全身麻醉中同時使用喉罩與持續靜脈注射Propofol之臨床經驗

Clinical Experience of Laryngeal Mask Airway Combined with Continuous Intravenous Propofol Infusion during General Anesthesia

陳坤堡(Kuen-Pao Chen) ； 陳豐熙(Feng-Shi Chen) ； 余佩燁(Pei-Yeh Yu) ； 陳克章(Hut-Cheung Chan)

《Acta Anaesthesiologica Sinica》 34卷4期 (1996/12) Pp. 209-212

https://doi.org/10.6955/AAS.199612.0209

摘要

目的：本實驗的目的在評估平躺接受全身麻醉的病患，使用喉罩做為呼吸道的維持，並同時經由靜脈持續灌注propofol來維持麻醉深度之可行性，及其可能的優缺點。方法：選擇六十位接受骨科上肢手術的病人，身體健康狀況為美國麻醉醫學會標準之第一級至第二級，以atropine 0.01 mg/kg, fentanyl 2-3μg/kg, propofol 2 mg/kg，succinylcholine 1-1.5 mg/kg, 2％ lidocaine 1-1.5 mg/kg靜脈注射做為麻醉誘導，待肌肉鬆弛劑完全作用後，經口腔放入喉罩來維持呼吸道至手術結束。麻醉深度的維持乃經由呼吸道給予40％氧氣與60％笑氣，並經靜脈點滴持續灌注1％ propofol，灌注的速率以6 mg/kg/h為基準，而後視需要調整劑量。麻醉中監視包括持續心電圖、非侵犯性自動量血壓計、脈搏血氧飽和度、及潮氣末端二氧化碳分壓。結果：喉罩放置第一次就成功的有55例、佔90.2％，放第二次才成功的有5例、佔8.2％，失敗的有一例、佔1.6％。propofol平均灌注速率為6.29±0.97 mg/kg/h，平均麻醉恢復時間為9.2±3.4分，所有病人均未發生手術中有知覺及回憶的現象。討論：對於骨科上肢手術採平躺姿勢的全身麻醉，若使用喉罩維持氣道並持續靜脈灌注propofol維持麻醉深度，是一個可以接受的方法。

關鍵字

麻醉：全身 ； 喉罩 ； 麻醉劑，靜脈：propofol

並列摘要

Background: Propofol's greatest attributes are its pharmacokinetic properties which result in a rapid, clear emergency and lack of cumulative effects even after prolonged administration. It is a drug of popular choice for the maintenance of general anesthesia. The laryngeal mask airway (LMA), originally described by Dr. Brain is now a good alternative as the airway management technique. Because of its high success rate in securing a clinically acceptable airway in anesthetized patients, LMA has been proposed as a practical airway and conveyer for general anesthesia. This study was designed to observe and evaluate the feasibility of propofol infusion combined with N_2O for maintenance of anesthesia, with a LMA as airway and conveyer during general anesthesia. Methods: Sixty patients, ASA class I-II, aged 15-59 years, were selected for this study. They were scheduled for upper-limb orthopedic surgeries in supine position. No patient was premedicated. Intraoperative monitoring included electrocardiography, pulse oximetry, end-tidal carbon dioxide and automatic non-invasive blood pressure. The agents for induction of anesthesia included atropine 0.01 mg/kg, atracurium 5 mg, fentanyl 2-3 μg/kg, 2% lidocaine 1.5-2 mg/kg, propofol 2 mg/kg, and succinylcholine 1-1.5 mg/kg, all of which were given intravenously in sequence. After that laryngeal mask airway (LMA) was inserted. The position of LMA was confirmed by even undulation of chest wall and breathing sound. Anesthesia was then maintained with nitrous oxide in 40% oxygen and continuous propofol infusion. The pumping rate was set to start at 6 mg/kg/h. Muscle relaxation was achieved by intravenous tracrium given intermittently. All patients were mechanically ventilated with a ventilator incorporated to the anesthesia machine. The ventilator was set to give a tidal volume of 8 ml/kg at a rate of 12-14/min. At the end of the operation, the propofol infusion and nitrous oxide were simultaneously discontinued. The effect of muscle relaxant was antagonized by atropine 1.0 mg and neostigmine 2.5 mg intravenously. The LMA was removed while the patient was awake and able to open mouth at request. They were followed 24 h postoperatively for inquiring intraopcrativc awareness and other complaints. Results: No patient was noted to experience awareness during the intraoperative period. Regarding LMA insertion, success in the first attempt was seen in 55 patients (90.2%). Success in the second attempt was seen in 5 patients (8.2%). Failure was encountered in one patient (1.6%). The average time of emergence was 92 ± 3.4 min. The average rate of speed of propofol infusion was 6.29 ± 0.97 mg/kg/h. Conclusions: The combination of propofol infusion and N_2O with laryngeal mask as airway and recovery was a good alternative in administration of general anesthesia.

並列關鍵字

Anesthesia: general ； Laryngeal masks ； Anesthetic, intravenous: propofol