Comparison Of The Effects Of SLIPA And Endotracheal Intubation To The Hemodynamics And Stress Hormone In General Anesthesia Induction Period Of Modified Radical Mamtectomy Patients

Background and objective:Modified radical mastectomy only needs to resect breast with lesion and do axillary lymph node dissection. Because the resection area was relatively reduced, after operation, the occurrence rates of complication, such as restriction of the shoulder movement and upper limb edema, and operation sequel reduced. In addition, modified radical mastectomy plus lymph node radiotherapy after operation can achieve the same curative effect with radical mastectomy. Therefore, nowadays radical mastectomy is given up, but modified radical mastectomy is adopted. Modified radical mastectomy can be performed under high segmental epidural anesthesia, however, because its block level is difficult to control, there are some unfavorable factors, such as frequent occurrence of respiratory depression, high rish of manipulation and patients’fear, therefore, most hospitals have abandoned it. At present, the usual anesthesia for modified radical mastectomy is endotracheal intubation general anesthesia,which can effectively solve the above risks and has higher safety and patients are more comfortable. However, patients had strong stress response while intubating and extubating, and after operation patients had angina and other discomforts. Therefore, a more effective anesthesia with small side effects is pursuing clinically. Laryngeal mask airway (LMA)’s adoption in general anesthesia respiratory tract care is over20years and made generally accepted clinical effect. The application scope of laryngeal mask enlarges ceaselessly. The kinds of laryngeal mask are also innovated ceaselessly. In recent years, SLIPA laryngeal mask is gradually applied in clinical. This study is to compare the effects of SLIPA laryngeal mask and endotracheal intubation to hemodynamics and stress hormone in induction of anesthesia for modified radical mastectomy patients and provide effective reference for anesthesia choices of modified radical mastectomy.Methods:Select40patients with ASA Ⅰ-Ⅱ grade that were performed modified radical mastectomy under general anesthesia in selected time. They were randomized into endotracheal intubation group (group Ⅰ) and SLIPA laryngeal mask group (group Ⅱ). Anesthesia induction:intravenously inject midazolam0.05mg/kg, fentanyl0.01mg/kg, propofol1.5mg/kg and rocuronium0.1mg/kg to the two groups successively and after mandibular relaxation perform endotracheal intubation or SLIPA laryngeal mask. Observe and record systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, PETCO2and bispectral index (BIS) at every time point of peri-induction period and at the same time extract patients’peripheral venous blood at every time point of before anesthesia induction (TO),after anesthesia induction T1),laryngeal mask insertion/endotracheal intubation immediate (T2) and3minutes after that (T3) and apply HPLC to test AE,NE levels.Results:1、The difference of HR, SBP, DBP and plasma E, NE concentration of the patients in the two groups had no statistical significance while compared before induction (p>0.05).2、Comparing HR,SBP,DBP and plasma E,NE concentration and before induction of group Ⅰ while endotracheal intubation and group Ⅱ, the difference had statistical significance (p<0.05).3、Comparing HR,SBP,DBP and plasma E, NE concentration at every time point of group Ⅱ, the difference had no statistical significance (p>0.05).Conclusion:General anesthesia SLIPA laryngeal mask ventilation is better than endotracheal intubation while applying to modified radical mastectomy and it is easy to maintain patients’stability of hemodynamics in induction period and the stress response is light.