Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA -
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA -
Minerva Anestesiol. 2017 Sep;83(9):947-955. doi: 10.23736/S0375-9393.17.11403-3. Epub 2017 Mar 28.
The use of flexible laryngeal mask airway (FLMA) in elective ear, nose and throat (ENT) surgery offers significant advantages, but is frequently considered inferior to tracheal intubation (TI) for ventilation and airway protection. We investigated the safety and success rate of intraoperative FLMA use with positive pressure ventilation (PPV), and the factors responsible for FLMA failure.
A 15-year single center retrospective study. FLMA failure was defined as the need for FLMA removal and TI, either during induction (primary failure), or after turning the patient over to the surgeon (secondary failure). Strict failure criteria included the inability to achieve and/or maintain all 3 essential FLMA functions, such as ventilation (tidal volume ≥6 mL/kg), airway protection from above the cuff (airway sealing pressure [ASP] >12 cm H2O), and separation of the respiratory and gastrointestinal tracts (absent gastric insufflation during PPV).
In 685 patients, FLMA was successfully inserted in 94%. Secondary failure rate was 1.5%, with half of failures observed intraoperatively. The inability to seat FLMA during induction or FLMA dislodgment were the most common reasons for failures. The number of FLMA insertion attempts and low ASP were associated with FLMA primary failure and the need for TI. There were no complications.
The results suggest an acceptably low failure rate of use of FLMA with PPV in selected ENT surgical procedures. True intraoperative FLMA failure is uncommon. We advocate observing strict criteria for adequacy of FLMA placement, and close monitoring of FLMA function intraoperatively at all times.
在择期耳鼻喉（ENT）手术中使用灵活的喉罩气道（FLMA）具有显著优势，但通常被认为在通气和气道保护方面不如气管插管（TI）。我们研究了使用正压通气（PPV）时术中 FLMA 的安全性和成功率，以及导致 FLMA 失败的因素。
这是一项为期 15 年的单中心回顾性研究。FLMA 失败定义为需要移除 FLMA 并进行 TI，无论是在诱导期间（原发性失败）还是在将患者转交给外科医生后（继发性失败）。严格的失败标准包括无法实现和/或维持 FLMA 的所有 3 个基本功能，如通气（潮气量≥6mL/kg）、袖套上方的气道保护（气道密封压[ASP]＞12cmH2O）和呼吸与胃肠道的分离（在 PPV 期间无胃充气）。
在 685 例患者中，94%的患者成功插入了 FLMA。继发性失败率为 1.5%，其中一半的失败发生在术中。诱导期间无法放置 FLMA 或 FLMA 移位是失败的最常见原因。FLMA 插入尝试次数和低 ASP 与 FLMA 原发性失败和需要 TI 相关。没有发生并发症。
结果表明，在选择的 ENT 手术中，使用 FLMA 联合 PPV 的失败率可接受较低。真正的术中 FLMA 失败并不常见。我们主张观察 FLMA 放置充分性的严格标准，并在整个手术过程中密切监测 FLMA 的功能。
