| Objective:To compare the effects of spray-as-you-go technique by FOB with ultrasound-guided superior laryngeal nerve block combined with transcricothyroid membrane injection on cardiovascular responses during double-lumen endotracheal intubation.Methods:Sixty-six,ASA Ⅰ-Ⅱ patients aged between 18-65 years old who were scheduled to undergo double-lumen tracheal intubation for thoracic surgery were included in the study.The patients were assigned into control(Group C),ultrasound(Group U),and FOB(Group F)groups with 22 cases in each group.Patients in Group C underwent double-lumen tracheal intubation after routine venous induction.Patients in Group U were treated with superior laryngeal nerve block combined with cricothyrocentesis before anesthesia induction to suppress the intubation response,and patients in Group F were given a spray-as-you-go airway topical anesthesia after anesthesia induction to suppress the intubation response.This study recorded the BP,HR and SpO2 of the patients entering the room(T0),immediately before tracheal intubation(T1)and at 1 min(T2),3 min(T3)and 5 min(T4)after tracheal intubation,and immediately after posture adjustment(T5).Additional patient data were recorded including the time of topical anesthesia,time for patient to take tube,the occurrence of adverse events,the occurrence of sore throat and hoarseness,memory function and the level of patient satisfaction with anesthesia.Results:(1)MAP:The MAP of patients in the three groups were significantly lower before intubation compared to base value(P<0.05).The MAP of patients in Group C increased significantly after tracheal intubation,and the MAP was significantly higher than that in group U and F at T2 and T3(P<0.05),and significantly higher than in group F at T4 and T5(P<0.05).While the MAP of patients in group U and F remained stable,moreover,there was no difference between the two groups(P>0.05).(2)HR:The HR of patients in group C was significantly higher at T2 and T3 compared to base value(P<0.05),and the HR was significantly higher than that in group U and group F at T2 and T3(P<0.05).While the HR of patients in group U and group F showed no significant fluctuations,and there was no difference between the two groups(P>0.05).(3)Adverse events:The incidence of hypertension in group C,group U and group F was 52.63%(10/19),28.57%(6/21)and 4.8%(1/21),respectively.The incidence of hypertension in group C was significantly higher than that in group F(P<0.05).Tachycardia occurred in group C,group U and group F(9/9/4)(P<0.05).In group U,4 patients were found to have blood stains at the throat puncture site when the throat was exposed,3 patients experienced hypotension during operation and 38.1%(8/21)of the patients had bad memory of the process of local anesthesia.(4)Operating time for local anesthesia:The operating times for topical anesthesia of group U was 116.8±10.1s longer compared to the patients in group F were 93.0±10.0 s(P<0.05).(5)No significant differences were found in the incidence of hoarseness,sore throat,and satisfaction with anesthesia in postoperative follow-up.Conclusions:Both spray-as-you-go technique and ultrasound-guided superior laryngeal nerve block combined with transcricothyroid membrane injection can effectively inhibit the cardiovascular response during double-lumen tracheal intubation.The spray-as-you-go technique has fewer complications and more advantages,which is superior to ultrasound-guided nerve block combined with transcricothyroid membrane injection. |
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