Application Of General Anesthesia Retaining Spontaneous Respiration With Laryngeal Mask In The Video-Assisted Thoracic Surgery

Objective:Explore the safety and feasibility of general anesthesia retaining spontaneous respiration with laryngeal mask in the video-assisted thoracic surgery(VATS).Method:60 patients who had VATS in our hospital from April 2018 to February 2019 were selected.All patients’ ASA grade is I-II,age18—65,BMI 18-25kg/ ㎡.The patients were divided into spontaneous respiration group(Group A)and double lumen bronchial intubation group(Group B)by using the random number table method.Each group had 30 cases.After entering the operation room,turned on the peripheral venous pathway and had the routine anesthesia monitoring: ECG,NBP,Sp02,PETCO2,BIS.Group A had VATS retaining spontaneous respiration with laryngeal mask without using muscle relaxant during the induction and maintenance process.The anesthesia induction was carried out by means of intravenous injection by using 0.1μg/kg sufentanil and target controlled infusion(TCI)propofol 2.0-3.5μg/ml.Insert laryngeal mask after assisted ventilation by using mask 3min and maintain anesthesia by Target-controlled infusion(TCI)of propofol 2.0-4.0μg/ml.Add5.0~10.0μg/time sufentanil as needed during the operation.Adjust the propofol speed according to BIS value and breathing condition so that the patients’ BIS value was maintained between 40—60 without inhibiting the respiration.Group B had VATS under general anesthesia with double lumen bronchial intubation.The anesthesia induction was carried out by means of intravenous injection using 0.4μg/kg sufentanil,target controlled infusion(TCI)propofol 2.0-3.5μg/ml and 0.2mg/kg cisatracurium.Insert the double lumen bronchial catheter through the mouth by using the visual laryngoscope after 3min assisted ventilation.Connect the ventilator to assist ventilation after locating the fiber bronchoscope.Target-controlled infusion(TCI)of propofol 2.0-4.0μg/ml to maintain anesthesia and add cisatracurium and 5.0~10.0μg/time sufentanil as needed during the operation.Adjust the propofol speed according to the BIS value and keep the BIS value between 40—60.The patients of the two groups took a lateral position after the general anesthesia and had thoracic paravertebral nerve block guided by ultrasound.Locate T4 and T8 inferior margin of spinous process 2-3cm apart as the point of puncture.Inject 40 ml 0.25% ropivacaine.Observe and record the HR,MAP 5min(T0)before the patients anesthesia induction and the critical time(T1)after inserting the laryngeal mask(double lumen bronchus);Record the minimum Sp O2 and maximum PETCO2 of the patients of the two groups;Record the doses of sufentanil and propofol per kg of body weight used for the patients during the operation;Record the anesthetic time,operation time,the score of visual field satisfaction of the surgeons,postoperative recovery time,time out of bed,length of stay,anesthetic cost,hospitalization expenses,and the occurrence of postoperative complications,such as,nausea and vomiting,postoperative throat discomfort,pulmonary infection,etc.Results:(1)General data: There were no significant differences in sex,age,BIM index,ASA grading,etc.between the two groups of patients(P>0.05).(2)The comparative difference of HR and MAP 5min(T0)before anesthesia induction of Group A and Group B patients had no statistical significance(P>0.05).The HR and MAP at the time of laryngeal mask insertion critical time(T1)of Group B patients was higher than that of Group A.The difference was statistically significant(P<0.05).There was no significant difference as to the minimum SP02 between the two groups patients during the operation(P>0.05).The highest PETC02 during the operation of Group A is higher than that of Group B.The difference was statistically significant(P<0.05).(3)Intraoperative condition: The dosage of sufentanil per kg body weight in group A was significantly less than that in group B.The difference was statistically significant(P<0.01).There was no significant difference by comparing the operation time used by the two groups(P>0.05).The anesthesia time used by Group A was less than that of Group B.The difference was statistically significant(P<0.05).There was no significant difference between the two groups as to the surgeons’ visual field satisfaction score.(Scored by surgeons:Good lung collapse,visual field exposure clear got 1 score;Part of lung collapse which had no influence to the visual field got 2 score;Bad lung collapse and the operation could be done with the help of surgical instruments got 3 score;Unable to complete surgery got 4 score.)There was no significant difference(P>0.05).(4)Postoperative condition: Group A used significant less time than Group B as to the postoperative recovery time,time out of bed,length of stay.There was significant difference(P<0.05).Group A used less money than Group B as to the anesthetic cost,hospitalization expenses,which had significant difference(P<0.05).Group A had obviously less incidence rate of postoperative complications,such as,nausea and vomiting,postoperative throat discomfort,pulmonary infection,etc.than that of Group B.There was significant differences(P<0.05).Conclusion:The application of general anesthesia retaining spontaneous respiration with laryngeal mask in VATS had little influence to the patients’ hemodynamics andpostoperative recovery was fast,cost less hospitalization expenses,and had less incidence rate of postoperative complications compared to the traditional double lumen bronchial intubation.It got better anesthetic result and had good application value.