局麻利多卡因和喉罩移除时机对儿童恢复期气道事件发生率的影响：一项随机对照试验。
The impact of topical lidocaine and timing of LMA removal on the incidence of airway events during the recovery period in children: a randomized controlled trial.
机构信息
Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China.
Tianjin Huaming Community Healthcare Service Center, Tianjin, China.
出版信息
BMC Anesthesiol. 2021 Jan 8;21(1):10. doi: 10.1186/s12871-021-01235-7.
BACKGROUND
The timing of laryngeal mask airway (LMA) removal remains undefined. This study aimed to assess the optimal timing for LMA removal and whether topical anesthesia with lidocaine could reduce airway adverse events.
METHODS
This randomized controlled trial assessed one-to-six-year-old children with ASA I-II scheduled for squint correction surgery under general anesthesia. The children were randomized into the LA (lidocaine cream smeared to the cuff of the LMA before insertion, with mask removal in the awake state), LD (lidocaine application and LMA removal under deep anesthesia), NLA (hydrosoluble lubricant application and LMA removal in the awake state) and NLD (hydrosoluble lubricant application and LMA removal in deep anesthesia) groups. The primary endpoint was a composite of irritating cough, laryngeal spasm, SpO < 96%, and glossocoma in the recovery period in the PACU. The secondary endpoints included the incidence of pharyngalgia and hoarseness within 24 h after the operation, duration of PACU stay, and incidence of agitation in the recovery period. The assessor was unblinded.
RESULTS
Each group included 98 children. The overall incidence of adverse airway events was significantly lower in the LA group (9.4%) compared with the LD (23.7%), NLA (32.6%), and NLD (28.7%) groups (P=0.001). Cough and laryngeal spasm rates were significantly higher in the NLA group (20.0 and 9.5%, respectively) than the LA (5.2 and 0%, respectively), LD (4.1 and 1.0%, respectively), and NLD (9.6 and 2.1%, respectively) groups (P=0.001). Glossocoma incidence was significantly lower in the LA and NLA groups (0%) than in the LD (19.6%) and NLD (20.2%) groups (P< 0.001). At 24 h post-operation, pharyngalgia incidence was significantly higher in the NLA group (15.8%) than the LA (3.1%), LD (1.0%), and NLD (3.2%) groups (P< 0.001).
CONCLUSIONS
LMA removal in the awake state after topical lidocaine anesthesia reduces the incidence of postoperative airway events.
TRIAL REGISTRATION
ChiCTR, ChiCTR-IPR-17012347 . Registered August 12, 2017.
背景
喉罩气道（LMA）的移除时机尚未明确。本研究旨在评估 LMA 移除的最佳时机，以及利多卡因局部麻醉是否可以减少气道不良事件。
方法
这是一项随机对照试验，纳入了年龄在 1 至 6 岁、ASA I-II 级、拟行斜视矫正手术的患儿。患儿随机分为 LA（LMA 插入前在套囊上涂抹利多卡因乳膏，在清醒状态下移除面罩）、LD（麻醉下应用利多卡因并移除 LMA）、NLA（水溶性润滑剂并在清醒状态下移除 LMA）和 NLD（麻醉下应用水溶性润滑剂并移除 LMA）组。主要终点是 PACU 恢复期间复合刺激性咳嗽、喉痉挛、SpO <96%和舌后坠。次要终点包括术后 24 小时内咽痛和声音嘶哑的发生率、PACU 停留时间和恢复期间激惹的发生率。评估者为非盲。
结果
每组均纳入 98 例患儿。与 LD（23.7%）、NLA（32.6%）和 NLD（28.7%）组相比，LA 组（9.4%）的不良气道事件总发生率显著降低（P=0.001）。NLA 组咳嗽（20.0%）和喉痉挛（9.5%）的发生率显著高于 LA（5.2%和 0%）、LD（4.1%和 1.0%）和 NLD（9.6%和 2.1%）组（P=0.001）。LA 和 NLA 组的舌后坠发生率（0%）显著低于 LD（19.6%）和 NLD（20.2%）组（P<0.001）。术后 24 小时，NLA 组咽痛发生率（15.8%）显著高于 LA（3.1%）、LD（1.0%）和 NLD（3.2%）组（P<0.001）。
结论
利多卡因局部麻醉后在清醒状态下移除 LMA 可降低术后气道事件的发生率。
试验注册
ChiCTR，ChiCTR-IPR-17012347。注册于 2017 年 8 月 12 日。
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