Using Study Of Endotracheal Tube With Injecting Medicine Between Endotracheal And Laryngopharynx In General Anesthesia

Endotracheal intubation is often used to keep airway patency,mechanical ventilate, attract upper respiratory tract and prevent aspiration.But the endotracheal tube is a foreign body, and endotracheal intubation alsois invasive and harmful for patients. It will cause some of the adversereactions, such as the heightened sympathetic nervous system activity, theenhancement of the hypothalamic-pituitary-adrenal axis function, bodystruggle and cough reflex and so on. These will bring the burden and thesome of side effect for the cardiovascular system.In order to evaluate the use of clinical benefit of “the endotracheal tubewith injecting medicine between endotracheal and laryngopharynx”（patentnumber: ZL200820111377.4）, in this study, we observe and contrast thedifference of the responses to endotracheal intubation, general anesthesiadose and extubation responses after surgery between the group of “theendotracheal tube with injecting medicine between endotracheal andlaryngopharynx” through which inject surface anesthetic and the group of theordinary endotracheal tube through which inject the same amount of salinesolution at the corresponding time points.Part1Effect of endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx on cardiovascular responsesduring intubationObjective: In order to evaluate the use of clinical benefit of “theendotracheal tube with injecting medicine between endotracheal andlaryngopharynx”（patent number: ZL200820111377.4） in the general anesthesia with endotracheal tube, in this study, we observe and contrast thedifference of the cardiovascular responses to endotracheal intubation betweenthe group of “the endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx” through which inject surface anesthetic andthe group of the ordinary endotracheal tube through which inject the sameamount of saline solution at the corresponding time points.Methods: Forty ASA I or Ⅱ patients with negative in the Allen’s testaged20～60y and BMI22kg/m2～30kg/m2, undergoing orthopedic surgeryelective general anesthesia were selected into our studies,who were dividedrandomely into the experimental group （the endotracheal tube with injectingmedicine between endotracheal and laryngopharynx, n=20） and the controlgroup （the ordinary endotracheal tube, n=20）, without suffering fromhypertension, coronary heart disease and diabetes mellitus and so on.Established an venous access to infuse Lactated Ringer’s Solution8ml/kg inthirty minutes after the patient into the operating room and before induction,monitored continuously EGG and SPO2, the patient was inserted a catheter intothe radial artery to monitor continuously the heart rate （HR）, the systolic bloodpressure （SBP）, the diastolic blood pressure （DBP） and the mean arterialpressure （MAP）. The way of anesthesia induction was sequently intravenousadministration of Midazolam （0.04mg/kg）, Sufentanil （0.2μg/kg）, Etomidate（0.25mg/kg） and Vecuronium （0.1mg/kg）. Then controlled the breathing,adopted orotracheal intubation with direct laryngoscopy for patients. Thepatented tube was used for the experimental group patients through whose twoinjection sac of the tube injected Dicaine （1%）1.5ml into the mucusmembrane of endotracheal and laryngopharynx. While the control grouppatients were injected saline1.5ml.Thereafter mechanical ventilation whosemodel was volume-controlled ventilation was performed with primesetting:tidal volume6～8ml/kg, breathing rate10～12times/min, inspirationand expiration ratio1︰1.5, oxygen flow1.5L/min, peak inspiratory pressure≤25cm/H₂O, in order to maintain the end-tidal carbon dioxide partial pressurebetween35cm/H₂O and45cm/H₂O. The values of SBP, DBP, MAP, HR were recorded at the time points of entering the operating room and being quietdown （T0）, immediately before intubation （T1）, immediately after intubation（T2）,1min after intubation （T3）,3min after intubation （T4）,5min afterintubation （T5）. Draw the radial artery blood samples for measuring theirblood glucose, epinephrine （E）, norepinephrine （NE） and cortisol （Cor） inplasma, at the time points of T0, T1, T3and T5.Results: The variation tendency of hemodynamics, catecholamine,cortisol and blood glucose was similar between the experimental group andthe control group during intubation. The value of SBP, DBP and MAP in theexperimental group was lower remarkably than that in the control group at theT2, T3, T4and T5（P<0.01）. Similarly the value of HR significantly decreasedin the experimental group as compared with the control group at the T2, T3andT4（P<0.01）. The plasma concentration of E