Ofer R, Dworzak H
Abteilung für Anästhesie und Intensivmedizin, Kreiskrankenhaus Mühldorf.
Anaesthesist. 1996 Mar;45(3):268-70. doi: 10.1007/s001010050263.
In cases of craniofacial and mandibulofacial malformations, which are mostly treated during childhood, difficult intubation conditions must generally be expected. In such cases, the laryngeal mask airway (LMA) an alternative instrument for use in endotracheal intubation is a new aid for ventilation. In certain instances, it can be used alone to induce general anaesthesia. Reports of endotracheal intubation by means of the LMA in adults have also been published.
In our case, a 6-year-old boy with Pierre-Robin syndrome (triad: micrognathia, broad palatoschisis, glossoptosis) needed dental resetting. After induction of anaesthesia in this very cooperative boy with thiopentone and fluothane and relaxation with succinylcholine, it was not possible to examine the hypopharynx by laryngoscopy preparatory to nasal intubation as usual. Repeated blind attempts at nasal intubation (again with spontaneous breathing) failed, as did the attempt at fibreoptic bronchoscopic intubation, because of the narrow anatomical conditions. Finally, a laryngeal mask airway (LMA; size 2) was introduced, and as a result of this ventilation was achieved. However, endotracheal intubation was required for performance of the surgical resetting. With the fibreoptic bronchoscope, we could verify the central position of the LMA over the glottis. A tracheal tube (size 4) was inserted across the laryngeal airway without optic control. The tube connector was disconnected and a normal guide inserted into the tube to remove the LMA. The dental resetting was also performed by oral intubation.
Therefore, the LMA is not only a ventilation aid, but also a valuable tool in difficult intubation conditions. In our opinion, it is necessary to provide this tool in every anaesthetic unit.
在颅面和下颌面部畸形病例中，这些畸形大多在儿童期进行治疗，通常必须预料到插管困难的情况。在这种情况下，喉罩气道（LMA）作为气管插管的一种替代器械，是通气的一种新辅助手段。在某些情况下，它可单独用于诱导全身麻醉。也有关于在成人中使用LMA进行气管插管的报道。
在我们的病例中，一名患有皮埃尔 - 罗宾综合征（三联征：小颌畸形、宽腭裂、舌后坠）的6岁男孩需要进行牙齿复位。在这个非常配合的男孩中，用硫喷妥钠和氟烷诱导麻醉并用琥珀酰胆碱松弛后，像往常一样在鼻插管前通过喉镜检查下咽是不可能的。多次盲目尝试鼻插管（同样在自主呼吸下）失败，纤维支气管镜插管尝试也失败了，原因是解剖条件狭窄。最后，插入了一个喉罩气道（LMA；2号尺寸），从而实现了通气。然而，进行手术复位需要气管插管。通过纤维支气管镜，我们可以确认LMA在声门上的中心位置。在没有直视控制的情况下，将一根气管导管（4号尺寸）穿过喉气道插入。断开导管接头，插入一根普通导丝以取出LMA。牙齿复位也通过口腔插管进行。
因此，LMA不仅是一种通气辅助工具，也是在困难插管情况下的一种有价值的工具。我们认为，每个麻醉单元都有必要配备这种工具。
