The experience of Xiao Wuxue laryngeal mask (2) Those who have a super high value and a variety of laryngeal masks~

The experience of Xiaowuxue laryngeal mask (2) Those who have a high value and a variety of laryngeal masks have recently participated in the "Panorama Airway 2022CAA Cloud Classroom of the Li Wenwen Team of the Airway Management Training Center of the Eye and ENT Hospital of Fudan University" Learn with you airway management experts.
The teachers are very serious and responsible.
I have learned a lot.
The laryngeal mask is really not a tool that is tasteless and discarded.
If you use the laryngeal mask well, it can really solve many difficult clinical problems.
OK Let everyone follow my learning step by step to uncover the mysterious veil of the laryngeal mask.
Part 1 link → The experience of the laryngeal mask in Xiao Wuxue (1) The status and history of the laryngeal mask What is the generation of the laryngeal mask? There are many classification methods for laryngeal masks.
Miller's classification method, international classification standards, and "Cook classification" are commonly used now.
Cook classification, that is, the first generation of laryngeal masks is the classic single-tube laryngeal mask, and the second generation of laryngeal masks.
It is a double-tube laryngeal mask plus SLIPA, a special laryngeal mask with other anti-aspiration mechanisms, although it is a single tube
.

The third-generation laryngeal mask is still controversial internationally
.

That is, a first-generation SGA includes an airway tube with a mask-like cuff, and a second-generation SGA may have other features such as inclusion of tooth pads, a cuff for improved sealing, and an esophageal passage to facilitate placement of an orogastric tube , a cuff pressure monitor, and in some cases a lumen to facilitate insertion of an upper GI endoscope
.

 Some other brands of SGA products replicate the functionality of the original LMA at a lower cost (eg, Portex's "Portex Soft Seal" and Ambu's "AuraStraight"), while others use different materials from the original LMA ( For example, i-gel, air-Q, Ambu Aura-i, LMA Supreme)
.

Many SGAs contain a vent grille above the throat entrance that helps prevent the epiglottis from entering the hollow rod of the SGA
.

The epiglottis may interfere with ventilation and may interfere with visualization of glottic structures through flexible intubating scope (FIS), but the clinical significance of this structural feature (vent fence) is controversial
.

 Second-generation SGAs may have additional features such as inclusion of tooth pads, cuffs for improved sealing, esophageal access to facilitate orogastric tube placement, cuff pressure monitors, and, in some cases, to facilitate insertion of upper gastrointestinal endoscopes lumen
.

The general structure of the components of the laryngeal mask: the cuff, the ventilation tube and the joint The structure of the inflatable laryngeal mask also includes: inflatable tube, indicator ball/airbag, one-way valve Here they come~ LMA Classic/Unique LMA Supreme Some LMAs are designed to prevent high pressure over-inflation of the cuff
.

The Tru-Cuff LM's inflation syringe has a built-in pressure indicator.
After the LMA is inserted, the cuff is inflated until the indicator is in the green area of ​​the syringe (40-60mmHg)
.

 The air-Q SPair-Q SP laryngeal mask features a self-inflating low pressure cuff
.


The i-gel differs from other SGAs in that its gel cuff cannot be inflated, but it still provides an excellent seal without worrying about cuff pressure
.

The i-gel has a gastric channel, integrated dental pads and flanges to prevent epiglottis folds
.

   Many SGAs can be used as a channel for endotracheal intubation, such as LMA Fastrach, air-Q intubating laryngeal airway (ILA), i-gel, Ambu Aura Gain, and LMA protector
.

LMA Proseal Some devices from various manufacturers also have other unique features, such as: the flexible reinforced LMA has a wire reinforced flexible airway tube with a smaller airway tube diameter than other LMAs
.

These features allow them to be placed away from the surgical field, which is especially useful in ENT surgery, oral surgery, and other head and neck procedures where the surgeon and anesthesiologist share the same airway or surgical field
.

For example, such LMA Flexible LMA, Ambu AuraFlex and Tru-cuff Ultra Flex EX For ease of placement, some LMAs have pre-shaped curved airway tubes such as Ambu AuraOnce, Ambu Aura Gain, LMA Supreme and LMA Protector
.