and NE was significantly lowerthan the control group at the T3（P<0.01,0.05） and T5（P<0.05）, and that of Corwas also lower at the T5（P<0.01）. There was no difference in the bloodglucose levels between the two groups at each time point （P>0.05）.Conclusion: To effectively attenuate the responses of cardiovascular andmaintain the stability of hemodynamics during intubation, we can performsurface anesthesia through “the endotracheal tube with injecting medicinebetween endotracheal and laryngopharynx”, which should be superior to theordinary endotracheal tube, to the mucus membrane of endotracheal andlaryngopharynx.Part2Effect of endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx on during anesthesia doseduring operationObjective: In order to evaluate the use of clinical benefit of “theendotracheal tube with injecting medicine between endotracheal andlaryngopharynx”（patent number: ZL200820111377.4） in the generalanesthesia with endotracheal tube, in this study, we observe and contrast the difference of the general anesthesia dose between the group of “theendotracheal tube with injecting medicine between endotracheal andlaryngopharynx” through which inject surface anesthetic and the group of theordinary endotracheal tube through which inject the same amount of salinesolution at the corresponding time points.Methods: Forty ASA I or Ⅱ patients with negative in the Allen’s testaged20～60y and BMI22kg/m2～30kg/m2,undergoing orthopedic surgeryelective general anesthesia were selected into our studies,who were dividedrandomely into the experimental group （the endotracheal tube with injectingmedicine between endotracheal and laryngopharynx, n=20） and the controlgroup （the ordinary endotracheal tube, n=20）, without suffering fromhypertension, coronary heart disease and diabetes mellitus and so on.Established an venous access to infuse Lactated Ringer’s Solution8ml/kg inthirty minutes after the patient into the operating room and before induction,monitored continuously EGG and SPO2, the patient was inserted a catheter intothe radial artery to monitor continuously the heart rate （HR）, the systolic bloodpressure （SBP）, the diastolic blood pressure （DBP） and the mean arterialpressure （MAP）. The way of anesthesia induction was sequently intravenousadministration of Midazolam （0.04mg/kg）, Sufentanil （0.2μg/kg）, Etomidate（0.25mg/kg） and Vecuronium （0.1mg/kg）. Then controlled the breathing,adopted orotracheal intubation with direct laryngoscopy for patients. Thepatented tube was used for the experimental group patients through whose twoinjection sac of the tube injected Dicaine （1%）1.5ml into the mucusmembrane of endotracheal and laryngopharynx. While the control grouppatients were injected saline1.5ml. Thereafter mechanical ventilation whosemodel was volume-controlled ventilation was performed with prime setting:tidal volume6～8ml/kg, breathing rate10～12times/min, inspiration andexpiration ratio1︰1.5, oxygen flow1.5L/min, peak inspiratory pressure≤25cm/H₂O, in order to maintain the end-tidal carbon dioxide partial pressurebetween35cm/H₂O and45cm/H₂O. Maintained a sufficient depth ofanesthesia by monitoring the value of BIS between40and45, by intravenous injection of Propofol (4～6mg/kg·h^-1) through micro pumping, by intermittentintravenous of Sufentanil （0.1μg/kg） and Vecuronium （0.08mg/kg） and byjusting the inhalational concentration of Sevoflurane. Replenished the bloodloss through intravenous drip of6%Hydroxyethyl Starch （200/0.5） andSodium Chloride Injection，and replenished the body fluid of physiologicaland extra requirement. Maintained stable hemodynamics through controllingthe the varied range of MAP and HR under±30%of the base values andensured the urine volume more than0.5ml/kg·min^-1. In the experimental group,we injected Dicaine （1%）1.5ml into the mucus membrane of endotracheal andlaryngopharynx by the two injection sac of the patented tube every hour, whilethe control group patients injected saline1.5ml. Stop Sevoflurane inhalationand intravenous injection of Propofol30and10minutes before the end of theoperation. Then through it injected Dicaine （1%）1.5ml in the experimentalgroup, and the control group patients injected saline1.5ml. The antagonism ofthe neuromuscular blockade is achieved through the intravenousadministration of Atropine （0.5mg） and Neostigmine （1mg）. The values ofSBP, DBP, MAP, HR were recorded and draw the radial artery blood samplesfor measuring the blood glucose at the time points of entering the operatingroom and being quiet down （T0）, before skin incision （T6）,15min afteroperation （T7）,60min after operation （T8）,90min after operation （T9）, at theend of the operation (T₁₀). Draw the radial artery