一项比较带套囊口咽气道与喉罩气道在自主呼吸麻醉成年患者中应用效果的随机对照试验。

A randomized controlled trial comparing the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anesthetized adults.

作者信息

Greenberg R S, Brimacombe J, Berry A, Gouze V, Piantadosi S, Dake E M

机构信息

Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

Anesthesiology. 1998 Apr;88(4):970-7. doi: 10.1097/00000542-199804000-00017.

DOI:10.1097/00000542-199804000-00017

PMID:9579506

Abstract

BACKGROUND

The cuffed oropharyngeal airway (COPA), a modified Guedel airway, was compared with the laryngeal mask airway (LMA) during spontaneous breathing anesthesia. Specifically examined were ease of use, physiologic tolerance, and the frequency of problems.

METHODS

Adult patients consented to random (2:1) assignment to either COPA (n = 302) or LMA (n = 151) for airway management during anesthesia with propofol, nitrous oxide, and oxygen.

RESULTS

Ease of insertion was similar, but the first-time successful insertion rate was higher with the LMA (COPA, 81% compared with LMA, 89%; P = 0.05). More brief manipulations (head tilt, chin lift, jaw thrust) were reported in the COPA group (average total number of manipulations: COPA, 1.1 +/- 1.6 compared with LMA, 0.1 +/- 0.2; P < 0.001). Continuous airway support was used more frequently in the COPA group (COPA, 30% compared with LMA, 0%; P < 0.0005). The incidences of aspiration, regurgitation, laryngospasm, wheezing, succinylcholine administration, oxygen saturation (SpO2) < 92%, failed use, and minor intraoperative problems were similar. When the airways were removed, blood was detected on the COPA less frequently than on the LMA (COPA, 5.8% compared with LMA, 15.3%; P = 0.001). The incidence of early and late sore throat was greater with the LMA (early: COPA, 4.7% compared with LMA, 21.9% [P = 0.001]; late: COPA, 8.4% compared with LMA, 16.1%; P = 0.01). The LMA did better than the COPA when anesthetists analyzed the technical aspects of the two devices.

CONCLUSIONS

Although the COPA and LMA are equivalent devices in terms of physiologic alterations and overall clinical problems associated with their use, the LMA was associated with a higher first-time insertion rate and fewer manipulations, suggesting that it is easier to use. The COPA was associated with less blood on the device and fewer sore throats, suggesting it may cause less pharyngeal trauma. Ultimately, both devices were similar in establishing a safe and effective airway for spontaneously breathing anesthetized adults.

摘要

背景

在自主呼吸麻醉期间，将改良的古德尔气道——带套囊口咽气道（COPA）与喉罩气道（LMA）进行了比较。具体研究了其易用性、生理耐受性及问题出现频率。

方法

成年患者同意随机（2:1）分配至COPA组（n = 302）或LMA组（n = 151），在使用丙泊酚、氧化亚氮和氧气进行麻醉期间进行气道管理。

结果

插入的难易程度相似，但LMA的首次成功插入率更高（COPA为81%，LMA为89%；P = 0.05）。COPA组报告的简短操作（头部后仰、抬颏、提颌）更多（平均总操作次数：COPA为1.1±1.6，LMA为0.1±0.2；P < 0.001）。COPA组更频繁地使用持续气道支持（COPA为30%，LMA为0%；P < 0.0005）。误吸、反流、喉痉挛、喘鸣、琥珀胆碱给药、氧饱和度（SpO2）< 92%、使用失败及术中轻微问题的发生率相似。当移除气道装置时，在COPA上检测到血液的频率低于LMA（COPA为5.8%，LMA为15.3%；P = 0.001）。LMA导致的早期和晚期咽痛发生率更高（早期：COPA为4.7%，LMA为21.9% [P = 0.001]；晚期：COPA为8.4%，LMA为16.1%；P = 0.01）。当麻醉医生分析这两种装置的技术方面时，LMA比COPA表现更好。