在自主呼吸的儿科人群中，不同头颈部位置下i-gel™喉罩与Laryngeal Mask Airway Supreme™喉罩的比较。
Comparison of i-gel™ and Laryngeal Mask Airway Supreme™ in Different Head and Neck Positions in Spontaneously Breathing Pediatric Population.
作者信息
Gupta Swati, Dogra Neelam, Chauhan Kanchan
机构信息
Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India.
出版信息
Anesth Essays Res. 2017 Jul-Sep;11(3):647-650. doi: 10.4103/aer.AER_238_16.
BACKGROUND
Although the advantages of ventilation with i-gel™ and laryngeal mask airway Supreme (LMA-Supreme™) has been well documented, they are still under debate for surgeries requiring flexion and extension of neck such as thyroid surgery, tonsillectomy, and neck exploration. Hence, we conducted a study to demonstrate the effect of neck flexion and extension in spontaneously breathing anesthetized pediatric patients utilizing i-gel™ and LMA-Supreme™.
METHODS
A prospective, randomized comparative study was conducted on sixty children, thirty each in i-gel™ and LMA-Supreme™ group. Oropharyngeal leak pressure (OPLP), fiberoptic view of vocal cords, and exhaled tidal volume were evaluated in neutral, flexion, and extension neck positions in spontaneously breathing children.
RESULTS
OPLP for i-gel™ was found to be significantly higher in flexion (29.00 ± 1.95 cmHO, < 0.001) and lower in extension (21.07 ± 2.08 cmHO, < 0.001) as compared to neutral (24.67 ± 2.08 cmHO). Similar results were observed for LMA-Supreme™ which showed significantly higher OPLP in flexion (24.73 ± 2.26, < 0.001 respectively) and lower in extension (18.67 ± 1.42 cmHO, < 0.001) as compared to neutral (20.87 ± 1.80 cmHO). Worsening of fiberoptic view occurs for i-gel™ and LMA-Supreme™ in flexion (10/12/5/3/0 and 11/14/2/2/1, < 0.05) as compared to neutral position (17/10/2/1/0 and 15/12/1/1/1), respectively. Significant change did not occur in extension. Ventilation worsening occurred in flexion as compared to neutral position evidenced by significant decrease in exhaled tidal volume (92.90 ± 11.42 and 94.13 ± 7.75 ml, < 0.05) as compared to neutral (100.23 ± 12.31 and 101.50 ± 8.26 ml) for i-gel™ and LMA-Supreme™, respectively.
CONCLUSION
Neck flexion caused a significant increase in leak pressure in both i-gel™ and LMA-Supreme™. With deterioration of fiberoptic view and ventilation, both devices should be used cautiously in pediatric patients in extreme flexion.
背景
尽管i-gel™喉罩和至尊型喉罩气道（LMA-Supreme™）通气的优势已有充分文献记载，但在诸如甲状腺手术、扁桃体切除术和颈部探查等需要颈部屈伸的手术中，它们仍存在争议。因此，我们开展了一项研究，以证明在自主呼吸的麻醉小儿患者中，颈部屈伸对使用i-gel™和LMA-Supreme™的影响。
方法
对60名儿童进行了一项前瞻性随机对照研究，i-gel™组和LMA-Supreme™组各30名。在自主呼吸的儿童处于颈部中立、屈曲和伸展位时，评估口咽漏气压（OPLP）、声带的纤维喉镜视野和呼出潮气量。
结果
发现i-gel™的OPLP在屈曲位时显著更高（29.00±1.95cmH₂O，P<0.001），在伸展位时更低（21.07±2.08cmH₂O，P<0.001），而中立位时为（24.67±2.08cmH₂O）。LMA-Supreme™也观察到类似结果，与中立位（20.87±1.80cmH₂O）相比，其在屈曲位时OPLP显著更高（分别为24.73±2.26，P<0.001），在伸展位时更低（18.67±1.42cmH₂O，P<0.001）。与中立位（分别为17/10/2/1/0和15/12/1/1/1）相比，i-gel™和LMA-Supreme™在屈曲位时纤维喉镜视野变差（分别为10/十二分之五/3/0和11/十四分之二/2/1，P<0.05）。伸展位时未发生显著变化。与中立位相比，屈曲位时通气变差，表现为i-gel™和LMA-Supreme™的呼出潮气量显著减少（分别为92.90±11.42和94.13±7.75ml，P<0.05），而中立位时为（100.23±12.31和101.50±8.26ml）。
结论
颈部屈曲导致i-gel™和LMA-Supreme™的漏气压显著增加。随着纤维喉镜视野和通气变差，在极度屈曲位的小儿患者中使用这两种装置时均应谨慎。
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