不应用肌松药可弯曲喉罩静脉全麻在小儿前牙区多生牙拔除术的临床效果观察

Clinical observation of flexible laryngeal mask intravenous anesthesia without muscle relaxant in extraction of supernumerary teeth in anterior region of children

目的探讨不应用肌松药可弯曲喉罩静脉全麻在小儿前牙区多生牙拔除术中的可行性和安全性。方法择期行前牙区多生牙拔除术的小儿40例,ASA分级Ⅰ、Ⅱ级。采用随机数字表法将患者分为两组(每组20例):无肌松可弯曲喉罩静脉麻醉组(Ⅰ组)和使用肌松药可弯曲喉罩静脉麻醉组(Ⅱ组)。均采用靶控输注丙泊酚-瑞芬太尼静脉全麻。记录两组心率、收缩压、舒张压、自主呼吸恢复时间、苏醒时间、拔管时间,两组喉罩置入成功例数、次数、总的置入时间、喉罩置入后和手术结束时纤维支气管镜判定喉罩的位置评分,术后并发症,两组麻醉医生的满意度和手术医生的满意度。结果Ⅰ组和Ⅱ组在麻醉前、诱导后、插入喉罩后即刻、手术开始、手术10 min和术毕的收缩压、舒张压和心率比较差异均无统计学意义(P>0.05);Ⅰ组在拔管即刻心率、收缩压和舒张压明显低于Ⅱ组,差异有统计学意义(P<0.05),两组的麻醉时间差异无统计学意义(P>0.05),Ⅰ组的自主呼吸恢复时间、苏醒时间、拔管时间均短于Ⅱ组差异有统计学意义(P<0.05),两组喉罩置入成功例数、次数、置入喉罩的时间、术后并发症比较,差异无统计学意义(P>0.05),两组纤支镜检查评分结果差异无统计学意义(P>0.05),两组麻醉医生的满意度和手术医生的满意度差异无统计学意义(P>0.05)。结论在小儿前牙区埋伏多生牙拔除术中,无肌松药可弯曲喉罩静脉全麻是安全、可靠的,具有临床可行性。

Objective To investigate the feasibility and safety of flexible laryngeal mask intravenous anesthesia without muscle relaxant in extraction of children's supernumerary teeth.Methods 40 children were selected for extraction of supernumerary teeth in anterior region,ASA gradeⅠandⅡ.Patients were randomly divided into two groups(20 cases in each group):No muscle relaxant flexible laryngeal mask intravenous anesthesia group(groupⅠ)and muscle relaxant flexible laryngeal mask intravenous anesthesia group(GroupⅡ).Target-controlled infusion of propofol-remifentanil was used for general intravenous anesthesia.SBP,DBP and HR were recorded,spontaneous breathing recovery time,recovery time,extubation time,the number of successful cases,the number of times,the total insertion time,the position score of the laryngeal mask after the insertion of the laryngeal mask and at the end of the operation,and the postoperative complications,the satisfaction of anesthesiologists and the satisfaction of surgeons in both groups.Results There were no significant differences in systolic pressure,diastolic pressure and heart rate between groupⅠand GroupⅡbefore anesthesia,after induction,after LMA insertion,at the beginning of operation,10 minutes after operation and after operation(P>0.05);Heart rate,systolic blood pressure and diastolic blood pressure in groupⅠwere significantly lower than those in GroupⅡimmediately after extubation(P<0.05);There was no significant difference in anesthesia time between the two groups(P>0.05),spontaneous breathing recovery time,recovery time and extubation time in groupⅠwere shorter than those in GroupⅡ(P<0.05);The number of successful cases,times,time of LMA insertion and postoperative complications were compared between the two groups,there was no significant difference between the two groups(P>0.05).There was no significant difference in the scores of bronchoscopy between the two groups(P>0.05).There was no significant difference between the two groups in the degree of satisfaction of the anesthesiologist and the surgeon(P>0.05).Conclusion In the extraction of embedded supernumerary teeth in the anterior region of children,it is safe and reliable to use flexible laryngeal mask intravenous anesthesia without muscle relaxant,it is clinically feasible.