Effects Of Different Thoracic Anesthesia On Postoperative Cough

Background and PurposePostoperative cough is a common complication after chest surgery.Chronic,intractable coughs seriously affect the postoperative recovery and quality of life.Some studies have reported that about 50% of patients with lung cancer undergo lobectomy.There is cough within 1 year,and 25% of patients have more than 5 years after operation[1].The two main factors affecting postoperative cough are anesthesia after tracheal intubation and surgical trauma.Double lumen endobronchial tube(DLT)is a traditional chest anaesthesia.In recent years,the development of spontaneous respiratory thoracic anesthesia is to perform various thoracoscopic surgery(VAST)under the condition of non-tracheal intubation [2].However,previous studies have failed to distinguish the effects of surgery(such as lung tissue trauma)and anesthetic factors(such as tracheal intubation)on cough.In this study,we retrospectively analyzed the postoperative cough status of the two anesthesia methods,compared the degree of influence of anesthesia and surgical factors,and explored whether spontaneous respiratory thoracic anesthesia could reduce the incidence of cough.Materials and methods General informationSelected cases must meet the following conditions:?1 age 18 to 65 years old,ASA grad: I ~II;?2 Mallampatis grade: I~II;?3 lung function tests are basically normal,no asthma,no serious cardiovascular disease,no COPD,History of blood system diseases and mental illnesses;?4 Body mass index(BMI)< 25 kg/m2;?5 No preoperative respiratory infections and chronic cough,sputum history,no history of gastric acid reflux,and postnasal drip syndrome.?6 Surgical methods are limited to VAST Pulmonary bullectomy,Pulmonary wedge resection,segmentectomy or lobectomy.Case groupFrom July 2011 to December 2015,a total of 1162 cases of the Center met the above conditions and were able to complete follow-up.All cases were divided into DLT intubation anesthesia group(T group,n=925 cases)and spontaneous respiratory anesthesia group(S group,n=456 cases).Among them,the S component was divided into two subgroups: intravenous compound intercostal nerve block anesthesia group(SB group,n=157 cases)and intravenous compound epidural anesthesia group(SE group,n=299 cases).Anesthesia methodAll patients received intramuscular midazolam(0.04-0.06 mg/kg)and atropine(0.01 mg/kg)30 min before anesthesia,and the upper extremity venous access was opened after admission.Noninvasive arterial blood pressure(NBP),II lead electrocardiogram(ECG),heart rate(HR),pulse oxygen saturation(Sp O2),respiratory frequency(RR)and bispectral index(BIS)were monitored with a Philips Inteli Vue MP40 monitor.After induction of anesthesia,the central venous catheter was placed,the radial artery was placed under the pressure(IBP),and blood gas analysis was performed when necessary.Patients in group T were monitored continuously for exhaled carbon dioxide pressure(Pet CO2).T group: According to the preoperative chest image measurement line and select the corresponding model of DLT(Mallinckrodt Corporation)[3].After the mask was deoxygenated for 3 minutes,plasma target-controlled infusion(TCI)propofol 2~3?g/ml,sufentanil 0.3~0.5?g/kg,and cisatracurium 0.2mg/kg.After placement of DLT,the bronchoscope was placed at the end of the tube,IPPV tidal volume(VT)was 6~8 ml/kg,and frequency(RR)was 10-15 beats/minute.Inhaled sevoflurane(1% ~ 2%),propofol(TCI,0.5~2 ?g/ml),and remifentanil(0.05~0.1 ?g/kg/min)to maintain anesthesia and intermittently add cisatracurium(Induced amount of(1/5~1/10)maintain muscle relaxation.At the end of the operation,a chest drainage tube was left behind.SB group: Intravenous anesthesia was performed with propofol(TCI,1.5~3.5 ?g/ml)and remifentanil(0.03~0.05 ?g/kg/min),and a single dose of sufentanil(2~5 ?g)was given depending on the course of the surgery as necessary.Local anesthesia(1% lidocaine 2~5ml)was performed on the surgical incision.After thoracotomy,2% lidocaine 5ml was sprayed on the visceral pleura,and T2~T8 intercostal nerve block was performed under direct intrathoracic view(0.75% ropivacaine and 2% lidocaine in a 1:1 mixture0.5 ml per rib),intraoperative chest vagal nerve block dry stagnation(0.75% ropivacaine and 2% lidocaine 1:1 mixture about 3ml).During the operation,spontaneous breathing was maintained and nasal oxygen was used(3~5 L/min)without any artificial airway.At the end of the operation,a chest drainage tube was left behind.SE group: After T7~8 or T8~9 