The Clinical Application Research Of Flexible Laryngeal Airway Mask In Laryngeal Cancer Surgery

Objective:To investigate the application feasibility and safety of flexible laryngeal airway mask in laryngeal cancer surgery during anesthesia.Methods:Fouty ASAⅡ～Ⅲselective patients(the patients with laryngeal cancer IV,have breath difficulty during dialy life and the contraindications of laryngeal mask were excepted ),aged 50-80y,undergoing laryngeal surgery were randomly assigned into two groups:the flexible laryngeal airway mask (LAM)group(E)and endotracheal intubation group(H),there were 20 patients in each group.All the patients were induced with midazolam,Cisatracurium Besilate,etomidate and fentany,Cisatracurium Besilate were given discontinuous to maintain the muscle loose,and all thepatients were given propofol and remifentanil to maintain the depth of anesthesia.Monitoring the changes of blood pressure (BP) and heart rate (HR),and the mean arterial pressur(eMAP)was maintained to 60-70% of the baseline,the anesthetics were stopped after surgery.Observation index were:1,general condition:the sex,age,height and body mass index. 2,The hemodynamic parameters:HR,systolic blood pressure(SBP)and diastolic pressure(DBP)were measured at different time:before intubation or LMA(T₀),immediate intubation(T₁),after intubation 1min(T₂),3min(T₃),5min(T₄),before trachea cut(T₅)and at the end of surgery(T₆).3,Record the inserting(place)time, operating time and awakening time of endotrcheal tube and LMA. 4,The tightness of LMA—Leak experiment:After the cuff was inflated,we can observe the movement of thorax,listen to the breath soungds and abnormal airflow sounds,to confirm that the LMA was placed in the right place. 5,Ventilation effect:the PEtCO2,P IP,p_mean and SPO₂ were recorded at different time:after intubation 1min(T_a),3min(T_b),5min(T_c),30min(T_d),before trachea cut(T_e)and at the end of surgery(T_f).Results:1,There was no significant difference in age,sex,weight and height of the two groups(P>0.05).2.In hemodynamic aspects:comparison in the same group,we found the MAP was lower at T1 than at T0 because of the influence of anesthesia,but there were no significant difference;The MAP and HR were higher at T2,T3 and T5 than at T₀ in H group,the difference had statistic significan(tP<0.05);The MAP and HR were higher at T₅ than T₀ in E group,the difference had statistic significan(tP<0.05),but there were no obvious difference at other time compare to T0;Comparison between the two groups,at T₂ and T₃,the MAP and HR of H group were obviously higher than E group,the difference had statistic significant(P<0.05),but there were no obvious difference at other time between the two groups(P>0.05).3.The comparison on success rate between E group and H group:17 patients were palced laryngeal mask successfully at once,and three patients were palced for the second time.18 patients were inserted endotracheal intubation successfully at once,and the other two patients were inserted for the second time.4. The comparison on ventilation effect between E group and H group: Comparison between the two groups,there were no difference in P_EtCO₂,PIP,p_meanand SPO₂ at any time(P>0.05).5. The comparison on The placed(inserted)time,operating time and awakening time between E group and H group:the placed(inserted)time of E group were lower than H group,the difference have statistical significant.There were no obvious difference in operating time and postoperative recovery time between two groups.Conclusions:The laryngeal mask have good tightness when it was used in laryngeal surgery,and there were no differences in Ventilation effect and postoperative recovery time compare to intubation.Moreover,so laryngeal masks were safe,feasible in laryngeal cancer surgery during anesthesia.