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Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivität der supraglottischen Atemwegssicherung

Eine prospektive randomisierte Studie zum Vergleich des LTS™-Larynxtubus mit der ProSeal™-Larynxmaske

Influence of head position and neuromuscular block on the clinical efficacy of supraglottic airway devices

A prospective randomized study to compare the laryngeal tube suction (LTS™) with the ProSeal™ laryngeal mask

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Zusammenfassung

Am Beispiel des LTS™-Larynxtubus (LTS) und der ProSeal™-Larynxmaske (PLMA) sollen die Auswirkungen wechselnder Kopfpositionen und der neuromuskulären Blockade (NMB) auf die Effektivität und Sicherheit der supraglottischen Atemwege geprüft werden. Bei 54 Patienten wurden die Cuff-Leckage-Drücke in 5 definierten Kopfpositionen vor und nach NMB erfasst. Als Aspirationsmarker wurde Methylenblau gastral appliziert. Postoperativ erfolgte ein standardisiertes Interview bezüglich subjektiver Beschwerden der Patienten.

Der LTS und die PLMA weisen mit und ohne Muskelrelaxation eine vergleichbare Dichtigkeit auf. Es fand sich kein Hinweis auf eine Aspiration. Eine Reklination reduziert die Dichtigkeit der PLMA. Beim LTS kam es zu behandlungswürdigen Obstruktionen der oberen Atemwege. Vier Patienten der LTS-Gruppe gaben postoperativ Heiserkeit an. Insgesamt wurden die postoperativen Beschwerden der Patienten in beiden Gruppen als mild bis moderat eingestuft.

Abstract

In the present study the laryngeal tube suction (LTS™) was compared with the ProSeal™ laryngeal mask (PLMA) with respect to the influence of different head positions and neuromuscular block (NMB) on the clinical efficacy. In 54 patients seal pressures were observed according to a protocol for five pre-defined head positions before and after NMB. Regurgitation was observed using methylene blue as an indicator. Postoperatively a standardized interview was performed to rate subjective patient complaints. The LTS and PLMA provide a comparable seal and neuromuscular block did not impair the performance of both devices. With the PLMA the seal deteriorated with extension of the neck and with the LTS more airway manipulations were necessary to keep the airway patent. No signs of aspiration were observed in either group but of the patients in the LTS group four noticed hoarseness in the postoperative course. Altogether the subjective postoperative complaints were rated as mild to moderate in both groups.

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Authors and Affiliations

  1. Abteilung Anaesthesiologie, operative Intensivmedizin, Schmerztherapie, Universitätsklinikum Gießen und Marburg GmbH,Campus Gießen, Rudolf-Buchheim-Straße 7, 35382, Gießen, Deutschland

    V. Mann, D. Rupp, R. Röhrig, M.A. Weigand & M. Müller

  2. Klinik für Orthopädie und Unfallchirurgie, Klinikum Fulda gAG, Fulda, Deutschland

    S.T.W. Mann

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  1. V. Mann
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Mann, V., Mann, S., Rupp, D. et al. Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivität der supraglottischen Atemwegssicherung. Notfall Rettungsmed 15, 136–141 (2012). https://doi.org/10.1007/s10049-011-1413-4

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