以喉罩行全身性自發性呼吸麻醉之臨床報告

Clinical Assessment of Laryngeal Mask Airway in General Anesthesia with Spontaneous Breathing

李毅(Yi Lee) ； 潘武熙(Wu-Hsi Pan) ； 郭金章(Jin-Chang Koh) ； 魏志濤(Tze-Taur Wei)

《Acta Anaesthesiologica Sinica》 29卷2期 (1991/06) Pp. 596-603

摘要

喉罩（laryngeal mask airway；LMA）是一種維持呼吸道暢通之新產品，在許多情況下可代替傳統面罩或氣管內插管，在全身麻醉時建立安全而通暢的氣道。病人經過誘導麻醉後，可不經由喉鏡目視即可將喉罩置入正確位置。本實驗中，有98.2％的自發性呼吸全身麻醉病人藉此建立通暢的氣道。觀察手術進行中的每分鐘通氣量和每小時動脈血氣體分析，發現喉罩對呼吸功能沒有妨礙，而且在ASA體位分等第I級的病人，於麻醉誘導時使用或不使用fentanyl，對喉罩置入時血壓心跳的變化並無統計上之差異，喉罩可以避免氣管內插管造成的傷害和不適，以及克服面罩的缺點。在困難插管和面罩難以建立通暢氣道時，顯得十分有用。但是對於可能胃內容物反流的病人，喉罩則不適用，因為它不能避免因胃反流所造成肺部吸入的危險。

關鍵字

喉罩 ； 全身麻醉 ； 自發性呼吸

並列摘要

The laryngeal mask airway (LMA) is a new form of oropharyngeal airway that provides an alternative to endotracheal intubation and face mask anesthesia in certain cases. Once the patient is adequately anesthetised, it can be inserted blindly without recourse to laryngoscopy. The advantages over standard mask anesthesia are: better airway control, minimal leakage of anesthetic gases, and it frees the anesthetist's hands, as no mandibular support is needed. LMA does not guarantee against the risk of aspiration and it is not recommanded for use in patients who may have risk of gastric regurgitation. Our preliminary study revealed that a clear and clinical satisfactory airway was obtained in 98.2% of patients. According to the intraoperative respiratory minute volume and arterial blood gases, the patency of the airway did not deteriorate during the course of the anesthesia. Blood pressure and heart rate were compared on induction in group I and II. Succinylcholine 1mg/kg, thiopentone 4-6mg/kg and fentanyl 2μg/kg were used in group I while using the same dosage of succinylcholine and thiopentone without fentanyl for group II. We found no significant differences in vital signs between the two groups.