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首页> 外文期刊>Anaesthesia and intensive care >Too much of a good thing--air, that is.
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Too much of a good thing--air, that is.

机译：太好了，空气。

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I read with interest the recent article of Andrews and colleagues, comparing the Classic-LMA™ (LMA) to the Cobra Perilaryngeal Airway~(TM) (PLA). Their primary conclusion, that the PLA provided superior pharyngeal seal pressure to the LMA, could have been a result of flaws in methodology rather than those of the LMA itself. In a group of adults aged 44 +- 15 years, weighing 77 +-16 kg, Table 1 indicates that 20 size 3 and 21 size 4 LMAs were placed. According to the manufacturer, a size 3, 4 and 5 LMA is recommended for patients weighing 30 to 50 kg, 50 to 70 kg and 70 to 100 kg respectively2. Additionally, investigators inflated the LMA cuff with "the appropriate volume of air". The resultant initial intra-cuff pressures of 86 mmHg exceed those recommended by the manufacturer for a size 3 (<50 cmH_2O), 4 and 5 (<60 cmH_2O) LMA. Keller et al reported the oropharyngeal leak pressure of a size 4 LMA to be optimal when the cuff was inflated with 15 ml of air, resulting in intra-cuff pressures of 53 to 63 cmH_2O and concluded that inflation to the maximum recommended volume (30 ml) provides suboptimal conditions3. Taken together, inappropriate sizing and over-inflation of the LMA may have accounted for the difference in pharyngeal seal between the PLA and LMA found in this study. Furthermore, the 31% increase in intra-cuff pressure over a 50 minute time period with the LMA could be explained by its starting position on the compliance curve. With the cuff already over-inflated at the outset, small changes would cause greater increases in intra-cuff pressure. Based upon the data of Keller et al3, an increase in cuff volume of <5 ml might have accounted for the increase in intra-cuff pressure from 86 to 113+-25 mmHg in the LMA group. Without clarification, the only sound conclusion to draw is that the PLA takes longer to place than a LMA.
机译：我感兴趣地阅读了安德鲁斯及其同事的最新文章，将Classic-LMA™（LMA）与Cobra咽喉气道（TM）（PLA）进行了比较。他们的主要结论是，PLA为LMA提供了优越的咽密封压力，这可能是方法缺陷的结果，而不是LMA本身的缺陷。在一组年龄在44±15岁，体重为77±-16 kg的成年人中，表1表明放置了20个3号和21个4号LMA。根据制造商的建议，建议分别为30至50公斤，50至70公斤和70至100公斤的患者使用3号，4号和5号LMA。此外，研究人员用“适当的空气量”为LMA袖带充气。对于3号（<50 cmH_2O），4号和5号（<60 cmH_2O）LMA，所产生的初始袖带内压力超过了制造商建议的86 mmHg。 Keller等人报告说，用15 ml空气给袖带充气时，大小为4 LMA的口咽泄漏压力是最佳的，导致袖带内压力为53至63 cmH_2O，并得出结论，充气至最大建议量（30 ml ）提供了次优条件。两者合计，不适当的大小和LMA过度充气可能是造成PLA和LMA在这项研究中发现的咽密封不同的原因。此外，LMA在50分钟的时间内袖带内压力增加了31％，这可以通过其在顺应性曲线上的起始位置来解释。袖带一开始就已经过度充气，小的变化将导致袖带内压力更大地增加。根据Keller等[3]的数据，LMA组的袖带内容积增加<5 ml，可能导致袖带内压力从86升高到113 + -25 mmHg。未经澄清，唯一得出的合理结论是，与LMA相比，PLA放置时间更长。

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