Goldmann K, Hoch N, Wulf H
Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2006 Apr;41(4):228-32. doi: 10.1055/s-2005-921200.
The ProSeal laryngeal mask airway (PLMA) is increasingly used for surgical procedures that might require the intraoperative use of neuromuscular blocking agents. The airway seal of the PLMA depends on the interplay of the surrounding soft tissue of the neck and the cuff of the mask. An intraoperative neuromuscular blockade could lead to a decrease of the airway leak pressure (P (leak)) secondary to the relaxation of the muscles of the neck. With this study we tested the hypothesis that a neuromuscular blockade can result in a decreased P (leak) of the PLMA.
The P (leak) of the PLMA was studied in 73 female patients under total intravenous anaesthesia with propofol (0.1 - 0.15 mg kg (-1) min (-1)) and remifentanil (0.1 - 0.3 microg kg (-1) min (-1)) before and after a complete neuromuscular blockade produced by intravenous injection of 0.6 mg kg (-1) Rocuronium.
The P (leak) decreased by more than 10 % of the baseline P (leak) in 8 out of 73 patients (11 %); however, in the entire study population there was no significant difference between the mean baseline P (leak) (28.5 +/- 7.3 cm H(2)O) and the mean P (leak) after complete neuromuscular blockade (29.1 +/- 7.0 cm H(2)O); (p = 0.128).
No general correlation between application of a neuromuscular blocking agent and a decrease of the mean P (leak) was found. However, the decrease of the P (leak) by more than 10 % in 11 % of the patients shows that in certain patients the application of neuromuscular blocking agents can result in a decreased P (leak) of the PLMA and indicates the necessity to control the P (leak) of the PLMA under complete muscle paralysis preoperatively when neuromuscular blocking agents are used.
食管-气管联合导管喉罩气道（PLMA）越来越多地用于可能需要术中使用神经肌肉阻滞剂的手术。PLMA的气道密封取决于颈部周围软组织与喉罩套囊之间的相互作用。术中神经肌肉阻滞可能会导致颈部肌肉松弛，进而引起气道漏气压力（P（leak））降低。在本研究中，我们检验了神经肌肉阻滞会导致PLMA的P（leak）降低这一假设。
在73例接受丙泊酚（0.1 - 0.15 mg·kg⁻¹·min⁻¹）和瑞芬太尼（0.1 - 0.3 μg·kg⁻¹·min⁻¹）全静脉麻醉的女性患者中，研究静脉注射0.6 mg·kg⁻¹罗库溴铵产生完全神经肌肉阻滞后PLMA的P（leak）变化，观察时间点为神经肌肉阻滞前后。
73例患者中有8例（11%）的P（leak）下降超过基线P（leak）的10%；然而，在整个研究人群中，平均基线P（leak）（28.5 ± 7.3 cmH₂O）与完全神经肌肉阻滞后的平均P（leak）（29.1 ± 7.0 cmH₂O）之间无显著差异；（p = 0.128）。
未发现神经肌肉阻滞剂的应用与平均P（leak）降低之间存在普遍相关性。然而，11%的患者P（leak）下降超过10%表明，在某些患者中，神经肌肉阻滞剂的应用可导致PLMA的P（leak）降低，这表明在使用神经肌肉阻滞剂时，术前在完全肌肉麻痹状态下控制PLMA的P（leak）很有必要。
