Effect Of Translaryngeal Anesthesia On The Stress Response Of Tracheal Intubation In The Rapid Sequence Induction Of Anesthesia

Objective:To investigate the effect of translaryngeal anesthesia on the hemodynamic response to tracheal intubation during rapid sequence induction of anesthesia.Methods:According to the different methods of anesthetic induction,172 patients enrolled for anesthesia with rapid sequence induction were assigned to four groups:translaryngeal anesthesia group?Group T,n=43?,dexmedetomidine?0.4ug/kg?group?Group D,n=43?,GlideScope videolaryngoscopes group?Group G,n=43?and control group?Group C,n=43?.patients?SBP?DBP?MAP?HR and PI were recorded when entering the operating room?T₁?,inducing 3 minutes?T₂?,immediately after thyrocricoid injection?T??,immediately after intubation?T₃?,surgery begins?T₄?,end of surger?T₅?and extubation?T₆?.Blood sugar and plasma cortisol was monitored at T₁,T?and T₃.Plasma propofol concentration were monitored when keeping the bispectral index?BIS?between the value of 40and 60.Besides,the incidence of cough during extubation,the tracheal mucosal trauma rate,postoperative Ricker sedation-incitement score,postoperative sore throat score,visual analogue scale?VAS?score on the night after surgery,serious adverse reaction and general anesthesia satisfaction were recorded.Results:Cardiovascular stress responses to tracheal intubation was determined by maximal HR and MAP after intubation?T₃?compared with baseline value?T₁?,positive reaction was defined as an increase of either HR or MAP rise above 15%.There were 6 patients?14.0%?in the T group with positive reaction to tracheal intubation,13 patients?30.2%?in the D group,16 patients?37.2%?in the G group and 18 patients?41.9%?in the C group.The hemodynamic response to tracheal intubation were significantly higher in group G and C than those in group T?P<0.05?.There was no significant difference in the hemodynamic response to tracheal intubation between group T and D,G and C.Compared with the T group,the SBP,DBP,MAP,and HR in D?G?C group were significantly higher at T₃?P<0.05?.There was no significant difference between the four groups at other times?P>0.05?.The value of blood sugar and plasma cortisol in group G and C was higher at T₃ than that at T₁?P<0.05?.The difference in PI between the four groups were not satistically significant?P>0.05?.When keeping the same depth of anesthesia during surgery,the mean value of plasma propofol concentration between the four groups were not satistically significant?P>0.05?.There were no significant differences in postoperative Ricker sedation-incitement score,tracheal mucosal trauma rate and VAS score?P>0.05?.The sore throat score in group C was higher than that in group T?P<0.05?.The incidence of extubation cough in group T was significantly lower than the incidence in other groups?P<0.05?.Compared with the T₁,the SBP?HR?blood sugar and plasma cortisol in T group were not significantly higher at T??P>0.05?.There were no serious adverse reactions during the perioperative period in the four groups.The highest satisfaction rate for general anesthesia experience was in group T,followed by group D,and finally in groups G and C.The differences were statistically significant?P<0.05?.Conclusion:This randomized clinical trial performed undergoing translaryngeal anesthesia during rapid sequence induction can effectively preventing cardiovascular stress responses to tracheal intubation without increasing the incidence of sore throat and tracheal mucosal trauma and can reduce the incidence of cough during extubation.