[Intubating laryngeal mask efficacy in obese and overweight patients].

UNLABELLED: We evaluated the Intubating Laryngeal MAsk (ILMA Fastrach) efficacy for airway management, ventilation and blind intubation in obese and overweight patients. Methods. 50 adult patients (22 men and 28 women) with predicted difficult trachea intubation (PDTI), undergoing general anaesthesia with ILMA were included in this study. ILMA was selected according to gender: ILMA No 5 for men and No 4 for women. PREMEDICATION: diazepam and H,-blockers. Anaesthesia induction: midazolam 0. I - 0.15 mg/kg, propofol 1.6-2.5 mg/kg, fentanyl 0.1-0.15 microg/kg, rocuronii bromide or atracurii besilate 0.6 mg/kg. RESULTS: 21/2/3 patients had morbid obesity with BMI over 40/45/55 kg/m'. 5 and more difficult trachea intubation (TI) predictors were found in 48 patients. The ILMA was placed successfully at the first try for 7.2+/-2.9 sec in all patients. Ventilation was successful in 100% of cases; TI via ILMA - in 94% of cases (90% - at the first try). Total TI time was 7,5+/-4,8 sec, ILMA removal time - 9,2+1,5 sec. 2 patients had 2 or 3 DTI predictors, but conventional TI was unsuccessfild; TI via ILMA was performed at the first try. There was one "can't intubate, can't ventilate" case, TI via ILMA was made at the first try. TI via ILMA was unsuccessful in 3 patients, ILMA was replaced by Proseal LM or Supreme LM, TI was performed conventionally. There were no complications observed. CONCLUSION: ILMA Fastrach was used successfiully in obese patients with PDTI for both ventilation and TI. Technique is simple in training, but a preliminary experience is essential for ILMA use in difficult cases.

[The difficulties of using intubating laryngeal mask in a patient with concomitant morbid obesity].

This is a case report of tracheal intubation with Intuhating Laryngeal Mask (ILMA) in a patient with morbid obesity.

[Optimization of anesthetic maintenance using two-channel laryngeal masks Proseal during endovascular correction of congenital defects in infants and young children].

The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.

[Clinical experience in using isoflurane, sevoflurane, and total intravenous anesthesia during visceral transplantation].

Based on 256 anesthesias, the authors comparatively studied the results of total intravenous anesthesia (TIVA) with neuroleptic analgesics and inhalational low- and minimal flow anesthesia with isoflurane in the anesthestic support of major operations on the liver. Both sevoflurane and isoflurane may be widely used during long and traumatic operations on the liver since the agents are distinguished by a low hepatotoxicity, the absence of pharmacological activity of their metabolism, a rapid elimination from the body in a virtually unchanged form. The use of sevoflurane and isoflurane in the low and minimal flow modes can substantially reduce the pharmacological load with opiates and myorelaxants, which is particularly important in patients with liver diseases and these modes have some advantage over TIVA during which the consumption of myorelaxants and neuroleptic analgesics has proved to be significantly higher. The minimal flow (0.4-0.5 l/min) mode uses mostly few inhalation anesthetics. The use of seroflurane reduces the period of spontaneous breathing recovery to a greater extent, activates the patient more rapidly, and substantially reduces the risk of iatrogenic complications after long and traumatic operations associated with visceral transplantation.

[Anesthesia during liver transplantation]. / Anesteziologicheskoe obespechenie transplantatsii pecheni.

Different methods and components of anesthesia during operations in donors and recipients were studied by using the experience in maintaining anesthesia during 39 relative and 7 cadaveric hepatic transplantations. The experience in using epidural anesthesia and total intravenous anesthesia at the donor stage of hepatic lobar transplantation was comparatively analyzed. Combined epidural anesthesia (CEA) may be used during long-term and traumatic operations dealing with hepatic lobectomy in a relative donor since it is noted for low hepatotoxicity and no drastic hemodynamic exposures. CEA can substantially reduce pharmacological loading with opioids or myorelaxants, which is particularly important in taking the lobe of the liver. This reduces the recovery period of adequate own respiration, activates a patient more rapidly, substantially reduces the risk for postoperative iatrogenic complications. Balanced general anesthesia whose major component is inhalational anesthesia with isoflurane is the method of choice in performing an operation in the recipient. The use of isoflurane in the minimal-flow mode is cost-effective and safe. When anesthesia is performed in the recipient, it is necessary to take in account drastic hemodynamic pattern changes at the liverless stage during vein-venous bypass surgery, including the liver into systemic circulation, and the likelihood of development of significant reperfusion and concomitant metabolic and coagulative disorders.

