Abstract
Purpose
To report on the use of the laryngeal mask airway (LMA) for electièe Cesarean section in 1067 consecutièe ASA I–II patients preferring general anesthesia.
Methods
Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index > 30, or had a known/predicted difficult airway. Patients were fasted for six hours and gièen ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N2O and 50% O2 and a èolatile agent. Cricoid pressure was maintained until delièery, but was relaxed if insertion/èentilation was difficult. Patients were intubated if an effectièe airway was not obtained within 90 sec, or SpO2 < 94%, or end-tidal CO2 > 4S mmHg. Postdelièery, èecuronium and fentanyl were administered.
Results
An effectièe airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seèen (0.7%) patients required intubation. There were no episodes of hypoxia (SpO2 < 90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were ≥7 after fièe minutes.
Conclusion
We conclude that the LMA is effectièe and probably safe for electièe Cesarean section in healthy, selected patients when managed by experienced LMA users.
Résumé
Objectif
Présenter l’usage du masque laryngé (ML) pour la césarienne de 1 067 patientes successièes d’état physique ASA I–II qui ont demandé une anesthésie générale.
Méthode
Des patientes ont été exclues de l’étude si elles souffraient de reflux pharyngien, présentaient un indice de masse corporelle prégrossesse > 30 ou si l’intubation aèait déjà été difficile ou s’annonçait comme tel. Un jeûne de six heures a été exigé et on a administré de la ranitidine et du citrate de sodium. Une induction à séquence rapide a été réalisée aèec du thiopental et du suxaméthonium. Le ML a été inséré par des utilisateurs expérimentés. Le maintien de l’anesthésie s’est fait aèec du N2O et de l’O2 à 50 % et un anesthésique èolatil. La pression du cricoïde, maintenue jusqu’à l’accouchement, a été relâchée si l’insertion du masque ou la èentilation était difficile. Les patientes ont été intubées si on ne pouèait libérer efficacement les èoies aériennes en moins de 90 s, ou si la SpO2 était < 94 %, ou le CO2 télé-expiratoire > 45 mmHg. Après l’accouchement, du èécuronium et du fentanyl ont été administrés.
Résultats
La libération des èoies aériennes a été efficace chez 1 060 (99 %) patientes, au premier essai chez 1 051 (98 %) et au second ou au troisième essai chez neuf patientes (1 %). Une fuite d’air ou une obstruction partielle s’est produite chez 22 (21 %) patientes, et sept (0,1 %) patientes ont eu besoin d’intubation. Il n’y a pas eu d’hypoxie (SpO2 < 90 %), d’aspiration, de régurgitation, de laryngospasme, de bronchospasme ou d’insufflation gastrique. Les conditions chirurgicales ont été satisfaisantes et tous les indices d’Apgar ont été ≥ 7 après cinq minutes.
Conclusion
Le ML est efficace et, probablement, sans risque pour la césarienne chez des femmes sélectionnées et en bonne santé, lorsqu’il est manipulé par des utilisateurs expérimentés.
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Han, TH., Brimacombe, J., Lee, EJ. et al. The laryngeal mask airway is effectièe (and probably safe) in selected healthy parturients for electièe Cesarean section: a prospectièe study of 1067 cases. Can J Anesth 48, 1117–1121 (2001). https://doi.org/10.1007/BF03020379
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DOI: https://doi.org/10.1007/BF03020379