[A new technique of extubation using laryngeal mask in the neurosurgical anesthesia]

Recently we experienced two cases of multiple cerebral aneurysms for the aneurysmal neck clipping operation. In these cases, as these aneurysms can not be clipped primarily, the patient may still be susceptible to the rupture of remaining aneurysm after operation. Frequent bucking and hypertension occurring during extubation and emergence from anesthesia, can lead to intracranial hemorrhage and increases of intracranial pressure. To reduce this hemodynamic responses, several studies have been reported, but techniques in those papers are not sufficient to prevent the bucking perfectly, and the anesthesiologist has to hold the face mask forcefully for a long time after operation. The laryngeal mask airway (LM) seemed preferable for prevention of bucking and attenuation of cardiovascular response. Therefore, we tried to use LM at the emergence from anesthesia. After surgery, tracheal tube was removed at the deep level of anesthesia, and LM was inserted. After muscle relaxant was reversed, oxygen, nitrous oxide, and 0.3-0.5% sevoflurane were administered until spontaneous breathing became adequate. When sufficient breathing volume was confirmed, all anesthetic agents were terminated, and LM was removed after ascertaining swallowing motion. No bucking and serious hypertension were seen during the procedures, and the patient recovered uneventfully.