Цель работы — сравнить клиническую эффективность ларингеальной маски второго поколения I-GEL и интубационной трубки при проведении тотальной внутривенной анестезии с искусственной вентиляцией легких (ИВЛ) у пациенток с высоким риском сердечно-сосудистых осложнений в хирургии молочной железы.
Материалы и методы. Нами обследованы 92 пациентки (ASA III, 47–76 лет), с высоким риском сердечно-сосудистых осложнений, которым была проведена общая анестезия с ИВЛ при операциях на молочной железе. Разделение на 2 группы (n=46) было проведено в зависимостиот выбора метода поддержания проходимости верхних дыхательных путей: I-GEL и эндотрахеальная трубка. Был проведен сравнительный анализ гемодинамических изменений, объёма и фракции утечки, а также дискомфорта в области глотки.
Результаты. Полученные данные позволяют использовать ларингеальную маску I-GEL при проведении тотальной внутривенной анестезии с ИВЛ в плановой хирургии молочной железы у пациенток с высоким риском сердечно-сосудистых осложнений в качестве разумной альтернативы эндотрахеальной трубке.
Cardiovascular complications are the most frequent type of life threatening complications
for the surgical group of patients and it is also the main reason of increasing the length of stay at the hospital.
The most dangerous complications for the patients with concomitant cardiovascular system diseases through anesthesia may occur at the induction stage and during the management of the upper airway. One of the recommendations in improving the safety of anesthesia is the usage of the laryngeal mask (LMA) I-GEL, which helps avoiding the development of hemodynamic responses associated with laryngoscopy and intubation. Comparing the clinical efficacy and safety of the LMA I-GEL of the second generation and the endotracheal tube during total intravenous anesthesia with mechanical ventilation mode PCV in patients with high risk of cardiovascular complications operated on for breast cancer. The study is conducted at the Department of Anesthesiology and Intensive Care Center of Reconstructive and Restorative Medicine (University Hospital) the Odessa National Medical University from 2011 to 2013. After the approval of the local ethics committee and signed
informed consent, 96 women aged 52–76 years with moderate or high risk of cardiovascular complications — class 3 and 4 on Lee’s Revised Cardiac Risk Index which undergoes a variety of surgical interventions for the breast cancer treatment-were recruited. Patients (ASA III) were divided into two groups depending on the method of maintaining the upper airway: group 1 — endotracheal tube (ETT) (n=48), group 2 — LMA I-GEL, the second generation (n=48). The systemic hemodynamic parameters (SBP, DBP, MBP, HR) are recorded prior to the anesthesia after the induction and immediately after the managing of the upper airway prior the surgery.
In addition, we assessed the volume fraction and leak traces, the blood trace in the mouth (or ETT/ LMA) after extubation and the presence of the discomfort or throat pain. Intubation associated with significantly higher increase in heart rate (HR), cardiac index (CI) and total peripheral vascular resistance (TPR). Use of LMA showed significantly fewer complaints of discomfort in the throat and requires significantly less time. Leakage rates were not significantly different in both groups.
