SOLUTION TO THE PROBLEM OF AIRWAYS PATRONAGE IN DENTAL OPERATIONS UNDER GENARAL INHALATION ANESTHESIA IN OUTPATIENT CHILDREN SURGERY

Abstract

In the practice of pediatric dentistry, when the off-consciousness of a patient is obligatory, the question of choosing the means of maintaining the patency of airways remains very important. Among all the ways ensuring the patency of airways during anesthesia the endotracheal tube has always been dominating. Despite the fact that intubation remains the "gold standard" in relation to ensuring the patency of airways, its implementation requires enough experience and some skill. In addition, it is necessary to foresee and be prepared in advance for a number of complications both during the operation and thereafter. According to various reports, the frequency of "difficult" intubation and related problems varies from 1 to 20%. In the ASA database, lawsuits for larynx damage make up the third part of all claims (33 %) registered for airway injury. Most (80%) of the claims were registered in cases of the larynx damage occurred after conventional tracheal intubation for planned anesthesia. Most (85 %) of them were associated with short-term intubation. The practice and analysis of scientific sources shows that introduction of the laryngeal mask into pediatric anesthetic practice has allowed avoiding the problems mentioned above. The technique of using the laryngeal mask in children has become an alternative to the use of the endotracheal tube. The purpose of this study is to develop an algorithm for applying the laryngeal mask in pediatric outpatient dental sanations and short-term operations in the mouth under general anesthesia. Materials and Methods. In the period from 2011 to 2014 on the basis of the Clinical Department of pediatric dentistry, orthodontics and implantology of Kharkiv Medical Academy of Post-graduate Education - Medical and Diagnostic Center "Fortune" – 480 manipulations of therapeutic and surgical nature have been performed in the oral cavity in children under general inhalation anesthesia by Sevoran. In all cases the laryngeal mask of the company «Laryseal» and additional tamponade of the peripharyngeal space were used. Results: The use of the laryngeal mask has revealed a number of advantages and disadvantages. When using laryngeal mask it is easier to maintain patency of airways without recourse to the use of additional means, the additional tamponade of the peripharyngeal space helps to avoid excessive mobility of the laryngeal mask, ensures airways’ protection from aspiration, surely fixes the mask in position. At the same time, it helps to free anesthesiologist’s hands that provides more comfortable recordkeeping, monitoring and administration of drugs. Application of the laryngeal mask helps to reduce air pollution with vapors of inhalation anesthetics in an operating theatre; the technique of its use requires a certain skill of a doctor. Compared to the endotracheal tube, the laryngeal mask installation is much less invasive, less risk of laryngeal and bronchial spasm, injuries of teeth and throat occur; it requires less anesthetic depth and time on its installation. However one of its drawbacks is when using the laryngeal mask - greater limitedness of the operating space in comparison with naso-tracheal intubation which requires a highly skilled dentist; rarely pain in deglutition in the early postoperative period. Conclusions: The technique of the laryngeal mask using in children is adequate, safe and can be an alternative to invasive procedure of trachea intubation in outpatient dental surgery under general inhalation anesthesia.