Ge Na, Guan Ming, Li Xi, Li Shuai, Wang En-bo
Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
Department of Implantology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Dec 18;47(6):1010-4.
To access the feasibility and safety of application of flexible laryngeal mask airway (FLMA) in oral & maxillofacial day surgery.
Retrospective study was conducted of 40 oral & maxillofacial day surgery patients (3 to 61 years of age) using FLMA under general anaesthesia in Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology. All the patients were with American Society of Anesthesiologists(ASA) physical status I-II,including 19 males and 21 females. The patients'vital signs were recorded at five different time points: baseline before anesthesia (T0), time right after the FLMA insertion (T1), time at incision (T2), 15 min after incision (T3) and time at the end of the operation (T4). The first attempted FLMA insertion successful rate and the number of timed of changing to endotracheal intubation were recorded. During operation, frequencies of movement, hypoxia and obstruction of airway were noted and the operation time, anesthesia time, time from the end of the operation to extubation, movement and coughing following extubation and sore throat within 24 h were taken down. Operation-related complications of bleeding, hematoma and injury of local nerves were recorded within 24 h as well.
The operations of all the 40 patients were successfully done under general anaesthesia. The 36(90%, 36/40)patients using FLMA successfully were under steady process, including 16 males and 20 females. The first attempted successful rate of FLMA insertion was 80% (32/40), and the second 50% (4/8). Three out of the 4 failed FLMA patients were changed to endotracheal intubation after the second attempt failed. The other patient was changed to endotracheal intubation before operation because of leak. The average operation time was (46.58 ± 22.57) min, the anesthesia time was (77.97 ± 26.82) min and the time from the end of operation to extubation was (8.31 ± 3.33) min. All the patients were recorded without obvious body movement during the operation procedure. There were 4 patients (11.11%, 4/36) with slight body movement during extubation. The incidence of sore throat was 13.89% (5/36) within 24 h postoperatively. There were no complications of bleeding, hematoma and injury of local nerves. The vital signs of baseline T0 were significantly different from those at other time points T1, T2, T3, and T4 (P<0.01). As to the hearts rate after anesthesia, the values at T1, T2, T3 and T4 for two-two comparison, there was no statistical difference (P>0.05). As to the values of systolic blood pressure and diastolic blood pressure after anesthesia at T1 and T4, T2 and T3, for two-two comparison, there was no statistical difference (P>0.05). As to the respiratory rate from the start of the surgery, the values at T2, T3 and T4 showed no statistical difference (P>0.05).
Flexible laryngeal mask airway is a supraglottic airway management method. It is suitable and safe for securing the airway in oral & maxillofacial day surgery. The advantages of fewer haemodynamic changes and postoperative complications are confirmed.
探讨在口腔颌面日间手术中应用喉罩（FLMA）的可行性及安全性。
对北京大学口腔医学院口腔颌面外科40例口腔颌面日间手术患者（年龄3至61岁）在全身麻醉下使用喉罩进行回顾性研究。所有患者美国麻醉医师协会（ASA）身体状况分级为I-II级，其中男性19例，女性21例。在五个不同时间点记录患者生命体征：麻醉前基线（T0）、喉罩插入后即刻（T1）、切开时（T2）、切开后15分钟（T3）及手术结束时（T4）。记录首次喉罩插入成功率及改为气管插管的次数。术中记录肢体活动、缺氧及气道梗阻发生频率，并记录手术时间、麻醉时间、手术结束至拔管时间、拔管后肢体活动及咳嗽情况以及术后24小时内咽痛情况。同时记录术后24小时内与手术相关的出血、血肿及局部神经损伤等并发症情况。
40例患者均在全身麻醉下顺利完成手术。36例（90%，36/40）成功使用喉罩的患者手术过程平稳，其中男性16例，女性20例。喉罩首次插入成功率为80%（32/（40），第二次为50%（4/8）。4例喉罩插入失败患者中，3例在第二次尝试失败后改为气管插管，另1例因漏气在手术前改为气管插管。平均手术时间为（46.58±22.57）分钟，麻醉时间为（77.97±26.82）分钟，手术结束至拔管时间为（8.31±3.33）分钟。所有患者术中均无明显肢体活动。4例患者（11.11%，4/36）拔管时有轻微肢体活动。术后24小时内咽痛发生率为13.89%（5/36）。无出血、血肿及局部神经损伤等并发症发生。T0时的生命体征与T1、T2、T3及T4时相比差异有统计学意义（P<0.01）。麻醉后心率方面，T1、T2、T3及T4两两比较差异无统计学意义（P>0.05）。麻醉后收缩压及舒张压在T1与T4、T2与T3两两比较差异无统计学意义（P>0.05）。手术开始后呼吸频率在T2、T3及T4时差异无统计学意义（P>0.05）。
喉罩是一种声门上气道管理方法，适用于口腔颌面日间手术气道管理，安全可行，血流动力学变化及术后并发症较少的优势得到证实。
