Clinical Effect Of Airway Superficial Anesthesia In Benign Masses Resection Of Vocal Cord Under Suspension Laryngoscope

Objective:To estimate the effect and feasibility of airway superficial anesthesia for benign masses resection of vocal cord under suspension laryngoscope.MethodsA total of 70 patients,ASA I-II,who scheduled to undergo elective benign masses resection of vocal cord under suspension laryngoscope were selected,all the patients were selected from the department of otolaryngological of The Second Hospital of Hebei Medical University from May 2018 to October 2018.The patients were randomly divided into two groups:group A（experimental group）and group B（control group）,with 35 patients in each group.In group A,local infiltration anesthesia of oropharyngeal superficial anesthesia were performed with 2%lidocaine and 1%tetracaine for 3 times before administration of propofol（3mg/kg）and remifentanil（2μg/kg）by vein.Then local infiltration anesthesia of subglottic was performed after exposed the glottis with glidescope.Whereafter,intubation tracheal was performed after controlled respiration by mask for 3 minutes at least.Instead of local infiltration anesthesia of oropharyngeal and subglottic,cisatracurium（0.1mg/kg）was administrated in group B patients after intravenous administration of the same dose of propofol and remifentanil as that in group A patients.Intubation tracheal was performed after controlled respiration by mask for 3 minutes too.Propofol and remifentanil were infused by vein continuously to maintain anesthesia.The monitoring indicators of all the patients include as follows:electrocardiogram（EEG）,blood pressure（BP）,heart rates（HR）,saturation of pulse oxygen（SpO₂）,end-tidal carbon dioxide（EtCO₂）,Bispectral index（BIS）.The patient’s BP and HR were recorded at the follow time points:T₀（5 minutes after entering the operating room）,T₁（administration of propofol and remifentanil）,T₂（tracheal intubation）,T₃（suspension laryngoscope insertion）and T₄（extubation）.Degree of jaw relaxation before intubation tracheal and after suspension laryngoscope insertion,degree of glottis exposure,glottis closure,vocal cord movement were estimated.The time of operation,the time of spontaneous breathing recovery,extubation and waking and in post-anesthesia care unit（PACU）were recorded.Observer’s Assessment of Alertness/Sedation（OAA/S）score;total amount of propofol and remifentanil.ResultsCompared with T₀ time point,the blood pressure（especially the systolic blood pressure）of the patients decreased significantly（P<0.05）at T₁,T₂ and T₃ time point,although the systolic blood pressure increased gradually at T₂and T₃ time point.Compared with T₀ time point,the HR of patients in group B increased significantly at T₄ time point（P<0.05）.The same significant fluctuation of HR was not observed in group A patients（P>0.05）.There was no significant differ in degree of glottis exposure between the two groups patients（P>0.05）.There was no glottis closure and vocal cord movement occurred in both groups patients.Compared with group B patients,spontaneous breath recovery time,extubation time,waking time and residence time in PACU of group A were significantly shortened in group A patients（P<0.05）.The Alertness/Sedation（OAA/S）score of group A patients in 5minutes after extubation was significantly higher than that of group B patients（P<0.05）.The amount of remifentanil used in group A patients was significantly less than that in group B patients（P<0.05）.ConclusionFor patients undergoing resection of benign tumors of the vocal cords under suspension laryngoscope,the new anesthesia protocol can still provide the same surgical field enough as the traditional anesthesia protocol though the absence of neuromuscular blocking agents.There is no significant differ in degree of jaw relaxation,BP and HR between the two group patients.More importantly,the postoperative recovery time of patients is shorten,the recovery quality is satisfied,and the operation efficiency is improved.At the same time,the dosage of narcotic analgesics can be reduced,which saves the cost for patients.