[Prevention of postoperative nausea and vomiting with highly selective 5-HT3 serotonin receptors antagonists during different types of surgery]. / Profilaktika posleoperatsionnoi toshnoty i rvoty s pomoshch'iu vysokoselektivnykh antagonistov 5-HT3 serotoninovykh retseptorov v razlichnykh oblastiakh khirurgii.

A prospective study was conducted to examine the efficacy of highly selective, 5-HT3 serotonin receptor antagonists (Zofran, 4 mg; Latran, 4 and 8 mg; Navoban, 2 and 5 mg) during plastic and abdominal (endoscopic and routine) interventions in 165 patients aged 14 to 77 years who had ASA Classes I-III. The drugs caused no adverse reactions and were effective in controlling postoperative nausea and vomiting (PONV) after surgery under total intravenous anesthesia. In plastic surgery, Navoban, Zofran, and Latran controlled PONV in 94, 81, and 70% of cases, respectively. In abdominal surgery, Zofran (4 mg) and Latran (4 mg and 8 mg) did this in 87, 80, and 90% of cases, respectively. Risk factors for PONV are analyzed. The pathophysiological aspects of PONV and practical approaches to making an antiemetic strategy are discussed.

[Use of laryngeal masks: variants of hemodynamic response to various methods of anesthesia]. / Ustanovka laringeal'noi maski: varianty gemodinamicheskogo otveta pri razlichnykh metodikakh anestezii.

Choice of induction agent is the decisive factor in utilization of a laryngeal mask (LM) under spontaneous respiration, as insufficient relaxation and unwanted laryngopharyngeal reflexes deteriorate the efficiency of LM functioning during operation and anesthesia. 132 anesthesias with LM were performed, 86 of these for laparoscopic cholecystectomies (LCE) (group 1) and 42 for saphenectomies (group 2). Control group consisted of 60 patients anesthetized for LCE by means of an endotracheal tube (ETT). Combined induction intravenous anesthesia with ketamine, barbiturates, and diprivan was used in group 1 and controls. In group 2 induction anesthesia was based on ketamine and diprivan. Group 1 and control group were matched for demographic characteristics and concomitant diseases. All groups were divided into subgroups, depending on anesthesia. In all groups pipecuronium bromide (0.06 mg/kg) was administered before insertion of EET or LM after injection of induction agents. In total myoplegia, installation of LM was simple, involving no untoward laryngo-pharyngeal reflexes. LM was correctly installed from the first attempt in 98.7% cases. In combined intravenous ketamine-based anesthesia, pressor reaction to LM installation consisted in an increase of heart rate by 5.6% (1K group--control), by 10.2% in 2K group (fractionated ketamine (1.5-2 mg/kg) + diazepam (0.1 mg/kg) and fentanyl (2.6 micrograms/kg); after barbiturates heart rate increased by 6.7% in 1B group (control), after diprivan it did not increase in 1D group (control), while the mean arterial pressure in 2D group (fractionated diprivan (1 mg/kg) + ketamine (25-50 mg), diazepam (0.08 mg/kg) and fentanyl (2.6 micrograms/kg) increased by 10% and heart rate by 6.6%. Reaction to tracheal intubation was pronounced in all types of induction anesthesia. No regurgitation or aspiration was observed in any case. Hence, use of total myoplegia in installation of LM allows the use of various modern anesthetics in optimal doses and notably simplifies the utilization of LM.

[Use of total myorelaxation for placing a laryngeal mask and further artificial lung ventilation]. / Ispol'zovanie total'noi miorelaksatsii dlia ustanovki laringeal'noi maski i posleduiushchei iskusstvennoi ventiliatsii legkikh.

