喉罩在非常规手术麻醉应用的新进展

New advances of laryngeal mask airway utilization beyond indications of routine anesthesia practice

喉罩作为一种声门上气道工具,由于无法完全保障气道的安全,临床应用受到某些患者特殊情况、手术类型和体位的限制。气管导管一直作为这类特殊患者或者手术术中维持气道的首选方法,近年来,随着喉罩设计的改进与技术的成熟,越来越多的麻醉医生选择喉罩代替气管导管用于非常规手术,有证据显示,只要谨慎选择患者和做好术中管理同样可以保障气道安全,并且更有利于维持循环稳定和减少气道并发症。本文通过讨论喉罩在剖宫产、俯卧位、妇科腹腔镜和胸腔镜手术中应用的优缺点,为临床应用提供参考意见。

Laryngeal mask airway(LMA)is a supraglottic airway device.Insertion of LMA can t guarantee the complete protection of the airway.The clinical application is limited by the special circumstances of certain patients,the type of operation,and the position of the procedure.Endotracheal intubation has always been a preferred modality to maintain the airway safety in such special scenarios during surgery.In recent years,with the improvement of the laryngeal mask airway design and the maturation of this technology,more and more anesthesiologists have selected LMA as an alternative approach to replace the endotracheal tube for such surgeries.There is evidence that careful patient selection and intraoperative management can also ensure airway safety and are more conducive to maintaining hemodynamic stability and avoiding airway complications.This review discusses the advantages and disadvantages of LMA in certain unusual surgical conditions like cesarean section,prone position procedures,gynecologic laparoscopy,and thoracoscopic surgeries.It provides strategic recommendations for clinical application of LMA in such conditions.