European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
Background and goal of study: Nasal surgery requires anaesthesia that facilitates a bloodless field. It is usually performed with orotracheal intubation and a throat pack for airway protection from bleeding. Use of the LMA may avoid hypertension and tachycardia following intubation and thus decrease surgical bleeding. It also avoids problems with muscle relaxants and reversal drugs. The LMA is not routinely used in nasal surgery, due to fear of tracheal contamination. However, dye placed above an LMA does not contaminate the larynx unless the LMA moves . We have evaluated the ability of the LMA to prevent airway contamination in nasal surgery.
Methods: We describe a prospective study, which received ethical permission, looking at 200 ASA I-III adult patients undergoing nasal surgery. An armoured LMA, sizes 3-5 was used. Induction was with propofol; maintenance was with a volatile agent or propofol infusion, plus fentanyl or remifentanil. At the end of surgery the oropharynx was suctioned to clear fluids accumulated above the LMA. Patients were recovered in the supine position, with LMA in situ and cuff inflated. Recovery nurses removed LMAs in recovery, when the patients awoke. The LMAs were examined on the inside for contamination of blood and secretions and scored (0-3) by the nurse according to soiling (0=no blood, 1=staining on the cuff; 2=staining on the inside of mask; 3=blood in the tube). A second person verified the score.
Results and discussion: [Mean (SD)]: Operative time was 29.9(16) min.; weight 75(14) kg; age 41 (14) yr.; time to LMA removal after end of surgery 5.5(3) min. There were 4 asthmatic patients and 2 with bleeding disorders. The contamination scores were [n (%)]: 0 = 174(87%); 1 = 22(11%); 2 = 4(2%); 3 = 0(0%). The verifying observer changed no score. We feel that the 2% incidence of LMA soiling at grade 2 is acceptable because it is outweighted by the known benefits of LMA use. No patients had adverse respiratory or other problems.
Conclusion: We recommend the use of the LMA for nasal surgery because it safely avoids the problems associated with tracheal intubation.
1 John RE, Hill S, Hughes TJ. Anaesthesia
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