The Application Effect Of Nasotracheal Conscious Intubation Guided By Fiberoptic Bronchoscope In The Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To compare the effect of blind nasotracheal intubation and nasotracheal intubation led by the fiberoptic bronchoscope on obstructive sleep apnea hypopnea syndrome patients with conscious sedation and supreficial anesthesia.Methods: Sixty severe OSAHS patients were received selective uvulopalatopharyngo-plasty with general anesthesia. The ages were in the range of 41 to 65 years old; BMI was more than 28 kg/m2 and Mallampatis grade (Sitting in an upright position with the head in the middle, the patient opened his or her mouth and stretched the tongue with great force. The visible parts of palatopharyngeal arch, soft palate and uvulae were graded as I; The visible parts of palatopharyngeal arch and soft palate as well as the part of uvulae covered by the tongue root as II; The observable parts of soft palate as III; The unseen parts of soft palate as IV)ⅢorⅣwere indudy. Anaesthesia Informing Notice for Consent was signed by each patient before anaesthesia. All patients were randomly divided into two groups (n=30), the patients were treated with blind nasotracheal intubation(group A)and nasotracheal intubationt led by the fiberoptic bronchoscope(group B) separately in the state of conscious sedation and supreficial anesthesia.The patients were injected with penehyclidine hydrochloride of 1 mg 30 min before anesthesia. After entering the operation room, the upper limber venous circuit of the patient was connected with I.V. infusion of sodium lacted of 10 ml/(kg·h). MAP and HR were dynamically monitored with the multi-function monitor. 5 min after calming down of the patient, the average value was taken as the basic value out of the three records of MAP and HR which were recorded in the consecutive consequence. A continuous recording of ECG was made with III Lead and, at the same time, SpO2 was monitored. BIS was monitored with Aspect Medical System 2000. The patient breathed pure oxygen of 3 L/min for 10min before induction. Profound superficial anesthesia was made on the throat with tetracaine of 1℅. Superficial anesthesia of pituitary membrance ephedrine and enlargement of the nasal passage was done with tetracaine of 1℅ and ephedrine of 1%. After intercricocentesis the trachea was injected with tetracaine of 1℅ which was of 2ml. I.V. Injection of midazolam of 1.5~2.0mg and remifentanil of 0.05μg/(kg·min) was made according to the change of BIS in order to keep the BIS range to be from 65 to 75 after that, nasotracheal intubation was made. All of the intubation operation was finished by the same proficient anesthesiologis. The patients of Mallampatis Grade IV received intubation operation with the presence of an otolaryngologist. which was marked by more than 2 intubation operations.The basic record was made as T0. Values of MAP, HR and SpO2 as well as ECG change is recorded before intubation as T1, 1min after intubation as T2; 2min as T3; 3min as T4. Concentration of Cortisol, adrenaline and noradrenal in the serum at T1, at T2, at T3 and T4 was made. Intubation time (Time between implanting of the endotracheal tube through the nasal passage and success of intubation of endotracheal tube), the situation of successful intubation and the state of myocardial ischemia (horizontal or adown & oblique depression of ST segments was more than 0.1 mV and lasted more than 1 min) and nose blooding during intubation were recorded.Results: 1 The changing situation of MAP and HR: Compared with T0, MAP rised at T2, T3 in group A, MAP rised at T2 in group B, HR rised at T2 in both groups(P <0.05); Compared with T0, T1(P >0.05). Compared with group A, MAP declined at T2 and T3 in group B, HR declined at T2 in group B (P <0.05); MAP and HR at T0, T1 and T4 were of no significante difference in both group(P >0.05). 2 Comparison of stressful hormone: Compared with T1, adrenaline and noradrenal concentration rised at T2 and T3 in both groups (P <0.05). Compared with group A, adrenaline and noradrenal concentration at T2 and T3 in group B obviously declined (P <0.05); adrenaline and noradrenal concentration at T1 and T4 between two groups were of no significante difference (P >0.05). 3 Intubation time, success rate of intubation and cardiovascular response. Compared with group A, intubation time in group B obviously declined (72±11svs.91±14s). intubation success rate in group B (100℅vs.86.7℅) is obviously higher. Less high blood pressure response during intubation (P <0.05) were in group B compared with group A (13℅vs.32℅). Less tachycardia during intubation (P <0.05) were in group B compared with group A (8℅vs.15℅)4 SpO2 of two cases during intubation in group A was less than 90℅. Nose blooding was found in one case in group A.Conclusion: Compared with blind nasotracheal intubation, nasotracheal intubation led by the fiberoptic bronchoscope lessens the stress reaction on OSAHS patients with conscious sedation and supreficial anesthesia. It also saves time, has the high success rate and resultes in less complications, provides a more comfortable way of intubation to patients.