Clinical Observation On Application And Evaluation Of Laryngeal Mask Airway With Spontaneous Breathing Patients Undergoing Pulmonary Bullae Resection:a Randomized, Parallel And Controlled Trial

Objectives:Pulmonary bullae is a common disease in the clinic,most patients receive the surgical treatment.At present,most of the pulmonary bullae surgery can be performed under the assistance of thoracoscope.In pass years we always applied double lumen tube and one lung ventilation to the pulmonary bullae surgery.Double lumen tube can seperate right and left lungs,however,it also has some disadvantages such as strong stimulation,difficulty of locating and injury of the larynx.One lung ventilation may cause mechanical related lung injury.The use of neuromuscular blocking agent can slow down muscular strength recovery and postoperative recovery.At present,minimal invasive treament,lung protection and rapid recovery are the trends of the development of thoracic surgery.The laryngeal mask,as a new type of airway tool,is recognized by most anesthesiologists because of the characteristics of minimal invasive treament.The purpose of this experiment was to observe on application and evaluation of laryngeal mask airway with spontaneous breathing.We tried to study whether laryngeal mask can satisfy operation,whether the vital signs in patients are stable,and whether it is beneficial to patients with early postoperative rehabilitation.We expect to provide a minimal invasive airway management for patients receiving this type of surgery and we hopethisairwaymanagementcanprovidesafeandrapid recovery.Methods:This is a randomized,parallel and controlled trial.60 patients were randomly divided into 2 groups:the laryngeal mask with autonomous respiration group（group A）and the double lumen tube with one lung ventilation group（group B）.Before the surgery,Dexmedetomidin（1μg/kg/h）was intravenous pumped for 15 minutes and Atropine（0.01mg/kg）was intravenous injected as well.Anesthesia induction:patients in two groups were intravenous injectedSufentanil（0.2μg/kg）,andintravenouspumped Propofol（2-3.5μg/ml,TCI）,patients in group B were intravenous injected Cisatracurium（0.2mg/kg）.Patients in group A were placed the laryngeal mask and retained the autonomous respiration,while the group B was placed double lumen tube with one lung ventilation.Anesthesia maintenance:Propofol（2-4μg/ml,TCI）,Remifentanil（4-6ng/ml,TCI）and Dexmedetomidine（0.5μg/kg/h）were intravenous pumped.Group B was added Cisatracurium based on muscle relaxation monitor TOF.Local anesthesia,pleura surface anesthesia,and intrathoracic vagus nerve block were performed during the operation.The patients in group B were given the antagonistic muscle relaxants Neostigmine（0.02mg/kg）.When the patients were awake,we removed the laryngeal mask or the double lumen tube and sent the patients to PACU.The observation data included the success rate of placement of laryngeal mask or double lumen tube at once,the duration of controlling the airways,the vital signs and blood gas analysis during operation,the classification of anesthesia satisfaction and surgical satisfaction,the duration from the end of the surgery to laryngeal mask or double lumen tube drawing,the resuscitation time,grip strength test,the success proportion of the chest tubes removed 4hours after the operation,the duration of being ambulant after surgery,postoperative analgesic dose and hospitalization duration.Results:There was no significant difference in sex,age and BMI index between the two groups（P>0.05）.The success rate of placement of laryngeal mask or double lumen tube at once in group A was higher than that in group B（P<0.05）,and the time used in group A was shorter than that in group B（P<0.001）.Heart rate and systolic blood pressure changes in critical time（T1:before anesthesia induction,T2:placement of airway tools,T3:20 minutes after opening the thoracic cavity,T4:after the closure of the thoracic cavity,T5:after the removal of airway tools）had significant difference（P<0.001）,the heart rate and systolic blood pressure in group B significantly increased when the double lumen tube was inserted,the diastolic blood pressure and pulse oxygen saturation in two groups were no significant difference in critical times（P>0.05）.PaCO₂ and PH of two groups in the key time point（T1’:after anesthesia induction,T2’:10 minutes after opening the thoracic cavity,T3’:20 minutes after opening the thoracic cavity,T4’:after the closure of the thoracic cavity,T5’:after the removal of airway tools）had significant difference（P<0.001）,PaCO₂ in group A were higher than that in group B,pH value in group A was lower than that in group B,PaO₂ showed no significant difference in two groups（P>0.05）.There was no statistical difference between the satisfaction of anesthesiologist and surgeon in the two groups during the whole operation（P>0.05）.In group A,the duration of extubation and resuscitation were shorter than those in the group B（P<0.001）.There was a statistical difference in gripping force between the two groups at different time points（P<0.001）.It decreased slightly in group A,while decreased significantly in group B.In group A,the rate of extraction of chest tube at 4 hours after operation was higher than that in group B（P<0.001）.The duration of getting out bed and walking after operation in group A was shorter than that in group B（P<0.001）.The dosage of morphine analgesia within 48 hours after operation in group A was less than that in group B（P<0.001）,but this difference had no clinical significance.The postoperative hospitalization time in group A was shorter than that in group B（P<0.001）.Conclusions:Under the conditions of this test,during the anesthesia management of pulmonary bullae resection,placing laryngeal mask airway and preserving autonomous respiration can improve the success rate of airways controlling,save time to the airways controlling and reduce cardiovascular stress induced by strong stimulation in airways controlling.Placing laryngeal mask airway and preserving autonomous respiration can maintain the stability of the cardiopulmonary function in the surgery.After surgery,placing laryngeal mask airway and preserving autonomous respiration shorten the awakening time of the patients and promote the recovery of the myodynamia.It can help the patients to remove the chest tube early and help early ambulation.It can shorten the time of postoperative hospital stay in patients.In summary,placing laryngeal mask airway and preserving autonomous respiration promote rapid postoperative recovery of patients.