blood samples for measuringthe Epinephrine （E）, Norepinephrine （NE） and Cortisol （Cor） in plasma, at thetime points of T0, T7, T8, T9and T₁₀. Finally the dose of general anestheticmedication was calculated at the end of the surgery.Results: The variation tendency of SBP, DBP, MAP, HR, E, NE, Cor andblood glucose was similar between the two groups during operation, and therewas no difference in all of that at each time point （P>0.05）. Similarly, thevariation tendency of the value of BIS was also similar, but the value of BISsignificantly increased in the experimental group as compared with the controlgroup at the T₁₀（P<0.05）. The dose of general anesthetic medication did notdiffer significantly between the experimental and control groups （P>0.05）. Conclusion: No significant advantage are found to reduce the dose ofgeneral anesthesia by using “the endotracheal tube with injecting medicinebetween endotracheal and laryngopharynx” compared to the ordinaryendotracheal tube, when performing the surface anesthesia to the mucusmembrane of endotracheal and laryngopharynx.Part3Effect of endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx on resistant tube responsesduring extubationObjective: In order to evaluate the use of clinical benefit of “theendotracheal tube with injecting medicine between endotracheal andlaryngopharynx”（patent number: ZL200820111377.4） in the generalanesthesia with endotracheal tube, in this study, we observe and contrast thedifference of the responses to extubation and resistant tube after surgerybetween the group of “the endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx” through which inject surface anesthetic andthe group of the ordinary endotracheal tube through which inject the sameamount of saline solution at the corresponding time points.Methods: Forty ASA I or Ⅱ patients with negative in the Allen’s testaged20～60y and BMI22kg/m2～30kg/m2,undergoing orthopedic surgeryelective general anesthesia were selected into our studies, who were dividedrandomely into the experimental group （the endotracheal tube with injectingmedicine between endotracheal and laryngopharynx, n=20） and the controlgroup （the ordinary endotracheal tube, n=20）, without suffering fromhypertension, coronary heart disease and diabetes mellitus and so on.Established an venous access to infuse Lactated Ringer’s Solution8ml/kg inthirty minutes after the patient into the operating room and before induction,monitored continuously EGG and SPO2, the patient was inserted a catheter intothe radial artery to monitor continuously the heart rate （HR）, the systolic bloodpressure （SBP）, the diastolic blood pressure （DBP） and the mean arterial pressure （MAP）. The way of anesthesia induction was sequently intravenousadministration of Midazolam （0.04mg/kg）, Sufentanil （0.2μg/kg）, Etomidate（0.25mg/kg） and Vecuronium （0.1mg/kg）. Then controlled the breathing,adopted orotracheal intubation with direct laryngoscopy for patients. Thepatented tube was used for the experimental group patients through whose twoinjection sac of the tube injected Dicaine （1%）1.5ml into the mucusmembrane of endotracheal and laryngopharynx.While the control grouppatients were injected saline1.5ml. Thereafter mechanical ventilation whosemodel was volume—controlled ventilation was performed with primesetting:tidal volume6～8ml/kg, breathing rate10～12times/min, inspirationand expiration ratio1︰1.5, oxygen flow1.5L/min, peak inspiratory pressure≤25cm/H₂O, in order to maintain the end-tidal carbon dioxide partial pressurebetween35cm/H₂O and45cm/H₂O. Maintained a sufficient depth ofanesthesia by monitoring the value of BIS between40and45, by intravenousinjection of Propofol (4～6mg/kg h^-1) through micro pumping, by intermittentintravenous of Sufentanil （0.1μg/kg） and Vecuronium （0.08mg/kg） and byjusting the inhalational concentration of Sevoflurane. Replenished the bloodloss through intravenous drip of6%Hydroxyethyl Starch （200/0.5） andSodium Chloride Injection, and replenished the body fluid of physiologicaland extra requirement. Maintained stable hemodynamics through controllingthe the varied range of MAP and HR under±30%of the base values andensured the urine volume more than0.5ml/kg·min^-1. In the experimental group,we injected Dicaine （1%）1.5ml into the mucus membrane of endotracheal andlaryngopharynx by the two injection sac of the patented tube every hour, whilethe control group patients were not injected. Stop Sevoflurane inhalation andintravenous injection of Propofol30and10minutes before the end of theoperation. Then through it injected Dicaine （1%）1.5ml in the experimentalgroup, and the control group patients were injected saline1.5ml. Theantagonism