局麻下喉部手术的局部麻醉技术：患者偏好的比较。

Topical anesthetic techniques in office-based laryngeal surgery: A comparison of patient preferences.

机构信息

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.

出版信息

Laryngoscope. 2020 Jan;130(1):166-170. doi: 10.1002/lary.27894. Epub 2019 Mar 5.

DOI:10.1002/lary.27894

PMID:30835852

Abstract

OBJECTIVES

Multiple topical anesthesia techniques exist for office-based laryngeal surgery. Our objective was to assess patient and surgeon satisfaction for three different techniques.

STUDY DESIGN

Cohort study.

METHODS

All consecutive patients presenting to an outpatient laryngology office for awake surgical procedures were enrolled. Patients were anesthetized with local anesthesia (2 cubic centimeters of 4% lidocaine) in one of three ways: 1) nebulizer, 2) flexible cannula through a channeled laryngoscope, or 3) transtracheal instillation. Demographics, procedure times, and surgeon satisfaction were recorded. A validated 11-item patient satisfaction questionnaire (Iowa Satisfaction with Anesthesia Survey) was administered after the procedure to calculate an overall satisfaction score (-3[worst] to 3[best]). Descriptive and correlative statistics were performed.

RESULTS

One hundred consecutive patients were included (37 females, 73 males), with relatively equal numbers between groups (32 nebulizer, 35 cannula, 33 transtracheal). Seven procedures were aborted (4 nebulizer, 2 cannula, 1 transtracheal) due to movement, anxiety, or technical issues. Three patients did not adequately complete the survey. Of the 90 remaining patients, patient satisfaction was highest with the transtracheal technique (2.04) versus cannula (1.46) or nebulizer (1.45), and this was statistically significant (P = 0.0167). This difference was driven by decreased pain and nausea scores in the transtracheal group. Surgeon satisfaction was lower with nebulizer and higher with transtracheal injection (P = 0.0081). There was a correlation between surgeon satisfaction and patient satisfaction (P < 0.0001).

CONCLUSION

Transtracheal instillation was favored by both patients and the surgeon. Choice of local anesthetic techniques may impact patient preferences and surgical success. This may serve as a basis for optimizing anesthetic care in office-based laryngeal surgery.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:166-170, 2020.

摘要

目的

有多种局部麻醉技术可用于门诊喉部手术。我们的目的是评估三种不同技术的患者和外科医生满意度。

研究设计

队列研究。

方法

所有连续出现于门诊喉镜室进行清醒手术的患者均被纳入研究。患者接受局部麻醉（2 立方厘米 4%利多卡因）麻醉，麻醉方法有三种：1）雾化器，2）通过带通道喉镜的柔性套管，或 3）经气管内滴注。记录患者人口统计学资料、手术时间和外科医生满意度。手术结束后，使用经过验证的 11 项患者满意度问卷（爱荷华州麻醉满意度调查）计算总体满意度评分（-3[最差]至 3[最好]）。进行描述性和相关性统计分析。

结果

共纳入 100 例连续患者（37 例女性，73 例男性），各组之间的数量相对相等（32 例雾化器，35 例套管，33 例经气管内滴注）。由于移动、焦虑或技术问题，有 7 例手术被中断（4 例雾化器，2 例套管，1 例经气管内滴注）。有 3 例患者未充分完成调查。在其余 90 例患者中，经气管内滴注技术的患者满意度最高（2.04），其次是套管（1.46）或雾化器（1.45），且差异具有统计学意义（P = 0.0167）。这种差异是由于经气管内滴注组的疼痛和恶心评分降低所致。外科医生对雾化器和经气管内注射的满意度较低（P = 0.0081）。外科医生满意度与患者满意度之间存在相关性（P < 0.0001）。