Application Of Different Auxiliary Ventilation Methods In Patients With Hypertension After Deep Anesthesia Extubation

Objective The hemodynamic changes of different extubation methods in hypertensive patients and the ventilation effect and adverse reactions after extubation under deep anesthesia were studied to explore the more suitable extubation methods and ventilation strategies for hypertensive patients.Methods A total of 90 patients with hypertension who underwent lumbar spine surgery in the people's hospital of ningxia hui autonomous region from December 2018 to February 2020 were randomly divided into 3 groups with 30 patients in each group.NA group:nasopharyngeal airway was placed after extubation under deep anesthesia.OA group:after extubation under deep anesthesia,oropharyngeal airway was placed.Group C:normal tracheal extubation.Invasive arterial blood pressure ?ABP?,heart rate?HR?,blood oxygen saturation?SpO₂?,tidal volume?VT?and BIS ?BIS?were recorded 5min?T₁?before extubation,5min?T3?after extubation,10min?T₄?after extubation,T₅)immediately after PACU entry,10min?T₆?after PACU entry,and T₇ after PACU exit.The respiratory rates of patients in the three groups after extubation were recorded,as well as the oxygen partial pressure?PO₂?and carbon dioxide partial pressure?PCO₂?values of arterial blood gas analysis after 10min of extubation.The occurrence of adverse events?restlessness,oropharyngeal pain, epistaxis,respiratory depression?from the time of extubation under deep anesthesia to the time of leaving PACU was recorded.The tolerability score was used to evaluate the tolerability of the three groups of patients after awakening from anesthesia.Results1.There were no statistically significant differences among the three groups in gender,age,weight,ASA classification,Mallampati classification,anesthesia time,sufentanil dosage,cis atracurium dosage,intraoperative fluid replacement and blood loss?P>0.05?.2.Comparison of MAP and HR in the three groups:compared with T₁,MAP and HR in group C were significantly increased at T₂,with statistically significant difference?P<0.05?.There was no statistically significant difference at other time points when compared with T₁?P>0.05?.3.There was no statistical difference between the three groups in MAP and HR at T₁?P>0.05?.At T₂-T₅,MAP and HR of patients in NA and OA groups were significantly lower than those in C group,and the difference was statistically significant?P<0.05?.There was no statistical difference between the NA and OA groups and between the groups at each time point?P>0.05?.4.Comparison of MAP and HR in the three groups at T₆,compared with the C group,MAP and HR in the NA and OA groups were significantly lower than those in the C group,with statistically significant differences?P<0.05?,and MAP and HR in the OA group were significantly higher than those in the NA group,with statistically significant differences?P<0.05,P=0.03?.5.Compared with group C,the respiratory rate of NA group?13.9 times/min?and OA group?14.3 times/min?significantly decreased after extubation,with statistically significant differences?P<0.05,P=0.03?.6.Compared with group C,there was no statistical difference in blood gas analysis of PO2 and PCO2 in the three groups after surgery?P>0.05?.7.Compared with group C,the incidence of agitation in the NA group?10%?and the OA group?16%?significantly decreased,with statistically significant differences?P<0.05?.There was no significant difference between the NA and OA groups?P>0.05?.8.Compared with the NA group,the incidence of nosebleed in the OA and C groups was significantly lower than that in the NA group?13%?,and the difference was statistically significant?P<0.05?.9.Compared with group C,the incidence of oropharyngeal pain in group NA and OA was significantly lower than that in group C,with statistically significant differences?P<0.05?.10.Compared with patients in group C,the tolerance scores of patients in NA group and OA group were significantly increased,and the difference was statistically significant?P<0.05,P=0.01?.ConclusionThe results of this study indicate that1.Hemodynamics of extubation with deep anesthesia is more stable in patients with hypertension.2.Nasopharyngeal airway and oropharyngeal airway placed after extubation under deep anesthesia in patients with hypertension can effectively relieve the upper airway obstruction such as posterior tongue drop and achieve good ventilation.3.Hmodynamic effects of nasopharyngeal airway placement after extubation under deep anesthesia in patients with hypertension were less and better tolerated.