Staffel J G, Weissler M C, Tyler E P, Drake A F
Division of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill.
Arch Otolaryngol Head Neck Surg. 1991 Oct;117(10):1123-8. doi: 10.1001/archotol.1991.01870220071012.
Tonsillectomy and adenoidectomy can predispose to stridor and laryngospasm in the immediate postextubation period. A prospectively randomized study of 133 patients undergoing tonsillectomy and adenoidectomy was undertaken to determine if the topical application of 4 mg/kg of 4% lidocaine at the time of intubation would decrease the incidence of postoperative stridor and laryngospasm. Taken together, eight (12%) of 67 control patients suffered stridor or laryngospasm vs two (3%) of 66 patients receiving lidocaine. It is concluded that lidocaine administered topically at the time of intubation for adenotonsillectomy helps prevent postoperative stridor and laryngospasm. Surgery of the upper aerodigestive tract often involves not only the technical aspects of the surgical procedure but also concomitant management of the airway. This can present a challenge to even the most adept otolaryngologist and anesthesiologist. Accidental extubation is always possible, and reintubation can be difficult in the presence of blood and saliva. The difficulty is often compounded with a patient who is not completely paralyzed.
扁桃体切除术和腺样体切除术在拔管后的即刻阶段可能会引发喘鸣和喉痉挛。对133例接受扁桃体切除术和腺样体切除术的患者进行了一项前瞻性随机研究，以确定在插管时局部应用4mg/kg的4%利多卡因是否会降低术后喘鸣和喉痉挛的发生率。总体而言，67例对照患者中有8例（12%）出现喘鸣或喉痉挛，而66例接受利多卡因治疗的患者中有2例（3%）出现此类情况。得出的结论是，在腺样体扁桃体切除术插管时局部应用利多卡因有助于预防术后喘鸣和喉痉挛。上呼吸道消化道手术不仅常常涉及手术操作的技术层面，还包括气道的同步管理。这甚至会给最熟练的耳鼻喉科医生和麻醉师带来挑战。意外拔管总是有可能发生，而且在有血液和唾液的情况下重新插管可能会很困难。对于未完全麻痹的患者，困难往往会加剧。