lines of epidural puncture,the catheter was placed into the epidural space 3cm,the test volume was 2ml of lidocaine 2%,0.5% ropivacaine was given in 5min intervals 4~ 5 ml(total 8 to 10 ml total),add 3~5 ml every 30~45 minutes.After intravenous anesthesia with propofol(TCI,1.5~3.5 ?g/ml)and remifentanil(0.03~0.05 ?g/kg/min),a single dose of sufentanil(2~5 ?g)was administered according to the course of the surgery.Dirty pleura,vagal nerve block,intraoperative breathing,airway management,and end of surgery were the same as in the SB group.Observation index:1.Record the number of cases removed in each group.2.Record the sex ratio,age,and BMI for each group.3.Record the postoperative antibiotic application time(days),thoracic drainage tube indwelling time(days)and hospital stay(days).4.Record the cough status of each group on the first day(T1),the second day(T2),the third day(T3),and the first month(T4),and the middle and long term,that is,the third month after the operation.Chronic cough in(T5),6 months(T6)and 12 months(T7).Chronic cough refers to no other reason after surgery,lasting more than 8 weeks,mainly with cough as the only symptom or main symptoms,X-ray without any other lesions.5.Inquired and recorded results for cough syndrome scores,the Leicester cough questionnaire(LCQ),and the visual visual analogue scale(VAS)for T6 chronic cough.The cough symptom score table reflects the cough frequency,intensity,and conditions that affect quality of life.The higher the score,the more frequently the frequency,intensity,and impact are reflected.LCQ evaluates the impact of cough on quality of life from the three parts of physiology,psychology and society.The higher the score,the lower the impact,and the greater the effect is[3].VAS uses a linear scoring method(0 to 10 points).The larger the value,the heavier the cough.ResultThere was no significant difference in the rejection rate between the three groups of SE group,SB group and T group(P>0.05).There was no significant difference in the proportions of cases among the SE group,SB group and T group in bullectomy,wedge resection,segmentectomy,and lobectomy(P>0.05).There was no significant difference in age and BMI between groups(P>0.05).There was no significant difference in age and BMI between different surgical procedures within each group(P>0.05)Among all surgical procedures,the number of postoperative days of antibiotic application,days of thoracic drainage tube dwelling,and days of hospitalization were all lower in group S than in group T.There was a statistically significant difference between groups(P < 0.05).The incidence of cough in the SE group,SB group and T group at T1,T2,T3,and T4 showed a decreasing tendency with the increase of postoperative time.There was a statistically significant difference between groups(P<0.05).There was no significant difference in the incidence of cough between the SE group and the SB group at T1,T2,T3,and T4(P>0.05).The incidence of cough at each time point in group T was significantly higher than that in other groups.There was a statistically significant difference between groups(P<0.05).In the mid-and long-term postoperative period,the incidence of chronic cough in all groups decreased with the increase of postoperative time,and there was a statistically significant difference between the groups(P<0.05);the occurrence rate of each point in the T group were significantly larger than other groups(P<0.05).The scores of cough symptoms in group T were higher than those in other groups.There was statistical difference between groups(P<0.05).There was no statistical difference between SE group and SB group(P>0.05).The scores and total scores of the physiological,psychological,and social components of the LCQ in the T group were lower than those in the other groups.There was a statistically significant difference between the groups(P<0.05),while the VAS scores were higher than those in the other groups.There was a statistical difference(P<0.05).conclusionThe combined thoracic epidural anaesthesia for spontaneous respiratory thoracic anesthesia and intercostal nerve blockade did not interfere with the airway,protected the integrity of tracheal and bronchial airway mucosa,reduced airway inflammation,and effectively reduced postoperative cough.Therefore,spontaneous respiratory thoracic anesthesia compared with double-lumen bronchial catheter intubation general anesthesia can effectively reduce postoperative cough,accelerate postoperative recovery and improve postoperative quality of life.