无肌松药下表面麻醉复合异丙酚靶控输注诱导病人气管插管的可行性

The feasibility of tracheal intubation without muscle relaxant after induction of anesthesia with target controlled propofol infusion and surface anesthesia

目的:探讨无肌松药下表面麻醉复合异丙酚靶控输注诱导病人气管插管的可行性。方法:拟行气管插管全身麻醉的手术病人40例,年龄20～60岁,ASAI或Ⅱ级,诱导前静脉注射芬太尼1μg/kg,以异丙酚效应室靶浓度4μg/ml行麻醉诱导,插管时用2%利多卡因4～5ml行气管黏膜表面麻醉。监测诱导、插管过程中的血压、心率和脑电双频指数(BIS)。插管时按面罩通气难易、下颌松弛度、声带位置高低、置入喉镜难易、是否有咳嗽体动以及对套囊充气反应等方面对插管条件进行评价。结果:与插管前即刻比较,插管后即刻心率加快,插管后即刻及插管后1min血压升高(P<0.01)。插管前后的BIS值比较差异无统计学意义(P>0.05)。所有病人均一次插管成功。插管条件综合评价的满意率为90%。结论:无肌松药下用2%利多卡因4～5ml行气管黏膜表面麻醉复合异丙酚4μg/ml效应室浓度靶控输注诱导病人气管插管时,可提供良好的气管插管条件。

Objective： To evaluate the feasibility of tracheal intubation without muscle relaxant after induction of anesthesia with propofol given by target controlled infusion（TCI） and surface anesthesia.Methods：Forty ASA Ⅰ or Ⅱ patients of both sexes （20 males,20 females） aged 20-60 years scheduled for elective operation under general anesthesia were studied. Fentanyl 1 μg/kg was given iv as premedication. Anesthesia was induced with propofol given by TCI. The target effect site concentration of propofol was set at 4 μg/ml. BP, HR and bispectral index（BIS） were monitored during induction and intubation. The results of tracheal intubation were graded as satisfactory, average and poor based on intubation conditions and intubation response including easiness of ventilating the patients via face mask ,jaw relaxation, easiness of inserting laryngoscope and visualization of larynx, the vocal cord position and patients response to intubation such as cough,limb movement and response to cuff inflation.Results：HR and BP were significantly increased within 1 min after intubation as compared to the baseline values before intubation（P〈0.01）. There was no significant defference in BIS values before and after intubation. All patients were successfully intubated at first attempt. 90% patients were graded as satisfactory.Conclusion：Induction of anesthesia with TCI of propofol at target effect site concentration of 4 μg/ml and surface anesthesia might provide satisfactory intubating conditions without muscle relaxant.