Observation Of Preoperative Budesonide Inhalation On Airway Protection In Adult Patients Undergoing One-lung Ventilation

Objective: We aimed to observe preoperative budesonide inhalation on oxygenation function and the protective effect of airway in adult patients undergoing one-lung ventilation.Visual analogue score was used to calculate the incidence and degree of complications such as postoperative throat pain.Methods: A randomized,double-blind,placebo-masked study was conducted,this study was approved by the Ethics Committee of the First Affiliated Hospital of Jilin University.Before the operation,patients and their families were informed about the relevant matters of inhalation of budesonide by atomization,and signing the informed consent.From December 1,2017 to December 1,2018,80 patients with ASA grade I-II were randomly selected in the Department of Extracoracic Surgery,in the First Affiliated Hospital of Jilin University.They were randomly divided into experimental group?group B?and control group?group C?,40 cases each.Patients were given routine treatment after admission,preoperative management included: arterial blood gas analysis after admission,supportive treatment,preoperative blood routine,coagulation routine,biochemical,renal function,liver function and lung function,chest CT scans,cardiac ultrasound,etc.And preoperative antibiotic shocking therapy.the control group was given 4 ml saline aerosol inhalation for 20 minutes,twice a day for 3 days,and the experimental group was assigned to receive saline 2 ml + budesonide 1 mg aerosol inhalation for 20 minutes,twice a day for 3 days,disposable aerosol inhalation device was used in both groups.After the patients entered the operating room,eliminating anxiety of patients by caring,keeping warm and preventing cold.The vital signs of patients were monitored routinely,such as electrocardiogram?ECG?,heart rate?HR?,blood pressure?BP?,peripheral blood oxygen saturation?SPO₂?,measured noninvasive blood pressure every 3 minutes,to be careful not to discount the inflatable belt of sphygmomanometer.The upper limb?s peripheral vein access was then opened by the nurse,radial artery puncture and catheterization were performed by anesthesiologists,and arterial blood gas was measured.Arterial blood samples were collected at admission?T0?,after induction of anesthesia?T1?,one-lung ventilation?T2?and 48 hours after surgery?T3?,respectively.Blood gas analysis was performed to determine PaO₂,PaCO₂,PaO₂/FiO₂ levels.The hemodynamic changes and intubation operation were recorded at the time of 2 minutes before endotracheal intubation?E0?,immediately after endotracheal intubation?E1?,2 minutes after endotracheal intubation?E2?and 5 minutes after endotracheal intubation?E3?.The recovery time of spontaneous breathing?C1?,the time of extubation?C2?and the time of spontaneous cough and expectoration?C3?after extubation were recorded,cough score scale was used to record cough after extubation.Hemodynamic changes were compared when discontinuation of anesthetics?C0?,C1,C2 and C3 were discontinued.Visual analogue scale?VAS?was used to calculate the incidence and degree of throat swelling and pain 12 hours?V0?,24 hours?V1?,48 hours?V2?,72 hours?V3?after operation.Results: 1.There was no significant difference in age,sex,BMI and smoking history between the two groups?P > 0.05?.2.The results of arterial blood gas analysis showed that the PaO₂ and PaO₂/FiO₂ values in group B were higher than those in group C,and the PaCO₂ values were lower than those in group C?P < 0.05?.3.There was no significant difference in mean arterial pressure,heart rate and peripheral blood oxygen saturation between the two groups before and after intubation.After intubation,average arterial pressure and heart rate increased in both groups,and the increase in group C was larger than that in group B?P<0.05?.4.There was no significant difference in intubation type,the time of intubation,the time of extubation and Mallampati grade between the two groups?P > 0.05?.5.The recovery time of spontaneous breathing,removing out of the endotracheal intubation and spontaneous cough and expectoration in group B was less than that in group C,and the choking condition was milder,the difference was statistically significant?P < 0.05?.6.The hemodynamics of group B was more stable at C1 and C2,the mean arterial pressure and heart rate were lower than those of group C,and the breathing was more stable,the difference was statistically significant?P < 0.05?.7.The high values of POST were noted up to 24 hours postoperatively in both groups,and VAS pain score in group C was higher than that in group B,and subsided at 72 hours?P < 0.05?.Conclusion: As for adult patients with one-lung ventilation,aerosol inhalation of budesonide preoperatively is beneficial to improve oxygenation ability of patients,reducing stress response to tracheal intubation stimulation.It also can reduce the extubation time after operation and the incidence of postoperative sore throat.It has protective effects on airway condition.