The Clinical Research Of Compound Dexamethasone Gel Applied Over Tracheal Tube To Prevent Postoperative Airway Complications

Background and ObjectiveAs the development of comfortable medical treatment and the enlargement of surgery operation field, it is necessary to increase anesthesia correspondingly. General anesthesia has several advantages such as effectively analgesia, safely anesthesia management, highly controllability and improvement of surgery efficiency. As a result general anesthesia has becoming the primary anesthesia method during surgeries. Furthermore, the keystone of perioperative anesthesia is to ensure the safety of respiratory management.Tracheal intubation is general anesthesia in the operation of the main breathing maintain is also the most secure way, but tracheal intubation will inevitably cause local soft tissue different degrees of injury, produce a series of respiratory complications, including postoperative sore throat, which patients underwent is one of the more common complications of airway of which the rate is30%～70%, often with a cough, sputum, swallowing hurts, voice hoarse and so on. It is the main demand of patients discomfort, how to effectively prevent and reduce postoperative complications such as sore throat airway, has been engaged in the research and urgent clinical subject by many persons who work in the career of anesthesia. This experiment is to evaluate the effect of compound dexamethasone gel on the incidence and severity of airway symptoms induced by orotracheal intubation, compared with two methods which are commonly used in clinical practice to assess the effect of compound dexamethasone ointment in prevention and reduction of general intubation sore throat and postoperative complications of airway and to guide the clinical works.MethodsNinety adult patients without respiratory symptoms and smoking habits preoperatively were adopted. The patients had ASA class Ⅰ～Ⅱ levels and were treated with uni-lateral tympanoplasty under general anesthesia requiring orotracheal intubation. Patients were expected to quickly awake after the surgery. The patients were randomly divided into three groups including group D, group L and group S, and were treated with compound dexamethasone gel, lidocaine gel and liquid paraffin respectively. Thirty minutes before anesthesia, patients were injected Penehyclidine Hydrochloride (0.015mg/kg, ⅳ.) to avoid airway secretion. The tracheal tubes were smeared with2g dexamethasone gel,2g lidocaine gel and liquid paraffin respectively. Anesthesia induction was performed by intravenous injecting midazolam (0.05mg/kg), fentanyl (3-5μg/kg), etomidate (2mg/kg) and atracurium (0.5mg/kg). After orotracheal intubation, remifentanil (0.1-0.2μg/kg/min) and propofol (4-8mg/kg/h) were continuing intravenous infused to maintain anesthesia. Atracurium (0.15-0.2mg/kg) was discontinuously intravenous injection to maintain muscle relaxation. The BP, SPO2, OT, TTE, and doses of remifentanil and propofol were record. The incidence and severity of postoperative respiratory symptoms were evaluated at1h,6h and24h post-operation.ResultsThe general conditions of all groups had no difference. The doses of remifentanil and propofol of all groups were meetly. At the first hour post-operation, the incidences of sore throat of group D, group L and group S were10%,10%and40%respectively; the incidence of cough of all groups were10%,16.7%and40%respectively, while the incidence of expectoration of all groups were16.7%,13.3% and26.7%respectively; the incidence and severity of airway complications of group D and group L were lower than that of group S (P<0.05). At the sixth hour post-operation, the incidence and severity of airway complications were increased than those of at the first hour in all groups (P<0.05). At the twenty four hour post-operation, the incidence of sore throat of all groups were lower than those at the sixth hour, which were10%,10%and40%respectively (P<0.05); the incidence of cough of all groups were10%,16.7%and40%respectively, while the incidence of expectoration of all groups were16.7%,13.3%and26.7%respectively; among these, the incidence of expectoration of group D was lower than that at the sixth hour (P<0.05), as well as was lower than those of group L and group S (P<0.05); the proportion of severe complication of all groups were lower than those at the sixth hours (P<0.05).At the sixth hour post-operation, the rates of sore throat in three groups were6.7%,6.7%and13.3%; while the incidences of Level2sore throat were13.3%,16.7%and40%respectively; the rates of Level3sore throat are0.In three groups, the incidences of Grade1cough were10%,20%and40%; the incidence of Grade2was6.7%,6.7%and6.7%; the incidence of Grade3was0.The incidences of Grade1sputum in all groups were20%,20%and20%; the rates of Grade2were13.3%,10%and6.7%; the incidences of Grade3were0,0and10%.ConclusionCompound dexamethasone gel could effectively reduce the incidence of postoperative airway complications, and it can be promoted in the clinical practice.