Effects Of Lidocaine And Tetracaine Topical Anesthesia On Extubation Of Patients With Nodular Goiter And Hyperthyroidism

Objective: To investigate the inhibitory effects of lidocaine,tetracaine,epiglottis and endotracheal anesthesia on the stress response during the extubation period in patients with nodular goiter and hyperthyroidism,and to provide clinical guidance for extubation in this group of patients.Methods: From February 2015 to February 2017 to select 90 cases of No.1 Hospital of Jilin University undergoing nodular goiter with hyperthyroidism surgery patients,ASA grade I-II,aged 18-65 years,the estimated operation time of 0.5 hours to 3 hours,were randomly divided into three groups,30 cases in each group.All patients were fully preoperative preparation,the emotional stability,good sleep,weight gain,pulse rate less than 90 times one minute,the basal metabolic rate less than20%.After the patient entered the operation room,routine non-invasive blood pressure,ECG,peripheral blood oxygen saturation monitoring,and open the peripheral vein access to the upper extremity.After all preparations,according to grouping,with different local anesthetics soaked cotton swab anesthesia,nasal mucosa surface observation of15 min,if the patients with rash,Chest tightness,palpitationsdyspnea orserious allergic reactions,give hormone symptomatic and supportive treatment and discharge of this experiment,if not an allergic reaction,then this experiment.If no allergic reaction occurred then,this experiment was carried out.Anesthesia was induced with intravenous midazolam0.05 mg /kg,sufentanil 0.3ug /kg,cisatracurium 0.15 mg /Kg,propofol1.5-2.0mg /kg.In group A,2% lidocaine 2ml was sprayed with a laryngeal tube after the laryngoscope was placed,and then the mask was given oxygen for about 3 minutes,insertion of tracheal catheter,tracheal intubation was successfully injected into the 2% lidocaine 1ml.In group B,0.5% 2ml of tetracaine was sprayed with a laryngeal tube after the laryngoscope was placed,and then exposed to oxygen for about 3minutes,Tracheal intubation was inserted and 0.5% 1ml.was injected into the endotracheal tube.In group C,spraying 0.9% 2ml sodium chloride with laryngeal anesthesia laryngoscope after tube placement,then pressurized oxygen mask 3 minutes after insertion of endotracheal tube intubation after the success of the tracheal catheter in 0.9% sodium chloride injection 1ml,connected to the ventilator control breathing.The control of respiratory parameters was to maintain the end expiratory CO₂ partial pressure(P_ETCO₂)at 35 45 mm Hg.Propofol,remifentanil and sevoflurane were used for anesthesia maintenance.The rate of propofol and remifentanil infusion and the concentration of inhaled anesthetics were adjusted according to the bispectral index value.The BIS value wasmaintained between 40 and 50.40 minutes before the end of surgery to stop the application of muscle relaxants and inhalation anesthetics,5minutes before the end of surgery to stop all maintain drug application,all patients without the use of muscle relaxant antagonist.When patients with spontaneous breathing recovery,peripheral oxygen saturation SPO₂ > 95%,VT > 5ml/kg,Pet CO₂ is less than 45 mm Hg,then can open eyes that pull out the endotracheal tube.And record the three groups of patients with 10min?T₁?,1 min before extubation?T₂?,extubation?T₃?,1min after extubation?T₄?,3min after extubation?T₅?,5min after extubation?T₆?systolic blood pressure,diastolic blood pressure and heart rate,and venous blood was collected at each time point measured at each time point?AD?,epinephrine,norepinephrine?NE?,plasma cortisol?CORT?level,and 10min?T₁?for burglary and tracheal intubation?T₃?at two time points of thyrotropin?TSH?,free T₃?FT₃?,free T₄?FT₄?levels were detected and recorded.And record the surgery time,extubation time,occurrence of choking cough severity and postoperative sore throat.All the experimental operation and data recording were performed by the anesthesiologist.Who do not know the packet.Results: A,B,C basic blood pressure of three groups of patients in general and T₁ time,there were no differences in heart rate and hormone levels?P > 0.05?.T₁ and T₂ T₆ each time point of hemodynamics and venous blood epinephrine?AD?,norepinephrine?NE?,plasma cortisol?CORT?compared with water Ping group,B group had no obvious fluctuations,there was no statistically significant difference?P >0.05?,A,C two groups appeared obvious fluctuations,the difference was statistically significant?P < 0.05?.In T₂ T₆ time between groups,B group of hemodynamics and epinephrine?AD?,norepinephrine?NE?,plasma cortisol?CORT?levels were significantly lower than A group and C group,the difference was statistically significant?P < 0.05?and.T₁ and T₃?TSH?,thyroid stimulating time free T₃?FT₃?,free T₄?FT₄?level within the group,the B group had no obvious fluctuations,there was no statistically significant difference?P > 0.05?,group A and group C appeared obvious fluctuation,the difference was statistically significant?P < 0.05?.Three groups of patients with thyroid hormone T₃?TSH?,free T₃?FT₃?,free T₄?FT₄?level between two groups has significant difference?P < 0.05?,and B group A group and C group,TSH level was significantly higher than that of A group and C group,and FT₃,FT₄ level significantly less than A group and C group,there was statistically significant difference?P < 0.05?.For the satisfaction of cough,the satisfaction rate of A group was 29.9%,that of group B was 82.7%,and that of group C was 13.3%.Compared with group A and group B,the control effect of cough control in group C was the best,the difference was statistically significant?P < 0.05?Conclusion: Compared with lidocaine,tetracaine throat andtrachea of small dose injection,can significantly reduce the nodular goiter with hyperthyroidism in patients with cough during tube pulling stress,avoid induced thyroid crisis,and reduce the incidence of sore throat after extubation.Dante ropivacaine safe range of small,high toxicity,clinical in the work we should strictly control the use of concentration and dosage.Postoperative sore throat VAS score,B group of 50% patients without postoperative sore throat,A group accounted for only 26.6%,C group accounted for only 10%,the difference was statistically significant?P < 0.05?.VAS scores were more than 1 branch percentage compared to A group 40%,B group 10%,C group 70%,the difference was statistically significant?P < 0.05?.