Kondo Takashi, Izumi Hiromichi, Kitagawa Makiko
Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan.
Department of Anesthesia, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
Anesthesiol Res Pract. 2020 Jun 19;2020:1302898. doi: 10.1155/2020/1302898. eCollection 2020.
The aim of this study was to compare the effects of desflurane, sevoflurane, and propofol on the glottic opening area during general anesthesia using remifentanil.
Ninety patients undergoing hand and upper limb surgery combined with brachial plexus block under general anesthesia were enrolled in the study. The patients were randomized into three groups to receive desflurane (group D), sevoflurane (group S), or propofol (group P) for maintenance of anesthesia. Following induction of general anesthesia with remifentanil, continuous fiberoptic video recording around the glottis via an i-gel™ supraglottic device was started after establishing mechanical ventilation. Desflurane, sevoflurane, or propofol was administrated after video recording was started. The changes in normalized glottic opening area (n-GOA) and peak inspiratory pressure (PIP) during surgery were compared between the three groups.
Intraoperative changes of n-GOA in group D showed significant differences compared with group S and group P (-0.0656 ± 0.0772 vs. -0.0076 ± 0.0499 and +0.0269 ± 0.0809, =0.005 and < 0.0001). The changes of PIP in group D showed significant differences compared with group S and group P (+3.7 ± 3.4 cmHO vs. +1.0 ± 1.3 cmHO and -0.3 ± 3.6 cmHO, =0.002 and < 0.0001). Four cases of relapsed glottic stenosis in group D were improved by changing desflurane to propofol.
Desflurane narrowed the n-GOA and increased the PIP compared to sevoflurane and propofol during general anesthesia with remifentanil. Clinicians should be aware of the possibility of glottic stenosis during desflurane-remifentanil anesthesia when the airway is secured by a supraglottic airway device without the use of neuromuscular blockade.
本研究旨在比较地氟烷、七氟烷和丙泊酚在使用瑞芬太尼进行全身麻醉期间对声门开口面积的影响。
90例在全身麻醉下行手部及上肢手术并联合臂丛神经阻滞的患者纳入本研究。患者被随机分为三组，分别接受地氟烷（D组）、七氟烷（S组）或丙泊酚（P组）维持麻醉。在使用瑞芬太尼诱导全身麻醉后，建立机械通气后通过i-gel™声门上装置对声门周围进行连续光纤视频记录。视频记录开始后给予地氟烷、七氟烷或丙泊酚。比较三组手术期间标准化声门开口面积（n-GOA）和吸气峰压（PIP）的变化。
D组术中n-GOA的变化与S组和P组相比有显著差异（-0.0656±0.0772 vs. -0.0076±0.0499和+0.0269±0.0809，P=0.005和P<0.0001）。D组PIP的变化与S组和P组相比有显著差异（+3.7±3.4cmH₂O vs. +1.0±1.3cmH₂O和-0.3±3.6cmH₂O，P=0.002和P<0.0001）。D组有4例复发性声门狭窄患者通过将地氟烷改为丙泊酚得到改善。
在使用瑞芬太尼进行全身麻醉期间，与七氟烷和丙泊酚相比，地氟烷会使n-GOA变窄并增加PIP。当使用声门上气道装置确保气道安全且未使用神经肌肉阻滞剂时，临床医生应意识到在使用地氟烷-瑞芬太尼麻醉期间发生声门狭窄的可能性。
