The Clinical Study Of Consistent Cuff Pressure Of Laryngeal Mask Insertion Before And After Cephalic Rotation In The Electronic Cochlear Implantation Of Infants

Objective:To research the safety and efficacy of laryngeal mask with constant cuff pressure in the electronic cochlear implantation of infants,keeping the laryngeal mask cuff pressure consistent in the neutral head position and rotated head position,so that it can be better applied in clinic.Methods:This study selected 75 infant patients of electronic cochlear implantation,under the age of 3,under the weight of 20 kg,ASA ? ~ ? lever.The infants were randomly divided into L1 group(laryngeal mask group 1,n=25),L2 group(laryngeal mask group 2,n=25)and T group(endotracheal intubation group,n=25).The L1 group adjusted the filling amount of the laryngeal mask to make the cuff pressure consistent in the neutral head position and rotated head position.Main observed indicators:(1)the sex,age,height,weight of the infants,operation duration and anesthesia duration;(2)the number and success rate of the insertion of the laryngeal mask or tracheal tube(if the insertion is more than 3 times,it is a failure),and whether there is displacement and leakage before the removal of the laryngeal mask or tracheal tube;(3)the laryngeal mask cuff pressure of the neutral head position and rotated head position after the laryngeal mask was successfully inserted in L2 group;(4)the heart rate and mean arterial pressure at the time before insertion(T1),the time of insertion(T2),5min after insertion(T3),and the time before extraction(T4),the time of extraction(T5)and 5min after extraction(T6)of the laryngeal mask or tracheal tube;(5)the end-tidal CO2 partial pressure,airway peak pressure and pulse blood oxygen saturation in the neutral head position,rotated head position and before the end of the operation;(6)the recovery time of spontaneous breathing(the time from the end of the operation to the children's spontaneous breathing recovered),the time of open eyes(the time from the end of the operation to the children's eyes opened),extubation time(the time from the end of the operation to the removal of thelaryngeal mask or trachea),and the PACU time(the time from the end of the operation to leaving PACU);(7)whether there is laryngospasm,hyoxemia,regurgitation,aspiration,bucking,hoarseness and irritable crying.Results:1.Situation of insert of the laryngeal mask airway or tracheal tube:The laryngeal mask and tracheal tube were successfully inserted.There was no significant difference in the success rate of insertion in the first time in the three groups(P >0.05).The incidence of shift and air leakage in the L1 group was lower than that in the L2 group(P < 0.05).2.The change of the laryngeal mask cuff pressure:In the L2 group,the laryngeal mask cuff pressure in the rotated head position was increased compared with that in the neutral head position(P<0.001).3.Hemodynamics: Compared with the T group,the changes in blood pressure and heart rate were more slight in the L1 and L2 groups when the laryngeal mask was inserted and extracted(P<0.05).4.Ventilation status: In the L2 group,there was no significant change in the end-tidal CO2 partial pressure in the rotated head position compared with the neutral head position(P>0.05),but the airway peak pressure in the rotated head position was higher than that in the neutral head position(P<0.001).In the L1 and T group,there was no significant change in the end-tidal CO2 partial pressure and the airway peak pressure in the rotated head position compared with the neutral head position(P>0.05).Compared with L2 group,L1 group had a smaller degree of increased airway peak pressure before the end of the surgery(P<0.05).5.Resuscitation: The recovery time of spontaneous breathing,eye-opening time,extubation time and PACU time of the L1 and L2 group were shorter than that of the T group(P<0.001).6.Complications after extubation: The incidence of irritable crying in the L1 and L2 group was significantly lower than that in the T group(P<0.025).Conclusions:When laryngeal mask is applied to infants,the hemodynamics is more stable,postoperative recovery is faster,and postoperative complications are less;and the incidence of shift and air leakage was lower when keeping the laryngeal mask cuff pressure consistent before and after cephalic rotation,so it is more safer in the electronic cochlear implantation of infants,which is worth promoting in clinical practice.