Clinical Study Of The Effects Of Different Methods On Attenuating The Responses To Tracheal Extubation Of Neurosurgery Patients

Objective:The aim of this study was to compare the effects of intravenous injection of lidocaine,labetalol and exchanging the tracheal tube for the laryngeal mask airway(the TT/LMA exchange)after surgery on the prevention of the extubation reaction of neurosurgery patients.Method:About 80 ASAⅠtoⅡpatients undergoing neurosurgical surgery under total intravenous anesthesia(TIVA)were randomly allocated to one of four groups.Patients in groupⅠwere given 5ml saline before tracheal extubation.Patients in groupⅡwere given intravenous 1.5mg/kg Lidocaine 3 minutes before extubation.Patients in groupⅢwere given intravenous 0.4mg/kg labetalol 5 minutes before extubation.In groupⅣ,tracheal tube was removed at the deep level of anesthesia and LM was inserted after surgery and before LMA removal,patients were given 5ml saline.Systolic blood pressure (SBP),diastolic blood pressure(DBP)and heart rate(HR)were measured and recorded at pre-induction,pre-medication,aspiration,when and 1,3,5,10, 15min after tracheal extubation or LMA removal.Rate-pressure product was derived from SBP*HR.The bucking degree and whether dysphoria were recorded during extubation or LMA removal,and so on. Results:Compared with groupⅠ,SBP,DBP,HR and RPP in groupⅡwere decreased from aspiration to 1 minute after extubation(P＜0.05),and there was no statistically significant relationship at 3 minutes after extubation(P＞0.05). SBP,DBP and HR in groupⅢwere significantly decreased from aspiration to 3 minute after extubation compared with groupⅠ(P＜0.05),and RPP was lower than groupⅠfrom aspiration to 15 minute after extubation(P＜0.05).SBP and RPP in groupⅣwere lower than groupⅠfrom aspiration to 3 minute after LMA removal(P＜0.05),and there was no statistically significant relationship at 5 minutes after LMA removal(P＞0.05),but HR was lower than groupⅠfrom pre-medication to 15 minutes after LMA removal(P＜0.05).SBP,DBP and RPP in groupⅢwere significantly decreased from aspiration to 1 minute after extubation compared with groupⅡ(P＜0.05),and DBP was lower than groupⅣ(P＜0.05).The frequency of severe bucking in groupⅡwas lower than groupⅠ(P＜0.05).The frequency of moderate/severe bucking and dysphoria in groupⅣwere lower than groupⅠ(P＜0.05),and there was no statistically significant relationship between groupⅢand groupⅠ(P＞0.05). %Conclusion:Lidocaine,labetalol and the TT/LMA exchange after surgery can effectively abate the extubation reaction.Labetalol has a better effect in keeping a relatively stable hemodynamics.The TT/LMA exchange after surgery can offer less bucking,dysphoria and cardiovascular response.