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Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.
Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.
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ABSTRACT:Background: Endotracheal intubation is gold standard of general anesthesia. various oral,Maxillofacial, Dental surgeries are carried out in high-risk patients having chances ofdifficult intubation. If we give sedation or general anesthesia, we can be trapped in criticalairway accidents.Aims & objectives: To access & compare efficacy of anatomical landmark guided/Ultrasound guided superior laryngeal nerve block associated with topical Anesthesia &transtracheal block for awake blind nasal intubation.Method:Group A: Anatomical landmark guided superior laryngeal nerve block given(n=30)Group B: ultrasound guided superior laryngeal nerve block(n=30)In both groups topical Anesthesia & transtracheal block for awake blind nasal intubation wasgiven.Results: upper airway block provide clinical ease to facilitate blind nasal awake intubation.ultrasound guided block has less adverse reactions.Conclusion: Both methods provide good quality of Endotracheal intubation, but ultrasoundguided block is more efficient & scientific method to block superior laryngeal nerve forawake nasal intubation.
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Objective To investigate the effect of ultrasonograpy (US )-guided bilateral superior laryngeal nerve (SLN)block by different concentrations of lidocaine combined with intrave-nous anesthesia for polypectomy of vocal cord by laryngoscope.Methods Sixty patients,aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective polypectomy of vocal cord by laryngoscope were divided into 3 groups (n=20 each)using a random number table:US-guided bilat-eral SLN block by 2% lidocaine (group A),S-guided bilateral SLN block by 1% lidocaine (group B), and traditional SLN block by 2% lidocaine (group C).HR,MAP,SpO2and plasma concentration of NE were detected at the time of patients entering the operating room (T0),immediately after intuba-tion(T1),suspensing laryngoscopy (T2),5 min after suspensing laryngoscopy (T3),immediately af-ter extubation(T4),5 min after extubation(T5).Extubation time and side effects such as dysphagia and dyspnea in two hours after extubation were recorded as well.Results HR and MAP in the three groups at T1-T5were increased compared to T0(P<0.05).Compared with group C,HR and MAP in groups A and B were decreased at T1-T5(P<0.05).Plasma concentration of NE of groups A and B was more significantly decreased than group C (P<0.05),and extubation time of groups A and B was less than that of group C (P <0.05 ).Conclusion US-guided bilateral SLN block by 1% lidocaine has definite effect and better comfort level,with stable haemodynamics and less extubation time.
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Objective To observe the efficacy of the ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intubation.Methods Forty patients with limited cervical activity scheduled for elective surgery under general anesthesia,23 males and 17 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were chosen.According to random number table method,they were randomly divided into two groups (n =20).Group N received superior laryngeal nerve block u-sing the acupoint-located method by anatomical landmark,and group D was under ultrasound-guided, combined with airway anesthesia.Awake orotracheal fiberoptic intubation was then performed.Intu-bation time and the changes of MAP,HR,Ramsay sedation score were recorded at the time of bur-glary (T0 ),before the endotracheal tube into the mouth (T1 ),endotracheal tube into the glottis im-mediately (T2 ),5 min after intubation (T3 ).Ramsay score was rated to assess the patients'comfort and tolerance,complications during intubation process were documented,the patient's satisfaction was received.Results Compared with the group N,the intubation time of group D was significantly shorter [(0.5±0.1)min vs (1.0±0.2)min,P <0.05].In group N,MAP and HR were obviously higher during intubation with lower Ramsay sedation score at T2 compared with group D (P <0.05). Patients in group D had lower comfort score and tolerance grade during intubation (P <0.05).The incidence of nausea,vomiting,restlessness and pharyngalgia were significantly lower in group D (P< 0.05 ).Besides, patients during intubation in group D were more satisfactory (P < 0.05 ). Conclusion Ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intuba-tion could provide an ideal sedative effect,maintain stable circulation and keep patients tolerable.
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Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females, with ASA physical statusⅡor Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group (group S)or general anesthesia group (group C).Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine (E)and norepinephrine (NE) when patients entering the operating room (T0 ),before intubation (T1 ),immediately after intubation (T2 ),at 1 min (T3 ),3 min (T4 ),5 min (T5 )and 10 min (T6 )after intubation.Adverse e-vents,such us hypertension and tachycardia,were recorded during induction and intubation.Results Com-pared with T0 ,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C (P<0.05 or P <0.01),while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C (P <0.05 or P <0.01).The incidence of hypertension in group S was significantly lower than that in group C during induction of intuba-tion (0% vs 37%,P <0.01).There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratra-cheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.