 LMA Fastrach The LMA Fastrach is designed for intubation and is then removed after intubation
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An additional 4 SGAs can be used as initial airway devices
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The LMA Gastro airway is designed for use during upper gastrointestinal endoscopic procedures, and the endoscope can be inserted through a dedicated lumen while maintaining airway patency
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An open observational study of 292 patients undergoing upper gastrointestinal endoscopy under general anesthesia showed a 99% successful insertion rate for both LMA and endoscopy
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The only notable adverse event was one patient who was hospitalized for sore throat and intolerance of oral fluids
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Larger diameter endoscopes (eg, ultrasound gastroscopes) may not be able to pass the LMA Gastro smoothly, so the gastroscope to be used should be tested to ensure that it will pass the LMA smoothly before using the LMA Gastro airway
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 Invented time name according to development time Features Indications 1988C—LMA (common laryngeal mask) ① Sealing pressure 20cmH2O; ② No drainage tube leading to the esophagus, short, body surface surgery, such as hernia repair surgery, limb surgery, lower abdominal surgery, pediatric surgery 1993F—LMA (flexible laryngeal mask) to preserve spontaneous breathing (1993F-LMA) ①The sealing pressure is 20cmH2O; ②There is no drainage tube leading to the esophagus; Treatment, pediatric surgery, etc.
2000P-LMA (multiplexed double-tube laryngeal mask) ① Sealing pressure> 30cmH2O; ② There is a drainage tube leading to the esophagus: 14F drainage tube can be placed; ③ Laparoscopic gallbladder surgery, laparoscopic gynecological surgery can be used repeatedly , Laparoscopic urological surgery (supine and lateral position), open abdominal surgery, obstetric surgery, limb surgery, fiberoptic bronchoscopy, etc.
2007S-LMA (disposable double-tube laryngeal mask) ① Sealing pressure> 24 ~ 25cmH2O ; ② There is a drainage tube leading to the esophagus: a 14F drainage tube can be placed; ③ Disposable laparoscopic gallbladder surgery, laparoscopic gynecological surgery, laparoscopic urological surgery (supine and lateral position), open abdominal surgery, Obstetric surgery, limb surgery, etc.
2010i-gel (non-inflatable laryngeal mask) ① airway sealing pressure 30cmH2O; ② esophagus sealing pressure 13cmH2O; ③ there is a drainage tube leading to the esophagus: a 12F drainage tube can be placed; Disposable laparoscopic gallbladder/gynecology/urology surgery, open abdominal surgery, obstetric surgery, limb surgery, fiberoptic bronchoscopy, etc.
2017GMA (non-inflatable laryngeal mask) ① airway sealing pressure 30cmH2O; Drainage tube: 14F; ③ The cuff is free of inflation; ④ One-time use
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Laparoscopic gallbladder/gynecology/urology surgery, open lower abdominal surgery, obstetric surgery, limb surgery, fiberoptic bronchoscopy, intubation via GMA laryngeal mask, etc.
2018SaCo VLM visual laryngeal mask ①Airway sealing pressure 30cmH2O; ②With access Drainage tube to the esophagus: 14F; ③ Install a camera device in the cuff, if intubation is required, a tracheal tube can be inserted through the visual laryngeal mask under visual inspection, without the assistance of a flexible visual intubation mirror; ④ One-time use of laparoscope Gallbladder/gynecology/urology surgery, open and lower abdominal surgery, obstetric surgery, limb surgery, fiberoptic bronchoscopy, intubation by GMA laryngeal mask, etc.
are classified according to their own characteristics and uses Model advantages and disadvantages Ordinary laryngeal masks can be divided into 8 models (No.
1, No.
1.
5, No.
2, No.
2.
5, No.
3, No.
4, No.
5, No.
6) are at risk of flatulence, regurgitation and aspiration, and long-term use of the reinforced laryngeal mask is not recommended.
There are six models: No.
2, No.
2.
5, No.
3, No.
4, No.
5, and No.
6.
The airway is bendable, and the airway is less likely to be angled compared to ordinary laryngeal masks, thereby reducing the risk of airway blockage.
There are 3 models of mechanical ventilation intubated laryngeal masks for eye, nose, throat, cranial and oral surgery.
Nos.
3 and 4 can pass an ID 6.
0 mm endotracheal tube, and No.
5 can pass an ID 7.
0 mm tracheal tube.
Endotracheal tubes are primarily used in patients with unanticipated or anticipated difficult intubation
.

 The double-lumen laryngeal mask is a ventilation mask that seals the larynx and communicates with the ventilation tube, and the front end of the ventilation mask seals the opening of the upper esophageal sphincter and communicates with the drainage tube.
The scope of clinical application is wider.
Anesthesiology Joseph R.
Brimacombe "Principles and Practices of Laryngeal Mask Anesthesia" (translated by Yue Yun, Tian Ming, Zuo Mingzhang) http:// other foreign books are welcome to pay attention and look forward to Next follow-up serialization ~ share favorites, like and watch