Gupta Anju, Saranlal A M, Gupta Nishkarsh
Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Onco-Anesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):564-573. doi: 10.4103/joacp.joacp_231_23. Epub 2024 Sep 11.
Interventional endoscopy procedures are challenging for anaesthesiologists due to the various patient, procedural, logistic, and position-related issues. Complex endoscopic procedures like biliary interventions and endoscopic myotomy necessitate longer procedural duration. The mode of anaesthesia is usually deep sedation without any definitive airway device and is frequently associated with hypoxemia events which can be catastrophic. An endotracheal tube, though the gold standard for securing the airway, would prolong the anaesthesia time and delay the recovery. The laryngeal mask airway Gastro™ is a novel supraglottic airway device specifically meant for these procedures as it provides access to the gastrointestinal tract simultaneously with a patent airway. Though its purported advantages are undoubted, its clinical usage has various pitfalls that can hinder its wider acceptance and practical utility, especially when newly introduced. The literature is limited on the feasibility of this device in both the ease of endoscopy and the prevention of hypoxemia. In this review, we have discussed the device's properties, its varied use cases, the supporting evidence for the same, the caveats, and the future perspectives.
由于存在各种与患者、手术、后勤和体位相关的问题,介入性内镜手术对麻醉医生来说具有挑战性。像胆道介入和内镜下肌切开术这样的复杂内镜手术需要更长的手术时间。麻醉方式通常是深度镇静,不使用任何确定性气道装置,并且经常与可能具有灾难性的低氧血症事件相关。气管内插管虽然是确保气道安全的金标准,但会延长麻醉时间并延迟恢复。喉罩气道Gastro™是一种新型的声门上气道装置,专门用于这些手术,因为它在保持气道通畅的同时能够进入胃肠道。尽管其声称的优点毋庸置疑,但其临床应用存在各种缺陷,可能会阻碍其更广泛的接受和实际应用,尤其是在刚引入时。关于该装置在内镜操作的便利性和预防低氧血症方面的可行性,文献报道有限。在本综述中,我们讨论了该装置的特性、其不同的使用案例、相关的支持证据、注意事项以及未来展望。