The intubating laryngeal mask .2. a preliminary clinical report of a new means of intubating the trachea
The intubating laryngeal mask .2. a preliminary clinical report of a new means of intubating the trachea
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DOI：
10.1093/bja/79.6.704
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发表时间：
1997-12-01
影响因子：
9.8
通讯作者：
Brimacombe, J
中科院分区：
文献类型：
--
作者：
Brain, AIJ;Verghese, C;Brimacombe, J
我们已经评估了一种新的喉罩原型，插管喉罩气道（ILMA），作为一种辅助设备和盲插管引导的有效性。ILMA由一个解剖学弯曲的、短的、宽口径的不锈钢管组成，该管套在硅胶中，与喉罩和引导手柄粘合。它有一个可移动的孔杆，一个引导坡道，可以容纳一个8 mm的气管插管（TT）。在用丙泊酚2.5 mg kg（-1）和芬太尼2.5 μ g kg（-1）诱导麻醉后，所有150名（100%）患者首次尝试时均成功插入该装置，并实现了充分的通气，4名患者需要进行微小调整。放置不需要移动头部和颈部或将手指插入患者口中。给予阿曲库铵0.5 mg kg（-1）后，尝试使用直型硅胶套囊TT进行盲探气管插管。如果在插管过程中感觉到阻力，则根据阻力发生的深度使用一系列调整操作。150例患者中有149例（99.3%）可以进行气管插管。在75例（50%）患者中，未遇到阻力，首次尝试气管插管，28例（19%）患者需要一次调整操作，46例（31%）患者需要2-4次调整操作才能成功插管。有13名患者存在潜在或已知的气道问题。所有这些患者的肺部通气容易，气管插管使用ILMA。13例患者中有10例（77%）未遇到阻力，首次尝试气管插管; 13例患者中有3例（23%）需要一次调整操作。在预测或已知困难气道的患者中，气管插管所需的调整操作显著减少（P < 0.05）。我们的结论是，初步评估显示ILMA对于没有胃误吸风险的常规和困难气道患者来说是一种有效的通气装置和插管指南。
We have assessed the efficacy of a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA), as a ventilatory device and blind intubation guide. The ILMA consists of an anatomically curved, short, wide bore, stainless steel tube sheathed in silicone which is bonded to a laryngeal mask and a guiding handle. It has a single moveable aperture bar, a guiding ramp and can accommodate an 8 mm tracheal tube (TT). After induction of anaesthesia with propofol 2.5 mg kg(-1) and fentanyl 2.5 mu g kg(-1), the device was inserted successfully at the first attempt in ail 150 (100%) patients and adequate ventilation achieved in all, with minor adjustments required in four patients. Placement did not require movement of the head and neck or insertion of the fingers in the patient's mouth. Blind tracheal intubation using a straight silicone cuffed TT was attempted after administration of atracurium 0.5 mg kg(-1). If resistance was felt during intubation, a sequence of adjusting manoeuvres was used based on the depth at which resistance occurred. Tracheal intubation was possible in 149 of 150 (99.3%) patients. In 75 (50%) patients no resistance was encountered and the trachea was intubated at the first attempt, 28 (19%) patients required one adjusting manoeuvre and 46 (31%) patients required 2-4 adjusting manoeuvres before intubation was successful. There were 13 patients with potential or known airway problems. The lungs of all of these patients were ventilated easily and the trachea intubated using the ILMA. In 10 of 13 (77%) of these patients, no resistance was encountered and the trachea was intubated at the first attempt; three of 13 (23%) patients required one adjusting manoeuvre. Tracheal intubation required significantly fewer adjusting manoeuvres in patients with a predicted or known difficult airway (P < 0.05). We conclude that the ILMA appeared on initial assessment to be an effective ventilatory device and intubation guide for routine and difficult airway patients not at risk of gastric aspiration.