| BACKGROUND: Intracranial aneurysms are common clinical diseases,and the incidence of intracranial aneurysms has been increasing year by year in recent years.The causes of intracranial aneurysms are uncertain and related to congenital vascular wall dysplasia or vascular malformations.In addition,they have acquired arteriosclerosis,intracranial abscess or infection,meningitis.Surgical trauma,and so on may also lead to the onset of the disease.The operation of intracranial aneurysm requires endotracheal intubation,and the vital signs are stable during indwelling and tracheal extubation.If severe cough and violent fluctuation of blood pressure can lead to rapid rise of intracranial pressure,cause aneurysm rupture,intracranial hemorrhage and wound hemorrhage,etc.It even leads to the death of the patient.In order to prevent these adverse reactions,routine measures are carried out under deep anesthesia,but they may lead to complications such as respiratory inhibition,aspiration,dyspnea and hypoxemia.It has been reported that ropivacaine can reduce cough reflex during anesthesia induction and tracheal extubation and control blood pressure fluctuation and heart rate change.However,the related experiments of craniocerebral surgery have not been reported in literature.OBJECTIVE: To observe the effect of 2% lidocaine and 0.75% ropivacaine on the stress reaction of endotracheal intubation and extubation in patients with intracranial aneurysm clamping,and to explore the anesthetic method which is more beneficial to the patients with intracranial aneurysm clamping.METHODS: From January to November 2017,60 patients(ASA ?-III)underwent intracranial aneurysm surgery in the first Hospital of Jilin University.They were randomly divided into two groups according to the digital table method: lidocaine group(group L)and ropivacaine group(group R).There were 30 patients in each group.3ml 2% lidocaine solution was used for pharynx and larynx and trachea surface anesthesia,and then the mask pressure was given to oxygen for 2 min,and endotracheal intubation was performed.In group R,3ml 0.75% ropivacaine solution was used for pharynx and larynx and trachea surface anaesthesia,and then the mask was pressurized for 2 minutes to intubate the trachea.After the patients were monitored in the operating room,fentanyl 1ug/kg was given intravenously,and then the radial artery puncture and catheterization were performed to monitor the invasive arterial pressure.All anesthetized patients were induced by midazolam: 0.03 mg/kg,fentanyl 3 ug/kg,homeopathic atracurium 0.15 mg/kg,propofol 2 mg/kg,if the BIS value was greater than 60,propofol was added.When the BIS value was less than 50,the throat and trachea surface were anesthetized by laryngoscope,and then the mask was pressurized for 2 minutes to intubate the trachea.The anaesthesia machine was connected and ventilated mechanically.The tidal volume was 8~10ml/kg.The respiratory frequency was adjusted according to the partial pressure of carbon dioxide(35~45mm Hg)at the end of respiration.Norepinephrine and nicardipine were used to maintain blood pressure in the range of ±20% before induction.At the beginning of the operation,fentanyl 2 ug / kg was added,remifentanil was used for analgesia,propofol was used for sedation,and atracurium hydrobenzenesulfonate was used to maintain anesthesia.Ten minutes before the end of the operation,40-60 mg of tazoxin was given.After awakening,if the spontaneous respiratory frequency was 12~20 times / min,tidal volume > 8ml/kg,the oxygen saturation was ? 96% when the partial pressure of carbon dioxide was less than 45 mm Hg,and the endotracheal intubation could be pulled out for 5 minutes.If the patient's spontaneous respiration did not meet the extubation requirements,the patient was restless or coughed.Lidocaine 1 mg/kg was injected intravenously,and 0.5 mg/kg was added if not relieved until the spontaneous respiration met the requirements.During extubation,if systolic blood pressure ? 160 mm Hg or diastolic blood pressure ? 90 mm mg,nicardipine 0.4 mg intravenously and heart rate ? 100 beats / min,esmolol 0.5 mg/kg was given after one minute injection.As appropriate,0.05 mg/kg neostigmine and 0.02 mg/kg atropine were given to neostigmine and atropine.After endotracheal intubation and extubation,the mask continued to absorb oxygen(oxygen flow rate was 5L/min).The blood pressure and heart rate of T0 before anesthesia induction,T1 immediately after intubation,2min T2 after intubation,T3 immediately after extubation and 2min T4 after extubation were recorded.The time of anesthesia and operation were recorded,the degree of cough reaction during extubation and the degree of sedation during extubation were followed up and recorded.RESULTS: The blood pressure and heart rate at T1 during intubation and 2min T2 after intubation were significantly lower than those at T0 in calm state,indicating that the two drugs could effectively prevent the blood pressure caused by endotracheal intubation.Stress response such as elevated heart rate;However,the blood pressure and heart rate of patients in ropivacaine group were significantly lower than those in lidocaine group at T3 and 2min T4 after extubation,and the incidence of cough and cough score were also significantly lower than those in lidocaine group(P < 0.05).The awake time of ropivacaine group was earlier than that of lidocaine group,and there was significant difference between the two groups(p < 0.05).There was no significant difference in sedation score and respiratory recovery time between the two groups(p > 0.05).CONCLUSION: Both 2% lidocaine and 0.75% ropivacaine can reduce the stress response of endotracheal intubation in patients with intracranial aneurysm clamping.Compared with 2% lidocaine,0.75% ropivacaine could more effectively inhibit the stress response during extubation,make the recovery time shorter,and improve the safety and comfort of patients during extubation.At the same time,it also broadens the application field of ropivacaine in craniocerebral surgery,and finds a new effect,which provides a new method for reducing tracheal intubation and extubation stress response. |
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