ABSTRACT
@#Objective To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery. Methods From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared. Results There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05). Conclusion The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.
ABSTRACT
Objective To observe the clinical responses and hemodynamic changes of single chamber endotracheal intubation general anesthesia applied to thoracoscopic resection of esophageal carcinoma under carbon dioxide pneumothorax. Method Sixty [ASA I ~ II, NYHA I ~ II, hight (148.57 ± 10.95) cm, weight (40.52 ± 3.97) kg] patients who were light weight, short height, and underwent thoracoscopic resection of esophageal carcinoma in pneumothorax with filling carbon dioxide under general anesthesia of tracheal intubation with single lumen were selected. CO2gas (6 ~ 8 L/min) was slowly inserted into the operative side thoracic cavity to maintain intrathoracic pressure 6 ~ 8 mmHg (1 mmHg=0.133 kPa), heart rate (HR), blood pressure (BP), central venous pressure (CVP), pulse oxygen saturation (SpO2), airway pressure (PaW), partial pressure of end-tidal carbon dioxide (PETCO2) and other indicators and so on, were collected at the 5 minutes before artificial pneumothora (T1), and at the 5 minutes (T2), 15 minutes(T3), 30minutes (T4), 60 minutes (T5), 100 minutes (T6) after artificial pneumothorax, and 10 minutes at the end of thoracic operation (T7), Samples of arterial blood gases were obtained at the same time. Results All cases were successfully completed by thoracoscopic surgery, significant arrhythmias and severe complications were not found at each time point; After CO2pneumothorax, HR, CVP, PaW, PETCO2and PaCO2at T2~ T6increased significantly than those at T1(P < 0.05); but BP, Arterial oxygen pressure (PaO2) and blood pH value decreased significantly at T2~ T6than those at T1(P < 0.05); SpO2at T3and T4was significantly lower than that at T1(P < 0.05), Although SpO2also decreased at T5and T6, there was no significant differences comparing to at T1(P > 0.05). After T7, most of the remaining indicators were restored to the base level excep that CVP remains high. Conclusion When patients with low weight and short stature underwent tracheal intubation under single lumen anesthesia for thoracoscopic resection of esophageal cancer under carbon dioxide pneumothorax, their hemodynamics were relatively stable,and all the indexes of respiration and arterial blood gas were within the acceptable range, It was a feasible, relatively safe method of anesthesia for such patients who could enjoy thoracoscopic techniques.
ABSTRACT
Objective To evaluate the feasibility and safety of thoracoscopic radical resection of non-small cell lung cancer(NSCLC)patients under laryngeal mask anesthesia. Methods A total of 40 patients with NSCLC from March to August 2016 in NanFang Hospital of Southern Medical University were recruited and divided into two groups,the laryngeal mask anesthesia(n=20)and the intubation anesthesia group(n=20). Patients from two groups were followed up. Post-operativerecovery ,systemic inflammation response and quality of life were assessed. Results There was no significant difference between the laryngeal mask anesthesia and the intubation anesthesia group in the operation time ,the lowest oxygen saturation ,the maximum end-tidal carbon dioxide partial pressure and the surgical field and the satisfaction of anesthesia and blood loss. Post-operative time to eat ,postoperative use of antibiotics , postoperative hospital stay and drainage time were much shorter in the laryngeal mask anesthesia group ,which also had lowerlevel of white blood cells ,neutrophils and C-reactive protein. Patients with NSCLC undergoing laryngeal mask anesthesia had much higher scores in the quality of life evaluation. Conclusion Thoracoscopic radical resectionunder laryngeal mask anesthesia is safe and feasible for NSCLC patients. It has advantages in reducing the systemic inflammatory response ,accelerating the recovery rate and improving postoperative life quality.
ABSTRACT
Lesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração. As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia). No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.
Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.
Durante la anestesia general pueden lesionarse los nervios en la región faringolaríngea. Los nervios más a menudo lesionados son el hipogloso, lingual y laríngeo recurrente. Las lesiones pueden surgir como resultado de varios factores que pueden ser, durante la laringoscopia, intubación endotraqueal e inserción del tubo y por presión del balón, ventilación con mascarilla, maniobra aérea triple, vía aérea orofaríngea, modo de inserción del tubo, posición de la cabeza y del cuello, y aspiración. Las lesiones nerviosas en esa región pueden comprometer un solo nervio aislado o causar la parálisis de 2 nervios en conjunto, como la del nervio laríngeo recurrente hipogloso (síndrome de Tapia). Sin embargo, la lesión combinada de los nervios lingual e hipogloso, después de la intubación para la anestesia, es una condición mucho más rara. El riesgo de una lesión se puede reducir con medidas preventivas. A continuación describimos un caso de paresia unilateral combinada de los nervios hipogloso y lingual después de la intubación para la anestesia.