Atemwegsmanagement – Supraglottische Atemwegshilfen

Zusammenfassung

Nicht zuletzt aufgrund des überwältigenden Erfolgs der Larynxmaske haben supraglottische Atemwegshilfen einen beispiellosen Siegeszug in der modernen Anästhesie erlebt und neben Weiterentwicklungen der klassischen Larynxmaske werden ständig auch neue supraglottische Atemwegshilfen entwickelt und auf den Markt gebracht. Im Gegensatz zu den Atemwegshilfen der 1. Generation ohne Möglichkeit der gastralen Drainage wie der Larynxmaske Classic und dem Larynxtubus verfügen Geräte der 2. Generation über einen gastralen Drainagekanal und/oder bieten eine bessere Dichtigkeit bei kontrollierter Beatmung (Larynxmaske ProSeal und Larynxtubus S). In letzter Zeit haben vor allem die zum einmaligen Gebrauch entwickelten Versionen dieser Atemwegshilfen und die neuartige I-Gel-Maske verstärktes Interesse gefunden. Die Eignung der Larynxmaske und der Larynxmaske ProSeal für Routineanästhesien und auch das Management des schwierigen Atemwegs ist in zahlreichen Untersuchungen gezeigt worden. Theoretisch ist eine Limitation aller Larynxmasken der fehlende Schutz gegen Aspiration, und es ist derzeit noch unklar, ob Atemwegshilfen mit gastraler Drainagemöglichkeit in dieser Hinsicht wesentliche Vorteile bieten.

Abstract

Supraglottic airway devices are developed with increasing frequency following the overwhelming success of the laryngeal mask airway (LMA). In contrast to the first generation devices such as the 'classic' LMA and the laryngeal tube second generation devices usually offer an oesophageal drainage tube and/or an improved oropharyngeal leak pressure during positive pressure ventilation such as the laryngeal mask ProSeal and the laryngeal tube S. Recently the disposable versions of these supraglottic airway devices and the novel I-Gel mask have gained increasing interest. Both the LMA and the PLMA have been shown to be perfectly suitable for routine anaesthesia and emergency airway management. While the lacking protection against aspiration is still considered a major limitation of the LMA, the value of airway devices with an oesophageal drainage tube in this respect remains untermined at present.

Kernaussagen

• Die Larynxmaske stellt derzeit die am besten evaluierte supraglottische Atemwegshilfe dar.

• Im Vergleich zur Larynxmaske zeigt der Larynxtubus eine höhere Atemwegsmorbidität.

• Nach wie vor stellen u. a. fehlende Nüchternheit und Adipositas permagna Kontraindikationen für die Anwendung einer Larynxmaske dar. Allerdings ist die wahre Inzidenz von Aspirationen bei Anwendung einer Larynxmaske unklar.

• Obwohl ständig neue Atemwegshilfen entwickelt und auf den Markt gebracht werden, ist es sinnvoll, sich nur mit 1 bis 2 erprobten Geräten intensiv zu beschäftigen, um ihre Anwendung sicher zu beherrschen.

• Neue supraglottische Atemwegshilfen müssen dem ”Goldstandard“ der etablierten Larynxmaske bzw. ihrem Einweg-Pendant hinsichtlich Effektivität und Sicherheit mindestens ebenbürtig sein.

• Um neue supraglottische Atemwegshilfen vergleichen zu können, sollten standardisierte Kriterien definiert werden, die mindestens die wichtigsten Endpunkte umfassen, wie

  • Erfolgsrate,

  • Zeit bis zur 1. suffizienten Ventilation,

  • Dichtigkeit und

  • Atemwegsmorbidität.

Schlüsselwörter:

Larynxmaske - Larynxtubus - Atemwegshilfe - Narkosebeatmung

Key words:

laryngeal mask airway - laryngeal tube - airway device - routine anaesthesia

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