Ray Shreyasi, Kirtania Jyotirmay
Department of Anesthesiology, ESI-PGIMSR, ESIC Medical College Joka, Kolkata, West Bengal, India.
Department of Anesthesiology, ESI-PGIMSR Manicktala, Kolkata, West Bengal, India.
Anesth Essays Res. 2020 Apr-Jun;14(2):305-311. doi: 10.4103/aer.AER_73_20. Epub 2020 Oct 12.
Passive movements of head and neck are sometimes unavoidable during surgery under general anesthesia due to patient positioning according to the needs of the surgery or transmitted movements from surgical manipulations.
This prospective crossover randomized study evaluates the effects of passive movements of the head and neck on the performance of i-gel supraglottic airway device in spontaneously breathing patients under general anesthesia.
Sixty spontaneously breathing patients on pressure support ventilation with positive end-expiratory pressure (PEEP) under general anesthesia were randomized to seven sequences of passive head-and-neck movements with i-gel® in situ. After steady state of general anesthesia was achieved and maintenance with sevoflurane in NO and O was reached, the passive head-and-neck movements were done. Peak airway pressure, exhaled minute volume, end-tidal carbon dioxide (ETCO), oxygen saturation, audible leak of airway gases, and visible outward displacement of the i-gel® were recorded in the neutral position and with each passive head-and-neck movement. Paired continuous data were analyzed by Friedman rank sum test with paired Wilcoxon signed-rank test. Paired nominal data were analyzed by Cochran's Q test with pair-wise McNemar test.
Extension, right or left lateral flexion, and right or left rotation of the head and neck resulted in significant reduction in the exhaled minute ventilation, rise in ETCO, and leak of airway gases compared to the neutral position ( < 0.05). Flexion movement did not cause significant changes in the exhaled minute ventilation, rise in ETCO, and audible leak of airway gases as compared to the neutral position.
Ventilatory performance of the i-gel® deteriorates upon extension, right or left lateral flexion, and right or left rotation of the head and neck in spontaneously breathing patients under general anesthesia on pressure support ventilation with PEEP.
在全身麻醉手术期间，由于根据手术需要进行患者体位摆放或手术操作产生的传导性运动，头颈部的被动运动有时是不可避免的。
这项前瞻性交叉随机研究评估了头颈部被动运动对全身麻醉下自主呼吸患者使用i-gel喉上气道装置的影响。
60例在全身麻醉下接受压力支持通气并设置呼气末正压（PEEP）的自主呼吸患者被随机分为七个序列，在i-gel原位的情况下进行头颈部被动运动。在全身麻醉达到稳态并使用七氟醚维持在一氧化氮和氧气中后，进行头颈部被动运动。记录中立位以及每次头颈部被动运动时的气道峰压、呼出分钟通气量、呼气末二氧化碳（ETCO）、氧饱和度、气道气体可闻泄漏以及i-gel的可见向外移位情况。配对连续数据采用Friedman秩和检验及配对Wilcoxon符号秩检验进行分析。配对名义数据采用Cochran's Q检验及两两McNemar检验进行分析。
与中立位相比，头颈部的伸展、右侧或左侧侧屈以及右侧或左侧旋转导致呼出分钟通气量显著降低、ETCO升高以及气道气体泄漏（P<0.05）。与中立位相比，屈曲运动未导致呼出分钟通气量、ETCO升高以及气道气体可闻泄漏出现显著变化。
在全身麻醉下接受压力支持通气并设置PEEP的自主呼吸患者中，头颈部的伸展、右侧或左侧侧屈以及右侧或左侧旋转会使i-gel的通气性能恶化。
