ABSTRACT
EXPERIÊNCIA E OBJETIVOS: A via aérea por máscara laríngea (LMA), que tem sido utilizada frequentemente no tratamento das vias aéreas, pode causar lesão e morbidade na área laringofaríngea. Nesse estudo, comparamos as alterações macroscópicas nas estruturas laringofaríngeas e a morbidade laringofaríngea pós-operatória pelo uso da LMA Supreme® versus LMA ProSeal® em crianças. MÉTODOS: Dividimos os pacientes em dois grupos. Inserimos LMA ProSeal #3 no primeiro grupo e LMA Supreme #3 no segundo grupo. Antes da inserção da LMA e em seguida à sua remoção, fizemos laringoscopia direta nos pacientes. Comparamos entre os dois grupos: hiperemia, lesão de mucosa e as manchas de sangue por ocasião da remoção da LMA, e também o tempo de inserção, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito e dor de garganta. RESULTADOS: Não foram observadas diferenças significativas entre os dois grupos para tempo médio de operação, gênero, idade, peso, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito, dor de garganta e lesão de mucosa. O tempo médio de inserção para o grupo LMA ProSeal foi significativamente maior versus grupo LMA Supreme (p = 0,0001). O índice de manchas de sangue na remoção da LMA foi significativamente mais alto no grupo LMA ProSeal versus LMA Supreme (p = 0,034). Os pacientes que apresentaram manchas de sangue por ocasião da remoção da LMA exibiram hiperemia e lesão de mucosa significativamente mais expressivas versus pacientes com LMA limpa (p = 0,0001, p = 0,020). CONCLUSÃO: Em crianças, a inserção da LMA Supreme é mais rápida e fácil do que a inserção da LMA ProSeal; e, em comparação com LMA ProSeal, causa menos lesão laringofaríngea.
BACKGROUND AND OBJECTIVES: Laryngeal mask airway (LMA), which has been used frequently in airway management, can cause laryngopharyngeal injury and morbidity. In this trial, we compare the macroscopic changes on laryngopharyngeal structures and the postoperative laryngopharyngeal morbidity by using LMA supreme with LMA proseal in children. METHODS: We divided patients into two groups. We inserted size three LMA proseal into the first group and size three LMA supreme into the second group. Before LMA insertion and after LMA removal, we performed direct laryngoscopy on the patients. We compared hyperemia, mucosal injury and blood staining on LMA removal, as well as insertion time, rate of success in gastric tube insertion on the first attempt, nausea, vomiting, and sore throat between the two groups. RESULTS: We recorded no significant differences between the two groups for mean operation time, sex, age, weight, rate of success in gastric tube insertion on first attempt, nausea, vomiting, sore throat and mucosal injury. Mean insertion time for the LMA proseal group was significantly longer than the LMA supreme group (p = 0.0001). The ratio of blood staining on LMA removal was significantly higher in the LMA proseal group than the LMA supreme group (p = 0.034). The patients with blood staining on LMA removal exhibited significantly more mucosal hyperemia and injury than the patients with clear LMA (p = 0.0001, p = 0.020). CONCLUSION: LMA supreme insertion is faster and easier than LMA proseal and causes less laryngopharyngeal injury than LMA proseal in children.
