氣囊式口咽人工氣道及喉罩在自發性呼吸麻醉之比較
Comparison of the cuffed oropharyngeal
airway and laryngeal mask airway in
spontaneous breathing anesthesia
陳建志
Hsu YW;Pan MH;Huang CJ;Cheng CR;Wu KH;Wei TT
and Chen CT
摘要. 背景：氣囊式口咽人工氣道是 Guedel 人工氣道的一種改良型，在其遠端加上一 個氣囊，近端加上一個 15 毫米連接頭，可接上呼吸管。本研究的目的是要比較 氣囊式口咽人工氣道及喉罩(LMA)在自發性呼吸麻醉的應用，是否氧囊式口咽人 工氣道有優於喉罩之處。方法：我們選擇 80 位成年病患，體位是 ASA class Ⅰ 及 ASA class Ⅱ，預計接受少於一個小時的手術，隨機分配病人於所囊式口咽人 工氣道(n=40)及喉罩(n=40)兩組，全身麻醉以 atropine 0.01mg/kg, fentanyl 2μg/kg 及 propofol 2mg/kg 誘導。病人睡著後分別置入氣囊式口咽人工氣道或喉罩，如 果下顎關節不夠鬆馳而無法置入，則以 succinylcholine 1mg/kg 來輔助置放，置入 後立即予氣囊充氣，籍由二氧化碳監視器及聽診器監視呼吸道順暢與否，手術中 麻醉以 isoflurane-N2O-O2 維持。兩組病人的成功率，血流動力學的變化，呼吸 量的變化，及副作用都予以記錄比較。結果：喉罩組的成功率(95%)較氣囊式口 咽人工氣道組(85%)高，然而置放或拔除喉罩時所引起的血壓昇高、心跳加快亦 明顯較氣囊式口咽人工氣道組高。氣囊式口咽人工氣道組比較不需要肌肉鬆馳劑 來輔助置入，但有 57.5%的病人需要額外的操作來維持呼吸道的通暢，而喉罩組 的病人則不需要這些操作。在副作用方面，喉罩組有兩個病人發生喉頭痙攣，手 術後追踨結果喉罩組喉嚨痛的機會亦較氣囊式口咽人工氣道組高(18%vs.10%)。 結論：氣囊式口咽人工氣道和喉罩比較起來，較易置放且對呼吸道刺激較小，但 是手術中大多數病人，尚需要額外的操作來幫忙維持呼吸道的通暢。臨床上氣囊 式口咽人工氣道可作爲自發性呼吸麻醉時，除了面罩及喉罩外的另一種選擇。 AbstractBackground: The cuffed oropharyngeal airway (COPA) is a modified Guedel airway with a cuff at its distal end and a standard 15mm connector at its proximal end. This study was performed to determine if the COPA would offer any advantage over the laryngeal mask
airway (LMA). Methods: Eighty ASA class I to II adult patients scheduled for short elective procedures (less than 1h) were randomly allocated into two groups. All patients were given atropine 0.01mg/kg, fentanyl 2pig/kg and propofol 2mg/kg intravenously for induction of anesthesia. The COPA or LMA was inserted following the loss of eyelash reflex. If the jaw was not relaxed enough for insertion of a COPA or LMA, succinylcholine 1mg/kg was given to facilitate the insertion. When correctly positioned, the cuff was immediately inflated with an appropriate volume. Gentle positive pressure ventilation was applied before spontaneous breathing resumed. Capnography was used to assess the patency of the airway. Anesthesia was maintained with isoflurane-N20-02 until the end of surgery. The success rate, vital signs, and adverse events were evaluated and compared. Results: The success rate in the LMA group (95%) was higher than the COPA group (85%). The increase in circulatory response after the LMA insertion was greater than that after the COPA insertion (P <0.05). Nine patients (22.5%) in the LMA group needed succinylcholine to facilitate insertion compared with only two patients (5%) in the COPA group. Additional manipulation was frequently (57.5%) needed after inserting the COPA to maintain the patency of the airways, but none needed so in the LMA group. Two patients had laryngospasms upon removal of the LMA, but none had laryngospasm in the COPA group. The incidence of sore throat in the LMA group was higher than in the COPA group (18% vs 10%). Conclusions: We demonstrated that the COPA could be easily inserted without the need of muscle relaxants in most patients. But the COPA needed airway intervention to provide an effective airway in most patients. Compared with the LMA, the COPA caused less stimulation than the LMA
