Value of modified gastroscopic laryngeal mask airway for airway management under general anesthesia in patients with liver cirrhosis undergoing endoscopic esophageal variceal ligation / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the value of modified gastroscopic laryngeal mask airway (LMA) for airway management under general anesthesia in the patients with liver cirrhosis undergoing endoscopic esophageal variceal ligation (EVL).Methods:Sixty-two American Society of Anesthesiologists physical status Ⅱor Ⅲ patients with liver cirrhosis of either sex, aged 25-64 yr, with body mass index of 18-30 kg/m 2, undergoing endoscopic EVL with general anesthesia, were divided into 2 groups ( n=31 each) using a random number table method: tracheal tube group (group T) and modified gastroscopic LMA group (group L). After induction of anesthesia, a tracheal tube was inserted in group T, and a modified gastroscopic LMA was inserted and the patients were mechanically ventilated to maintain P ETCO 2 at 30-40 mmHg in group L. Successful tracheal intubation or insertion of modified gastroscopic LMA, successful ligator insertion and duration of ligator insertion were recorded.The occurrence of intraoperative hypotension, bradycardia and hypoxemia and consumption of propofol and remifentanil were recorded.At 1 min after tracheal intubation or right placement of LMA (T 1), immediately after the ligator insertion (T 2) and at the end of operation (T 3), Peak (P peak) and mean (P mean) airway pressure were monitored, and airway leak pressure in group L was measured.The extubation time, duration of post-anesthesia care unit stay and bucking during extubation were recorded.The occurrence of sore throat and nausea and vomiting was recorded within 6 h after operation.Postoperative satisfaction scores of endoscopists and patients were also recorded. Results:Sixty-one patients were finally enrolled in the study, with 31 in group T and 30 in group L. Compared with group T, no significant changes were found in the success rate of tracheal intubation or LMA placement, success rate of ligator insertion, P mean at each time point, incidence of postoperative nausea and vomiting, and postoperative satisfaction score of endoscopists ( P>0.05), duration of the ligator insertion was significantly shortened, P peak at each time point was decreased, the incidence of intraoperative hypotension and bradycardia was decreased, the consumption of propofol and remifentanil was reduced, the incidence of bucking during extubation and postoperative sore throat was reduced, and extubation time and duration of post-anesthesia care unit stay was shortened, and satisfaction scores of patients were increased in group L ( P<0.05). No hypoxemia was found in two groups.Airway leak pressure was maintained at 24-26 cmH 2O at each time point in group L. Conclusions:Modified gastroscopic LMA can be safely and effectively used for airway management under general anesthesia in the patients with liver cirrhosis undergoing EVL.