CAJ | 학술논문

目的探讨不同头颈位置时i-gel喉罩对全麻手术患者气道密封压(OLP)和通气效果的影响.方法择期全麻手术患者30例,性别不限,年龄32 ～ 64岁,BMI 18 ～ 30 kg/m2,ASA分级Ⅰ或Ⅱ级.麻醉诱导后,采用单手旋转盲插法置人i-gel喉罩,置入成功后行机械通气.分别在头颈正中位、俯屈位、仰伸位及侧旋位(右侧)时记录OLP、呼出潮气量(VTE)、气道峰压(PPeak)和通气效果,并采用纤维支气管镜观察咽部解剖结构显露情况.结果与头颈正中位比较,头颈俯屈位时OLP和PPeak升高,VTE降低,头颈仰伸位时OLP和PPeak降低,VTE升高,头颈俯屈位时通气效果较差(P＜0.05),不同头颈位置时咽部解剖结构显露程度差异无统计学意义(P＞0.05).结论 i-gel喉罩用于全麻手术患者时应避免头颈俯屈位.
목적 탐토불동두경위치시i-gel후조대전마수술환자기도밀봉압(OLP)화통기효과적영향.방법 택기전마수술환자30례,성별불한,년령32 ～ 64세,BMI 18 ～ 30 kg/m2,ASA분급Ⅰ혹Ⅱ급.마취유도후,채용단수선전맹삽법치인i-gel후조,치입성공후행궤계통기.분별재두경정중위、부굴위、앙신위급측선위(우측)시기록OLP、호출조기량(VTE)、기도봉압(PPeak)화통기효과,병채용섬유지기관경관찰인부해부결구현로정황.결과 여두경정중위비교,두경부굴위시OLP화PPeak승고,VTE강저,두경앙신위시OLP화PPeak강저,VTE승고,두경부굴위시통기효과교차(P＜0.05),불동두경위치시인부해부결구현로정도차이무통계학의의(P＞0.05).결론 i-gel후조용우전마수술환자시응피면두경부굴위.
Objective To investigate the influence of different head and neck positions on airway sealing pressure (OLP) with i-gel laryngeal mask airway (LMA) in patients undergoing elective surgery under general anesthesia with mechanical ventilation.Methods Thirty ASA Ⅰ or Ⅱ patients of both sexes aged 32-64 yr with a body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were studied.Size 4 i-gel LMA was placed blindly after induction of anesthesia and connected to anesthetic circuit.The criteria for successful placement were easy inflation with small leak,peak inspiratory pressure (PPeak) within normal range and normal PETCO2 wave form.Fiberoptic bronchoscopy was performed to check the position of LMA.OLP,expiratory tidal volume ( VTE ),PPeak and efficiency of mechanical ventilation were measured in different head and neck positions.OLP was measured by gradually increasing airway pressure until PPeak was reached.The measurement was stopped when there was large leak or OLP ＞ 35 cm H2 O.The efficacy of ventilation was evaluated by manually inflating the lungs (perfect:easy inflation,no audible leak; satisfactory:easy inflation,small leak; poor:difficult inflation,large leak).Results Flexion of the head significantly increased OLP and PPeak and decreased VTE,while hyperextension significantly decreased OLP and PPeak and increased VTE as compared with middle position of the head.Lung ventilation was less satisfactory when the head was flexed.Turning the head to either side did not affect ventilation.Conclusion Flexion of the head should be avoided when i-gel LMA is used during anesthesia.