Die Larynxmaske bei Adenotonsillektomie bei Kindern

Abstract

Anaesthesia both for adenotomy (AT) and for tonsillectomy (TE) frequently presents a challenge. On one hand, children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm; on the other hand the ENT surgeon and the anaesthetist have to share the "workspace" in the patient's mouth. Since the succinyl choline debate in the early 1990s, the question of the best muscle relaxant has gone hand in hand with that of the most appropriate means of securing the airway. The concept of the laryngeal mask as airway was initially greeted with scepticism. Following several years' use of the mask for this purpose in AT and TE in young children, we report our experience and summarise the literature on this topic. The laryngeal mask represents a safe alternative to intubation, provided there is close cooperation with the ENT surgeon.

Predictive risk factors of failed laryngeal mask airway insertion at first attempt

“…This study was designed to investigate the potential risk factors for first-attempt LMA insertion failure and to explore the correlation between the success rate of LMA insertion and the operator’s experience by observing the daily routine of the anesthesiologists. The results showed that the incidence of successful LMA insertion at the first attempt was 95.23%, which is consistent with the results of previous large-scale clinical studies 11 , 14 and further demonstrates that the use of an LMA for airway management during general anesthesia is a simple, safe, and reliable method. 15 , 16 Additionally, we found no significant correlation between the working life of the anesthesiologists and the success rate of first-attempt LMA insertion, confirming that use of an LMA as an airway tool is easy to learn and can be readily popularized compared with endotracheal intubation.…”

Comparison of Flexible Laryngeal Mask Insertion and Endotracheal Intubation in Adenotonsillectomy Surgery

“…In addition, Kretz et al 13 report that F-LMA can be used safely in adenotonsillectomy surgeries when it provides better coordination with the surgeon. The complication rates in our study were similar in the two groups.…”

Anästhesieverfahren und Techniken der Atemwegssicherung bei HNO-ärztlichen Eingriffen

“…Der größere "Raumbedarf" der Larynxmaske im Hypopharynx schien zunächst eine Anwendung der Larynxmaske bei operativen Eingriffen in dieser Region auszuschließen. Die kritische Wertung dieser Methodik aufgrund langjähriger Erfahrungen, klinischer Untersuchungen und technischer Neuentwicklungen ("flexible Larynxmaske") lässt jedoch die Larynxmaske zur Atemwegssicherung bei häu-figen HNO-ärztlichen Eingriffen wie der Adenotomie und/oder Tonsillektomie durchaus vorteilhaft erscheinen [8,10].…”

“…Die SHFJV erfährt in jüngster Vergangenheit wieder ein verstärktes Interesse [2,3]. Außerdem haben -neben der endotrachealen Intubation -weitere Verfahren der Atemwegssicherung wie die Larynxmaske in ihren Modifikationen eine intensivierte Anwendung bei HNO-Eingriffen erfahren [8,10]. Das Operationsspektrum insbesondere in der HNO-Heilkunde erlaubt und erfordert sogar ein weit gefasstes Spektrum an Anästhesieverfahren bzw.…”