目的 探討雙管喉罩與氣管插管用于全身麻醉婦科腹腔鏡手術的安全性和可行性。 方法 2009年1月-5月擇期婦科腹腔鏡手術患者60例，ASAⅠ～Ⅱ級，隨機分為喉罩組（P組）和氣管插管組（T組）。記錄入室基礎值（T0），置罩（管）前（T1），置罩（管）后即刻（T2），置罩（管）后5 min（T3 ），拔除罩（管）即刻（T4），拔除罩（管）后5 min（T5）的收縮壓（systolic pressure, SBP），舒張壓（diastolic pressure, DBP），心率（heart rate, HR）和脈搏血氧飽和度（pulse oxygen saturation, SpO2），喉罩和氣管插管控制呼吸時氣腹前后不同時段的氣道峰壓（airway. maximum pressure, Pmax），潮氣量（vital volume, VT）和呼氣末二氧化碳分壓（end tidal CO2, PETCO2）。記錄插罩（管）成功率，及相關并發癥。 結果 T2時T組SBP，DBP和HR顯著高于P組（P＜0.05），兩組術中通氣均滿意；Pmax，VT和PETCO2組間比較各時點無差異（P＞0.05）。氣腹后Pmax和PETCO2組內比較均高于氣腹前，差異有統計學意義（P＜0.05）。置罩（管）成功率組間比較差異無統計學意義，拔罩（管）期及術后24 h并發癥，喉罩組明顯低于氣管導管組，差異顯著（P＜0.05）。 結論 雙管喉罩用于全麻婦科腹腔鏡手術通氣效果滿意，安全可行。
Objective To investigate the effective dose of remimazolam benzenesulfonate to suppress cardiovascular responses to laryngeal mask placement in elderly patients. Methods Elderly patients undergoing laryngeal mask anesthesia between March and June 2023 were selected. Combined with sulfentanil 0.2 μg/kg, remimazolam was used as induction hypnotic. The first patient was given remizolam benzenesulfonate 0.16 mg/kg infused by pump for 1 min. The dose of remimazolam for the next patient was determined by the biased coin up-and-down method based on the patient’s response to the laryngeal mask placement. The score of Modified Observer’s Assessment of Alert/Sedation, vital signs and anesthesia depth index (AI) were recorded during induction. Probit analysis was used to calculate the half effective dose (ED50), 95% effective dose (ED95) and half effective AI (AI50). According to the statistical requirements, at least 45 negative patients were required. Results A total of 53 elderly patients were enrolled in the study until the end of the trial. The ED50 and ED95 of remimazolam benzenesulfonate for inhibiting cardiovascular responses to laryngeal mask insertion were 0.154 mg/kg [95% confidence interval (CI) (0.034, 0.170) mg/kg] and 0.207 mg/kg [95%CI (0.190, 0.614) mg/kg], respectively. AI decreased during induction, with an AI50 of 64.119 [95%CI (60.609, 69.984)]. Conclusion When combined with 0.2 μg/kg sufentanil, infusing 0.2 mg/kg remimazolam benzenesulfonate for 1 min is effective and safe for laryngeal mask anesthesia induction in elderly patients.
【摘要】 目的 比較喉罩全麻與氣管插管全麻兩種麻醉方法在小兒側臥位短小手術中的優缺點。 方法 2009年6月-2010年2月，將40例擇期行側臥位短小手術兒患，隨機分為喉罩全麻（L）組與氣管插管全麻（T）組，每組各20例。觀察患兒術中心率（HR）、平均動脈壓（MAP）、脈搏血氧飽和度（SpO2）、氣道峰壓（Pmax），惡心嘔吐、術后躁動等圍術期不良反應。 結果 T組插管后及拔管后即刻HR、MAP均高于L組患兒（Plt;0.05）；SpO2、Pmax在兩組之間比較差異無統計學意義（Pgt;0.05），T組患兒術后躁動發生率明顯高于L組（Plt;0.05）。 結論 喉罩可以安全、有效地用于小兒側臥位短小手術麻醉，且操作簡便，插管期和拔管期心血管應激反應輕，術后躁動發生率低。【Abstract】 Objective To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children. Methods From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded. Results HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L. Conclusions LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.
