Raokadam Vasanth, Thiruvenkatarajan Venkatesan, Bouras George S, Zhang Alex, Psaltis Alkis
Department of Anaesthesia, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia.
Department of Otolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville South, Australia.
Indian J Anaesth. 2024 May;68(5):460-466. doi: 10.4103/ija.ija_966_23. Epub 2024 Apr 12.
During endoscopic sinus surgery, anaesthetic conditions significantly impact the intraoperative surgical field and bleeding during emergence. While the endotracheal tube (ETT) has been traditionally used in sinus surgery, a reinforced laryngeal mask airway (RLMA) that produces less upper airway stimulation may result in smoother emergence.
A randomised controlled trial of 72 patients undergoing elective sinus surgery was conducted, with the allocation of airway technique to either ETT with a throat pack or RLMA. The primary outcome measure was emergence time, measured by time to opening eyes on commands at the cessation of anaesthesia, and the secondary outcomes were time to removal of airway device, remifentanil use, procedure times, mean arterial pressure (MAP) and the RLMA grade of blood contamination. The continuous variables were analysed using Student's -tests and discrete variables, count tables were analysed using Fisher's exact tests.
There was no significant difference in the emergence time between the ETT and RLMA groups ( = 0.83). Remifentanil use was significantly higher in the ETT group than in the RLMA group ( = 0.022). The ETT group showed a significantly increased total anaesthetic time ( = 0.01). MAP was not significant during preinduction, maintenance or post-RMLA removal. The highest grade of contamination was grade 2 in RLMA. RLMA had lower rates of postoperative adverse events.
RLMA comparable to ETT in terms of emergence time. The RMLA group had lower remifentanil use, anaesthesia duration and fewer postoperative adverse events such as cough and throat pain.
在内镜鼻窦手术中，麻醉条件会显著影响术野及苏醒期出血情况。虽然传统上鼻窦手术一直使用气管内插管（ETT），但一种对上气道刺激较小的加强型喉罩气道（RLMA）可能会使苏醒过程更平稳。
对72例行择期鼻窦手术的患者进行随机对照试验，气道技术分配为使用带喉塞的ETT或RLMA。主要观察指标为苏醒时间，通过麻醉停止后按指令睁眼的时间来测量，次要观察指标为气道装置拔除时间、瑞芬太尼使用量、手术时间、平均动脉压（MAP）以及RLMA的血液污染分级。连续变量采用学生t检验进行分析，离散变量、计数表采用Fisher精确检验进行分析。
ETT组和RLMA组的苏醒时间无显著差异（P = 0.83）。ETT组的瑞芬太尼使用量显著高于RLMA组（P = 0.022）。ETT组的总麻醉时间显著延长（P = 0.01）。诱导前、维持期或拔除RLMA后MAP无显著差异。RLMA的最高污染等级为2级。RLMA的术后不良事件发生率较低。
RLMA在苏醒时间方面与ETT相当。RLMA组的瑞芬太尼使用量、麻醉持续时间较低，术后咳嗽和咽痛等不良事件较少。
