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Objective:To investigate the effects of endotracheal intubation anesthesia versus laryngeal mask anesthesia on the incidence of pulmonary infection in young children undergoing surgery. Methods:A total of 100 young children who underwent surgery under general anesthesia in Hangzhou Children's Hospital from January 2020 to December 2020 were included in this study. They were randomly allocated into the endotracheal intubation anesthesia and laryngeal mask anesthesia groups ( n = 50/group). The symptoms of respiratory tract infection (nasal congestion, cough, sputum ringing, rale, and sputum excretion) and the incidence of pulmonary infection evaluated 24 hours after surgery were compared between the two groups. At the same time, the pathogens of infection and perioperative conditions as well as prognosis were also compared between the two groups. Results:The incidences of nasal obstruction, cough, sputum ringing, rale, sputum excretion, and pulmonary infection were 56.0% (28/50), 42.0% (21/50), 14.0% (7/50), rale 38.0% (19/50), 16.0% (8/50), and 38.00 (19/50) respectively in the endotracheal intubation anesthesia group, which were significantly higher than those in the laryngeal mask anesthesia group [28.0% (14/50), 14.0% (28/50), 4.0% (8/50), 24.0% (12/50) 4.0% (2/50), 6.0%(3/50), χ2 = 12.18, 21.47, all P < 0.001]. A total of 34 strains of pathogens were detected in the two groups, including 4 strains in the laryngeal mask anesthesia group and 30 strains in the endotracheal intubation anesthesia group. The 34 strains of pathogens included 7 strains of gram-positive bacteria (20.6%), 23 strains of gram-negative bacteria (67.6%), and 4 strains of fungi (11.8%). There was no significant difference in pathogen composition between the two groups ( χ2 = 1.04, P = 0.310). The time to recovery and the time to extubation in the laryngeal mask anesthesia group were (10.3 ± 3.1) minutes and (13.5 ± 2.4) minutes, which were significantly shorter than those in the endotracheal intubation anesthesia group [(16.1 ± 5.1) minutes, (19.5 ± 4.1) minutes, t = 3.17, 7.19, both P < 0.05]. There were no significant differences in the proportion of children who needed prolonged hospitalization and the proportion of children scheduled to undergo readmission between the two groups (both P > 0.05). Conclusion:Laryngeal mask anesthesia is simpler to operate, remarkably decreases the incidence of pulmonary infection, and is safer compared with endotracheal intubation anesthesia. Therefore, laryngeal mask anesthesia is preferred for general anesthesia for surgery in young children. The study is of great innovation and science.
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Objective To evaluate the efficacy of injecting drugs through fiberoptic bronchoscope (FOB) and epidural catheter in improving topical anesthesia for awake tracheal intubation in patients undergoing cervical surgery.Methods Fifty patients with cervical spine injury that requiring surgical treatment,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 2 groups (n=25 each) using a random number table method:FOB injection hole group (group Ⅰ) and FOB combined with epidural catheter group (group Ⅱ).In group Ⅰ,2％ lidocaine was sprayed through the FOB injection hole on the oropharynx posterior (2 ml),glottis above vocal cords (3 ml) and the site 5 cm below the glottis (2 ml).In group Ⅱ,2％ lidocaine was sprayed via the epidural catheter implanted through FOB injection hole on the oropharynx posterior (1 ml),the site above vocal cords (3 ml),the site immediately after crossing the glottis (1 ml),the site 5 cm below the glottis (1 ml),and 2％ lidocaine 1 ml was slowly injected into the site 5 cm below the glottis to protuberance via the epidural catheter.Awake nasotracheal intubation was then performed under FOB guidance at 5 min after administration in both groups.When patients presented with severe bucking during operation and did not tolerate severe bucking,the previous procedure was repeated for rescue.When severe bucking was not significantly improved after carrying out rescue measures,thyrocricoceniesis was performed and the patients were tracheally intubated.The development of hypertension,tachycardia and hyoxemia was recorded during anesthesia and intubation.The operation time,intubation time,success of intubation at first attempt,requirement for rescue measures and thyrocricocentesis were recorded.The development of bucking,body movement and laryngeal spasm were record during anesthesia and tracheal intubation.JOA score was used to evaluate the occurrence of accentuated spinal cord injury after intubation.Parents' satisfaction with intubation was recorded and scored on 2nd day after operation.Results Compared with group Ⅰ,the incidence of hypertension and tachycardia was significantly decreased,the operation time was prolonged,the requirement for rescue measures and incidence of thyrocricocentesis were decreased,the incidence of body movement and bucking was decreased,and the parents' satisfaction scores were increased (P＜0.05),and no significant change was found in intubation time,success rate of intubation at first attempt or incidence of hyoxemia in group Ⅱ (P＞0.05).Accentuated spinal cord injury or laryngeal spasm was not found in either group.Conclusion Injecting drugs through FOB and epidural catheter can achieve better efficacy of topical anesthesia for awake tracheal intubation with reduced adverse reactions than injecting drugs through FOB injection hole in patients undergoing cervical surgery.
