[Laryngeal mask under total myoplegia and artificial pulmonary ventilation during laparoscopic cholecystectomies].
The problem of using a laryngeal mask (LM) under total myorelaxation and artificial pulmonary ventilation (APV) is still topical and unsolved. A hundred and forty six anesthesias for laparoscopic cholecystectomy by employing LM in 86 patients or endotracheal tube (ETT) in 60 were comparatively evaluated. Anesthesia included premedication (diazepam, dimedrol, atropine, the H2-blocking agent ranitidine), induction (ketamine, barbiturates and propofol in combination with diazepam and fentanyl; the NMBs pipecuronium bromide and succinylcholine), maintenance (N20:O2 = 2:1. Fentanyl, pipecuronium bromide), monitoring (Capnomac-Ultima (Datex), Dinamap (Criticon) and acid base balance measurements. The quantity and pH of gastric contents were examined. Methylene blue in gelatin capsules was used as a regurgitation indicator. Unlike ETT, LM caused no reactions. The hemodynamic parameters at the traumatic stages of an operation were higher in the ETT group. Smaller amount of analgetics was used in the LM group. The use of manual APV at Pinsp of < 10 cm H2O fully prevented a gas mixture from entering the stomach. Pneumoperitoneum caused increases in Et CO2, pCO2, P inspiration and decreases in breathing volume and lung compliance. The hermetic sealing of joints was 95.6-98.5% in the LM group. Regurgitation was not found in 33 patients. LM NMB and APV may be successfully and safely used in clinical practice.
Buniatian
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Scientific Center of Surgery RAMN, Moscow.
Dolbneva
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EL
D000768:Anesthesia, General / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D006801:Humans; D017214:Laryngeal Masks; D009126:Muscle Relaxation; D012121:Respiration, Artificial / Q000379:methods*; D012449:Safety