of the neuromuscular blockade is achieved through theintravenous administration of Atropine （0.5mg） and Neostigmine （1mg）. Thetube was removed on the condition that the patients followed doctor’s orders to open eyes, raise head and hands, recovering swallowing reflection andconsciousness, the values of BIS between75and85, the tidal volume morethan6ml/kg under spontaneous breathing, the respiratory rate more than12times/min, the oxygen saturation more than95%, the blood pressure and heartrate being stable. The values of SBP, DBP, MAP, HR were recorded at thetime points of entering the operating room and being quiet down （T0）,immediately before extubation （T11）, immediately after extubation （T12）,5minafter extubation （T14）. The values of BIS were recorded at the time points ofimmediately before extubation （T11）, immediately after extubation （T12）,3minafter extubation （T13）,5min after extubation （T14）,7min after extubation （T15）,10min after extubation （T16） and15min after extubation （T17）. Draw theradial artery blood samples for measuring their Epinephrine （E）,Norepinephrine （NE） and Cortisol （Cor） in plasma, at the time points of T11.Draw the radial artery blood samples for measuring their Blood Glucose at thetime points of T11, T12, T13, T14, T15, T16and T17. Graded the happening ofbucking and/or restlessness and nausea and vomiting and OAA/S duringextubation. Finally the total operation time （min）, the recovery time ofspontaneous breathing （between stopping intravenous injection of Propofoland resuming breathing, min）, eye-opening time （between stoppingintravenous injection of Propofol and openning eyes, min） and extubation time（between stopping intravenous injection of Propofol and extubation, min）were estimated.Results: The variation tendency of hemodynamics was similar betweenthe experimental group and the control group during extubation. The value ofSBP, DBP and MAP was significantly lower than the control group at the T11（P<0.05） and T12（P<0.01）, and the value of HR was also lower at the T11（P<0.01） and T12（P<0.05）. At the T11, the plasma concentration of E, NE andCor was significantly lower than the control group （P<0.01）. The value of BISsignificantly increased in the experimental group comparison with that at T11、T12,T13,T14,T15,T16and T17（P<0.01）, while the blood glucose levels did notdiffer significantly between the two groups （P>0.05）. The tracheal extubation time in the experimental group was longer than the control group. Theincidence rate of bucking with or serious （the score of one） and without （thescore from two to four） was obviously lower and higher than the control group,respectively （P<0.01）. There were no difference in the recovery time ofspontaneous breathing and eye-opening, the recovery status of cough reflex,the happening of hoarseness, laryngospasm and tracheal or bronchial spasm,the score of OAA/S and nausea and vomiting between the two groups duringextubation （P>0.05）.Conclusion: To effectively attenuate the responses of cardiovascular andmaintain the stability of hemodynamics during extubation, we can performsurface anesthesia through “the endotracheal tube with injecting medicinebetween endotracheal and laryngopharynx”, which should be superior to theordinary endotracheal tube, to the mucus membrane of endotracheal andlaryngopharynx. The incidence rate of bucking and/or restlessness is lower,the time of endurance of tube is longer, the patient’s comfortableness is betterand the safety is greater after extubation.CONCLUSIONS1To effectively attenuate the responses of cardiovascular and maintainthe stability of hemodynamics during intubation, we can perform surfaceanesthesia through “the endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx”, which should be superior to the ordinaryendotracheal tube, to the mucus membrane of endotracheal andlaryngopharynx.2No significant advantage are found to reduce the dose of generalanesthesia by using “the endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx” compared to the ordinary endotracheal tube,when performing the surface anesthesia to the mucus membrane ofendotracheal and laryngopharynx.3To effectively attenuate the responses of cardiovascular and maintain the stability of hemodynamics during extubation, we can perform surfaceanesthesia through “the endotracheal tube with injecting medicine betweenendotracheal and laryngopharynx”, which should be superior to the ordinaryendotracheal tube, to the mucus membrane of endotracheal andlaryngopharynx. The incidence rate of bucking and/or restlessness is lower,the time of endurance of tube is longer, the patient’s comfortableness is betterand the safety is greater after extubation.