目的:阐明在接受腹腔镜腹股沟疝修补术的儿科患者中使用喉罩气道(LMA)的安全性和有效性。
方法:在PubMed上搜索了研究,EMBASE,和Cochrane图书馆数据库。仅包括随机对照试验(RCTs)。主要结果是主要的围手术期呼吸不良事件(PRAEs),即喉痉挛,支气管痉挛,去饱和,和渴望。次要结果是次要PRAE,麻醉时间,和恢复时间。进行荟萃分析以计算风险比(RR),加权平均差(WMD),和95%置信区间(CI),采用随机效应模型。
结果:总计,纳入5个包含402名患者的RCTs。关于主要的PRAE,喉痉挛(RR:0.43,95%CI:0.12至1.47;p=0.18),支气管痉挛,和误吸均显示喉组和气管内组之间无差异。不饱和表现出一种趋势,但这一趋势没有得到统计学证据的充分支持(p=0.09).对于未成年人,使用喉罩后出现咳嗽的患者较少(RR:0.27,95%CI:0.11~0.67;p=0.005).其他PRAE,即声音嘶哑(p=0.06),喉咙痛(RR:1.88,95%CI:0.76至4.66;p=0.18),和喘鸣,两组之间没有差异。此外,两种麻醉时间(WMD:-6.88分钟,95%CI:-11.88至-1.89;p<0.00001)和恢复时间(大规模杀伤性武器:-4.85分钟,95%CI:-6.51至-3.19;p<0.00001)在LMA组中缩短。
结论:LMA用于小儿腹腔镜腹股沟疝修补术没有比气管插管更高的安全风险。因此,麻醉医师可能会从传统的气管导管使用转变为LMA使用.此外,LMA组的麻醉和恢复时间缩短,从而更有效地利用手术室。因为这些好处,LMA可能是接受腹腔镜腹股沟疝修补术的小儿患者的合适选择。
方法:治疗研究,三级。
OBJECTIVE: To elucidate the safety and effectiveness of laryngeal mask airway (LMA) use in pediatric patients undergoing laparoscopic inguinal hernia repair.
METHODS: Studies were searched on the PubMed, EMBASE, and Cochrane Library databases. Only randomized controlled trials (RCTs) were included. Primary outcomes were major perioperative respiratory adverse events (PRAEs), namely laryngospasm, bronchospasm, desaturation, and aspiration. Secondary outcomes were minor PRAEs, anesthesia time, and recovery time. A meta-analysis was performed to calculate risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (CI) by using random effects models.
RESULTS: In total, 5 RCTs comprising 402 patients were included. Regarding major PRAEs, laryngospasm (RR: 0.43, 95 % CI: 0.12 to 1.47; p = 0.18), bronchospasm, and aspiration all demonstrated no difference between the laryngeal and endotracheal groups. Desaturation exhibited a trend, but this trend was not sufficiently supported with statistical evidence (p = 0.09). For minor PRAEs, fewer patients experienced incidence of cough after laryngeal mask use (RR: 0.27, 95 % CI: 0.11 to 0.67; p = 0.005). Other PRAE, namely hoarseness (p = 0.06), sore throat (RR: 1.88, 95 % CI: 0.76 to 4.66; p = 0.18), and stridor, did not differ between the 2 groups. Additionally, both anesthesia time (WMD: -6.88 min, 95 % CI: -11.88 to -1.89; p < 0.00001) and recovery time (WMD: -4.85 min, 95 % CI: -6.51 to -3.19; p < 0.00001) were shortened in the LMA group.
CONCLUSIONS: LMA used in pediatric laparoscopic inguinal hernia repair demonstrated no greater safety risks than endotracheal tube intubation did. Thus, anesthesiologists may shift from conventional endotracheal tube use to LMA use. Moreover, anesthesia and recovery times were shortened in the LMA group, which resulted in more efficient use of the operating room. Because of these benefits, LMA could be an appropriate option for pediatric patients undergoing laparoscopic inguinal hernia repair.
METHODS: Treatment Study, LEVEL III.