Erweiterte Indikationen der Larynxmaske – Wo liegen die Limitationen?

Zusammenfassung

Die Verwendung extraglottischer Atemwegshilfen (EGA) erfreut sich bezüglich klassischer Indikationen, z.B. elektiver Extremitäteneingriffe in Rückenlage, einer hohen Akzeptanz. Doch so eindeutig auch der Stellenwert von EGA im Rahmen einer unerwartet schwierige Atemwegssicherung ist, wird ihr Einsatz bei den erweiterten Indikationen, z.B. bei laparoskopischen Eingriffen oder bei Vorliegen einer Adipositas, kontrovers diskutiert. Dieser Artikel bietet eine möglichst evidenzbasierte Übersicht, die als Entscheidungshilfe für – oder in begründeten Fällen auch gegen – die Anwendung einer EGA bei den genannten Indikationen dienen kann. Weiterhin werden Empfehlungen zum Vorgehen während der Verwendung bei erweiterten Indikationen gegeben.

Abstract

The use of extraglottic airway devices (EGA) is well accepted for airway management for certain classic indications such as general anaesthesia during limb surgery in the supine position. Furthermore, EGA have been deemed a useful tool during the management of an unrecognized difficult airway. On the other hand, the use of EGA has been controversially discussed for advanced indications such as during general anaesthesia during laparoscopic surgery and in coexisting morbid obesity. This article provides an evidence based review of the role of EGA during a variety of indications and is designed to assist with the decision making process of whether an EGA may or may not be appropriate for a particular indication. Moreover, recommendations are given for advanced indications.

Kernaussagen

• Respirations- und Gastrointestinaltrakt werden durch die Abdichtung der Maskenspitze im oberen Ösophagussphinkter und die Integration eine Drainagekanals voneinander getrennt.

• Für die Anwendung von EGA bei erweiterten Indikationen werden Modelle mit Drainagekanal unbedingt empfohlen.

• Die Anlage eines Pneumoperitoneums scheint die Gefahr von Reflux und Regurgitation nicht zu erhöhen – eines der Hauptargumente gegen den Einsatz von Larynxmasken bei laparoskopischen Eingriffen.

• Die eigentliche Limitation von EGA bei erweiterten Indikationen sind inadäquat niedrige oropharyngeale Verschlussdrücke (OLP). Der OLP muss eine sichere Ventilation des Patienten auch bei erhöhten Beatmungsdrücken, inkl. der Anlage eines PEEP, ermöglichen.

• Die Narkoseführung mit einer EGA bedarf einer hohen Wachsamkeit, um vermeidbare intraoperative Komplikationen zu umgehen.

Schlüsselwörter:

Larynxmaske - Laparoskopie - Adipositas

Key words:

laryngeal mask airway - laparoscopy - obesity

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