Clinical Study Of Tetracaine Douche Applied In Transnasal Sphenoid Sinus Pituitary Surgery

Objective:Tetracaine was used for nasal cavity and skull base mucosal surface anesthesia to observe its effect on analgesia and hemodynamics.Methods:A total of 100 patients undergoing transsphenoidal pituitary surgery under elective general anesthesia were randomly divided into tetracaine group and control group,with 50 cases in each group.In the tetracaine group,the nasal cavity was filled with 0.25% tetracaine epinephrine cotton pad first,and 0.25% tetracaine solution was used for flushing after opening the sphenoid sinus,and finally 0.25% tetracaine was used to infiltrate the nasal packing;In the control group,the nasal cavity was filled with epinephrine cotton pads,the skull base is flushed with normal saline,and tetracaine infiltration is not used in the nasal packing.Observation indicators:(1)Heart rate and mean arterial pressure at the time before anesthesia(T0),when tamponade with epinephrine(T1),3 minutes after tampon with epinephrine(T2),at the beginning of nasal mucosal dissection(T3),5 minutes after dissecting(T4)),10minutes(T5),20 minutes(T6),30 minutes(T7),40 minutes(T8),50 minutes(T9),60minutes(T10),90 minutes after peeling(T11),120 minutes(T12),immediately after extubation(T13),and 10 minutes after extubation(T14);(2)The quality of the surgical field of view at T4,T6,T8,T10,T12;(3)Operation time,open circuit time,blood loss,total dosage of propofol,remifentanil,and nitroglycerin;(4)Extubation time,10 minutes after extubation Richmond agitation-sedation score and digital pain Score;(5)Whether there are adverse reactions such as intraoperative and postoperative skin rash,malignant arrhythmia,local anesthetic poisoning,and whether there are surgical complications such as cerebrospinal fluid leakage and postoperative bleeding.Results:1.Hemodynamics: Comparison within the group,the hemodynamics during nasal mucosal dissection between the two groups were significantly higher than before(p < 0.05);comparison between groups showed statistical differences in blood pressure during nasal mucosal dissection and 10 minutes after extubation,the tetracaine group is lower than the control group(p < 0.05);there was no statistical difference in hemodynamics between the two groups at other time points(p > 0.05).2.Awakening situation: The digital pain scores of the two groups at 10 minutes after extubation were statistically different,and the tetracaine group was lower than the control group(p < 0.05),and there was no statistical difference in the extubation time,sedation and restlessness scores(p>0.05).Conclusions:Tetracaine topical anesthesia is beneficial to reduce hemodynamic fluctuations in the initial stage of surgery and after extubation;it is beneficial to reduce postoperative pain without affecting the recovery of patients after surgery.It has a certain clinical value in transsphenoidal pituitary surgery.