Comparison Between Gastroscope Laryngeal Mask Airway And Reinforcedtracheal Tube Used For Transcatheter Aortic Valve Replacement

Background and objectiveAortic stenosis(AS)is the most common valvular disease in the elderly,which is mostly caused by degenerative calcification.The incidence of the disease increased with age.The average incidence rate of the 50-59 year old group was 0.2%,and the average prevalence rate of the 80-89 year old group was 9.8%.Progressive aortic stenosis with left ventricular pressure overload and left ventricular hypertrophy lead to the typical triple symptoms of aortic stenosis:heart failure,syncope and angina pectoris.If symptomatic aortic stenosis is not treated,the annual mortality is 25%.Since the first trans catheter aortic valve replacement(TAVR)was performed in 2001,it has attracted the attention of the medical community and the public.A large number of clinical trials show that TAVR is not inferior to or even superior to SAVR.Transesophageal echocardiography(TEE)plays a key role in valve replacement.TEE examination in TAVR is usually carried out under general anesthesia.Because the process involves sharing airway,it is usually used to reinforced tracheal tube(RTT)for airway management.However,RTT implantation and extubation can easily lead to severe circulatory fluctuations,which is especially unfavorable for elderly patients with TAVR complicated with pulmonary hypertension,left ventricular dysfunction,renal failure and other diseases.Gastroscope laryngeal mask airway(GLMA)is a new type of supraglottic ventilation equipment.It is improved on the basis of common double tube laryngeal mask.The inner diameter of the esophageal passage parallel to the airway passage is increased to 20*22mm,which can accommodate digestive endoscopy and TEE probe.At present,gastro scope laryngeal mask is mostly used for gastrointestinal endoscopy in clinic,and there are few reports on the application of gastro scope laryngeal mask in TAVR.The syudy aimed to evaluate the safety and effectiveness of the gastro scope laryngeal mask during TEE by comparing the application of gastro scope laryngeal mask and reinforced tracheal tube in TAVR general anesthesia.Material and MethodsThere were 80 patients with TAVR in our hospital,randomly divided into GLMA group and RTT group.All patients were treated with "fast track" after induction of general anesthesia.In RTT group,the catheter was inserted through the mouth through the video laryngoscope,and in GLMA group,the laryngeal mask was inserted blindly.(1)The general data were recorded.(2)The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded at T0,T1,T2,T3,T4,Ts,and T6.(3)The SpO2,PetCO2 and Ppeak were recorded at T2,T3,T4 and T5.(4)The oropharyngeal leak pressure(OLP)and fiberoptic bronchoscopy(FOB)scores in GLMA group were recorded.(5)The time required for the successful implantation of implantation TEE probe,and adverse reactions such as reflux,cough,nausea and vomiting,hoarseness,sore throat within 24 hours were recorded.Result1.There were no significant differences in gender,age,BMI,NYHA,Mallampati airway grade,NYHA,Mallampati airway grade,anesthesia grade score(ASA),American Society of Thoraics(STS),complications,CT mean aortic ring diameter and operation time between the two groups(P>0.05).2.Compared with T0,SBP,DBP and HR of GLMA group and RTT group were significantly decreased at T1(P<0.05).There were no significant differences in SBP,DBP and HR between T2 and T1,T6 and T5 in GLMA group(P>0.05).There was no significant difference in SBP,DBP and HR between T2 and Ti in RTT group(P>0.05).The SBP,DBP and HR were significantly increased between T6 and T5 in RTT group(P<0.05).There was no significant difference in SBP,DBP and HR between GLMA group and RTT group at T0,T1,T2,T3,T4 and T5(P>0.05).At T6,SBP,DBP and HR in RTT group were significantly higher than those in GLMA group(P<0.05).3.There was no significant difference in SpO2 between the two groups at each time point(P>0.05).There was no significant difference in PetCO2 between the two groups at each time point(P>0.05).The Ppeak of GLMA group at T2-T5 was significantly lower than that of RTT group(P<0.05).4.There was no significant difference in OLP and FOB scores at T2 and T3 in GLMA group(P>0.05).5.The successful time of TEE probe implantation in GLMA group was shorter than that in RTT group(P<0.05).There was no statistically significant difference in the incidence of reflux between the two groups(P>0.05).The incidence of cough,nausea and vomiting,hoarseness and sore throat in GLMA group was significantly lower than that in RTT group(P<0.05).ConclusionGastroscope laryngeal mask airway can keep the hemodynamics stable,has good ventilation effect and airway sealing function,and less postoperative respiratory complications.It can be effectively and safely used in the surgical treatment of trans catheter aortic valve replacement.