Prasad Chandrakant, Radhakrishna Nayani, Pandia Mihir Prakash, Khandelwal Ankur, Singh Gyaninder Pal, Bithal Parmod Kumar
Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesia, Command Hospital (Eastern Command), Kolkata, West Bengal, India.
J Neurosci Rural Pract. 2021 Sep 28;12(4):745-750. doi: 10.1055/s-0041-1735321. eCollection 2021 Oct.
Cuff leak test is an effective and established maneuver to predict airway edema. Standard fluid therapy (SFT) based on conventional monitoring is often associated with postoperative airway edema after complex spine surgeries. We conducted this prospective randomized controlled study to compare the effect of SFT versus goal-directed fluid therapy (GDFT) on the cuff leak gradient (CLG) in patients undergoing complex spine surgery in prone position. Our secondary objectives were to compare the effect of SFT and GDFT on sore throat, hoarseness, and length of intensive care unit (ICU) and hospital stay. Thirty consecutive American Society of Anesthesiologists physical status I and II patients (18-60 years), of either sex, scheduled for spine surgery in prone position with expected duration of surgery more than 5 hours were included. The patients were randomized into two groups of 15 each. Group S patients ( = 15) served as control group and received SFT intraoperatively, while patients in group G ( = 15) received GDFT. Standard anesthetic protocol was followed in both the groups. The CLG was defined as the difference between the cuff leak volume (CLV) after intubation (CLV ) and before extubation (CLV ). CLG was significantly less in group G (group S, 137.12 mL; group G, 65.52 mL; -value <0.001). Intravenous fluids, blood loss, and postoperative sore throat were comparatively lesser in group G, though not statistically significant. Postoperative hoarseness was significantly lower in group G ( -value = 0.003). Duration of ICU stay in group G (19.43 hours) was significantly lower ( -value = 0.009) than group S (24.64 hours), but length of hospital stay was comparable. GDFT significantly reduces airway edema and consequently reduces CLG as compared with SFT in patients undergoing complex spine surgery in prone position. Postoperatively, it also reduces sore throat, hoarseness of voice, and duration of ICU stay.
套囊漏气试验是预测气道水肿的一种有效且成熟的方法。基于传统监测的标准液体疗法（SFT）在复杂脊柱手术后常与术后气道水肿相关。我们进行了这项前瞻性随机对照研究，以比较SFT与目标导向液体疗法（GDFT）对俯卧位复杂脊柱手术患者套囊漏气梯度（CLG）的影响。我们的次要目标是比较SFT和GDFT对咽痛、声音嘶哑以及重症监护病房（ICU）住院时间和住院总时长的影响。
连续纳入30例美国麻醉医师协会身体状况分级为I级和II级、年龄在18至60岁之间、计划进行俯卧位脊柱手术且预计手术时长超过5小时的患者，性别不限。患者被随机分为两组，每组15例。S组患者（n = 15）作为对照组，术中接受SFT，而G组患者（n = 15）接受GDFT。两组均遵循标准麻醉方案。CLG定义为插管后套囊漏气量（CLV₁）与拔管前套囊漏气量（CLV₂）之差。
G组的CLG显著更低（S组为137.12 mL；G组为65.52 mL；P值<0.001）。G组的静脉输液量、失血量和术后咽痛相对较少，尽管无统计学意义。G组术后声音嘶哑明显更低（P值 = 0.003）。G组的ICU住院时长（19.43小时）显著低于S组（24.64小时）（P值 = 0.009），但住院总时长相当。
与SFT相比，GDFT在俯卧位复杂脊柱手术患者中显著减轻气道水肿，从而降低CLG。术后，它还能减轻咽痛、声音嘶哑以及ICU住院时长。
