在牙科麻醉自發性呼吸的病人使用加強型喉頭罩時滲漏情況之研究

Evaluation of Airway Leakage Using Reinforced Laryngeal Mask during Dental Anesthesia with Spontaneous Breathing

背景：本研究目的是針對在智障牙科使用加強型喉頭罩時，治療過程前後是否有因操作及頭部位置的改變，而有滲漏的情形。方法：所有的病人在誘導麻醉後，置入加強型喉頭罩，以sevoflurane維持麻醉深度。然後在口腔注入染有甲基藍的生理食鹽水，以支氣管鏡經由喉頭罩進入觀察咽喉部位有否因滲漏而染到藍色。然後在牙科醫師做完治療之後，再進行一次觀察，將結果紀錄並做比較分析。結果：在51個病人中治療前有一位有滲漏佔1.96％，牙科治療後發現有十位有滲漏佔19.6％，其中一位是在牙醫師操作時喉頭罩不慎被拔出，另一位則因滲漏嚴重而改成插管。這些病人沒有發生血氧濃度低於90％的情形，也沒有發燒或是吸入性肺炎等嚴重的併發症發生。結論：使用加強型喉頭罩可減少因氣管插管產生的的併發症，同時也可讓牙科治療加速順利進行。雖然在牙科的治療當中有些發生滲漏的情形，但並未造成重大的問題，在這些病人中並未有吸入性肺炎的情形發生。所以加強型喉頭罩可以作為另一種選擇使用在智障牙科麻醉而沒有重大的問題。

Background: The purpose of this study was to evaluate whether manipulation or position change of the head during dental procedures for handicapped patients (mentally retarded) using a reinforced laryngeal mask airway for ventilation would lead to air leak. Methods: All patients had a reinforced laryngeal mask airway inserted after induction of anesthesia; anesthesia was maintained with sevoflurane. Normal saline stained with methylene blue was instilled into the oral cavity of the patient. Then, the patient's laryngeal region was checked for blue staining with a fiberoptic bronchoscope. After dental treatment, the laryngeal region was checked again under fiberoptic bronchoscopy. The staining results were recorded and analyzed. Results: In one of 51 patients (1.96%), the laryngeal region was stained blue after the flexible laryngeal mask airway was inserted. In ten of 51 (19.6%) patients, the laryngeal area was stained blue after the dental procedure. One of the ten patients who had a leak because the laryngeal mask was pulled out during the dental procedure. And in another one patient endotracheal tube was placed in lieu of laryngeal mask due to severe leakage. No oxygen desaturation below 90% occurred in all patients. No major complications such as fever or aspiration pneumonia were reported. Conclusions: The use of a reinforced laryngeal mask airway eliminates the complications due to endotracheal intubation and enhances the progress of the dental procedure. Although leakage may happen during dental manipulation, it usually does not raise serious problem. No serious complications such as aspiration were found in our cases. So a reinforced laryngeal mask airway may be considered to be another safe choice for maintenance of a patent airway in handicapped patients during dental procedures.