| PART ? The Application and Experience of a Novel Dual-channel Laryngeal Mask Airway in Gastric Endoscopic Mucosal ResectionObjective We studied the feasibility and safety of the novel dual-channel LMA in the treatment of gastric polyps by EMR through clinical randomized controlled trials,then explored whether a new type of airway tool can provide effective airway management for treatment of digestive endoscope.Methods This study was a randomized control,prospective,open-label,observational clinical that trial performed at Second Hospital Affiliated to Chongqing Medical University,a teaching hospital.Study approval was obtained from the ethics committee of the Second Affiliated Hospital of Chongqing Medical University and written informed consent was obtained from all the study participants.The study was performed between August 2317 and October 2017 and involved adult patients of ASA status 1 and 2(? to ?)in the age group 25-64 years,BMI ranged from 18.5 kg/m2 to 26.6 kg/m2,9 males and 51 females,scheduled for elective gastric EMR.Those patients were allocated to either LMA ventilation(L group,n=30)or nasal cannulae ventilation(B group,n=30)using a computer-generated random table.After fasting for at least 8 hours,subjects were taken to the operating room placed in left lateral position baseline,then parameters such as heart rate,blood pressure,electrocardiogram,respiration frequency,Bis and oxygen saturation were recorded.Intravenous(I/V)fluid started,subjects did not receive any premedication.All patients received general anesthesia.Preparation of the novel dual-channel LMA(Zhejiang Jane Cheng Medical Technology Co.,Ltd.):the size following the manufacturer's recommendation according to subjects' weigh(30-50kg select number 3rd,50-7kg select 4th,greater than 70kg choice 5th);to well lubricate the back of throat mask regularly with right amount of paraffin oil,while checking the LMA without obstruction,leakage and breakage before device cuff deflated.At the same time,prepared the orotracheal intubation apparatus,so that the LMA failure could be replaced in a timely manner.After 5 mins oxygen inhalation(5L/min)before operation,anesthesia was induced with midazolam l.mg,fentanyl(1?g/mg)and propofol 1.5?2.0mg/kg was injected in all groups after 3 minutes.After the monitoring Bis value was less than 45,eyelash reflex of patients disappeared and jaw relax,the conventional oral was placed in group B,and the novel dual-channel LMA was inserted blindly by an experienced anesthesiologist in group L.Correct placement of device was confirmed by adequate chest movement on ventilation and auscultation for bilateral air entry.Anesthesia maintenance was achieved using propofol 4-7mg/(kg·h)to keep Bis value between 40 to 60.Fresh gas flow was set at 2 L/min during the operation.The MAP,HR,RR,SPO2 were recorded before anesthetic induction(TO),immediately after the placement of LMA or conventional oral(T1),at the beginning of operation(T2),5 min after operation(T3),at the end of operation(T4)and immediately after the remove of LMA or oral(T5)in the two groups.The incidence of successful LMA insertion at first attempt,effective ventilation after first attempt and LMA displacement in group L were observed.The endoscopist assessed the ease of endoscopic accessing to the esophagus at the end of the procedure.Operation time,the incidence of intraoperative and postoperative adverse events and the satisfaction of endoscopist,patient as well as anesthesiologist of both groups were recorded.Results There was no significant differences between the two groups of ratio of gender,BMI,ratio of ASA,the duration of operation(P>0.05).The RR at T2 in group L were significantly higher than that of group B[(12.5±2.9)times/min vs.(10.1±3.5)times/min](P<0.05).The SPO2 in group L was significantly higher than that of group B at T2[(99.2±2.5)%vs.(96.6±6.4)%](P<0.05).Compared with TO,in group L there was no significant difference in MAP at T1 and T5[(84.7±11.2)mmHg vs.(79.3±12.2)mmHg,(84.7±11.2)mmHg vs.(80.4±6.8)mmHg](P>0.05)and in HR at T1 and T5[(75.1±9.5)times/min vs.(74.3±9.0)times/min,(75.1±9.5)times/min vs.(72.0±7.8)times/min](P>0.05).The incidence of successful LMA placement at the first attempt and the effective ventilation after first attempt were 100%separately.The performing of endoscopic accessing to the esophagus was easy.There was no case of reflux and aspiration in the two groups.All completed treatment safely and no one needed for tracheal intubation.The procedure was interrupted in 2 patients in the group B because of desaturation(1 case)or intraoperative cough(1 case),but the incidence of apnea,cough,sore throat after operation and operation suspension between the two groups were no significant difference[(0%vs.13.3%,0%vs.6.7%,10%vs.0%,0%vs.6.7%)](P>0.05).While the incidence of and SpO2<90%in group L were significantly lower than those in group B(0%vs.20%)(P<0.05).The anesthesiologist satisfaction scores in group L were significantly higher than that in group B[(8.3±3.0)scores vs.