Application of Intubation Laryngeal Mask in Laparoscopic Anesthesia for Elderly Patients with Hypertension / 中国微创外科杂志

ABSTRACT

Objective To investigate the application of intubation laryngeal mask in laparoscopic anesthesia for elderly patients with hypertension. Methods A total of 80 patients ( ASA Ⅱ -Ⅲ) over 70 years old undergoing laparoscopic gastrointestinal and gallbladder surgery from March 2014 to February 2015 were selected.They were randomly divided into the intubating laryngeal mask group ( ILMA group) or endotracheal tube group ( ET group) , with 40 patients in each group.After the intubation, the two groups were anesthetized with remifentanil by target-controlled infusion ( TCI ) and sevoflurane inhalation.The ILMA group was inserted matching laryngeal mask to control respiratory ventilation and deepened to the proper depth of anesthesia.An endotracheal tube were inserted through the mask 5 min later, and then the breath was controlled via transtracheal catheter to maintain anesthesia.The ET group was inserted tracheal intubation after induction, and then the breath was controlled until extubation after the recovery of the tracheal extubation after surgery.The heart rate (HR), blood pressure (SBP and DBP) and bispectral index (BIS) were recorded at time points of before induction (T0), laryngeal mask or endotracheal tube insertion (T1), after endotracheal tube insertion (T2), skin incision (T3), beginning tissue dissection or entry of laparoscope (T4), resection of organs or tissues (T5), and tracheal extubation ( T6 ) , respectively.In addition, the recovery time, the recovery of spontaneous breathing, complications during the recovery time, such as restlessness, nausea and vomiting, were observed and compared. Results There were significant differences in HR, SBP, DBP, BIS between the two groups and among different time points (P=0.000).At time points of before operation ( T0 -T2 ) and anesthesia maintaining stage ( T3 -T6 ) , the HR, SBP, DBP and BIS were stable in both groups.At the time points of after endotracheal intubation ( T2 ) and extubation ( T6 ) , the ET group had significantly increased HR, SBP, and DBP, which were higher than the ILMA group (P<0.05).At the time point of T6, the BIS values were significantly increased in the ET group than the ILMA group (P<0.05).On postoperative recovery quality, the time from anesthesia to spontaneous breathing recovery and from end of surgery to call to open eyes was significantly longer in the ET group than the LIMA group [(130.1 ±26.1) min vs. (96.4 ±24.5) min, t=5.94, P=0.000;(16.1 ±2.7) min vs.(5.5 ±2.2) min, t=19.07, P=0.000]. Conclusion For elderly patients with hypertension undergoing laparoscopic surgery, use of intubation laryngeal mask for anesthesia is more stable and has less adverse cardiovascular reactions, with good outcomes of anesthesia recovery.