Laryngeal Mask Airway In Elderly Patients With Short Surgical Application

Objective: To seek A method of anesthesia in the elderly patients during application of small operation through Laryngeal mask airway was used and compared with the advantages and disadvantages of tracheal intubation and CSEA..Methods: Sixty ASA classâ… -â…¢patients of both sexes( 33 male,27 female)aged 65-85 yrs weighing 45-85 kg BMI no more than 30 kg/m2 undergoing short surgery and were randomly divided into three groups with 20 patients each:laryngeal mask airway group(L), tracheal intubation group (T), combination with spinal and epidrul anesthesia(C).The surgery species including 45 cases of abdominal:6 patients with hernia repair surgery, 13 cases with transurethral resection of prostate and 8 cases with abdominal; 8 cases with transurethral resection of bladder tumor and 5 cases with abdominal; 5 cases with abdominal resection of bladder calculi and 15 cases with lower limbs: 6 cases with Internal fixation remove of femoral fracture, 6 cases with Internal fixation remove of fracture of the tibia and fibula and 4cases with arthroscope. Main monitoring index including BP(SBP,MAP and DBP),HR, SpO2,PETCO2 and Ppeak. The last two items only limit L group and T group.Choices of time points: Group L and T: after a repose of ten minutes(T0),immediately before tracheal intubation (T1), at 1 (T2) and 5 min (T3) after intubation. ,immediately before decannulation (T4), at 1 (T5) and 5 min (T6) after decannulation. Group C: after a repose of ten minutes (T0), 5 min (T1) ,10 min (T2), 20 min (T3) and 30 min(T4) after injection.Observation items are not wholly same: Group L and T: State of insert of the laryngeal mask airway or tracheal intubation. The time from the beginning of anesthesia to the beginning of operation. The usages of narcotic and vascular active drugs. Recovery time,the time of tracheal extubation,time of achievement of a modified Aldrete of 9(or above) after surgery. Restless,choked and hypoxemia situation during the extubation period. Adverse reactions (sore throat, abdominal distension).Group C: Anaesthetic puncture; The time from the beginning of anesthesia to the beginning of operation; The usages of vascular active drugs; Adverse reactions and complications.Results: Compare Group L with Group T: Group L: State of insert of the laryngeal mask airway or tracheal intubation: A laryngeal mask airway was successfully inserted through more than 3 times placement adjustments,two were successfully inserted through the 2 placement adjustments,the rest were successfully inserted althrough only one times. Group T:A patient appeared difficult intubation,the others were successfully inserted althrough only one times. The time from the beginning of anesthesia to the beginning of operation: The two groups were not statistically significant(pï¹¥0.05). The usages of narcotic and vascular active drugs: The dosage of proposol in group T was less 62.0 mg, of remifentanyl was less 0.2 mg,and of vecuronium was less 6.0mg than Group T(p<0.05).The usage times of vascular active drugs in group L were significantly reduced than group T(p<0.01).Group L: HR and MAP at T1,T2,T3 were not statistically significant during the period of intubation(pï¹¥0.05). HR and MAP at both T5 comprared with T4 or T6 and T4 or T5 comprared with T0 were not statistically significant during the period of extubation(pï¹¥0.05). Group T: HR and MAP at T2 compared with T1 or T3 were statistically significant during the period of intubation(p<0.05). HR and MAP at both T5 comprared with T4 or T6 and T4 or T5 comprared with T0 were statistically significant during the period of extubation(pï¹¥0.05). Compare between the two groups:The declination extent of HR and MAP at T1 and the rising extent of HR and MAP at T2 , T4 or T5 in group L were lower than in group T(p<0.05).SpO2 and PETCO2 between the two groups were not statistically significant,but Ppeak at T2 and T3 was higher than in group T(p<0.01).The emergence time from anesthesia occurred in an average of 4.1 min earlier,the time to tracheal extubation was 5.1 min shorter,and the time of achievement of a modified Aldrete of 9(or above) was 5.6 min earlier(p<0.01 ) . Rstless,choked ,hypoxemia and sore throat situation during the extubation period in group L was significantly less than in group T, but abdominal distension was more than in group T(p<0.01).Compare Group L with Group C: Anaesthetic puncture in group C:A case was implementation of general anesthesia after Anaesthetic puncture was failed,and eliminated experiment. Two cases of intraoperatie block were not perfect, One epidural catheter to pump blood, breathing difficulties appeared after giving the auxiliary medicine,the other example of epidural space additioned 2% lidocaine 5ml, patients appeared nausea and vomiting, bloodpressure dropped significantly. .And a case was endorhachis burst. The time from the beginning of anesthesia to the beginning of operation:The time in group C extend an average of 708s. The usages of vascular active drugs: The dosage in group C was less than in group L(p<0.05). HR and MAP in group C at T2,T3 and T4 were not statistically significant(pï¹¥0.05).but they were statistically significant compared with at T1(p<0.05). Incidence of adverse reactions and complications in group C was significantly increased.Conclusion: Firstly, to compare with tracheal intubation, laryngeal mask airway is easier to operate, and do not need muscle relaxant and Laryngoscope auxiliary. Perioperative dosages of narcotic drugs are relatively less than tracheal intubation,hemodynamics is more steady. Recovery is earlier. Restless, choked and hypoxemia situation during the extubation period is less seen. Adverse reactions, for example, sore throat is less seen.To the patient appearing difficult airway, laryngeal mask airway is preferance. LMA is more suited to the cases with lower limbs and abdominal. Secondly, to compare with CSEA, posture is less strict. Because the time from the beginning of anesthesia to the beginning of operation is shorter, LMA improves the operational efficiency of turnover. Breathe is more smoothly steady. Patients'tolerability is better to the intraoperative force and tourniquet reaction. All spinal anesthesia, spinal cord injury and extradural hematoma that can cause serious complications is impossible to appear. LMA is more suited to the eldly with the elective but not full stomach especially when the anesthesia taboo or failure exists. Thirdly, to compare with tracheal intubation and CSEA,LMA increases the risk of abdominal distension, reflux and aspiration .So it isn't suited to the eldly with full stomach, high intra-abdominal pressure or habitual reflux vomiting.