Study On The Accuracy Of The Respiratory Volume Monitor And Clinical Observation Of Endoscopic Retrograde Cholangiopancreatography In Patients With Non-intubated General Anesthesia

The paper is divided into two parts:the first part is the accuracy study of the Respiratory Volume Monitor（RVM）;The second part is the clinical observation of the application of RVM in Endoscopic Retrograde Cholangiopancreatography of non-intubated general anesthesia patients.Part 1:study on the accuracy of the Respiratory Volume Monitor（RVM）Objective:to evaluate the accuracy of the Respiratory Volume Monitor.Methods:A total of 12 patients with tracheal intubation under general anesthesia were selected from January 2019 to March 2019.All patients were selected from The Second Hospital of Hebei Medical University neurosurgery inpatients.The left lateral decubitus position was used during the operation,the enrolled patients both lungs were normal and there were no abnormal lung function.At the same time,the Tidal Volume（TV measure）,Respiratory Rate（RR measure）measured by RVM and the Tidal Volume（TV true）and Respiratory Rate（RR true）measured by Drager anaesthesia monitor were recorded.Results:There was a strong linear correlation between RVM and the measured values of MV,TV and RR of the Drager anaesthesia machine（r value>0.90,P=0.00,ICC>0.9）.The average MV difference between RVM and Drager anaesthesia machine was 0.06 L/min.The average TV difference was 6.29m L;the average RR difference was-0.14b/min.Conclusion:RVM provides accurate and continuous data to assess ventilatory function in real time.Part 2:Clinical observation on the application of the Respiratory Volume Monitor in ERCP in patients with non-intubated general anesthesiaObjective:to compare RVM with existing respiratory monitoring to provide evidence for its application in ERCP in patients non-intubated general anesthesia.Methods:A total of 60 patients who scheduled to undergoing elective ERCP for non-intubated general anesthesia were selected.All patients were selected from the general surgery department of The Second Hospital of Hebei Medical University from April 2019 to October 2019.Routine monitoring of Electrocardiogram（ECG）,noninvasive Blood Pressure（BP）,Heart Rate（HR）,Pulse Oxygen Saturation（Sp O₂）,Pressure of End-tidal Carbon Dioxide(P_ETCO₂),and Minute Ventilation（MV）,Respiratory Rate（RR）,Tidal Volume（TV）were administered.Apnea,hypoxaemia or visual assessment of respiratory abnormalities is the airway treatment standard.Patients were divided into two groups according to whether or not the airway was treated during the operation.The treatment group was group T and the untreated group was group N.Record the occurrence of airway processing events and their causes,low minute ventilation events.Record intraoperative sedative dose,sedative time and postoperative hospital stay;The satisfaction score of postoperative surgeons to anesthesia was recorded.Prognostic indicators at 6h after surgery,including Post Operative Nausea and Vomiting（PONV）score and complications associated with severe anesthesia（refractory hypoxia,severe hemodynamic abnormalities,delirium）;Intraoperative hemodynamic abnormalities（hypotension,hypertension,arrhythmia）and body movement were recorded.Results:Low MV events all occurred before airway treatment.The sensitivity and specificity of the low MV event prediction scheme were 93.5%and 98.1%respectively.In the existing airway treatment criteria,hypoxemia index was better than apnea or visual assessment index（P<0.05）,and there was no statistical difference between apnea and visual assessment index（P>0.05）.The general conditions of the two groups of patients were analyzed and the factors that might affect the intraoperative airway processing were analyzed.Age,gender,Body Mass Index（BMI）,smoking history,pulmonary disease history,sedative dose and sedation time had no effect on the intraoperative airway processing.Statistical analysis of the two groups showed that there was no significant difference in PONV score,operator satisfaction score and postoperative length of stay（P>0.05）.The most common complication of anesthesia during surgery was airway problems,followed by hypotension,body movement and decreased heart rate.Conclusions:In ERCP non-intubated general anesthesia,the monitoring of hypoventilation by RVM is more accurate and earlier than the existing monitoring.