Application Of Anesthesia With Laryngeal Mask Airway In Endourology

Part 1 Influence of anesthesia with laryngeal mask airway on obturator nerve reflex in transurethral resection of bladder tumorObjective To study the influence of total intravenous anesthesia with laryngeal mask airway (LMA) on obturator nerve reflex in transurethral resection of bladder tumor (TURBT).Methods Sixty ASA I-II patients undergoing TURBT were randomly assigned to two groups. Spinal anaesthesia with 0.75% plain bupivacaine 8 - 12 mg was applied to patients in GroupⅠ(n = 30). Patients in GroupⅡ(n = 30) received total intravenous anaesthesia with continuous infusion of propofol and remifentanil; a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side-effects were monitored and recorded. Results The hemodynamics in groupⅡexperienced more stable than those in groupⅠ. Obturator nerve reflex was observed in 15 (50.0%) patients in GroupⅠ, but none (0%) in GroupⅡ(P<0.01).Conclusions Total intravenous anaesthesia with laryngeal mask is a safe, reliable and simple maneuver for patient undergoing TURBT which could effectively eliminate obturator nerve reflex.Part2 Comparison of different dosages of remifentanil anesthesia for Holmium laser ureterolithotripsy with laryngeal mask airway ventilationObjective To compare the clinical anesthetic effects of three different dosages of remifentanil for Holmium laser ureterolithotripsy (HLU) under laryngeal mask airway (LMA) ventilation.Methods 60 ASAⅠ-Ⅱselective patients, aged 28-69 y, undergoing HLU were randomly assigned into three groups (n = 20). After intravenous quick induction and the insertion of a proper size LMA, anesthesia was maintained with continuous infusion of propofol 4 mg·kg^-1·h^-1 and one of the three dosages of remifentanil 0.1μg·kg^-1·min^-1 for groupⅠ, 0.2μg·kg^-1·min^-1 for groupⅡ, and 0.4μg·kg^-1·min^-1 for groupⅢ. ECG, MAP, HR, SpO2 and PetCO2 were continuously monitored and intraoperative extremity movement and recovery time were recorded. Results Each operation was accomplished without any intraoperative consciousness. Compared with groupⅡ, patients in groupⅠhad larger fluctuation of HR and MAP, longer recovery time, and the incidence of extremity movements was 45% that demanded higher dose of muscle relaxant. In groupⅢ, 0.4μg·kg^-1·min^-1 remifentanil resulted in significant depression of HR and MAP, leading to the usage of higher dose of vasopressors and longer recovery time. Conclusions Continuous infusion of remifentanil with LMA ventilation is a reliable approach for HLU anesthesia. 4 mg·kg^-1·h^-1 propofol + 0.2μg·kg^-1·min^-1 remifentanil might be an adequate dosage that we recommend for such kind of surgical procedures, which could compromise the depth of anesthesia and quick recovery time. Keywords remifentanil, laryngeal mask airway, ureterolithotripsy, Holmium laser...