喉頭罩在側躺麻醉的應用

Clinical Experience of Laryngeal Mask Airway in Lateral Position during Anesthesia

陳介絢(Cay-Huyen, Chen) ； 林志中(Chih-Chung Lin) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 33卷1期 (1995/03) Pp. 31-34

摘要

目的：本實驗目的在評估喉罩（laryngeal mask）在側躺病人置入及維持氣道暢通之可行性。方法：選擇八十位接受hemorrhoidectomy的病人，以propofol 2 mg／kg，fentanyl 2μg／kg，atracurium 0.5 mg／kg靜脈注射作為麻醉誘導。當病人嘴巴能完全張開後，在左側躺的姿勢下置入喉罩來維持氣道暢通至手術結束。假如第一次置入時無法確實維持氣道暢通，則可第二次或第三次再置入。在整個麻醉過程，以EKG、血壓、pulse oximeter、end-tidal CO_2及inspiratory pressure為監視。結果：有70%（56／80）的病人能第一次喉置入就能成功維持氣道暢通，其中20%（18／80）的病人經第二次或第三次置入就能成功維持氣道暢通。僅有4例因為大量漏氣及2例無法確實置入正常位置而失敗，於是都改以面罩完成麻醉，其它可能的併發症皆沒有發生。討論：我們證明在側躺麻醉狀態下，喉置的置入及維持氣道暢通是可行的，並且可取代面罩麻醉之不方便及可能併發症等。

關鍵字

喉罩 ； 側躺姿勢 ； 氣道暢通維持

並列摘要

Background: The laryngeal mask airway (LMA), inserted blindly into hypopharynx in patients in supine position, has been reported to be successful in the management of the airway and can provide adequate ventilation during anesthesia. In our study, we used LMA to maintain airway during anesthesia in patients in lateral position. Methods: Eighty surgical patients, ASA class I-II, undergoing hemorrhoidectomy, were placed in lateral surgical position before induction. The induction agents were propofol (2 mg/kg), fentanyl (2μg/kg) and atracurium (0.5mg/kg, i.v.). When mouth opening can be done passively, a LMA was inserted into the mouth and advanced blindly over the tongue into the pharynx until resistance was felt. The rim was immediately inflated with air and several manual positive pressure ventilatory breaths were given to the patient to check for leaks in the LMA system. Chest movement was observed and bilateral lung auscultation was performed to confirm the adequacy of ventilation. Once the LMA was in place, enflurane with oxygen was administerd until operation was completed. During the anesthetic course, EKG, blood pressure, pulse oximeter, end-tidal CO_2 and inspiratory pressure were monitored. Results: Blind insertion of LMA in lateral position was successful in the first attempt in 70% (56/80) of patients. Twenty (18/80) patients required a second or third trial making the total successful rate of LMA insertion as high as 90% (74/80). In four patients, airway control through LMA was unsatisfactory due to large air leakage during manual ventilation. In two patients the LMA could not be inserted in proper position for maintaining airway. In six cases, the LMA was immediately removed and was substituted by face-mask for anesthesia. Two patients complained of postoperative sore throat. No other specific complications such as cough, laryngospasm and aspiration was noted. Conclusion: We demonstrated that LMA can be easily inserted and can provide effective patency of airway during anesthesia even in lateral position. It can be used as a substitute for face-mask in anesthesia in this position to prevent complications such as pressure injury that a face-mask may cause.