| Objective: To observe the effects of different dosage types of lidocaine on tracheal intubation stress response,cough during recovery period of general anesthesia,postoperative sore throat,hoarseness and other complications.Analyze the advantages and disadvantages of different dosage forms.To find the appropriate method to reduce the complications of endotracheal intubation.Methods: A total of 180 patients who underwent laparoscopic total hysterectomy for tracheal intubation under general anesthesia in the Affiliated Hospital of Yan ’an University from November 2019 to December 2020 were selected.The study was divided into two parts.In the first part,A total of 120 patients were included when different dosage forms of lidocaine were used alone and divided into four groups: group A(control group n=30),group B(2% lidocaine hydrochloride glottis and subglottis spraying group n=30),group C(5% lidocaine cream group n=30),group D(1.73% lidocaine carbonate in endotracheal tube cuff group n=30).All patients underwent endotracheal intubation after anesthesia induction:Group A was the control group,and the front end of the catheter was wetted with normal saline;In group B,when BIS value was 40 after anesthesia induction,2ml of 2% lidocaine hydrochloride was sprayed around the glottis with a laryngeal anesthetic tube open airway,and 3ml of the laryngeal anesthetic tube was sprayed deep under the glottis,waiting for 1min.Tracheal intubation was performed after the drug took effect;In group C,2g of 5% lidocaine cream was applied in the front 1/3 of the tracheal tube,and the BIS value was 40 lines of tracheal intubation;Group D received endotracheal intubation when BIS value was 40,after which 1.73% lidocaine carbonate was injected into the tracheal catheter balloon.The systolic bloodpressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the patients were recorded 5 minutes after admission.The difference of SBP,DBP and HR before and after intubation was recorded.The difference of SBP,DBP and HR before and after extubation was recorded.The degree of tube resistance during the awakening period of general anesthesia was recorded.The degree of throat pain was recorded at 0.5h,2h,4h,6h,12 h and 24 h after extubation.Postoperative hoarseness and postoperative cough were recorded.After the completion of the first part of the study,the analysis and summary were carried out.The second part,different dosage forms of lidocaine were used together.A total of 60 patients were included and divided into two groups: group E(2% lidocaine hydrochloride glottic and subglottic spraying + 5% lidocaine cream group n=30),group F(2% lidocaine hydrochloride glottic and subglottic spraying + 1.73% lidocaine carbonate in endotracheal tube cuff group n=30).After induction of anesthesia: In group E,when BIS value was 40 after induction,2ml of 2% lidocaine hydrochloride was sprayed around the glottis with a laryngeal anesthetic tube after opening the airway,and 3ml of the laryngeal anesthetic tube was sprayed deep under the glottis,waiting for the drug to take effect in 1min.2g of 5% lidocaine ointment was applied to the front 1/3 of the tracheal tube for endotracheal intubation;In group F,when the BIS value was 40 after induction,2ml of 2% lidocaine hydrochloride was sprayed around the glottis with a laryngeal anesthetic tube after opening the airway,and 3ml of the laryngeal anesthetic tube was sprayed deep under the glottis,waiting for 1min.After the drug took effect,tracheal intubation was performed,and 1.73% lidocaine carbonate was injected into the tracheal tube balloon after intubation.The recorded indicators were the same as in the first part of the study.Results: The first part of this study(1)Compared with several other dosage forms,the changes of systolic blood pressure,diastolic blood pressure and heart rate before and after intubation were significantly reduced in group B compared with group A,C and D(P<0.05).(2)The changes of systolic blood pressure,diastolic blood pressure and heart rate before and after extubation were significantly decreased in group D compared with group A and B(P<0.05).The changes of heart rate before and after extubation were significantly decreased in group C compared with group A and B(P<0.05).(3)0.5h after extubation,the degree of throat pain in group D was decreased compared with that in group A and B(P<0.05).2h after extubation,the degree of throat pain in group D was decreased compared with that in group A and B(P<0.05).4h after extubation,the degree of throat pain in group C and D was decreased compared with that in group A(P<0.05).6h after extubation,the degree of throat pain in group D was decreased compared with that in group A and B,the degree of throat pain in group C was reduced compared to group A(P<0.05).12 h after extubation,the degree of throat pain in group D was decreased compared with that in group A and B(P<0.05).(4)Compared with group A and B,group C and D showed better tube tolerance during the recovery period of general anesthesia(P<0.05).(5)The incidence of hoarseness after extubation was significantly lower in group D than in group A,B,and C(P<0.05).The incidence of cough after extubation was higher in group C than in group A,B,and D(P<0.05).The second part of this study(1)Compared with group F,there were no significant differences in the changes of systolic blood pressure,diastolic blood pressure and heart rate before and after intubatio(P>0.05).Compared with group A,the changes of systolic blood pressure,diastolic blood pressure and heart rate before and after intubation in group E and F were significantly reduced(P<0.05).(2)Compared with group F,group E had no significant changes in systolic blood pressure,diastolic blood pressure and heart rate before and after extubation(P>0.05).Compared with group A,changes in heart rate before and after extubation were reduced in group E(P<0.05)Compared with group A,the changes of systolic blood pressure,diastolic blood pressure and heart rate decreased before and after extubation in group F(P<0.05).(3)Compared with group F,there was no significant difference in the degree of throat pain at 0.5h,2h,4h,6h,12 h and 24 h after extubation in group E(P>0.05).Compared with group A,the degree of throat pain in group F was decreased at 0.5h,2h,4h,6h,12 h and 24 h after extubation(P<0.05).Compared with group A,the degree of throat pain in group E was decreased at 0.5h,2h and 6h after extubation(P<0.05).(4)Compared with group F,group E had better tube tolerance during the awakening period of general anesthesia(P<0.05).Compared with group A,group E had better tube tolerance during the awakening period of general anesthesia(P<0.05).Compared with group A,group F showed better tube tolerance during the awakening period of general anesthesia(P<0.05).(5)The incidence of postoperative hoarseness.Compared with group A and E,the incidence of hoarseness in group F was lower(P<0.05).The incidence of postoperative cough in group E was higher than that in group F and A(P<0.05).Conclusion: The first part of this study,lidocaine is used separately in different dosage forms :(1)supraglottic and subglottic spraying of 2% lidocaine hydrochloride can reduce the stress response during intubation.(2)5% Lidocaine cream and 1.73% lidocaine carbonate in endotracheal tube cuff can reduce the stress response during extubation,increase the tube resistance during the recovery period of general anesthesia,and reduce the incidence and severity of sore throat after extubation of general anesthesia.The second part of this study,lidocaine is used in combination with different dosage forms :(1)The supraglottic and subglottic spraying of 2% lidocaine hydrochloride + 5% lidocaine cream group and the supraglottic and subglottic spraying of 2% lidocaine hydrochloride +1.73% lidocaine carbonate endotracheal tube cuff group can not only reduce the stress response during intubation,but also reduce the incidence of throat pain and cough during extubation..(2)In terms of reducing choking during wake-up period and postoperative hoarsess under general anesthesia,2% lidocaine hydrochloride spraying on the glottis and subglottis plus endotracheal tube sleeve 1.73% lidocaine carbonate had better effect. |
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