Wu Lei, Wei Si Wei, Xiang Zhen, Yu Er You, Qu Shuang Quan, Du Zhen
Department of Anaesthesiology, Hunan Children's Hospital, Changsha, Hunan, China.
Department of Anaesthesiology, Hunan Children's Hospital, Changsha, Hunan, China.
Br J Anaesth. 2021 Aug;127(2):281-288. doi: 10.1016/j.bja.2021.04.031. Epub 2021 Jun 17.
Use of an LMA ProSeal™ laryngeal mask airway (P-LMA; Teleflex) with no neuromuscular block is considered a safe alternative to tracheal intubation in short-duration paediatric laparoscopic surgery. However, few studies have evaluated surgical conditions of short-duration paediatric laparoscopic surgery using this anaesthetic technique. We assessed surgical conditions for paediatric laparoscopic inguinal hernia repair using P-LMA with and without neuromuscular block.
Sixty-six patients undergoing laparoscopic inguinal hernia repair were randomised to receive a neuromuscular block (train-of-four 1-2 twitches) using rocuronium or no neuromuscular block with the P-LMA. All operations were performed by the same surgeon who determined the surgical conditions using the Leiden-surgical rating scale (L-SRS). Secondary outcomes included perioperative data, haemodynamics, and adverse events.
Neuromuscular block improved surgical conditions compared with no neuromuscular block: mean (standard deviation) L-SRS 4.1 (0.5) vs 3.5 (0.6), respectively (P<0.0001). Mean rocuronium dose in the neuromuscular block group was 12.7 (4.4-29.7) mg or 0.7 (0.6-0.8) mg kg. The insufflation Ppeak was higher in the no neuromuscular block group than in the neuromuscular block group: mean (standard deviation) Ppeak 17.9 (1.8) cm HO vs 16.2 (1.9) cm HO, respectively (P=0.0004). Fifteen children (45.5%) in the no neuromuscular block group had adverse events during the surgery and anaesthesia vs four children (12.1%) in the neuromuscular block group (P=0.006).
Neuromuscular block significantly improved surgical conditions and reduced the incidence of adverse events during surgery and anaesthesia when an LMA Proseal™ was used in short-duration paediatric laparoscopic surgery.
ChiCTR2000038529.
在小儿短时间腹腔镜手术中，使用无神经肌肉阻滞的LMA ProSeal™喉罩气道（P-LMA；泰利福公司）被认为是气管插管的一种安全替代方法。然而，很少有研究评估使用这种麻醉技术进行小儿短时间腹腔镜手术的手术条件。我们评估了使用P-LMA并采用或不采用神经肌肉阻滞进行小儿腹腔镜腹股沟疝修补术的手术条件。
66例接受腹腔镜腹股沟疝修补术的患者被随机分为两组，一组使用罗库溴铵进行神经肌肉阻滞（四个成串刺激1-2次颤搐），另一组使用P-LMA但不进行神经肌肉阻滞。所有手术均由同一位外科医生进行，该医生使用莱顿手术评分量表（L-SRS）确定手术条件。次要结局包括围手术期数据、血流动力学和不良事件。
与不进行神经肌肉阻滞相比，神经肌肉阻滞改善了手术条件：L-SRS的平均值（标准差）分别为4.1（0.5）和3.5（0.6）（P<0.0001）。神经肌肉阻滞组罗库溴铵的平均剂量为12.7（4.4-29.7）mg或0.7（0.6-0.8）mg/kg。不进行神经肌肉阻滞组的气腹峰值压力高于神经肌肉阻滞组：平均值（标准差）气腹峰值压力分别为17.9（1.8）cmH₂O和16.2（1.9）cmH₂O（P=0.0004）。不进行神经肌肉阻滞组有15名儿童（45.5%）在手术和麻醉期间发生不良事件，而神经肌肉阻滞组有4名儿童（12.1%）发生不良事件（P=0.006）。
在小儿短时间腹腔镜手术中使用LMA ProSeal™时，神经肌肉阻滞显著改善了手术条件，并降低了手术和麻醉期间不良事件的发生率。
ChiCTR2000038529。
