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Vergleich von zwei Larynxmaskenmodellen zur Atemwegssicherung bei Patienten mit Immobilisation der Halswirbelsäule

Comparison of two different laryngeal mask models for airway management in patients with immobilization of the cervical spine

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Zusammenfassung

Hintergrund und Fragestellung

Eine eingeschränkte Beweglichkeit der Halswirbelsäule (HWS) kann die Laryngoskopie und somit die endotracheale Intubation erschweren. Supraglottische Beatmungshilfen bieten hier einen wichtigen Ansatz zur erfolgreichen Oxygenierung des Patienten. Bei Patienten mit immobilisierter HWS werden Ambu-Larynxmaske (ALM) und Larynxmaske-Classic (LMA) miteinander verglichen.

Material und Methoden

Bei 60 Patienten, die für elektive ambulante Eingriffe vorgesehen waren, wurden ALM oder LMA nach Anlage einer Zervikalstütze und Erfassung des Laryngoskopiebefundes platziert. Platzierungszeit (Entfernen der Gesichtsmaske bis erstes Tidalvolumen), Anzahl der Platzierungsversuche, „airway leak pressure“ (Cuffdruck 60 cm H2O), perioperative Komplikationen sowie postoperative Beschwerden wurden erfasst.

Ergebnisse

Die demographischen Daten, Platzierungsversuche, Platzierungszeiten (ALM 15,6±4,4 s, LMA 15,5±4,9 s) und der Airway leak pressure (ALM 25,6±5,2 cm H2O, LMA 26,5±6,5 cm H2O) waren vergleichbar. Blutspuren nach Entfernen fanden sich bei 6 LMAs und 3 ALMs, leichte Schluckbeschwerden (visuelle Analogskala [VAS] 2–4) im Aufwachraum und nach 24 h gaben 2 LMA-Patienten und ein ALM-Patient an.

Schlussfolgerungen

Bei Patienten mit immobilisierter HWS erlauben LMA und ALM eine vergleichbar rasche und zuverlässige Sicherung des Atemweges.

Abstract

Background

Reduced cervical spine mobility can impair laryngoscopy and tracheal intubation. Supraglottic airway devices can be important alternatives for oxygenation under these circumstances. The Ambu laryngeal mask (ALM) and the LMA-Classic (LMA) are compared in patients with immobilization of the cervical spine.

Methods

In 60 patients scheduled for elective ambulatory interventions, ALM or LMA were inserted after cervical immobilization with an extrication collar and assessment of laryngoscopic view. Insertion time (removal of facemask until first tidal volume), number of insertion attempts, airway leak pressure (cuff pressure 60 cm H2O), intraoperative complications and postoperative complaints were assessed.

Results

Demographical data, insertion attempts, insertion time (ALM 15.6±4.4 s, LMA 15.5±4.9 s) and airway leak pressure (ALM 25.6±5.2 cm H2O, LMA 26.5±6.5 cm H2O) were comparable. Traces of blood were found in 6 LMAs and 3 ALMs after removal, mild trouble with swallowing (visual analogue scale, VAS 2–4) in the recovery room and after 24 h were complaints by 1 ALM and 2 LMA patients.

Conclusions

LMA-Classic and Ambu laryngeal masks are suitable for rapid and reliable airway management in patients with cervical immobilization.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum, Mannheim

    C. Gernoth, O. Jandewerth, M. Contzen, J. Hinkelbein & H. Genzwürker

  2. Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim

    C. Gernoth

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  1. C. Gernoth
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  2. O. Jandewerth
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  3. M. Contzen
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  4. J. Hinkelbein
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  5. H. Genzwürker
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Correspondence to C. Gernoth.

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Gernoth, C., Jandewerth, O., Contzen, M. et al. Vergleich von zwei Larynxmaskenmodellen zur Atemwegssicherung bei Patienten mit Immobilisation der Halswirbelsäule. Anaesthesist 55, 263–269 (2006). https://doi.org/10.1007/s00101-005-0921-3

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  • DOI: https://doi.org/10.1007/s00101-005-0921-3

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