Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room / 南方医科大学学报

ABSTRACT

<p><b>OBJECTIVE</b>To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room.</p><p><b>METHODS</b>In this prospective study, 30 uncooperative patients with MR receiving total intravenous anesthesia (TIVA) with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care (MAC group), inserted classic laryngeal mask airway under general anesthesia (LMA group), or endotracheal tube placement (ETT group). The blood pressure (BP), heart rate (HR), SpO(2) and pH, PaCO(2), and HCO(3)(-) were monitored at 5 min and 1 h after anesthesia, before completion of the operation and at 1 h after the operation. The total operative time, dosage of propofol, awake time and body movement during the procedure were recorded.</p><p><b>RESULTS</b>Compared with LMA and ETT groups, the MAC groups showed a significantly increased total dosage of propofol (66.07±5.41, 35.83±5.80, and 34.61±3.68 g·kg(-1)·min(-1), respectively, P<0.05 ), body movements (9.90±3.07, 2.5 1±1.50, and 0.82±0.93, P<0.05) and awake time (16.82±7.60, 4.31±1.32, and 3.73±1.33 min, P<0.05). The pH, PaCO(2), or HCO(3)(-) showed no marked changes at 5 min after anesthesia and at 1 h after the operation in the 3 groups (P>0.05). At 1 h after anesthesia, the pH in MAC group decreased markedly compared with that in LMA and ETT groups (P<0.05), and maintained a low level till the completion of the operation; the PaCO(2) was significantly elevated in MAC group and remained so till the end of the surgery (P<0.05).</p><p><b>CONCLUSION</b>Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT, and allows rapid onset of sedation with minimal cardiovascular responses, body movement and recovery, therefore is more suitable in the setting outside the operating room.</p>