Ambulatory surgery laryngeal mask using progress

by:Honde     2020-06-03

as laryngeal mask ( LMA) In short, use the experience accumulated in the cases of spontaneous breathing, on some controversial, the use of laryngeal mask frequency also began to increase. In 2007, the European society of anesthesia ( ESA) Annual meeting of the British Smith summary report for laryngeal mask on some thought to use controversial progress in the use of ambulatory surgery. In the simple application of laparoscopic surgery because pneumoperitoneum and head low can increase the risk of aspiration, so the use of laryngeal mask in gynecological laparoscopic surgery was controversial. Now, the study found that the use of laryngeal mask and its operation caused by esophageal sphincter pressure increases the degree of pressure is greater than the stomach. Therefore, the use of laryngeal mask can actually increase reflux barrier pressure, avoid reverse flow. Some ongoing esophageal pH monitoring research also confirmed that the use of laryngeal mask in laparoscopic surgery, low incidence of severe gastroesophageal reflux, and seldom happen other adverse events. In an evaluation of laparoscopic surgery in the study of the use of laryngeal mask ( In 20% of obese patients, and 14% coexist reflux disease) , the incidence of intraoperative reflux is only 1%, and no patients with aspiration. In clinical practice, through the laryngeal mask retains the spontaneous breathing did not increase the incidence of adverse events, and can in a short time ( Operation time & lt; 15 minutes, head low amplitude & lt; 15 degrees or pneumoperitoneum pressure & lt; 15 mmHg) Used in gynecological laparoscopic surgery. In a long time or complex laparoscopic surgery, the independent ventilation adverse events, and the safety of the laryngeal mask is not clear. In the application of laparoscopic cholecystectomy increased laparoscopic gallbladder excision become ambulatory surgery, compared with pelvic laparoscopic surgery, the surgery with head high, from the perspective of ventilation is more suitable for the use of laryngeal mask. However, the operation time is too long or upper gastrointestinal disturbances can increase the risk of aspiration. Moreover, bile reflux, may occur when aspiration can cause severe lung damage. In addition, bile reflux can increase gastric contents, increase the possibility of gastric reflux. In the laparoscopic cholecystectomy, through a laryngeal mask or endotracheal intubation can obtain satisfactory control ventilation breath at the end of the carbon dioxide, oxygen saturation, gas pressure and operation conditions. There are small sample study confirmed the effectiveness of the laryngeal mask use. However, the evidence of laryngeal mask for the safety of laparoscopic cholecystectomy is less, and have been reported aspiration pneumonia than in 1 case. Many experts think the laryngeal mask is not suitable for laparoscopic cholecystectomy. Proseal laryngeal mask can be well drainage gastric contents, through the capsule of the higher internal pressure to avoid aspiration. Studies have shown that in the establishment of pneumoperitoneum, Proseal laryngeal mask ventilation effect is good normal laryngeal mask. Although the Proseal laryngeal mask may be the most suitable for laparoscopic cholecystectomy in laryngeal mask, but compared with endotracheal intubation, its security evidence is still insufficient, and may not be able to completely avoid aspiration. In the application of prone position surgery prone position laryngeal mask is still the most controversial, the main worry is that patients with face down, ventilation equipment may emerge or shift, which can lead to catastrophic events happen. But there is no such incident reports, and case reports and small sample study support the validity of the laryngeal mask in prone position. Smith, introduces his own experiences, usually in the routine induction, placing a laryngeal mask airway security to ensure cases, flip patients become prone position. There are experts, however, let the patient in a comfortable prone position at the beginning, then anesthesia induction, and then gently move for laryngeal mask placement head. This approach has been significantly reduced the number of patients with artificial handling and patient injury risk. Laryngeal mask easily under the prone position in the fact that the once intraoperative laryngeal mask shift, can put again in prone position. And under the prone position in endotracheal intubation is hard, so endotracheal intubation was gradually replaced.


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