儿童喉罩气道：两种置入技术的比较

The Proseal laryngeal mask airway in children: a comparison between two insertion techniques.

作者信息

Teoh Chuan Yeong, Lim Felicia S K

机构信息

Department of Anaesthesia & Intensive Care, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

出版信息

Paediatr Anaesth. 2008 Feb;18(2):119-24. doi: 10.1111/j.1460-9592.2007.02385.x.

DOI:10.1111/j.1460-9592.2007.02385.x

PMID:18184242

Abstract

BACKGROUND

The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children.

METHODS

One hundred and twenty-four children aged 1-12 years, weight 8-29 kg, ASA I-II, undergoing peripheral surgery were studied. Patients were randomly divided into either IT group (n = 64) or GEB group (n = 60). Following a standardized anesthesia protocol, the IT technique was performed according to the manufacturer's instruction. The GEB-guided technique involved priming the drain tube with a GEB, placing the distal end of the GEB into the esophagus under gentle laryngoscopy and railroading the Proseal LMA into position. All insertions of Proseal LMA were performed by two experienced investigators. Data were collected regarding rate of successful insertion, incidence of oral, gastric and drain tube air leak, ease of gastric tube placement and frequency of airway-related complications.

RESULTS

Insertion was equally successful at the first attempt (IT 96.9%, GEB 95.0%) in both groups. Efficacy of seal was better in the GEB group (oral leak, IT 35.9%, GEB 18.3%, P < 0.05; gastric leak, IT 21.9%, GEB 5.0%, P < 0.05; drain tube leak, IT 7.8%, GEB 0%, P < 0.05). Position of Proseal LMA in relation to the glottis was better in the IT group (grade I, IT 0%, GEB 11.7%; grade II, IT 29.7%, GEB 23.3%; grade III, IT 28.1%, GEB 25.0%; grade IV, IT 42.2%, GEB 40.0%; P < 0.05). Gastric tube placement was equally successful (IT 100%, GEB 100%) and frequency of airway-related problems was similar for both groups (IT 3.2%, GEB 6.1%).

CONCLUSIONS

A gum elastic bougie-guided insertion technique in children is comparable with the IT technique in terms of success rate and may be useful as a backup technique when the IT technique fails.

摘要

背景

喉罩气道（PLMA）是一种相对较新的声门上气道装置，带有引流管，可将胃胀气和误吸的风险降至最低。我们比较了在儿童中使用引导器工具（IT）和弹性橡胶探条（GEB）引导技术插入喉罩气道的情况。

方法

研究了124例年龄1至12岁、体重8至29千克、ASA I-II级、接受外周手术的儿童。患者被随机分为IT组（n = 64）或GEB组（n = 60）。按照标准化麻醉方案，IT技术根据制造商的说明进行。GEB引导技术包括用GEB对引流管进行准备，在轻柔喉镜检查下将GEB远端放入食管，并将喉罩气道沿其推送至合适位置。所有喉罩气道的插入均由两名经验丰富的研究人员进行。收集了关于首次插入成功率、口腔、胃和引流管漏气发生率、胃管放置的难易程度以及气道相关并发症发生率的数据。

结果

两组首次尝试插入的成功率相同（IT组96.9%，GEB组95.0%）。GEB组的密封效果更好（口腔漏气，IT组35.9%，GEB组18.3%，P < 0.05；胃漏气，IT组21.9%，GEB组5.0%，P < 0.05；引流管漏气，IT组7.8%，GEB组0%，P < 0.05）。IT组中喉罩气道相对于声门的位置更好（I级，IT组0%，GEB组11.7%；II级，IT组29.7%，GEB组23.3%；III级，IT组28.1%，GEB组25.0%；IV级，IT组42.2%，GEB组40.0%；P < 0.05）。胃管放置成功率相同（IT组100%，GEB组100%），两组气道相关问题的发生率相似（IT组3.2%，GEB组6.1%）。