The specific features of placing a laryngeal mask (LM) under total myoplegia were studied. The first attempt at placing LM was successful in 98.7% of cases. A pressor response to LM appeared as increases in heart rate by 5.6% with combined intravenous ketamine anesthesia used during laparoscopic cholecystectomies (Group 1), by 10.2% at saphenectomies (Group 2), and by 6.7% with barbiturates. When diprivan was used, changes were absent in Group 1, there were increases in mean blood pressure and heart rate by 10 and 6.6%, respectively, in Group 2. The response to tracheal intubation was significant under all types of anesthesia. Regurgitation and aspiration were absent in all groups. The use of total myoplegia to place LM allows different current anesthetics to be used in the optimal doses and the procedure for placing LM to be greatly simplified.

[Laryngeal mask under total myoplegia and artificial pulmonary ventilation during laparoscopic cholecystectomies]. / Laringeal'naia maska v usloviiakh total'noí mioplegii i iskusstvennoí ventiliatsii legkikh pri laparoskopicheskikh kholetsistéktomiiakh.

The problem of using a laryngeal mask (LM) under total myorelaxation and artificial pulmonary ventilation (APV) is still topical and unsolved. A hundred and forty six anesthesias for laparoscopic cholecystectomy by employing LM in 86 patients or endotracheal tube (ETT) in 60 were comparatively evaluated. Anesthesia included premedication (diazepam, dimedrol, atropine, the H2-blocking agent ranitidine), induction (ketamine, barbiturates and propofol in combination with diazepam and fentanyl; the NMBs pipecuronium bromide and succinylcholine), maintenance (N20:O2 = 2:1. Fentanyl, pipecuronium bromide), monitoring (Capnomac-Ultima (Datex), Dinamap (Criticon) and acid base balance measurements. The quantity and pH of gastric contents were examined. Methylene blue in gelatin capsules was used as a regurgitation indicator. Unlike ETT, LM caused no reactions. The hemodynamic parameters at the traumatic stages of an operation were higher in the ETT group. Smaller amount of analgetics was used in the LM group. The use of manual APV at Pinsp of < 10 cm H2O fully prevented a gas mixture from entering the stomach. Pneumoperitoneum caused increases in Et CO2, pCO2, P inspiration and decreases in breathing volume and lung compliance. The hermetic sealing of joints was 95.6-98.5% in the LM group. Regurgitation was not found in 33 patients. LM NMB and APV may be successfully and safely used in clinical practice.

[The problem of airtightness during the use of a laryngeal mask under conditions of carboperitoneum and muscle relaxation]. / Problema germetizma pri ispol'zovanii laringeal'noi maski v usloviiakh karboperitoneuma i miorelaksatsii.

This study was aimed at assessing the airtightness of the airways during the use of a laryngeal mask (LM) under conditions of myoplegia and traditional forced ventilation of the lungs (FVL) with carboperitoneum (CP) during laparoscopic cholecystectomy (LCE). A total of 146 anesthesias for LCE were carried out using LM (n = 86) or endotracheal tube (ETT) (n = 60). The groups did not differ by the demographic characteristics or concomitant diseases. After premedication and induction of anesthesia it was maintained with N2O:O2--2/1 (Fi O2 = 0.3), fractionated administration of fentanyl (0.1-0.2 mg), and pipecuronium bromide (0.06 mg/kg). A gastric tube was inserted. Two variants of FVL were used: 1) permanent minute respiration volume (MRV) was maintained and 2) MRV was increased in order to maintain the Et CO2 at a constant level. The amount of gastric contents was measured and its pH assessed. Regurgitation and aspiration was assessed (in 33 patients) using methylene blue in gelatin capsules administered orally 10 min before anesthesia. Gas exchange was monitored by the Datex Capnomac-Ultima and by check-ups of acid base balance in the arterial capillary blood, hemodynamics was monitored by noninvasive Criticon Dynamap monitor. Manual FVL with inhalation P no more than 10 cm H2O completely prevented the entry of gas narcotic mixture into the stomach. Application of LM under conditions of total myoplegia and FVL with inhalation P of 23-25 cm H2O provided a satisfactory airtightness of the LM-airways contact without audible (appreciable) leaking of gas narcotic mixture. Leakage of gas narcotic mixture during LM application under total myoplegia and carboperitoneum (with CO2 pressure in the abdominal cavity 12 cm Hg) is no more than 6%, which indicates that LM is a reliable air guide providing good airtightness of the LM-airways contact even under conditions of increased abdominal pressure. No cases of regurgitation and aspiration were observed.