The Laryngeal Mask Airway- Clinical Experience

喉頭罩臨床應用之經驗

馬振來(Chun-Loi Ma) ； 陳捷(Chit Chen) ； 黃樹欽(Delta S. Y. Wong) ； 許汝寧(Yu-Ling Hui) ； 譚培炯(Peter P. C. Tan)

《Acta Anaesthesiologica Sinica》 29卷4期 (1991/12) Pp. 697-702

摘要

The laryngeal mask airway (LMA),a new type of airway, when it is inserted blindly into the hypopharynx forms a seal around the larynx and allows easy and convenient spontaneous or controlled positive pressure ventilation. A clinical application of the LMA to 70 surgical patients in our hospital have been evaluated. LMA was successfully applied to 68 (97%) patients who all received general anesthesia with unobstructed controlled ventilation. The patency of the airway did not change throughout the course of anesthesia. There were 2 patients whose airway was obstructed at the first attempt due to downfolding of epiglottis; in one of them the obstruction was confirmed by flexible fibreoptic laryngoscopy. Subsequent placement was successful in these 2 patients. Insertion failure was seen in 2 patients respectively due to small mouth and excessive salivation. The placement of LMA does not require laryngoscopy and there is no fear of misplacement in the esophagus. It becomes obvious that the LMA would substantially gain a place in the armamentarium in anesthesia and we think that its use would be of interest to anesthesiologists.

關鍵字

Intubation: laryngeal mask airway ； Respiration: positive pressure ventilation

並列摘要

喉頭罩是Brain醫師於1983年發明，用於維持病人氣道通暢，它是由矽樹脂質做成，前端呈橢圓型的小型面罩與後端的管型口咽氣道連接而成。使用時，並不需要喉鏡，而直接用盲目法經口腔放置於下咽腔內，在氣囊充氣後即可緊密地把喉頭入口週圍包圍，讓病人自然呼吸或接受機械性呼吸。本研究選70位女性病人，接受婦科手術，以喉頭罩給予機械性呼吸，大部份病人（97%）至手術結束時都能維持良好的呼吸道通氣。其中2例於第一次置放喉頭罩時有氣道阻塞情形，重新置放後始獲得良好的通氣。另2例因嘴太小及唾液分泌太多而放棄。事實上，喉頭罩並不能確保當病人發生胃反芻時，不會導致吸入性肺炎。所以在使用喉頭罩時，須謹慎挑選病人，並於手術前禁食。同時，利用光纖維支氣管鏡隨機檢查20位病人，發現15例之喉頭罩放置正確且喉頭入口週圍被罩密。4例會厭軟骨被往下翻折，其中1例因完全翻折而造成氣道阻塞；其餘只有部份翻折，並未造成氣道阻塞。有1例因有較大的披裂會厭皺襞往喉頭入口移置，而把喉頭入口堵塞，但此亦未造成臨床上氣道阻塞現象。喉頭罩在國外已被採用多年，多次曾報告成功地使用於困難氣管內插管的病患，結論認爲於臨床使用上，喉頭罩應有其價值和重要性。