Clinical Application Of CIS Atracurium Besilate In The Operation Of Infant Tracheal Foreign Body

ObjectiveTo evaluate the efficacy and safety of CIS atracurium besilate in the operation of in infant tracheal foreign body by comparing two kinds of anesthesia methods. The infants in the control group require removal of foreign body under spontaneous breathing, and the experimental group plan to take the removals of tracheal foreign body with CIS atracurium besilate (muscle relaxant) under the assisted breathing with ventilator.Methods298infants who were diagnosed with American Society of Anesthesiologists (ASA) Ⅰ～Ⅱ and performed unilateral tracheal foreign body operation were chosen and randomly divided into two groups, experimental group Ⅰ and the control group Ⅱ (Ⅰ Ⅱ group).149cases were included in each group.All patients were induced by8%Sevoflurane after entering the operating room. When their consciousness disappeared, they were injected intravenously with0.01mg/kg midazolam, propofol2mg/kg, sufentanil citrate0.2ug/kg. Group Ⅰ required CIS atracurium besylate0.15mg/kg under the assisted breathing with ventilator. Group Ⅱ were given normal saline under spontaneous breathing, the same capacity of CIS atracurium besilate. Maintenance:Propofol10mg/kg.h was pumped into vein, and Sevoflurane was inhaled continuously. When BIS value dropped to about40, rigid bronchoscopy was placed in. Sevoflurane concentration was adjusted to2%～6%to make the BIS value fluctuation between40-50.After operation, Group I were immediately sent to the surgical intensive care unit (SICU) under the tracheal intubation assist breathing. Group Ⅱ were sent to SICU under the mask oxygen.We mainly observed heart rate (HR), Sevoflurane expired concentration, Sevoflurane dosage, BIS value, SPO2, and blood pressure of some key point moments such as going into operating room(T1), the moment of placing the rigid bronchoscopy(T2), after removing the foreign bodies(T3), at the end of the operation(T4), and the moment when they were awake(T5). Abnormal conditions during operation, postoperative awake time, SICU stay time, and hospitalization time were also recorded.ResultAge, gender, weight, height between the two groups were not significantly different (P>0.05).The Comparison of the heart rates in two groups:in T2, the HR of group I, group II were100.72±2.91and130.74±3.31, repectively. The heart rate of experimental group was significantly lower than control group through t test(P<0.05).The comparison of exhaled concentration and dosage of Sevoflurane: Sevoflurane exhaled concentrations of group II in T2,T3,T4(T2:4.67±0.27, T3:2.96±0.18, T4:0.96±0.18) were significantly higher than that of group I (T2:3.44±0.31, T3:2.46±0.21, T4:0.77±0.21). The two groups had significant difference in the dosage of Sevoflurane through t test(P<0.05),14.05±0.83ml and15.92±1.14ml, respectively.The comparison of operative time and SICU stay time:the operation time of the experimental group was significantly shorter than that of the control group through t test P<0.05. There was no significant difference in SICU stay time.The comparison of SPO2:the changes of SPO2in two groups were stable, and there was no significant difference (P>0.05).The comparison of blood pressure:the systolic and diastolic blood pressure of group I in T2. T3were lower than that of group II through t test(P<0.05).The comparison of BIS value:there was no significant difference between group I and group II (P>0.05).The comparison of abnormal situations:the satisfaction rate of placing mirror in the experimental group increased, and the incidence of the abnormal situation decreased obviously.Conclusion.1. The anesthetic efficacy of infant tracheal foreign body operation is obvious when using propofol, sufentanil citrate, Sevoflurane composite CIS atracurium. And these drugs are more conducive to place the rigid bronchoscopic, and they can also shorten the operation time. 2.The. application.of.the. CIS. atracurium.besilate.makes.intraoperative hemodynamics more stable, reduces the occurrence of intraoperative breathholding, body movement, cough, laryngospasm and bronchospasm, and shortens the operation time and SICU stay time.3. The composite application of CIS atracurium besilate reduces the dosage of Sevoflurane and the risk of airway management in postoperative revival period. It is an ideal anesthesia method of infant tracheal foreign body operation.