摘要:目的:評價II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在擇期手術中應用效果。方法:檢索了Cochrane圖書館(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相關II代引流型喉管(LTS II)和Proseal喉罩在擇期手術中應用的隨機對照試驗(RCT),同時篩檢納入文獻的參考文獻。由2名研究者對文獻質量進行嚴格評價和資料提取,根據指標相應異質性進行描述性分析或Meta分析(RevMan 5.0)。結果:共納入3個RCT,共244例研究對象,文獻質量均為B級。3個RCT的結果顯示與PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、術畢即刻上呼吸道損傷發生率(P=1.00)、術后24 h咽痛發生率(P=0.81)、術后24 h吞咽困難發生率(P=0.12)。2個RCT的結果顯示兩組引流管置入均較容易。1個RCT的結果顯示兩組的操作者主觀評價相近(OR=1.86,95%CI 0.39～ 8.99)。氣道封閉效果由于采用方法學差異性較大,指標也不盡相同,尚不能得出準確結果。結論:LTS II在擇期手術中用于氣道管理具有較好的前景。但是現時仍不宜用于需在擇期術中進行控制通氣的病人。關于氣道封閉效果,尚需采用更合理規范的指標、更高質量的研究設計進一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.
摘要:目的:定量測定50 %小兒在喉罩表面涂抹丁卡因膠漿的情況下平穩拔除喉罩時呼氣末七氟烷濃度。方法:25例擇期行四肢及體表手術的患兒,高流量吸入七氟烷誘導并以七氟烷和氧化亞氮維持麻醉,不使用肌肉松弛劑及靜脈麻醉藥物,手術結束后停止吸入氧化亞氮,并維持設定的七氟烷濃度10min后拔除喉罩。根據Dixon序貫法確定喉罩拔除時的七氟烷濃度,每0.1 Vol%七氟烷為1個增減單位。患兒未出現咳嗽、牙關緊閉、體動、屏氣及喉痙攣則認為拔除喉罩平穩。結果:50 %小兒平穩拔除喉罩時呼氣末七氟烷濃度(EC50)為1.22 Vol%(95 %的置信區間分別為0.99 Vol%～1.49 Vol%)。結論:在喉罩表面涂抹丁卡因膠漿的情況下,3～8歲患兒喉罩滿意拔除時呼氣末七氟烷EC50值為1.22 Vol%。Abstract: Objective: To determine the concentration of sevoflurane where 50%( EC50 ) of the attempts to remove the laryngeal mask airway (LMA ) with the Teracainum Gel would be successful in children. Methods: Twentyfive nonpremedicated children, aged 38 years old, ASA physical status I, scheduled for extremities or peripherical surgery were enrolled in this study. General anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide in oxygen. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration was predetermined by the Dixon’s upanddown method (with 0.1 Vol% as a step size), starting at 1.20 Vol% concentration of sevoflurane. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful. Results:The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.22 Vol% (95%CL, 0.99 Vol%1.49 Vol%). Conclusion: The EC50 value of sevoflurane for LMA smooth extubation in children aged 38 years old with teracainum gel was 1.22 Vol%.
【摘要】 目的 觀察依托咪酯乳劑復合舒芬太尼用于全麻下喉罩置入的血流動力學變化。 方法 選擇2009年4月-2010年2月間，46例需全麻手術、適合使用喉罩，美國麻醉醫師協會（ASA）Ⅰ～Ⅱ級，年齡18～60歲的患者，隨機分為兩組:依托咪酯乳劑組（E組）23 例，靜脈推注咪達唑侖0.05 mg/kg，依托咪酯乳劑0.3 mg/kg；依托咪酯乳劑+舒芬太尼組（ES組）23 例，靜脈推注咪達唑侖0.05 mg/kg，依托咪酯乳劑0.15 mg/kg，加舒芬太尼0.5 mg/kg，誘導后置入喉罩，記錄患者誘導前、用藥后1 min、喉罩置入后1 min的心率（HR）、平均動脈壓（MAP）以及評估喉罩置入條件的6項指標（張口困難分級、置入喉罩困難分級、舌咽反射、干咳干嘔反射、肢動反應及喉痙攣分級），同時記錄呼吸暫停時間。 結果 ES組能提供更好的喉罩置入條件，且能減少舌咽反射和肢體反應， 更能保證喉罩置入時血流動力學的穩定。 結論 依托咪酯乳劑復合舒芬太尼能為全麻喉罩置入時提供更好的條件，且能保證更好的血流動力學穩定。【Abstract】 Objective To investigate the hemodynamics changes when etomidate combined with sufentanil was applied for laryngeal mask airway insertion under the general anaesthesia. Methods From April 2009 to February 2010, 46 patients requiring general anesthesia using laryngeal mask airway (LMA) (American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ) aged 18-60 were randomly divided into two groups: 23 in etomidate emulsion group (group E) underwent the intravenous injection with midazolm (0.3 mg/kg) and etomidate (0.05 mg/kg); 23 in etomidate emulsion + sufentanil group (group ES) underwent the intravenous injection with etomidate (0.15 mg/kg), midazolm (0.05 mg/kg), and sufentanil 0.5 mg/kg. The patients were evaluated by six indexes of LMA insertion (mouth opening, swallowing reflex, cough reflex,vomiting reflex, body motion, and laryngospasm classification). After the anesthesia induction, LMA was inserted. The blood pressure (BP), heart rate (HR), and mean arterial pressure (MAP) were recorded before anesthesia induction one minute after the injection and one minute after LMA insertion. Meanwhile, the apnea time was recorded. Results Compared with group E, group ES offered better anesthesia for LMA insertion, less swallowing reflex and body motion, and more stable haemodynamics. Conclusion Etomidate combined with sufentanil provides good condition for LMA insertion under the general anaesthesia with steady haemodynamics.
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
ObjectiveTo investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia.MethodsFrom January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared.ResultsThe baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05).ConclusionThe "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.
【摘要】 目的 比較喉罩和氣管內插管吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查的麻醉效果、蘇醒時間、蘇醒質量。 方法 將2008年3月-2009年3月40例行纖支鏡檢查的患兒隨機分為喉罩組（L組，21例）和氣管內插管組（T組，19例）。兩組均采用逐漸誘導法吸入七氟烷，靜脈給予芬太尼1 μg/kg；L組置入喉罩，T組氣管插管后控制呼吸。手術中，兩組均吸入2%～5%七氟烷維持麻醉。分別記錄麻醉前（T0）、麻醉后纖支鏡進入前（T1）、進鏡至咽部（T2）、聲門部（T3）、氣管內（T4）及第15 min（T5）時的血壓（BP）、心率（HR）、MAP和動脈血氧飽和度（SPO2）。觀察纖支鏡檢查期間有無嗆咳、氣道痙攣或體動；記錄停藥至拔管的時間，蘇醒后是否再入睡及麻醉滿意度。 結果 兩組HR在T1、T3、T4時升高，與T0時比較，有統計學意義（Plt;0.05）；其中HR在T1時T組高于L組，組間比較有統計學意義（Plt;0.05）；MAP在T1、T2、T3、T4時，T組低于L組，組間比較有統計學意義（Plt;0.05）。兩組患兒鏡檢期間均無嗆咳、氣道痙攣或體動；L組蘇醒時間短于T組（Plt;0.05），蘇醒后再入睡率低于T組（Plt;0.05），麻醉滿意度高于T組（Plt;0.05）。 結論 喉罩吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查，能保證穩定的血流動力學狀態，蘇醒快速，效果滿意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
