Tait A R, Pandit U A, Voepel-Lewis T, Munro H M, Malviya S
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109, USA.
Anesth Analg. 1998 Apr;86(4):706-11. doi: 10.1097/00000539-199804000-00006.
Several studies suggest that placement of an endotracheal tube (ETT) in a child with an upper respiratory infection (URI) increases the risk of complications. However, the development of the laryngeal mask airway (LMA) has provided anesthesiologists with an alternative means of airway management. This study was therefore designed to evaluate the use of the LMA in children with URIs and to compare it with the ETT. The study sample consisted of 82 pediatric patients (3 mo to 16 yr of age) who presented for elective surgery with an URI. Patients with URIs were randomly allocated to receive either an ETT (n = 41) or a LMA (n = 41) and were followed for the appearance and severity of any perioperative complications. The two groups were similar with respect to age, gender, anesthesia and surgery times, number of attempts at tube placement, and presenting URI symptoms. There were no differences between groups in the incidence of cough, breath-holding, excessive secretions, or arrhythmias. Although one patient in the ETT group required a muscle relaxant for laryngospasm, the overall incidence of laryngospasm was similar between the two groups. There was, however, a significantly greater incidence of mild bronchospasm in the ETT group compared with the LMA group (12.2% vs 0%, P < 0.05). The incidence of major arterial oxygen desaturation events (SpO2 <90%) during placement of the airway device was also significantly increased in the ETT group (12.5% vs 0%, P < 0.05). Furthermore, the total number of all episodes of respiratory complications, i.e., breath-holding, laryngospasm, bronchospasm, and major oxygen desaturation, was significantly greater in the ETT group (35 vs 19, P < 0.05). Despite this, all respiratory complications were easily managed, and there were no adverse sequelae. Although the risks associated with anesthetizing a child with an URI remain controversial, results from this study suggest that the LMA offers a suitable alternative to the ETT for use in children with URIs.
This study compares the use of the laryngeal mask airway with the endotracheal tube for airway management in children with upper respiratory infections. Results suggest that if the decision is made to proceed with anesthesia for the child with an upper respiratory infection, then the laryngeal mask airway provides a suitable alternative to the endotracheal tube.
多项研究表明，给患有上呼吸道感染（URI）的儿童放置气管内导管（ETT）会增加并发症风险。然而，喉罩气道（LMA）的出现为麻醉医生提供了另一种气道管理方法。因此，本研究旨在评估LMA在患有URI的儿童中的应用，并将其与ETT进行比较。研究样本包括82例患有URI并接受择期手术的儿科患者（3个月至16岁）。患有URI的患者被随机分配接受ETT（n = 41）或LMA（n = 41），并对围手术期并发症的出现和严重程度进行随访。两组在年龄、性别、麻醉和手术时间、插管尝试次数以及所呈现的URI症状方面相似。两组在咳嗽、屏气、分泌物过多或心律失常的发生率上没有差异。虽然ETT组有1例患者因喉痉挛需要使用肌肉松弛剂，但两组喉痉挛的总体发生率相似。然而，与LMA组相比，ETT组轻度支气管痉挛的发生率显著更高（12.2%对0%，P < 0.05）。气道装置放置期间主要动脉血氧饱和度降低事件（SpO2 < 90%）的发生率在ETT组也显著增加（12.5%对0%，P < 0.05）。此外，ETT组呼吸并发症（即屏气、喉痉挛、支气管痉挛和主要氧饱和度降低）的所有发作总数显著更多（分别为35次对19次，P < 0.05）。尽管如此，所有呼吸并发症都易于处理，且无不良后遗症。虽然给患有URI的儿童麻醉相关风险仍存在争议，但本研究结果表明，LMA为患有URI的儿童提供了一种适合替代ETT的方法。
本研究比较了喉罩气道与气管内导管在患有上呼吸道感染儿童气道管理中的应用。结果表明，如果决定对患有上呼吸道感染的儿童进行麻醉，那么喉罩气道是气管内导管的一种合适替代方法。
