| Objective:To stud the effect of Supreme laryngeal mask on carotid sinus hemodynamics in general anesthesia patients under specific intracapsular pressure and to analyze its related risk factors.With a view to guiding the safer application of laryngeal masks in future clinical work.Methods:Sixty patients with elective laryngeal mask general anesthesia were selected from the research institute of The First Hospital of Jilin University.The operation time was< 4 hours,the age was> 18 years,and the ASA grade was I-II.Patients were grouped according to patient age(A1 age ? 60;A2 age> 60)BMI(B1 ? 28;B2> 28),neck circumference(C1 neck circumference ? mean;C2 neck circumference> mean).Patients were routinely monitored after entering the operating room.Sufentanil 0.5 ?g / kg,cis-atracurium besylate 0.15 mg / kg and etomidate 0.3 mg / kg were used.After the BIS value is ? 60,the laryngeal mask is placed after the jaw is relaxed.The laryngeal mask model is selected according to the gender of the patient(female: 3 # laryngeal mask;male: 4 # laryngeal mask).If the hand-controlled ventilation is good without resistance,intermittent positive pressure ventilation should be performed with a tidal volume of 8ml / kg and a respiratory rate of 12 times / min.Check whether the laryngeal mask is in good alignment,whether there is air leakage,and whether the leak test of the drainage tube is negative(Put hydrosol 1 ~ 2 cm in the drainage tube of the laryngeal mask,and observe whether there are a large number of air bubbles leaking during normal mechanical ventilation.Air bubble leak is negative),put the suction tube in the drainage tube.If the ventilation is poor,the drainage tube leak test is positive,and the suction tube fails to be inserted,then re-insert the laryngeal mask.After 3 failed attempts,the case is rejected.Intraoperative continuous pumping of 2% propofol 5-8mg / kg · min,remifentanil 0.05-0.2ug / kg · min.The patient's blood pressure was maintained at ± 20% of the baseline value,and the BIS value was maintained at 40-60.Observe and record the indicators: use color Doppler ultrasound to monitor patients before the laryngeal mask is placed(T1);after the laryngeal mask is placed,the alignment and ventilation are good 1 minute(T2);Cross-sectional area at the lateral carotid sinus,blood flow velocity.The incidence of airway-related complications during surgery and after removal of the laryngeal mask was recorded.Results:Ultrasound measurements of carotid sinus were successfully performed in all 60 patients.No complications such as cough,laryngeal spasm and reflux aspiration occurred during laryngeal mask implantation.No change in tracheal intubation occurred.Supreme laryngeal mask can cause slight changes in the cross-sectional area and blood flow velocity of the carotid sinus,but it is not statistically significant.When the BMI and neck circumference are different,the Supreme laryngeal mask has a slight effect on the hemodynamic changes of the carotid sinus,but there is no statistical significance.However,when the age is greater than 60 years old,the cross-sectional area of the carotid sinus is 0.53±0.10cm2 at T1,0.45±0.07cm2 at T2,and the P value is 0.026.The change is statistically significant.No vomiting,aspiration,coughing,or hoarseness occurred during laryngeal mask placement,during surgery,or after removal of the laryngeal mask.After removal of the laryngeal mask,3 cases had bloodshot surfaces and 1 patient complained of sore throat.No change in tracheal intubation occurred.Conclusion:Supreme laryngeal mask has no significant effect on the cross-sectional area and blood flow velocity of the carotid sinus.There was no correlation between BMI and cervical circumference and hemodynamic changes in the carotid sinus.However,the cross-sectional area in elderly patients changed greatly,and the blood flow velocity did not change significantly. |
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