严重程度的影响。
130例患者纳入这项前瞻性、双盲、随机双中心研究。麻醉诱导采用瑞芬太尼和丙泊酚，维持麻醉使用瑞芬太尼和七氟醚，吸入30%氧气和70%空气。患者以15次/分钟的频率进行机械通气，潮气量以维持呼气末二氧化碳分压（Petco₂）在30 - 40 mmHg。患者在插入LMA前被随机分配接受无神经肌肉阻滞剂（无阻滞组）或顺式阿曲库铵（阻滞组）。手术结束前，静脉注射吗啡3至5 mg。记录LMA的插入难易程度、套囊压力和吸气压力。术后2小时和24小时，询问患者咽痛、声音嘶哑或吞咽困难的程度，分为无、轻微、中度或重度。连续数据和分类数据分别采用t检验和卡方检验进行比较。
分别有68例和62例患者被随机分配到无阻滞组和阻滞组。无阻滞组和阻滞组首次尝试成功插入的比例分别为89%和92%。无阻滞组套囊平均压力和吸气压力分别为85±35 mmHg和13±3 mmHg，阻滞组分别为96±34 mmHg和15±2 mmHg。两组术后即刻、2小时和24小时咽痛、声音嘶哑和吞咽困难的发生率及严重程度无显著差异。
神经肌肉阻滞不影响LMA插入的难易程度或成功率，也不影响使用LMA进行正压通气后咽喉部不适的发生率和严重程度。
