Effects Of Combined Application Of Three Topical Anesthesia Methods On Stress Reaction Caused By Endotracheal Intubation And Extubation In Craniocerebral Surgery

Background:Cardiovascular adverse reaction which is mainly characterized by increasedblood pressure and faster heart rate is a common complication of general anesthesiaintubation. In order to reduce and prevent the happening of the endotrachealintubation and extubation stress response, the domestic and foreign medicals usedmany measures, including deepen anesthesia, one or two respiratory tract mucosalsurface anesthesia, drug prevention, and so on.but there is a little research abouteffects of combined application of three topical anesthesia methods on stress reactioncaused by endotracheal intubation and extubation.Objective：To observe effects of combined application of throat mucosa and subglotticspray using2%lidocaine solution and Compound Lidocaine Cream on stressreaction caused by endotracheal intubation and extubation in craniocerebral surgery.Methods:Ninety patients (ASAⅠ~Ⅱ)undergoing elective craniotomy surgery wererandomly divided into three groups, each group30cases. Patients in group A weredeal with throat mucosa surface anesthesia using2%lidocaine solution, then givensubglottic spray with normal saline2ml through laryngeal hemp tube, and givenendotracheal intubation after Water soluble gelatin2mg was besmeared on the frontend of the endotracheal tube. In addition to subglottic spray with2%lidocainesolution，patients in group B were deal with in the same way. Patients in group Cwere given endotracheal intubation after Compound Lidocaine Cream2mg wasbesmeared on the front end of the endotracheal tube and other process is the same.Anesthesia induction adopts fast induction, intravenous injection of midazolam0.05mg/kg, etomidate emulsion0.3mg/kg, fentanyl0.03mg/kg, benzene sulfonic shun atracurium0.15mg/kg, patients were given mask ventilation for4min when eyelashreflex disappears. After proper muscle relaxant, patients were given endotrachealintubation with reinforced endotracheal tube (ID: female7.0mm, male7.5mm),then given mechanical ventilation, tidal volume8-10ml/kg, maintaining the breathat the end of the CO2partial pressure (PETCO2)35~45mmHg. The maintenance ofanesthesia with1%propofol and Remifentanil Hydrochloride, and properly givenbenzene sulfonic acid cis atracurium, adjusting the dose of anesthetic according tothe depth of anesthesia to maintain Narcotrend index in30~60. Stopping druginfusion at the end of surgery, patients were sent to Postanesthesia Care Unit afterthe sputum suction under deepen anesthesia. Patients were given endotrachealextubation When spontaneous breathing recovery, SpO2>95%,tidal volume>5ml/kg, and can open eyes when awoke by an anesthetist who didn’t know thesituation of grouping, then collection the data at the same time. In three groups,theHR,SBP,DBP were recorded at time points before intubation (T0), immediateintubation (T1),3min after intubation (T2),5min after intubation (T3),10min afterintubation (T4), immediate extubation (T5),3min after extubation (T6) and5min afterextubation (T7),venous blood was collected at every point time to measure plasmalevels of adrenaline (AD), norepinephrine (NE) and cortisol (CORT). The operationtime and anesthesia time was also recorded, tracking and recording incidence ofanesthesia emergence agitation and sore throat in24hours after extubation.Results:Patients in group C, the HR,SBP,DBP and plasma levels of AD, NE and CORTat every point time were significantly lower than that in group A and B (p <0.05),and the incidence of anesthesia emergence agitation and sore throat in24hoursafter extubation were also significantly lower than other two groups (p <0.05).Conclusion:The Combined application of three topical anesthesia methods can reduce theincidence of endotracheal intubation reaction, and improve the patients’ tolerance ofthe endotracheal tube in craniocerebral surgery.