EXPERIENCIA Y OBJETIVOS: La vía aérea por mascarilla laríngea (LMA), que ha sido utilizada a menudo en el tratamiento de las vías aéreas, puede causar lesión y morbilidad en el área laringofaríngea. En ese estudio, comparamos las alteraciones macroscópicas en las estructuras laringofaríngeas y la morbilidad laringofaríngea postoperatoria por el uso de la LMA Supreme® versus LMA ProSeal® en niños. MÉTODOS: Dividimos los pacientes en dos grupos. Insertamos LMA ProSeal #3 en el primer grupo y LMA Supreme #3 en el segundo grupo. Antes de la inserción de la LMA e inmediatamente después de su retirada, hicimos una laringoscopia directa en los pacientes. Comparamos entre los dos grupos: hiperemia, lesión de mucosa y las manchas de sangre en razón de la retirada de la LMA, y también el tiempo de inserción, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito y dolor de garganta. RESULTADOS: No fueron observadas diferencias significativas entre los dos grupos para tiempo promedio de operación, sexo, edad, peso, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito, dolor de garganta y lesión de mucosa. El tiempo promedio de inserción para el grupo LMA ProSeal fue significativamente mayor versus grupo LMA Supreme (p = 0,0001). El índice de manchas de sangre en la retirada de la LMA fue significativamente más alto en el grupo LMA ProSeal versus LMA Supreme (p = 0,034). Los pacientes que tenían manchas de sangre en razón de la retirada de la LMA tenían hiperemia y una lesión de la mucosa significativamente más expresivas versus pacientes con LMA limpia (p = 0,0001, p = 0,020). CONCLUSIONES: En los niños, la inserción de la LMA Supreme es más rápida y fácil que la inserción de la LMA ProSeal; y en comparación con LMA ProSeal, causa menos lesión laringofaríngea.
Subject(s)
Adolescent , Child , Female , Humans , Male , Laryngeal Masks/adverse effects , Larynx/pathology , Morbidity , Postoperative Period , Pharyngitis/epidemiology , Pharynx/pathologyABSTRACT
Stereotactic surgery is a technique allowing the operation of an intracranial lesion without the need for craniotomy. Now stereotactic technique is widely used for aspiration of brain abscess or hemorrhage, biopsy of brain tumor and treatment of movement disorder etc. Because of the frame of stereotactic system, that is fixed on the scalp, laryngoscopic endotracheal intubation may be disturbed. So, in this case, we used laryngeal mask airway Proseal (PLMA(TM)) for maintenance of airway during stereotactic biopsy of brain tumor under general anesthesia. It was easily to insert PLMA(TM) using the introducer at once. The ventilation during the operation was not impeded at all time. There were not excessively changes of vital sign during general anesthesia. We think that PLMA(TM) may be a good alternative method for maintenance of airway during stereotactic surgery under general anesthesia.
Subject(s)
Anesthesia, General , Biopsy , Brain Abscess , Brain Neoplasms , Brain , Craniotomy , Hemorrhage , Intubation , Intubation, Intratracheal , Laryngeal Masks , Movement Disorders , Scalp , Stereotaxic Techniques , Ventilation , Vital SignsABSTRACT
BACKGROUND: The laryngeal mask airway Proseal (LMA-Proseal) is a renewed airway device with a modified cuff to improve the mask seal around the larynx. The classic LMA is known to have an incomplete mask seal during high positive pressure ventilation. Therefore, we examined whether the ventilation via a LMA-Proseal during laparoscopic surgery may be adequate and also observed the complications associated with a LMA-Proseal. METHODS: Thirty four patients undergoing elective gynecological laparoscopies were studied. After the insertion of a LMA-Proseal, we measured the peak airway pressure, plateau airway pressure, oropharyngeal leakage pressure, and the leakage around the neck before and after intra-abdominal CO2 insufflation. After extubation, we observed the complications, including the gastroesophageal regurgitation using a methylene blue staining method. RESULTS: The peak and plateau airway pressures after pneumoperitoneum increased significantly (P<0.05), compared with those before insufflation. However, the oropharyngeal leakage pressure was not changed and leakages around the neck were not observed. After extubation, a cuff stained with methylene blue occurred in 10 of 34 patients. Sore throat and dysphagia occurred in 8 and 4 of 34 patients, respectively. CONCLUSIONS: A LMA-Proseal during laparoscopic surgery permits adequate airway pressure, but does not protect the gastroesophageal regurgitation.
