Abstract
The purpose of the study was to compare the incidence of complications (coughing, biting, retching, vomiting, excessive salivation and airway obstruction) associated with removal of the laryngeal mask airway. The laryngeal mask airway was used in 100 adults undergoing urological procedures. The patients were randomly assigned to two groups. In 50 patients the laryngeal mask was removed by a nurse when the patient responded to commands in the recovery area. In the other 50 patients it was removed by the anaesthetist with the patient deeply anaesthetized in theatre. The majority of patients were elderly men who had relatively short procedures. The incidence of gastric regurgitation was assessed by measurement of pH of secretions at the tip of the laryngeal mask airway. Complications occurred more frequently in the awake patients (P < 0.01). Most were minor and occurred before removal of the laryngeal mask airway during emergence in the recovery room. Airway obstruction occurred in three patients in whom the laryngeal mask was removed in the recovery room. In two of these patients the oxygen saturation decreased below 80% and the other to 90%. No decrease in arterial oxygenation occurred in the anaesthetised patients in whom the laryngeal mask was removed by the anaesthetist. In 14 patients in the awake group the pH of secretions at the tip of the laryngeal mask was ≤3 compared with only four patients in the anaesthetised group (P < 0.05). It is concluded that it may be safer to remove the laryngeal mask airway whilst the patients are deeply anaesthetised in the operating room than when they are awake in the recovery room.
Résumé
Cette étude a pour objectif de comparer l’incidence des incidents (toux, morsures, haut-le-coeur, vomissements, salivation excessive et obstruction des voies respiratoires) associés à l’ablation du masque laryngé. Un masque laryngé est mis en place chez 100 adultes soumis à une intervention urologique. Les patients sont répartis au hasard entre deux groupes. Dans le premier groupe de 50 patients, le masque laryngé est enlevé par l’infirmière de la salle de réveil dès que le patient répond aux ordres verbaux. Dans le deuxième groupe, le masque est retiré par l’anesthésiste en salle d’opération alors que le patient est toujours sous anesthésie profonde. La majorité des patients sont des personnes âgées opérées pour des interventions relativement courtes. L’incidence de la régurgitation gastrique est évaluée par la mesure du pH des sécrétions recueilles à la pointe du masque laryngé. Les complications sont plus fréquentes chez le patient éveillé (P < 0,01). La plupart sont mineures et surviennent à la phase d’émergence, avant l’ablation du masque, en salle de réveil. On note de l’obstruction chez trois patients dont le masque a été enlevé à la salle de réveil. Chez deux de ces patients, la saturation en oxygène baisse sous 80% et chez le troisième à 90%. Cette complication ne survient chez aucun des patients encore sous anesthésie lorsque le masque laryngé est retiré par un anesthésiste. Chez 14 patients du groupe éveillé, le pH des sécrétions prélevées à la pointe de masque laryngé est de ≤3 comparativement à quatre patients seulement du groupe encore anesthésie (P < 0,05). En conclusion, il est préférable pour la sécurité du patient d’enlever le masque laryngé alors qu’il est encore anesthésié profondément en salle d’opération qu’en salle de réveil à la phase de récupération.
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Gataure, P.S., Latto, I.P. & Rust, S. Complications associated with removal of the laryngeal mask airway: A comparison of removal in deeply anaesthetised versus awake patients. Can J Anaesth 42, 1113–1116 (1995). https://doi.org/10.1007/BF03015098
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DOI: https://doi.org/10.1007/BF03015098