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目的探讨ProSealTM喉罩通气道(PLMA)应用于超快通道小儿心脏麻醉的可行性和安全性。方法选取实施择期心脏手术的患儿40例,年龄6个月～5岁,均为美国麻醉医师协会(ASA)身体状况分级Ⅱ级。患儿按体质量分为2组,Ⅰ组(20例):体质量5～10kg,插入1.5号PLMA;Ⅱ组(20例):体质量>10～20kg,插入2.0号PLMA。采用80mL.L-1七氟烷实施吸入麻醉诱导,采用持续静脉泵入瑞芬太尼和异丙酚及吸入七氟烷维持麻醉,静脉应用维库溴铵维持肌肉松弛。结果术中全部患儿采用容量控制通气,并能达到设定的潮气量而无漏气。插入PLMA后,患儿总呼吸道峰压为(15.8±4.2)cmH2O(1cmH2O=0.098kPa);Ⅰ组插入PLMA后呼吸道峰压明显高于Ⅱ组[(18.9±3.8)cmH2Ovs(12.8±1.7)cmH2O,P<0.05]。Ⅱ组PLMA插入后的呼吸道峰压明显低于胸骨闭合后[(12.8±1.7)cmH2Ovs(16.5±3.8)cmH2O,P<0.05]。停机前,全部患儿肺复张膨肺采用的呼吸道压为25～35cmH2O,肺复张满意,且无脱离体外循环后低氧血症。全部患儿在手术室内拔除PLMA,PLMA使用的平均时间为(174.7±30.9)min。虽然拔出PLMA前后的脑电双频指数、血压和心率变化比较差异有统计学意义,但各参数的变化均小于10%。术后X线胸片检查无异常。结论 PLMA应用于超快通道小儿心脏手术麻醉是可行且相对安全的。
Objective To investigate the feasibility and safety of ProSeal TM laryngeal mask ventilation (PLMA) for ultra-fast access to pediatric cardiac anesthesia. Methods Forty children with elective cardiac surgery were selected, ranging in age from 6 months to 5 years. All of them were ASA physical status grade Ⅱ. The children were divided into 2 groups according to body mass. Group I (20 cases): body weight 5 ~ 10kg, inserted PLMA 1.5; group Ⅱ (20 cases): body weight> 10 ~ 20kg. Induction anesthesia was induced with 80 mL.L-1 sevoflurane, sustained intravenous infusion of remifentanil and propofol and inhalation of sevoflurane to maintain anesthesia, vecuronium intravenous maintenance of muscle relaxation. Results All patients with intraoperative volume control ventilation, and can reach the set tidal volume without leakage. After PLMA insertion, peak pressure of total airway in children was (15.8 ± 4.2) cmH2O (1cmH2O = 0.098kPa); peak pressure of airway in group Ⅰ was significantly higher than that in group Ⅱ [(18.9 ± 3.8) cmH2O vs (12.8 ± 1.7) cmH2O , P <0.05]. The peak airway pressure of PLMA after Ⅱ insertion was significantly lower than that after sternal closure [(12.8 ± 1.7) cmH2O vs (16.5 ± 3.8) cmH2O, P <0.05]. Before shutdown, all children with pulmonary reexpansion of the airway pressure used for the 25 ~ 35cmH2O, pulmonary seizure satisfaction, and without hypoxemia after cardiopulmonary bypass. All children with PLMA were removed in the operating room. The average time for PLMA was (174.7 ± 30.9) min. Although before and after pulling out PLMA EEG index, blood pressure and heart rate changes were statistically significant differences, but the changes of the parameters were less than 10%. Postoperative X-ray examination no abnormalities. Conclusion It is feasible and relatively safe to use PLMA for ultra-fast access to pediatric cardiac surgery.