Subject(s)
Humans , Deglutition Disorders , Insufflation , Laparoscopy , Laryngeal Masks , Larynx , Masks , Methylene Blue , Neck , Pharyngitis , Pneumoperitoneum , Positive-Pressure Respiration , VentilationABSTRACT
Backgroud: The purpose of this study was to assess the effect of inflating a laryngeal mask airway ProSeal(TM) (PLMA(TM)) cuff, prior to insertion, on the degree of difficulty of inserting a PLMA(TM) by the inexperienced, and the incidence of postoperative sore throat. METHODS: Before induction, we measured the thyromental and sternomental distance. PLMA(TM) insertions were conducted by those with experience of less than 15 previous insertions. One hundred and five consecutive patients undergoing general anesthesia were randomized into 3 groups: In group 1, the PLMA(TM) was inserted with the cuff fully deflated, in group 2, the cuff was partially inflated (i.e., filled with half the recommended air), in group 3, the cuff was fully inflated. Successful insertion was judged primarily by the clinical function of the airway. The number of insertion attempts to achieve a satisfactory airway were recorded. Each patient was asked whether he had a sore throat, dysphonia, or dysphagia just before leaving the postanesthesia care unit (PACU) and again 24 hr after surgery. RESULTS: The number of insertion attempts required to achieve a satisfactory airway and the failure rate of insertion were not significantly different in the 3 groups. However, the 3 groups were significantly different in terms of the incidence of postoperative sore throat in the PACU. This was highest in group 3 (P<0.05). The incidences of other variables of laryngopharygeal morbidity in the PACU and 24 hrs after surgery were not significantly different in the 3 groups. CONCLUSIONS: Inflation of the cuff prior to insertion did not affect the success rate of inserting a PLMA(TM) by the inexperienced, and PLMA(TM) insertion after partial inflation was associated with higher incidence of postoperative sore throat in the PACU. Thus, in general anesthesia, it is desirable that the inexperienced insert the PLMA(TM) with the cuff fully deflated.
Subject(s)
Humans , Anesthesia, General , Deglutition Disorders , Dysphonia , Incidence , Inflation, Economic , Laryngeal Masks , PharyngitisABSTRACT
BACKGROUND: The purpose of this study was to determine the cuff volume of the laryngeal mask airway ProSeal(TM)(PLMA (TM)) in Korean adults, which was measured at an intracuff pressure of 60 cmH2O. METHODS: A size 3 PLMATM was used for females (n = 57) and a size 4 PLMATM for males (n = 45). Anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane, nitrous oxide and oxygen. After 5 minutes of conventional mask ventilation, the PLMATM was inserted using an the index finger in one motion. Increments of air up to a final intracuff pressure of 60 cmH2O were introduced and the patency of the airway was confirmed. Following successful placement during ventilation, the intracuff pressure was maintained at 60 cmH2O during anesthesia. The volume of air required to inflate the cuff to this pressure was measured, first after successful insertion of the mask (CV ins), and then 10 minutes before the end of anesthesia (CV end). Each patient was asked whether they had a sore throat, just before leaving the postanesthesia care unit (PACU) and again 24h after surgery. Data is presented as means standard error of mean (SEM). Statistical analysis was performed by bivariate correlation analysis, and by the paired t-test. Significance was accepted when P < 0.05. RESULTS: CV ins was 15-26 ml (22.8+/-0.3 ml)(female), 23-45 ml (33.6+/-0.6 ml)(male) and CV end was 17-27 ml (23.2+/-0.3 ml)(female), 22 45 ml (33.8+/-0.7 ml)(male). There were no significant correlation between BMI (body mass index), thyromental distance, sternomental distance and cuff volume (CV ins). In males, there was no significant difference between CV ins and CV end, but, in females, there was a significant difference between CV ins and CV end (CV ins < CV end)(P < 0.05). Incidences of postoperative sore throat just before leaving the PACU were 22.8% in females, 15.6% in males, and 24 hrs after surgery, these were 7% in females, 4.4% in males. CONCLUSIONS: We conclude that CV ins in both male and female was widely variable and that there is no correlation between anatomical variation and inflated cuff volume. Moreover, we could not prevent postopertative sore throat by changing cuff volume at an intracuff pressure of 60 cmH2O. Especially in Korean females, the cuff volume required to inflate the cuff to 60 cmH2O increased with anesthesia.