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Kontinuierliche Cuff-Druck-Messung bei Larynxmaskennarkosen

Eine obligatorische Maßnahme zur Vermeidung postoperativer Komplikationen

Continuous cuff pressure measurement during laryngeal mask anesthesia

An obligatory measure to avoid postoperative complications

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Zusammenfassung

Hintergrund

Vielfach wird die Blockung der Larynxmaske ausschließlich nach klinischem Eindruck und ohne objektive Messung des Cuff-Drucks durchgeführt. Daraus resultieren häufig postoperative Komplikationen wie Halsschmerzen, Heiserkeit, Schluckstörungen oder Nervenschäden. In der vorliegenden Arbeit wurde der Einfluss der kontinuierlichen Cuff-Druck-Messung auf die Inzidenz postoperativer Halsschmerzen bei Patienten untersucht, bei denen eine Larynxmaskennarkose durchgeführt wurde.

Patienten/Material und Methoden

Im Rahmen eines retrospektiven Audits wurden Patienten, die sich einer elektiven Operation in Larynxmaskennarkose unterzogen haben, gebeten, einen postoperativen Narkosefragebogen auszufüllen. Primäre Zielgröße war das Auftreten von Halsschmerzen. Zur Analyse wurden die Patienten in 2 Gruppen eingeteilt. In der ersten Gruppe erfolgte die Cuff-Druck-Kontrolle ausschließlich nach klinischen Gesichtspunkten. In der zweiten Gruppe wurde der Cuff-Druck direkt mittels kontinuierlicher Manometrie gemessen. Der Beobachtungszeitraum umfasste jeweils 10 Monate.

Ergebnisse

Insgesamt wurden in dem genannten Zeitraum 4169 Larynxmaskennarkosen durchgeführt. Von diesen machten 917 Patienten (Manometriegruppe: n = 433, Kontrollgruppe: n = 484) freiwillig Angaben zum postoperativen Verlauf. Vor Einführung der Cuff-Druck-Messung klagten 36 % aller Patienten über Halsschmerzen, während dies unter kontinuierlichem Monitoring nur bei 12 % der Fall war (p < 0,001). Postoperative Übelkeit und Erbrechen traten bei 16 % der Patienten auf, und über starke Schmerzen im Operationsgebiet klagten 13 %. In der Gruppe mit kontinuierlicher Cuff-Druck-Messung waren 97 % aller Patienten mit dem Narkoseverfahren zufrieden, während dies in der Vergleichsgruppe nur bei 79 % der Patienten der Fall war (p = 0,006).

Schlussfolgerungen

Aufgrund unserer eigenen Untersuchungsergebnisse und angesichts der in der Literatur verfügbaren Daten muss für alle Larynxmaskennarkosen eine Cuff-Druck-Messung gefordert werden.

Abstract

Background

Inflation of laryngeal masks is often performed only with regard to the clinical impression and without any objective measurement of cuff pressure. As a result the use of laryngeal masks frequently leads to postoperative complications, such as sore throat, dysphonia, dysphagia and nerve palsy. In this study the influence of continuous measurement of cuff pressure on the incidence of postoperative sore throat was investigated in patients who underwent laryngeal mask anesthesia.

Patients/material and methods

In the context of a retrospective audit all patients who underwent laryngeal mask anesthesia were asked to complete a questionnaire on anesthesia. The primary endpoint of the study was the postoperative occurrence of a sore throat. For analysis the patients were divided into two groups. In the first group the cuff pressure was controlled only by clinical means and in the second group the cuff pressure was controlled using continuous manometry. The study covered a 10-month period of observation for each group.

Results

During the observation period laryngeal mask anesthesia was performed in 4169 patients. Of these 917 patients (manometry group n = 433 and control group n = 484) voluntarily completed the questionnaire. In the group without cuff pressure measurement 36 % of patients complained of sore throat postoperatively but only 12 % of the patients in the group with cuff pressure measurement (p < 0.001). Postoperative nausea and vomiting occurred in 16 % of the patients and 13 % complained of severe pain in the area of the operation. No differences between the two groups were found. While 97 % of patients in the group with continuous measurement of cuff pressure were satisfied with the anesthesia, this applied to only 79 % of patients in the control group (p = 0.006).

Conclusion

In terms of the results of this study and with respect to data from the literature, measurement of cuff pressure should be compulsory during laryngeal mask anesthesia.

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Danksagung

Wir bedanken uns bei Frau Katrin Kramer für die große Unterstützung bei der Sammlung und Aufbereitung der Daten.

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Authors and Affiliations

  1. Abteilung Anästhesiologie u. Intensivmedizin, Park-Klinik-Weissensee, Schönstr. 80, 13086, Berlin, Deutschland

    M. Hensel, T. Güldenpfennig, A. Schmidt & M. Krumm

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  1. M. Hensel
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  2. T. Güldenpfennig
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  3. A. Schmidt
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  4. M. Krumm
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Correspondence to M. Hensel.

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M. Hensel, T. Güldenpfennig, A. Schmidt und M. Krumm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hensel, M., Güldenpfennig, T., Schmidt, A. et al. Kontinuierliche Cuff-Druck-Messung bei Larynxmaskennarkosen. Anaesthesist 65, 346–352 (2016). https://doi.org/10.1007/s00101-016-0160-9

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  • DOI: https://doi.org/10.1007/s00101-016-0160-9

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