Tatsumi K, Furuya H, Nagahata T, Hashimoto M, Sha K, Tanaka O, Matsunaga T, Okuda T
Department of Anesthesiology, Nara Medical University, Kashihara.
Masui. 1993 Mar;42(3):441-4.
The laryngeal mask (LM) was employed for the removal of a bronchial foreign body (screw) in a 2-year-old boy weighing 16 kg since the 6.0 mm external diameter fiberoptic bronchoscope (FBS) for extraction forceps could not be used under tracheal intubation. Anesthesia was induced with sevoflurane in 100% oxygen. After injection of fentanyl 25 micrograms and vecuronium 2 mg, a gastric tube and a size 2 LM were inserted. Throughout the extraction procedure by the FBS in the left main bronchus, the boy had one lung ventilated manually. The airway pressure was kept under 15 cmH2O to avoid gas leakage around the cuff and gastric inflation. Oxygen saturation of 100% with pulse oximetry and PETCO2 of 35 to 45 mmHg with capnometry were maintained. The foreign body was extracted by biopsy forceps. A Fogarty catheter was not effective because the balloon tip was broken by the screw. The LM does not prevent regurgitation and does not provide adequate ventilation under increased airway pressure, but it facilitates the use of a larger size FBS equipped with a variety of extraction forceps. Therefore, it seems to be a useful device for the removal of bronchial foreign bodies in children.
由于在气管插管下无法使用外径6.0 mm的带活检钳的纤维支气管镜（FBS），因此在一名体重16 kg的2岁男孩中使用喉罩（LM）取出支气管异物（螺丝钉）。采用七氟醚和100%氧气诱导麻醉。注射25微克芬太尼和2毫克维库溴铵后，插入胃管和2号喉罩。在通过FBS于左主支气管进行整个取出过程中，该男孩通过手动进行单肺通气。气道压力保持在15 cmH2O以下，以避免袖带周围漏气和胃胀气。通过脉搏血氧饱和度仪维持氧饱和度为100%，通过二氧化碳监测仪维持呼气末二氧化碳分压为35至45 mmHg。用活检钳取出异物。由于球囊尖端被螺丝钉弄破，Fogarty导管无效。喉罩不能防止反流，在气道压力增加时不能提供充分通气，但它便于使用配备各种活检钳的更大尺寸FBS。因此，它似乎是用于取出儿童支气管异物的一种有用器械。