(6.6±3.1)scores](P<0.05).Conclusions The novel dual-channel LMA which has simple and quick operation with reliable ventilation effect,high success rate and no obvious influence on the surgical operation,can effectively reduce the occurrence of cough and hypoxemia and can provide more safe and effective airway management for endoscopic treatment.PART ? Observation of the Anesthetic effect of Propofol Combined with Nalbuphine Hydrochloride on Gastric Endoscopic Mucosal ResectionObjective Based on the first part of the study,we conducted a randomized controlled trial,studied the clinical effect of the combination nalbuphine hydrochloride with propofol in the treatment of gastric polyps in patients with EMR,and explored whether it could provide accurate digestive analgesia and less respiratory depression for endoscopic treatment.Methods This study was a randomized control,prospective,open-label,observational clinical that trial performed at Second Hospital Affiliated to Chongqing Medical University,a teaching hospital.Study approval was obtained from the ethics committee of the Second Affiliated Hospital of Chongqing Medical University and written informed consent was obtained from all the study participants.The study was performed between August 2017 and October 2017 and involved adult patients of ASA status 1 and 2(? to ?)in the age group 23-64 years,BMI ranged from 18.7 kg/m2 to 28.4 kg/m2,11 males and 49 females,scheduled for elective gastric EMR.Those patients were allocated to either nalbuphine combined with Propofol group(N group,n=30)and fentanyl combined with Propofol group(F group,n=30)using a computer-generated random table.After fasting for at least 8 hours,subjects were taken to the operating room placed in Left lateral position baseline,then parameters such as heart rate,blood pressure,electrocardiogram,respiration parameters,Bis and oxygen saturation were recorded.Intravenous(?/?)fluid started,subjects did not receive any premedication.Preparation of the novel dual-channel LMA(Zhejiang Jane Cheng Medical Technology Zhejiang Jane Cheng Medical Technology Co.Ltd.):the size following the manufacturer's recommendation according to subjects' weigh(30-50kg select number 3rd,50-70kg select 4th,greater than 70kg choice 5th);to well lubricate the back of throat mask regularly with right amount of paraffin oil,while checking the laryngeal mask without obstruction,leakage and breakage before device cuff deflated.At the same time,prepared the orotracheal intubation apparatus,so that the LMA failure could be replaced in a timely manner.After 5min oxygen inhalation(5L/min)before operation,anesthesia of both group was received intravenously midazolam lmg,then group N and group F were respectively injected intravenously with nalbuphine at the dose of 0.1mg/kg and fentanyl at the dose of 1?g/kg,and after 3 min,Propofol was injected intravenously at an initial dose of 1.5-2.0mg/kg.After eyelash reflex disappeared,jaw relax and BIS<45 of all patients,the novel dual-channel LMA was inserted blindly by an experienced anesthesiologist,following continuous intravenously pumped at a rate of 4-7mg/(kg · h).The dose of sedative and analgesic drugs was adjusted according to the depth of anesthesia,and the value of BIS was maintained between 40 to 60.The MAP,HR,ECG,and SPO2 before anesthetic induction(TO),immediately after the placement of LMA(T1),at the beginning of operation(T2),5min after operation(T3),at the end of operation(T4),immediately after the LMA remove(T5),5min after LMA remove(T6)and intraoperative PETCO2 of both groups were recorded;operation time,extubation time,recovery time(based on Aldrete scores),the total amount of propofol,the satisfaction scores of endoscopist,patient and anesthesiologist and the incidence of adverse reactions were recorded.Pain was assessed by VAS scores at 0,3,6,12,24h postoperatively,and the incidence of abdominal pain within postoperative 24h in each group were recorded.Result There was no significant differences between the two groups of ratio of gender,BMI,ratio of ASA(P>0.05).All patients completed treatment safely with spontaneous breathing during intraoperative period,and there was no case of regurgitation or aspiration,operation suspended,tracheal intubation,postoperative itchy skin,restlessness and complications associated with surgery recorded.There was no significant difference in incidence of respiration depression(SPO2<90%?RR<8times/min and PETCO2>50mmHg)[(0%vs 3.3%),(0%vs 13.3%),(0%vs 6.7%)](P>0.05).There was no significant difference in operation time,recovery time,extubation time,the total amount of propofol and the satisfaction scores of endoscopist[(13.0±3.9)min vs.(12.8±3.9)s,(7.5±2.9)min vs.(7.2±2.6)min,(6.3±1.9)min vs.(5.7±1.8)min,(182.0±33.9)mg vs.(173.0±37.1)mg,(9.9±0.3)scores vs.(9.3±2.1)scores](P>0.05).The RR at T2 in group N were significantly higher than that of group F[(14.0±2.0)times/min vs.(12.0±3.3imes/min](P<0.05).The incidence of the various adverse reactions between the two groups were no significant differences(P>0.05).The incidence of abdominal pain within postoperative 24h in group N were significantly lower than those in group F(0%vs.20%)(P<0.05).The patient and anesthesiologist satisfaction in group N were significantly higher than that of group F[(9.5±0.8)scores vs.(8.3±3.0)scores,(9.8±0.4)scores vs.(9.2±1.6)scores](P<0.05).Conclusion The 0.1mg/kg hydrochloride combined with Propofol in the clinical application of gastric EMR with less respiratory depression,better analgesic effect of digestive endoscope and no increase of postoperative adverse reaction,is a more safe and effective drug for precision analgesia. |
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