| Objective: Observing the effects of nebulized inhalation of different local anesthetics on the stress response to tracheal intubation,coughing response during extubation,and the incidence of postoperative sore throat(POST),providing reference for surface anesthesia of nebulized inhalation of local anesthetics in tracheal intubation patients.Methods: After approval by the Ethics Committee of our hospital,120 patients who received endotracheal intubation and general anesthesia in the Affiliated Hospital of Yan’an University from November 2021 to December 2022 and met the inclusion and exclusion criteria were selected and divided into 3 groups according to the numerical random table method,with 40 patients in each group.The three groups were as follows:5ml 1% tetracaine for 15 min before anesthesia induction(group A),5ml 2% lidocaine for15 min before anesthesia induction(group B)and 5ml normal saline for 15 min before anesthesia induction(group C),which were the control group.During induction of general anesthesia,midazolam 0.05mg/kg,Sufentanil 0.5ug/kg,etomidate 0.25mg/kg,rocuronium 0.6mg/kg were injected intravenously.Endotracheal intubation was performed when BIS was between 40 and 50.Ensure that all patients have the same general anesthesia induction and maintenance protocol.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded at 5min after entry(marked as T0 moment),after airway surface anesthesia(marked as T1 moment),immediately after intubation(marked as T2 moment),and 3min after tracheal intubation(marked as T3 moment),respectively.Respiratory parameters of mechanical ventilation were recorded,including airway pressure,plateau pressure and peak airway pressure.The duration of recovery,anesthesia and operation were recorded after the operation.The coughing reaction of patients during extubation period was recorded and scored.Visual analog scale(VAS)was used to record the occurrence of POST at 0h,4h,12 h and 24 h after extubation.The occurrence of postoperative pulmonary complications,including atelectasis,pulmonary infection,pulmonary edema,respiratory failure,and other adverse reactions such as local anesthetic poisoning,were recorded through postoperative follow-up observation,and the above observation indicators of the three groups of patients were compared.Results:(1)There was no statistically significant difference in the preoperative,intraoperative,and postoperative general conditions of the three groups of patients,such as age,gender,height,weight,surgical duration,anesthesia duration,and recovery duration(P>0.05).(2)Comparison of SBP among three groups of patients at different time points.Intragroup comparison: There was no statistically significant difference in SBP between Group A and Group B as compared to T1 at T0,T2,and T3(P>0.05).SBP in Group C was significantly higher than T1 at T2 and T3,with SBP(mean)being 6.0mm Hg higher than T1 at T2,and SBP(mean)being 4.87 mm Hg higher than T1 at T3,with significant differences(P<0.05).Inter group comparison: There was no statistically significant difference in SBP between Group A and Group B and Group C at T0 and T1(P>0.05).There was a statistically significant difference in SBP between Group A and Group B and Group C at T2(P<0.05).There was a statistically significant difference in SBP between Group B and Group C at T3(P<0.05).(3)Comparison of DBP among three groups of patients at different time points.Intragroup comparison: There was no statistically significant difference in DBP between Group A and Group B as compared to T1 at T0,T2,and T3(P>0.05),while DBP in Group C was significantly higher at T2,T3,and T1.DBP(mean)at T2 was 7.96 mm Hg higher than T1,and DBP(mean)at T3 was1.56 mm Hg higher than T1.It can be seen that DBP increased significantly at T2,with significant differences(P<0.05).Inter group comparison: There was no significant difference in SBP between Group A and Group B and Group C at T0 and T1(P>0.05),while there was significant difference in SBP between Group A and Group B and Group C at T2 and T3(P<0.05).(4)Comparison of HR among three groups of patients at different time points.Intragroup comparison: There was no statistically significant difference between Group A and Group B in HR at T0,T2,and T3 compared to T1(P>0.05),while Group C had a significant increase in HR at T2,T3 compared to T1.HR(mean)at T2 was 4.25 mm Hg higher than T1,and HR(mean)at T3 was 3.85 mm Hg higher than T1,with significant differences(P<0.05).Inter group comparison: There was no significant difference in HR between Group A and Group B and Group C at T0 and T1(P>0.05),while there was significant difference in HR between Group A and Group B and Group C at T2 and T3(P<0.05).(5)Comparison of patients in the three groups during extubation: The incidence of coughing and other conditions during extubation in Group A was 12.5%,the incidence of coughing and other conditions during extubation in Group B was 15.0%,and the incidence of coughing and other conditions during extubation in Group C was 37.5%.It can be seen that the incidence of coughing and other conditions during extubation in Group C was the highest,followed by Group B and Group C.There were significant differences in the extubation period between Group A and Group B compared with Group C(P<0.05).(6)Comparison of POST status among three groups of patients.At 0 h after surgery,the incidence of POST in Group A was15.0%,the incidence of POST in Group B was 20.0%,and the incidence of POST in Group C was 47.5%.The difference in the incidence of POST among the three groups was statistically significant(P<0.05),The incidence of POST in Group A and Group B was significantly different from that in Group C(P<0.05).At 4 hours after surgery,the incidence of POST was 14.3% in Group A,15.0% in Group B,and 42.5% in Group C.There was a statistically significant difference in the incidence of POST among the three groups(P<0.05),The incidence of POST in Group A and Group B was significantly different from that in Group C(P<0.05).At 12 hours after surgery,the incidence of POST was 5.0% in Group A,7.5% in Group B,and 22.5% in Group C.There was a statistically significant difference in the incidence of POST among the three groups(P<0.05),The difference in the incidence of POST between Group A and Group C was statistically significant(P<0.05).At 24 hours after surgery,the incidence of POST was2.5% in Group A,2.5% in Group B,and 10.0% in Group C.There was no statistically significant difference in the incidence of POST among the three groups(P>0.05).(7)There was no statistically significant difference in respiratory parameters(peak airway pressure,plateau pressure,average airway pressure)during mechanical ventilation among the three groups of patients during surgery(P>0.05).(8)All three groups of patients did not experience postoperative pulmonary complications.Conclusion: Preoperative aerosol inhalation of tetracaine and lidocaine can reduce the stress response of tracheal intubation.In order to reduce the cough during extubation and reduce the incidence of POST,preoperative aerosol inhalation of tetracaine is preferred.This anesthetic method and medication are recommended for clinical use. |
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