背景:气腹后袖带充气时,气管导管袖带压力会增加,高压会导致气管粘膜损伤。这项前瞻性试验旨在评估在全身麻醉的腹腔镜手术中,用生理盐水或利多卡因充气是否可以防止气管管袖带压力增加和气管粘膜损伤。气管导管套囊横径(CD)的变化能否预测气管导管套囊压力的变化。
方法:将90例全麻下行腹腔镜结直肠肿瘤切除术的患者随机分为空气(A)组,盐水(S)或利多卡因(L)。A组(n=30)气管内套囊充入室温空气,S组生理盐水(n=30),2%盐酸利多卡因打针剂L组(n=30)。插管后,通过校准的压力传感器监测气管导管袖带压力,将袖带压力调节至25cmH2O(T0.5)。获取气腹后15分钟(T1)和排气后15分钟(T2)的气管导管袖带压力。在T0.5和T1通过超声测量CD,获得ΔCD(T1-0.5)预测袖带压力的能力。还记录了手术结束时的气管粘液损伤。
结果:在T1和T2时,三组之间的气管导管袖带压力没有显着差异。ΔCD对袖带压力具有预测值(AUC:0.92[95%CI:0.81-1.02];灵敏度:0.99;特异性:0.82)。A组手术结束时气管黏液损伤为0(0,1.0),S组中0(0,1.0),0(0,0),L组(p=0.02,L组低于A组和S组,p=0.03和p=0.04)。
结论:与空气充气相比,生理盐水和2%利多卡因不能改善全身麻醉气腹期间气管导管套囊压力的升高,但利多卡因能减轻术后气管黏膜损伤。通过超声测量的ΔCD是气管导管袖带压力变化的预测因子。
背景:中国临床试验注册中心,标识符:ChiCTR2100054089,日期:08/12/2021.
BACKGROUND: Tracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure.
METHODS: Ninety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded.
RESULTS: Tracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81-1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04).
CONCLUSIONS: Compared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure.
BACKGROUND: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.