[A laryngeal mask as an instrument of ventilation support during regional anesthesia]

When the duration of limb segment replantation is more than 8-10 hours under nerve block anesthesia, prominent are the factors of the patient's lassitude and fatigue caused by position discomfort, the elimination of which and the possibility of uncontrolled motor activity of the patient require deep sedation or his/her unconsciousness. In this connection, a laryngeal mask (LM) has proven to be a convenient and reliable alternative to an endotracheal tube, which allows tracheal intubation to be avoided in most cases. Our clinical observations of the course of anesthesia in patients during carpal segment replantations of 14 hours or more in duration have demonstrated that the LM reliably ensures upper airways patency, adequate ventilation, and gas exchange throughout the surgery. An algorithm of switching patients to different assisted ventilation modes to rapidly restore adequate ventilation and gas exchange if drug-induced respiratory distress occurs during regional anesthesia has been tested during 120 emergency and elective anesthesias. Indications for the clinical use of a LM in patients who need emergency reparative operations using microsurgical techniques are warranted. Various actions of an anesthesiologist are proposed while using a LM in patients with limb segment replantation.