Li Meng-meng, Zhang Qing-hong, Liu Ying-hui, Yue Li, Liu Zhi-hui, Hao Jian-hua
Department of Anesthesiology, First Affiliated Hospital of General Hospital of P LA, Beijing 100048, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2011 Jun;31(7):1193-6.
To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room.
In this prospective study, 30 uncooperative patients with MR receiving total intravenous anesthesia (TIVA) with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care (MAC group), inserted classic laryngeal mask airway under general anesthesia (LMA group), or endotracheal tube placement (ETT group). The blood pressure (BP), heart rate (HR), SpO(2) and pH, PaCO(2), and HCO(3)(-) were monitored at 5 min and 1 h after anesthesia, before completion of the operation and at 1 h after the operation. The total operative time, dosage of propofol, awake time and body movement during the procedure were recorded.
Compared with LMA and ETT groups, the MAC groups showed a significantly increased total dosage of propofol (66.07±5.41, 35.83±5.80, and 34.61±3.68 g·kg(-1)·min(-1), respectively, P<0.05 ), body movements (9.90±3.07, 2.5 1±1.50, and 0.82±0.93, P<0.05) and awake time (16.82±7.60, 4.31±1.32, and 3.73±1.33 min, P<0.05). The pH, PaCO(2), or HCO(3)(-) showed no marked changes at 5 min after anesthesia and at 1 h after the operation in the 3 groups (P>0.05). At 1 h after anesthesia, the pH in MAC group decreased markedly compared with that in LMA and ETT groups (P<0.05), and maintained a low level till the completion of the operation; the PaCO(2) was significantly elevated in MAC group and remained so till the end of the surgery (P<0.05).
Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT, and allows rapid onset of sedation with minimal cardiovascular responses, body movement and recovery, therefore is more suitable in the setting outside the operating room.
观察在手术室以外进行自体外周血单个核细胞移植（APBMCT）时，不同气道管理方式应用于智力发育迟缓（MR）患者的麻醉效果及安全性。
在这项前瞻性研究中，30例接受丙泊酚全静脉麻醉（TIVA）用于APBMCT的不合作MR患者被随机分为3组，即监护麻醉（MAC组）、全身麻醉下插入经典喉罩气道（LMA组）或气管插管（ETT组）。在麻醉后5分钟、1小时、手术结束前及术后1小时监测血压（BP）、心率（HR）、脉搏血氧饱和度（SpO₂）以及pH、动脉血二氧化碳分压（PaCO₂）和碳酸氢根（HCO₃⁻）。记录总手术时间、丙泊酚用量、苏醒时间及术中体动情况。
与LMA组和ETT组相比，MAC组丙泊酚总用量显著增加（分别为66.07±5.41、35.83±5.80和34.61±3.68 μg·kg⁻¹·min⁻¹，P<0.05），体动次数增多（分别为9.90±3.07、2.51±1.50和0.82±0.93，P<0.05），苏醒时间延长（分别为16.82±7.60、4.31±1.32和3.73±1.33分钟，P<0.05）。3组在麻醉后5分钟及术后1小时pH、PaCO₂或HCO₃⁻均无明显变化（P>0.05）。麻醉后1小时，MAC组pH较LMA组和ETT组显著降低（P<0.05），并持续维持在较低水平直至手术结束；MAC组PaCO₂显著升高并持续至手术结束（P<0.05）。
在APBMCT期间，对于MR患者，气管插管比喉罩气道置入及监护麻醉更安全，能使镇静快速起效，心血管反应、体动及恢复最小，因此更适用于手术室以外的环境。
