在第二代喉罩通气道中使用和不使用插入式胃管进行胃充气：随机对照交叉试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-10-17 DOI:10.1016/j.jclinane.2024.111653

Johannes Hell MD , Grischa Schelker , Stefan Schumann PhD , Axel Schmutz PhD

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引用次数: 0

摘要

研究目的第二代喉罩通气道配有一个额外的胃管管腔，目的是通过排出胃内容物来降低吸入风险。然而，在正压通气过程中，通过胃通道插入胃管对胃充气（吸入病理机制的重要组成部分）的影响尚不清楚。我们假设，插入胃管会增加胃充气的风险。设计单中心、前瞻性、随机对照交叉试验。干预措施在使用两种不同充气罩囊设计（充气式或热塑式）的喉罩气道中的一种时，在最高气道压力为 30 cmH2O 的增压试验中以及在插入或未插入胃管的情况下测量口咽漏压时对胃充气进行了研究。主要结果在增压试验（10.9 % (16/147) vs. 2.7 % (4/147)，p = 0.009）和口咽漏压测量（16.3 % (24/147) vs. 5.4 % (8/147)，p = 0.004）期间，插入胃管比未插入胃管的胃充气频率更高。两种袖带类型的胃充气风险没有差异（p = 0.100）。在正压通气期间（p = 0.003）和口咽漏压测量期间（p = 0.049），开放胃通道的流量与胃充气有关。结论通过第二代喉罩通气道的胃通道放置胃管（与充气罩囊类型无关）会增加胃充气的风险。胃通道上方的流量表明胃充气的风险较高，而胃充气可能会增加术后恶心和呕吐的风险。

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Gastric insufflation with and without an inserted gastric tube in second-generation laryngeal mask airways: A randomized controlled cross-over trial.

Study objective

Second-generation laryngeal mask airways are equipped with an additional lumen for a gastric tube, with the intention to reduce the risk of aspiration by draining gastric content. However, the effect of an inserted gastric tube through the gastric channel on gastric insufflation, a substantial part of the pathomechanism of aspiration, during positive-pressure ventilation is not clear. We hypothesized, that an inserted gastric tube increases the risk of gastric insufflation.

Design

Single center, prospective, randomized-controlled cross-over trial.

Setting

Tertiary academic hospital in Germany.

Patients

152 patients, ASA I-III, scheduled for general anesthesia with a laryngeal mask airway.

Interventions

Gastric insufflation was investigated during an incremental pressure trial up to a maximum airway pressure of 30 cmH₂O and during oropharyngeal leak pressure measurement with and without an inserted gastric tube while one of two laryngeal mask airways with different cuff designs (inflatable or thermoelastic) was used.

Measurements

Gastric insufflation was detected with real-time ultrasound.

Main results

Frequency of gastric insufflation was higher with than without inserted gastric tube during the incremental pressure trial (10.9 % (16/147) vs. 2.7 % (4/147), p = 0.009) and during oropharyngeal leak pressure measurement (16.3 % (24/147) vs. 5.4 % (8/147), p = 0.004). Risk of gastric insufflation didn't differ between the two cuff-types (p = 0.100). Flow over the open gastric channel was associated with gastric insufflation during positive-pressure ventilation (p = 0.003) and during oropharyngeal leak pressure measurement (p = 0.049). Incidence of postoperative nausea and vomiting was higher in patients in which gastric insufflation was detected, compared to others (17.1 % (6/35) vs. 5.4 % (6/112), p = 0.037).

Conclusion

Placement of a gastric tube through the gastric channel of a second-generation laryngeal mask airway, independent of the cuff-type, increases the risk of gastric insufflation. Flow over the gastric channel indicate a higher risk of gastric insufflation and gastric insufflation may increase the risk of postoperative nausea and vomiting.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.