目的評價喉罩或單腔氣管內插管在胸腔鏡下胸交感神經鏈切斷術的應用效果。 方法選擇80例行胸腔鏡下胸交感神經鏈切斷術的手汗癥患者，采用計算機隨機法將患者分為A、B兩組，每組各40例。其中A組男20例、女20例，平均年齡24歲；B組男21例、女19例，平均年齡23歲。A組使用喉罩通氣，B組使用單腔氣管內導管，均應用小潮氣量較快頻率正壓通氣及間歇人工氣胸。觀察兩組麻醉期間各時點心率（HR）、平均動脈壓（MAP）、呼氣末二氧化碳分壓（PetCO2）、動脈血氧飽和度（SpO2）、心電圖（ECG）的變化。同時記錄喉罩/單腔導管置入時間、CO2充氣時間、手術時間、術中術后不良反應和并發癥。 結果兩組患者手術順利，無并發癥。A組喉罩/插管置入時間和喉罩/單腔管嗆咳、術后咽喉疼痛發生率低于B組，差異有統計學意義（P<0.05）。B組MAP、HR水平在T2（喉罩/單腔管置入后）和T7（蘇醒后撥喉罩/單腔管時）明顯高于T1（麻醉誘導完成），差異有統計學意義（P<0.05）；A組MAP、HR水平在T2和T7時亦明顯低于B組，差異有統計學意義（P<0.05）。所有患者術中ECG、SpO2和PetCO2無明顯變化。 結論喉罩或單腔氣管內插管結合間歇的人工氣胸都能滿足胸交感神經切斷術的操作需要，喉罩具有更穩定的血流動力學狀態和更高的安全性。
Objective To systematically assess the effectiveness and safety of streamlined liner of the pharynx airway (SLIPA) compared with endotracheal tube (TT) for airway management in patients undergoing laparoscopic cholecystectomy surgery. Methods Databases such as PubMed (1992 to February 2012), EMbase (1984 to February 2012), MEDLINE (Ovid, 1964 to February 2012), SCI (1992 to February 2012), CNKI (1992 to February 2012), CBM (2002 to 2012) as well as WanFang Data (1992 to February 2012) were searched for relevant literature. The references of the included articles were also manually traced. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Meta-analyses were performed using RevMan 5.0 software. Results Ten randomized controlled trials (RCTs) involving 664 patients were included. Results of meta-analysis showed that: a) as for side effects, none of the patients experienced regurgitation or hypoventilation during operation; b) as for extubation response, SLIPA was proved fewer than TT during extubation with a significant difference (RR=0.14, 95%CI 0.05 to 0.36, Plt;0.000 1); c) SLIPA was superior to TT with regard to reducing postoperative sore throat (RR=0.15, 95%CI 0.06 to 0.38, Plt;0.000 1); d) SLIPA was similar to TT with regard to Ppeak after peritoneal insufflations (WMD=–0.07, 95%CI –0.73 to 0.59, P=0.83); e) as for PETCO2, the SLIPA group was lower than the TT group obviously after peritoneal insufflations (WMD=–1.09, 95%CI –1.70 to –0.49, P=0.000 4); f) as for hemodynamic change, the SLIPA group was more stable than the TT group during the operation with significant differences (Plt;0.05). Conclusion Current studies suggest that it is safe and effective to apply SLIPA for ventilation in laparoscopic cholecystectomy surgery. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
目的 評價地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查的效果。 方法 將2012年10月－12月擬行纖維支氣管鏡檢查，且按美國麻醉醫師協會分級Ⅰ或Ⅱ級的60例患者，隨機分為芬太尼組（F組）、地佐辛組（D組）、生理鹽水組（N組）,每組20例。采用雙盲法給藥，靜脈注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理鹽水0.1 mL/kg，5 min后3組緩慢靜脈注射丙泊酚2 mg/kg誘導后置入喉罩，術中保留自主呼吸，持續泵入丙泊酚4～6 mg/（kg·h）維持麻醉，觀察3組患者誘導前（T0）、誘導后時（T1）、纖維支氣管鏡操作時（T2）、術畢時（T3）及拔除喉罩時（T4）的生命體征，記錄丙泊酚總用量、蘇醒時間、蘇醒時的呼吸道疼痛視覺模擬評分（VAS），記錄術中及術后有關并發癥的發生情況。 結果 與N組相比，D、F兩組丙泊酚總用量減少、蘇醒時間縮短，頭昏及術中體動發生率、VAS評分明顯降低（P＜0.05）；呼吸暫停的發生率D組最低（P＜0.05）；惡心、嘔吐的發生率F組最高（P＜0.05）。 結論 地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查，麻醉效果滿意，術后鎮痛效果好，值得臨床推廣。