背景:术后咽喉痛(POST)是使用气管导管(ET)进行甲状腺手术后的常见并发症。I-gel®是一种声门上气道装置,与ET相比,在气道管理方面具有更大的优势。这项前瞻性试验旨在探索I-gel®与ET相比在POST上的潜在益处。
方法:在本试验中,106名患者,使用美国麻醉医师协会(ASA)身体状况分类系统进行分类,属于I类和II类,年龄18-65岁,预先安排进行选择性甲状腺根治术,随机分为ET组和I-gel®组。所有患者均行全凭静脉麻醉(丙泊酚,舒芬太尼,和顺式阿曲库铵)。评估并比较两组术后1、6、24和48h的POST发生率和严重程度以及术后声音嘶哑(PH)。此外,记录并比较麻醉期间的血流动力学数据.阿片类药物消耗(舒芬太尼,异丙酚,和瑞芬太尼)并记录术后恶心和呕吐。还评估并记录了术后1、6、24和48h切口部位疼痛的视觉模拟量表评分以及Ramsay镇静量表评分。
结果:术后1、6、24和48h的POST发生率没有显着差异(61.2%vs.51.0%,P=0.309;75.5%vs.83.7%,P=0.316;83.7%vs.85.7%,P=0.779;12.2%vs.22.4%,分别为P=0.182)和ET和I-gel®组之间手术后咽喉痛的严重程度(P=0.392)。I-gel®组术后1、6、24、48h的PH发生率明显低于ET组(均P<0.05)。与ET组相比,在I-gel®组中,插管后1分钟(P=0.045)和拔管后1分钟(P=0.001)心率波动明显较小.
结论:虽然I-gel®不能降低甲状腺手术后正常BMI患者POST的发生率和严重程度,与ET相比,它可以减少PH的发生和严重程度。I-gel®在插管期间的插入时间和更好的血液动力学状况方面显示出优异的结果。
BACKGROUND: Postoperative sore throat (POST) is a common complication following thyroid surgery with an endotracheal tube (ET). The I-gel® is a supraglottic airway device that has greater advantages in airway management compared with ET. This prospective trial aimed to explore the potential benefits of I-gel® compared with ET on POST.
METHODS: In this trial, 106 patients, classified using the American Society of Anesthesiologists (ASA) physical status classification system, belonging to classes I and II, aged 18-65 years old who were prearranged for elective radical thyroidectomy, were randomly divided into the ET and I-gel® groups. All patients underwent total intravenous anesthesia (propofol, sufentanil, and cisatracurium). The incidence and severity of POST and postoperative hoarseness (PH) at 1, 6, 24, and 48 h following the operation were assessed and compared between the two groups. Moreover, the hemodynamic data during anesthesia were recorded and compared. Opioid consumption (sufentanil, propofol, and remifentanil) and postoperative nausea and vomiting were recorded. The visual analog scale scores for pain at the incision site 1, 6, 24, and 48 h postoperatively and Ramsay Sedation Scale scores were also evaluated and recorded.
RESULTS: No significant difference was observed in the incidence of POST 1, 6, 24, and 48 h postoperatively (61.2% vs. 51.0%, P=0.309; 75.5% vs. 83.7%, P=0.316; 83.7% vs. 85.7%, P=0.779; and 12.2% vs. 22.4%, P=0.182, respectively) and the severity of sore throat (P=0.392) following surgery between the ET and I-gel® groups. The incidence of PH in the I-gel® group was significantly lower than that in the ET group 1, 6, 24, and 48 h postoperatively (all P<0.05). Compared with the ET group, a significantly less fluctuation in heart rate 1 min after intubation (P=0.045) and extubation (P=0.001) was observed in the I-gel® group.
CONCLUSIONS: Although the I-gel® cannot reduce the incidence and severity of POST in patients with normal BMIs following thyroid surgery, it can reduce the occurrence and severity of PH compared with ET. The I-gel® showed superior results in terms of insertion time and better hemodynamic condition during intubation.