Clinical Observation Of The Correlation Between The Gas Leakage Of SLIPA Laryngeal Mask Airway And The Factor Of Muscle Relaxation

The First step:A Comparative Study of Gas Leakage in SLIPA Laryngeal Mask Airway VentilationTarget:the purpose of this study was to compare whether there is air leakage and the probability of air leakage when using SLIPA laryngeal mask airway ventilation for use and non-use of muscle relaxants during general anesthesia;to observe whether it is possible to use the SLIPA laryngeal mask without muscle relaxant;And to guide SLIPA laryngeal mask to be applied to clinical anesthesia more effectively,feasibly and safely.Technology:This study was a prospective study,using a completely randomized design scheme,which was carried out after the approval of the ethics committee of our hospital.and selected 120 patients from the affiliated hospital of yan'an university who underwent general anesthesia surgery from October 2018 to December 2019.The patients were selected after strict inclusion,exclusion and elimination criteria.Patients were divided into two groups according to the time sequence of operation and the principle of random allocation.non-muscle release group:the SLIPA laryngeal mask was inserted without muscle relaxants during general anesthesia induction?60 cases?.muscle release group:SLIPA laryngeal mask was implanted with muscle relaxants during induction of general anesthesia?60 cases?.Gas leakage assessment methods?Satisfy one or the other?:?1?inspiratory volume-expiratory volume>suction moisture volume1/10;?2?The oropharynx can hear the sound of air leakage;?3?With the fresh gas flow rate of 2 L/min as the standard,the bellows of the anesthesia machine cannot operate normally or the peak pressure of the airway is lower than 10cmH2O.Observed indicator:?1?Whether there is air leakage in the two groups of patients during the operation;?2?Evaluation of the placement position of laryngeal mask in two groups of patients;?3?Hemodynamic indexes:HR,SBP,DBP,SpO₂,BIS at six moments before induction?T0?,when the laryngeal mask was inserted?T1?,1min?T2?after insertion,3min?T3?after insertion,at the beginning of surgery?T4?,and at the time when the laryngeal mask was removed?T5?.?4?Respiratory mechanical indicators:Ppeak and PetCO₂ at four moments after insertion of laryngeal mask?T1?,1min after insertion?T2?,3min after insertion?T3?,and at the beginning of surgery?T4?.?5?Adverse reactions:limb movement,laryngeal spasm,laryngeal mask or oral blood,intraoperative awareness,aspiration,postoperative pharyngeal pain,dysphagia,hoarseness,gastric distension,nausea,vomiting.?6?Two groups of patients and surgeons satisfaction.Statistical analysis:The data were analyzed with SPSS version 26.0,The measurement data are expressed as mean and standard deviation?`x±s?,The comparison was conducted with t test or repeated measurement analysis of variance.Enumeration data were expressed by rate?%?and analyzed by Chi-square test.Rank data were analyzed by Kruskal-Wallis test.All data P<0.05 were considered statistically significant.Results:1.There was no statistically significant difference in gender,age,height,weight and other general information between the two groups?all P>0.05?.There was no statistically significant difference in the size of the laryngeal mask in Mallampati grading,ASA grading,fiberbronchoscope field grading between the two groups?all P>0.05?.There was no significant difference in the operation time?P>0.05?and the time of laryngeal mask insertion?P>0.05?between the two groups.The difference in the recovery time between the two groups?P<0.05?was statistically significant.These results indicated that the group without muscle relaxant had faster recovery than the group with muscle relaxant;2.The difficulty of laryngeal mask insertion was evaluated in the two groups,and there was no statistical difference between the two groups?Z=-1.230,P=0.219>0.05?.3.Comparison of hemodynamics:compared within the group,there were statistically significant differences in hemodynamics indexes between the two groups at different times?P<0.01?.There was no statistically significant difference in hemodynamics between the two groups at the same time?P>0.05?.4.Comparison of respiratory mechanics:There was no statistically significant difference in Ppeak between the two groups?P>0.05?.The difference of PetCO<sub>2</sub> was statistically significant between the two groups?P<0.01?.The differences of Ppeak and PetCO<sub>2</sub> in the two groups at different time were statistically significant?P<0.01?.5.There were 31 cases of air leakage in the non-muscle relaxant group,with an air leakage probability of 51.7%.There were 6 cases of air leakage in the muscle relaxant group,the probability of air leakage was 10%.and there was a statistical difference in gas leakage between the two groups?P<0.01?.The probability of air leakage was higher in the group without muscle release than in the group with muscle release.6.Adverse reactions:There were 2?3.33%?cases of limb movement during laryngeal mask insertion,11?18.33%?cases of blood in laryngeal mask or oral cavity,8?13.33%?cases of