Laryngeal Mask Anesthesia Under Spontaneous Ventilation In Uniportal Video-assisted Thoracoscopic Surgery

We have designed this clinical trial to obtain practical experience and experimental data,explore the clinical feasibility and safety with the use of laryngeal mask.and further guide the general application of laryngeal mask general thoracic surgery in thoracic surgery.Methods laryngeal mask group anesthesia method:All patients underwent intramuscular injection of scopolamine 0.3mg,luminal sodium 0.1mg.Before the induction of anesthesia to prepare fiberoptic bronchoscopy,tracheal intubation equipment,double-lumen bronchial catheter,if necessary,immediately tracheal intubation.Patients after the operation room to establish peripheral venous access,infusion of lactic acid Ringer’s solution(37-38 ℃).To detect ECG,SPO2,T,RR,BIS and Pet CO2.Before induction,dexmedetomidine was given0.6 mg/kg and pumped in 20 minutes.Local arterial descending radial artery puncture catheter was used to detect invasive arterial blood pressure.Anesthesia induced by propofol2mg/kg,sufentanil 0.3μg/kg,laryngeal mask placement operation by the same skilled anesthesia deputy chief physician to complete.If necessary we choose to use laryngoscopy.After the placement of the laryngeal mask,the propofol input pump continued to pump and aspirate 1% sevoflurane to maintain anesthesia.Intraoperative maintenance BIS value of 40 to 60.After anesthesia induction,if respiratory depression,manual control of the respiratory capsule assisted ventilation until the spontaneous breathing recovery.According to the surgery need to intravenous injection of small doses of sufentanil.Intraoperative patients under the armpit pad,the use of lateral position,before the start of the surgeon with 0.375%ropivacaine injection surgery operation hole intercostal nerve block.Surgery to take axillary line 4(or 5)intercostal space 4cm for the operation hole and observation hole.Hole operation set up for side due to the communion with the atmosphere,causing iatrogenic pneumothorax,so as to make the side gradually atelectatic lungs.If poor lung atelectatic instrument assisted extrusion lung to make gas discharge.Keep oxygen saturation ≥90%during surgery.The use of cutting stapler to deal with arteries,veins,bronchus,plus a small dose of sufentanil to slow down the respiratory rate,to maintain the respiratory rate of 3 to 5times/min,in order to facilitate surgical operation.When the Pet CO2 is higher than 70 mm Hg,the small tidal volume of breath is controlled manually to induce CO2 emissions.Add sufentanil 0.1μg/kg before closing the chest,and stop inhalation of sevoflurane,propofol continuous pump until the end of surgery.Surgery with laryngeal mask into the anesthesia recovery room observation,remove the laryngeal mask after awake.Patients were sent to the ward when the Steward score reached 6 points.Double-lumen bronchial intubation group anesthesia:Patients preoperative intramuscular injection of scopolamine 0.3mg,luminal sodium 0.1mg.Before the induction of anesthesia to prepare fiberoptic bronchoscopy,tracheal intubation equipment,double-lumen bronchial catheter,if necessary,immediately tracheal intubation.Patients after the operation room to establish peripheral venous access,infusion of lactic acid Ringer’s solution(37-38℃)。To detect ECG,SPO,T,RR,BISand Pet CO2.Before induction of administration of dexmedetomidine 0.6mg/kg within 20 minutes of pumping.Anesthesia induction using propofol 2.5mg/kg,sufentanil 0.4μg/kg,atracuronium sulfonate 0.2 mg/kg,intravenous slow injection.Laryngoscopy exposed glottic line double-lumen bronchial intubation,using bronchoscopy positioning.And then propofol input pump continued to pump,1%sevoflurane inhalation,aspartic acid sulforic acid intermittent injection to maintain anesthesia.Intraoperative patients under the armpit pad,the use of lateral position,before the start of the surgeon with 0.375% ropivacaine injection surgery operation hole intercostal nerve block.Before operation,change to single lung ventilation,tidal volume set 6ml / kg,respiratory rate of 14 beats/min.Keep oxygen saturation≥90% during surgery.Muscle loose drug surgery is not used before the end of 30 minutes.Add sufentanil 0.1μg / kg before closing the chest,and stop inhalation of sevoflurane,propofol continuous pump until the end of surgery.Surgery with double lumen into the anesthesia recovery room,after the patient awake pull out the tracheal tube.Patients were sent to the ward when the Steward score reached 6 points.Results Laryngeal mask and double lumen group in operation time,intraoperative lowest oxygen saturation,preoperative and postoperative 1 hour of Pa CO2 without obvious difference(P>0.05).In laryngeal mask/double lumen tube placed satisfied consumption time,extubation time,residence time in the recovery room,laryngeal mask group were shorter than double lumen(P<0.05).Before and after intubation or laryngeal mask replacement,mean arterial pressure difference and heart rate difference(△MAP、△HR),laryngeal mask group is lower than the double lumen tube group(P < 0.001).(P <0.001).The dose of sufentanil per kilogram of body weight was significantly less than that of the double lumen group(P <0.05).The Pa CO2 after lobectomy and the highest Pet CO2 in surgery,laryngeal mask group is significantly higher than double lumen tube group(P <0.001).The incidence of postoperative sore throat and the total hospital cost of laryngeal mask were lower than that of double lumen group(P <0.05).Conclusion 1.Laryngeal mask which is applied to the thoracoscope lung resection surgery,has the advantages of simple operation,low stimulation,little injury and less anesthesia complications.Keep spontaneous breathing is helpful to maintain the physiological state of the pulmonary function.The incidence of postoperative sore throat is decreased obviously with the use of laryngeal mask.2.Laryngeal mask applied to thoracoscopic lobectomy,can reduce the number of hospital days,saving the total cost of hospitalization,so that patients with rapid recovery after surgery.