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Objective To compare the clinical effect of different doses of oxycodone on endotracheal intubation during general anesthesia induction period.Methods Ninety-five patients with endotracheal intubation general anesthesia were selected as the research subjects,and the patients were randomly divided into group A,group B and group C.31 patients in group A received intravenous administration of oxycodone 0.20mg/kg,32 patients in group B received intravenous administration of oxycodone 0.25mg/kg,and 32 patients in group C received intravenous administration of oxycodone 0.30mg/kg.The adrenaline,norepinephrine,dopamine concentration,as well as mean arterial pressure and heart rate at different time points were compared among the three groups.Results The mean arterial pressure and heart rate at T0 time point were decreased to varying extent compared with those at T1 time point(t =23.618,7.412;22.928,9.063;32.636,9.422,P =0.000,0.000;0.000,0.000;0.000,0.000).The heart rate,mean arterial pressure at T2,T3 and T4 time points in group A were increased compared with T0 time point (t =13.834,6.506,7.015;17.604,14.796,16.323,P =0.000,0.000,0.000;0.000,0.000,0.000).The adrenaline,norepinephrine and dopamine at T2,T3 and T4 time points in group A were increased compared witb T0 time point (t =121.662,64.533,15.687;31.498,16.933,9.286;39.712,116.049,147.102,P =0.000,0.000,0.000;0.000,0.000,0.000;0.000,0.000,0.000).The heart rate,mean arterial pressure,adrenaline,norepinephrine and dopamine at T2,T3 and T4 time points in group B and group C were decreased significantly compared with those in group A (t =19.586,31.972,16.844,27.087;14.046,14.822,15.377,23.826;7.756,14.396,13.268,23.342,100.573,1 04.010,37.612,38.892,107.377,117.969;56.135,56.757,24.223,25.300,95.057,82.088;22.878,25.731,5.532,5.934,134.763,83.628,P =0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000),and the differences were statistically significant (all P ＜ 0.05).Conclusion During the induction of general anesthesia,the appropriate dose of oxycodone in patients with endotracheal intubation was 0.25mg/kg,which could effectively maintain the hemodynamic stability,such as mean arterial pressure,and could reduce the stress response.
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Objective To evaluate the efficacy of an airway topical anesthesia catheter for topical anesthesia using a spray-as-you-go technique via the fiberoptic bronchoscope (FOB).Methods Forty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients with obstructive sleep apnea syndrome,aged 20-64 yr,with body mass index of 23-35 kg/m2,with no upper respiratory tract infection within 1 week before operation,scheduled for elective uvulopalatopharyngoplasty,were divided into 2 groups (n =20 each) using a random number table:routine control group (group C) and FOB-airway topical anesthesia catheter group (group F).In group C,the pharynx and larynx were sprayed with lidocaine FOB by using a laryngo-tracheal mucosal atomization device,and cricothyroid membrane puncture was performed and then lidocaine was injected.In group F,airway topical anesthesia was performed using a spray-as-you-go technique via the FOB with an airway topical anesthesia catheter spraying lidocaine via the nose.At 5 min after topical anesthesia of the airway,FOB-guided intubation was performed,and dexmedetomidine was intravenously infused at 0.1 μg · kg-1 · min-1 for sedation in both groups.Ramsay sedation scores were assessed after topical anesthesia and before intubation.The scores for the intubating condition and tolerance of tracheal tube were assessed during FOB-guided intubation.Successful intubation and the development of responses to intubation and hypoxemia were recorded.The patients were followed up one day after the end of operation,and parents' satisfaction with the procedure of intubation was recorded.Results Compared with group C,the intubating condition score,tolerance of tracheal tube score,success rate of intubation at first attempt and rate of parents' satisfaction with the procedure of intubation were significantly increased,and the incidence of responses to intubation was decreased (P＜0.05),and no significant change was found in Ramsay sedation scores before intubation and incidence of hyoxemia in group F (P＞0.05).Conclusion When the FOB is used to guide awake nasotracheal intubation,the airway topical anesthesia catheter provides better efficacy,better intubating conditions,and fewer side effects when applied for topical anesthesia using a spray-as-you-go technique via the FOB,it can be easily accepted by the patients and the efficacy is better that of routine airway topical anesthesia.