postoperative pharyngeal pain,5?8.33%?cases of dysphagia,2?3.33%?cases of hoarseness,12?20.00%?cases of nausea,and 3?5.00%?cases of vomiting in the non-muscle relaxant group.There were no limb movements during laryngeal mask insertion in the muscle relaxant group,14?23.33%?cases with blood in the laryngeal mask or oral cavity,5?8.33%?cases with postoperative pharyngeal pain,6?10.00%?cases with dysphagia,1?1.67%?cases with hoarse voice,14?23.33%?cases with nausea,and7?11.67%?cases with vomiting.There was no statistical difference in the comparison of perioperative adverse events between the two groups?P>0.05?.7.There was no statistically significant difference in satisfaction between the two groups?P>0.05?.Conclusions:the probability of gas leakage in SLIPA laryngeal mask ventilation was higher in the non-muscle relaxant group than in the muscle relaxant group.The use of muscle relaxant can significantly improve the gas leakage.The Secend step:Clinical observation of the correlation between gas leakage and muscle relaxation factorTarget:On the basis of the first step of the study,some patients who did not use the muscle relaxant at the time of induction and had gas leakage were given the muscle relaxant in time to observe whether the air leakage was improved after the same patient was given the drug,so as to verify whether the muscle relaxant was correlated with the gas leakage in the laryngeal mask airway.Technology:The present study was a prospective study,Adopt self-matching design scheme,Patients with gas leakage after induction in the first step non-muscle group were selected to observe whether the air leakage was improved after the use of muscle relaxant in the same patient.Inclusion,exclusion and elimination criteria are the same as the first step.The same patients were divided into two groups before and after the use of muscle relaxant.Gas leakage assessment method and gas leakage solution are the same as the first step.Observation indicators:?1?the number of cases with and without air leakage after the use of muscle relaxant;?2?fibrobronchoscope field grading for air leakage patients before and 3min after the use of muscle relaxant;?3?tidal volume,airway peak pressure,platform pressure and PetCO<sub>2</sub> of the patients with air leakage 3min before and3min after the use of muscle relaxant.?4?HR,SBP,DBP,SpO<sub>2</sub>,BIS in patients with air leakage 3min before and 3min after the use of muscle relaxant.?5?in the patient with air leakage,the number of cases of limb movement when the laryngeal mask is inserted,laryngeal spasm,laryngeal mask or oral blood,intraoperative awareness,aspiration,postoperative pharyngeal pain,dysphagia,hoarseness,flatulence,nausea and vomiting;?6?Leakage of patients and surgeon satisfaction.The data were analyzed with SPSS version 26.0,The measurement data are expressed as mean and standard deviation?`x±s?,The comparison was conducted with t test;Paired t test was used before and after comparison of the same patient.Enumeration data were expressed by rate?%?and analyzed by Chi-square test.Rank data were analyzed by Kruskal-Wallis test.All data P<0.05 were considered statistically significant.Results:1.There were 31 cases of air leakage without muscle release induction,accounting for 51.67%of all the patients.There were 2 cases of air leakage after use of muscle relaxant,accounting for 6.45%of all patients.The results showed that Z=18.079,P<0.01,indicating that the difference of air leakage before and after administration was statistically significant,the air leakage in laryngeal mask airway can be improved after administration.2.There were 2,24,5,and 0 cases of fibronchoscope visual field grading of grade I,II,III,and IV before administration,and 1,7,13,and 10 cases of grade I,II,III,and IV after administration,respectively.The Kruskal-Wallis test was used to analyze Z=-4.575,P<0.01,indicating that the changes in fibronchoscope visual field grading before and after administration were statistically significant.3.The P values of tidal volume,airway peak pressure,platform pressure and PetCO₂ of the patients with air leakage before and after administration were all<0.01,indicating that the differences in tidal volume,airway peak pressure,platform pressure and PetCO₂ before and after administration were statistically significant.4.P values of HR,SBP,DBP,SpO₂ and BIS in vital signs of patients with air leakage before and after administration were all>0.05,indicating that changes in HR,SBP,DBP,SpO₂ and BIS before and after administration were not statistically significant.5.The perioperative satisfaction of patients and surgeons can be divided into poor,general,good,satisfactory,patients corresponding to 0 cases,3 cases,8 cases,20 cases,the surgeon corresponding to 0 cases,5 cases,8 cases,18 cases.Kruskal-Wallis test was used to analyze for both cases,Z=-0.634,P>0.05,indicating that there was no statistically significant difference in patients'and surgeons'perioperative satisfaction.Conclusions:The air leakage in SLIPA laryngeal mask airway is related to the muscle relaxation factor,which can improve the air leakage in SLIPA laryngeal mask airway.