| Objective 1. To evaluate whether the way of intubation by intubated laryngeal mask airway (ILMA) and stylet optical system (SOS) could take advantage of intubation by macintosh laryngeal scope (MAC) in reducing cardiovascular response.2. To observe which is the best among the three tools (MAC, ILMA and SOS) to facilitate the intubation and could reduce the complication to the most extent.Methods 1. Sixty undergoing orbital plastic surgery patients, ASA grade I or II, airway evaluated normal, were randomly divided into three groups:Macintosh group (MAC, n=20), intubated laryngeal mask airway group (ILMA, n=20) and stylet optical system group (SOS, n=20), and all the patients of three groups received intubation by MAC, ILMA, SOS respectively after induction intravenously. All the patients did not have operation before, have no nervous system and psychiatry disease history. The liver, kidney and pulmonary function were also normal. EEG, SPO2, BIS, and IBP were monitored when the patients arrive at the operating room. Record the patients'IBP, HR and BIS at time point 5min after arriving (baseline value, TBL), immediately before intubation (TBI), immediately after intubation (TAI), 01-5min after intubation (T1-T5); left radial artery was punctured by a 20G catheter needle and the catheter was connected to pressure exchanger device and heparined normal saline. The blood samples of left radial artery were taken for determination of serum NA concerntration at the moment before intubation (baseline value, TBL),1 min after intubation (T1),3 min after intubation (T3).2. Sixty undergoing orbital plastic surgery patients, ASA grade I orⅡ, airway evalutated normal, were randomly divided into three groups:Macintosh group (MAC, n=20), intubated laryngeal mask airway group (ILMA, n=20) and stylet optical system group (SOS,n=20), and all the patients of three groups received intubation by MAC, ILMA, SOS respectively after induction intravenously. All the patients did not have operation before, and have no nervous system and psychiatry disease history. The liver, kidney and pulmonary function were also normal. The times of intubation trying, the time of intubation needed and the incidence of successful intubation at one time were recorded. Also the uncomfortable complains and complications were recoded during the investigation after extubation.Results 1. There are no significant differemces at the aspect of general status of the three groups. Intra-group comparison:SBP, DBP of three groups at time point TBI, T1, T2 is different to that of time point TBL(P<0.05)and HR of time point TAI-T3 is higher than that of TBL·-NA concentration at time point of T1 and T2 is higher than that of time point TBI (P<0.05). And also NA concentration at time point T1 is higher than that of time point T2. BIS value at time point T1-T5 is significantly lower than that of time point TBL(P<0.05). And BIS value at time point TBI-T5 is significantly higher than that of time point TBL(P<0.05). No significant difference about plasma glucose level was observed between the 3 groups. Inter-group comparison:SBP, DBP and HR of group SOS at time point T1 were lower than that of group MAC (P<0.05) and group ILMA, but no significant difference was found between group ILMA and group MAC. As to BIS value, no difference was observed among the three groups (P<0.05). There is also no significant difference of plasma NA at time point TBI (P>0.05), but at time point T1 AND T3 Plasma NA concentration is different among three groups (P<0.05). And the NA level of group MAC is the highest, then the group ILMA and group SOS is the lowest. No significant difference of BIS value was observed among the three groups at any time points.2. There are no significant differences at the aspect of general status of the three groups. Intubation duration:intubation duration of group ILMA is significantly more than that of group SOS and MAC (P<0.05), while there is no significant difference between group SOS and MAC (P>0.05). Successful intubations incidence: all the 60 patients of the 3 groups were intubated successfully at the first time. Uncomfortableness incidence:there are only 2 cases of group SOS complained uncomfortableness, and this incidence is significantly lower than that of the other 2 groups (P＜0.05), and the incidence of the 2 groups is similar (P>0.05).Conclusion 1. Endotracheal intubation could cause cardiovascular response compared to intubation by Macintosh laryngeal scope, intubation by ILMA could not decrease the level of cardiovascular, but SOS could decrease the cardiovascular response.2. Compared to MAC and ILMA, SOS could facilitate the intubation process and lead to less uncomfortableness. |
PDF Full Text Request