气道内喷洒利多卡因与静脉使用芬太尼减轻高浓度地氟醚对小儿气道刺激作用的比较

Comparison of lidocaine nebulization in trachea and intravenous administration of fentanyl in reducing the pediatric airway irritation induced by high concentrations of desflurane

目的探讨气道内喷洒利多卡因在减轻高浓度地氟醚对使用喉罩患儿的气道刺激反应中的作用及与静脉内使用小剂量芬太尼作用的比较。方法选取80例按美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ～Ⅱ级,6～12岁,无循环、无呼吸系统疾病拟在喉罩全身麻醉下行择期手术的患儿,随机分成两组:气道内喷洒利多卡因组(L组)和静脉注射芬太尼组(F组),每组40例。比较两组患儿在吸入地氟醚浓度骤然增加到2 MAC (最小肺泡浓度,minimal alveolar concentration,MAC)时的气道反应和心率、血压、潮气量,分钟通气量等的变化。结果两组患儿在接受2 MAC地氟醚气体后,L组中能耐受2 MAC地氟醚的患儿概率(即成功率)高于F组,并且气道反应也较少;插入喉罩后的5 min和10 min,L组患儿收缩压和舒张压较前有明显下降,潮气量即刻有明显下降,与F组比较差异有统计学意义(P<0.05)。结论气道内喷洒利多卡因可用于降低地氟醚对使用喉罩患儿的气道刺激反应,对患儿循环和呼吸状态的改变优于静脉使用芬太尼。

ObjectiveTo compare the effects of lidocaine nebulization in trachea and intravenous administration of small dose of fentanyl on pediatric airway irritation induced by high concentrations of desflurane. MethodsEighty patients aged 6-12 years with ASA Ⅰ-Ⅱ,and without circulation or respiratory diseases,scheduled for laryngeal mask airway (LMA) anesthesia were randomly assigned to one of the two groups:lidocaine nebulization in trachea group (L group, n =40) and fentanyl injection intravenously group (F group, n =40).The incidence of typical airway irritation events and the changes of heart rate,blood pressure,tidal volume and minute ventilation volume of the two groups were compared when the concentration of desflurane was suddenly raised from 1 MAC up to 2 MAC. ResultsUnder 2 MAC desflurane,the successful rate in L group was higher compared with F group.The airway events were also less in L group.The systolic and distolic blood pressure 5 and 10 min after intubation, and minute ventilation volume in L group were significantly lower than those in F group ( P <0.05). ConclusionsLidocaine nebulization in airway significantly reduced airway irritation,hemodynamic and respiratory response induced by high concentration of desflurane in children undergoing LMA anesthesia compared with intravenous administration of fentanyl.