Sawasdiwipachai Prasert, Boonsri Settapong, Suksompong Sirilak, Prowpan Paron
Mahidol University, Bangkoknoi, Bangkok, Thailand.
J Anesth. 2015 Oct;29(5):660-5. doi: 10.1007/s00540-015-2004-1. Epub 2015 Mar 28.
The use of an endobronchial blocker in conjunction with a supraglottic device in elective thoracic cases has never been studied. The aim of this study was to report the success rate and time to placement of the endobronchial blocker in anaesthetized patients with a laryngeal mask airway (LMA)-ProSeal™ in place.
This was a single-center, prospective, descriptive pilot study that enrolled 30 patients aged 18-75 years, with ASA I-III, who underwent elective thoracotomy or video-assisted thoracoscopy. We collected data on time to placement of the endobronchial blocker into the selected bronchus, time consumed for final blocker positioning and inflation, lung deflation score at chest opening, and postoperative airway complications.
One patient was excluded because of high peak airway pressure during LMA ventilation. The time required for blocker placement in the right main bronchus was shorter [mean 160 (78-480) s] compared with that for the left main bronchus [225 (117-420) s]. The blocker was successfully placed on the first attempt in 25 patients. Lung deflation score graded by the surgeon was 8/10 (median). Minor postoperative airway complications, such as sore throat (28.6 %) and hoarseness of voice (17.9 %), were reported.
The use of LMA-ProSeal™ in conjunction with the COOPDECH Endobronchial Blocker Tube may be considered an alternative one-lung ventilation technique in selected cases. However, success rates and time required for placement of the blocker seem dependent on the operator's skill. Although postoperative sore throat and hoarseness of voice were reported, these improved in 24 h.
在择期胸科手术中，联合使用支气管内封堵器与声门上装置的情况尚未得到研究。本研究的目的是报告在已置入喉罩气道（LMA）-ProSeal™的麻醉患者中，支气管内封堵器的成功率及置入时间。
这是一项单中心、前瞻性、描述性的试点研究，纳入了30例年龄在18 - 75岁、ASA分级为I - III级、接受择期开胸手术或电视辅助胸腔镜手术的患者。我们收集了将支气管内封堵器置入选定支气管的时间、最终封堵器定位和充气所花费的时间、开胸时的肺萎陷评分以及术后气道并发症的数据。
1例患者因LMA通气期间气道峰压过高被排除。与左主支气管相比，将封堵器置入右主支气管所需时间更短[平均160（78 - 480）秒]，左主支气管为[225（117 - 420）秒]。25例患者首次尝试即成功置入封堵器。外科医生评定的肺萎陷评分为8/10（中位数）。报告了轻微的术后气道并发症，如咽痛（28.6%）和声音嘶哑（17.9%）。
在特定病例中，LMA-ProSeal™联合COOPDECH支气管内封堵器管可被视为一种替代的单肺通气技术。然而，封堵器的成功率和置入所需时间似乎取决于操作者的技术。尽管报告了术后咽痛和声音嘶哑，但这些症状在24小时内有所改善。
