Discussion On A New Method Of Anesthesia With Discontinuous Spontaneous Ventilating For Mckeown Esophagostomy By Laryngeal Mask

Objective:To explore the feasibility and safety of a new method of non-intubated anesthesia with discontinuous spontaneous ventilating for Mckeown Esophagostomy by laryngeal mask.To provide a new anesthesia option for the rapid recovery of esophageal cancer patients after surgery.Methods:Twenty eight patients with elective thoracoscopy and laparoscopy combined with three-incision radical resection for esophageal cancer（Mckeown Esophagostomy）,were divided into two groups:general anesthesia group with double lumen endotracheal intubation（group A）and discontinuous spontaneous ventilating anesthesia group under laryngeal mask（group B）.There were 15 cases in group A and 13 cases in group B.Group A was operated with conventional double-lumen endobronchial intubation under general anesthesia.Group B were underwent new anesthesia method with discontinuous spontaneous ventilating under the laryngeal mask:The laryngeal mask was placed after induction of anesthesia,the paravertebral nerve block was administrated on the thorax,bilateral transverse abdominal plane block was administrated on the abdomen,and the superficial cervical plexus nerve block was administrated on the cervix.Respectively record the time of operation of two groups;Record peak about the range of P_ETCO₂changes during the operation;Record the total dosage of remifentanil;The leucocyte count level on the first,second and third day after the operation was recorded respectively;Visual analogue scores were recorded at rest and cough at 2 and 24 hours postoperatively;The degree of postoperative pharyngeal discomfort was recorded;Record the length of postoperative stays.Group B were recorded whether the anesthesia method was transferred;Results:One patient in group B had circulatory depression due to excessive PaCO₂during operation,which switched the anesthesia mode to double-lumen endobronchial intubation.This patient was extubated and awoke immediately at the end of the operation.The operation time of group B was shorter than that of group A,but there was no significant difference（P>0.05）.The peak value of intraoperative P_ETCO₂in group B was significantly higher than that in group A,and the difference was statistically significant（P<0.05）.Group B was significantly lower than group A in total intraoperative consumption of remifentanil（P<0.05）.The level of leukocyte count in group B was lower than that in group A within three days after operation,but the difference was not statistically significant（P>0.05）.There was no significant difference in VAS scores between the two groups（P>0.05）.The postoperative pharyngeal discomfort was significantly lower in group B than in group A.No anesthesia-related complications occurred in both groups after operation.There was no significant difference in postoperative hospitalization days between the two groups.Conclusion:It is feasible to perform a new method of anesthesia under the laryngeal mask with discontinuous spontaneous ventilating in Mckeown esophagostomy.To some extent,it is beneficial to accelerate postoperative recovery of patients.However,the safety and benefits of this method of anesthesia for patients still need to be demonstrated in a large,multi-center,randomized controlled clinical study.