| 1.Objective:To observe the effect of I-gel laryngeal mask combined with endotracheal tube for perioperative stress response in patients with posterior fossa surgery.2.Methods:Sixty patients undergoing posterior fossa surgery, aged 20 to 60 years old, weighing 35 ~ 90 kg, ASA class Ⅰ or Ⅱ, were randomly allocated to receive either tracheal tube intubation(Group TT), or I-gel facilitated endotracheal tube intubation(Group TI). The endotracheal tube(TT group) and I-gel facilitated endotracheal tube(TI group) were inserted after induction of anesthesia and then the patients were ventilated. MAP and HR were recorded at eight time points: baseline(T0); before anesthetic induction(T1); endotracheal tube intubation(T2); 3 min after intubation(T3); end of surgery but before awakening(TT group) or before endotracheal tube removed(TI group)(T4); after patients entered the PACU(T5); and throughout emergence from anesthesia at 1, 5, 15, and 30 minutes after extubation or I-gel removal(according to group assignment)(T6-9); Ppeak and ETCO2 were recorded at T2, T3 and T4; Pa CO2 and Pa O2 were recorded at T0, T3, T4, T6 and T9; FBG, β-EP and Cor were tested at T0, T1, T3, T5, and T6; IL-6, IL-8, TNF-α, MDA and SOD were tested at T0 and T6; Operation time, spontaneous breathing recovery time(The time that the patients resumed breathing after stopping giving anesthetics), eye opening time(The time that the patients opened their eyes after stopping giving anesthetics), extubation or I-gel removal time(The time that extubation in Group TT or I-gel removal in Group TI), the MOAA/S score when extubation or I-gel removal, occurrence of the complications of convalescence, and usage of vasoactive drugs were recorded were also recorded. 3.Results:No differences were found between groups at baseline. Group TI had lower MAP and HR during intubation and extubation, the highest mean intergroup difference of 12.73 mm Hg in MAP and 22.0 beats/min in HR(P < 0.0001). Vasoactive drugs were administered to more TT-group patients than TI-group patients(13 [43.3%] vs. 2 [6.7%] patients, respectively; P =0.000). Ppeak, ETCO2, Pa O2 and Pa CO2 were similar during intraoperative period; Group TI had better Pa O2 and Pa CO2 at 1 and 30 minutes after emergence(P = 0.0002 and P = 0.0407; P < 0.0001 and P = 0.0011; respectively). Plasma β-EP and Cor concentration and BG level were lower during intraoperative period than at baseline in both groups(P < 0.0001); Group TI had a lighter stress reaction during emergence(P < 0.05). IL-8 level was decreased with time in both groups; IL-6 and TNF-α were decreased in TI Group, but increased in TT group. Intergroup comparison, there were no differences in both experimental groups during pre-operation. However, IL-6 and TNF-α were significant lower in TI Group during post-operation.(P = 0.0186 and P = 0.0273). MDA and SOD levels were decreased with time in both groups, but group TI had a significant decrease of MDA(P = 0.0384). Between-group comparison, MDA levels were significantly higher(P = 0.0409) in TT Group during post-operation. SOD activity was greater in TI Group during post-operation. However, no significant difference in SOD levels was observed between the groups(P = 0.6263). Spontaneous breathing recovery time and eye opening time were shorter in Group TI; the differences were not significant(P = 0.084 and P = 0.426). However, I-gel removal time was longer(P = 0.000), but the MOAA/S score was higher(P = 0.032). No serious bucking,hypertension and tachycardia were seen in Group TI. 4. Conclusion:Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. |
PDF Full Text Request