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Objective To evaluate the efficacy of topical anesthesia with inhaled aerosolized lidocaine during tracheal intubation under the guidance of fiberoptic bronchoscopy (FOB) in patients with cervical cord injury complicated with high paraplegia. Methods Sixty-four patients with cervical cord injury complicated with high paraplegia were randomly divided into 2 groups ( n = 32 each): group Ⅰ aerosol inhalation and group Ⅱ spray and cricothyroid membrane puncture. In group Ⅰ aerosolized 2% lidocaine was inhaled. In group Ⅱ after the pharynx and larynx was sprayed with 2% lidocaine, cricothyroid membrane puncture was performed and then 2% lidocaine 2 ml was injected. Midazolam 0.01 mg/kg and fentanyl 1 μg/kg were injected iv in both groups 15 min before tracheal intubation guided by FOB. During tracheal intubation guided by FOB, the intubation condition was assessed, and MAP, HR, ECG and SpO2 were monitored. Results The satisfactory rate of intubation condition and success rate of intubation under the guidance of FOB were significantly higher, and the incidences of arrhythmia and bad memory lower in group Ⅰ than in group Ⅱ ( P ＜ 0.05). Conclusion The topical anesthesia with inhaled aerosolized 2% lidocaine is helpful for improving the FOB-guided tracheal intubation condition, and can reduce the occurrence of adverse effects in patients with cervical cord injury complicated with high paraplegia.
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0 05)respeetively before induction, which shoued no statistic difference between two groups.AEP index and BIS of two groups after induction were decreased to below 30 a nd 55 respeetively(T 1 vs. T 0 ,P0 01) ) . The changing tendency of the elderly group and the young group were identical a t all time points. Conclusions AEP index can be used for the anesthesia depth monitoring for the elderly without obvious auditory dysfunction during tracheal intubation.
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Objective To investigate the effectiveness and safety of applying compound lidocaine cream on tracheal mucosa as topical anesthesia to reduce the stress reaction during extubation of tracheal tube. Methods Sixty patients (aged 18-65yr,body weight 40-80kg,ASA Ⅰ-Ⅱ) scheduled for elective surgery under general anesthesia were selected,and they were randomly divided into compound lidocaine cream group (group L,n=30) and control group (group C,n=30). Orotracheal intubation was performed in all the patients. Compound lidocaine cream was uniformly smeared on the foremost third of endotracheal tubes before intubation in group L,and no drug was coated on endotracheal tubes in group C. The changes in blood pressure and heart rates during extubation,the use of hypotensive drugs,cough reflex,breath holding,sore throat and pharyngeal discomfort after extubation were compared between the two groups. Results The operation and intubation time of the two groups showed no significant difference. The blood pressure and heart rate during extubation,the rate of using hypotensive drugs,and the incidence of cough reflex and breath holding were lower in group L than in group C,while the foreign body sensation in pharynx were after extubation was more frequent in group L than in group C. The incidence of pharyngodynia was similar in the two groups,and the pharyngodynia and foreign body sensation in pharynx markedly improved one day after operation in both groups. Conclusion Topical anesthesia of tracheal mucosa using compound lidocaine cream may reduce the cough reflex and breath holding during extubation,and inhibit the stress reaction.