LMAS喉罩全凭静脉麻醉在脑室腹腔分流术中的应用

Application of total intravenous anesthesia(TIVA) with the LMAS-Supreme in adult patient undergoing ventriculoperitoneal shunting

[目的]比较LMAS喉罩和SLIPATM喉罩用于全凭静脉麻醉脑室腹腔分流术患者的气道管理效果和围术期并发症。[方法]收集40例ASA I或Ⅱ级在全麻下实施脑室腹腔分流术手术的患者,随机均分为LMAS组(L组)和SLIPATM组(S组)。在麻醉诱导前(T0)、插入喉罩即刻(T1)、插入后5 min(T2)、切皮时(T3)、拔出喉罩后即刻(T4)和拔出喉罩后5 min(T5),分别记录平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳(ET-CO2)及脑电双频指数(BIS),同时记录吸气潮气量(VTI)、呼气潮气量(VTE)、分钟通气量(VE)、平均气道阻力(RAWM)和气道密闭压等,比较两组的区别。[结果]两组患者插入喉罩后,MAP和HR都较麻醉诱导前有明显变化,但SLIPATM组(S组)T1、T4时MAP、HR高于LMAS组(L组)(P<0.05);S组气道密闭压(27±5)cmH2O低于L组的(31±4)cmH2O(P<0.05);L组喉罩漏气率6%,明显低于S组的11%;S组有5例患者术后发生恶心、呕吐及咽喉部不适,明显高于L组(仅2例)。[结论]两种喉罩通气方式均可安全应用于全凭静脉麻醉脑室腹腔分流术患者,但LMAS喉罩通气优于SLIPATM喉罩。

[Objective] To compare the airway management and perioperative complications between SLIPATM and LMAS for adult patient undergoing ventriculoperitoneal shunting under total intravenous anesthesia（TIVA）.[Methods] To collect 40 ASA I or Ⅱ patients undergoing ventriculoperitoneal shunt who were randomly allocated into SLIPATM group（S group） and LMAS group（L group）.Before induction of anesthesia（T0）,time insert SLIPATM / LMAS immediately（T1）,5 min after insertion（T2）,skin incision（T3）,time after extubation（T4）,5 min after extubation（T5）,MAP,HR and bispectral analysis（BIS） were monitored and recorded.Meanwhile,inspiratory tidal volume（VTI）,expiratory tidal volume（VTE）,minute ventilation（VE）,Airway sealing pressure,mean airway resistance（RAWM）,SPO2,ETCO2 were also monitored and compared between the 2 groups during the operations.[Results] In each group,after laryngeal mask insertion,MAP and HR were both significantly higher than before induction of anesthesia.But the SBP,DBP and HR of the S group at T1 and T4 was higher than L group（P0.05）.And the airway sealingpressure（27±5）cmH2O was lower than the LMAS group（31±4）cmH2O（P0.05）.L group laryngeal mask leak rate of 6% was significantly lower than 11% of the S group.S group,five cases of postoperative nausea,vomiting and throat discomfort,Significantly higher than the L group（Only two cases）.[Conclusion] LMAS and SLIPATM laryngeal mask airway can be safely applied for the ventriculoperitoneal shunt patients under the total intravenous anesthesia,but the LMAS may be better than SLIPATM in ventilation.