Deparment of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305, Taoyuan City, Taiwan.
BMC Anesthesiol. 2023 Jan 17;23(1):29. doi: 10.1186/s12871-023-01972-x.
Endotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy.
This prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days.
At 5 min before Time Zero either oxygen partial pressures (PaO) or carbon dioxide partial pressures (PaCO) between the two groups were comparable. No significant PaCO change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar.
Compared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions.
The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022.
在接受颅脑手术的患者中，全身麻醉下进行气管插管（深拔管）已被证明在麻醉苏醒过程中可提供稳定的血流动力学和稳定的颅内压。本研究旨在比较在全身麻醉下进行气管插管和喉罩（LMA）通气在接受颅脑手术的患者中的安全性和苏醒平稳性。
这是一项前瞻性随机对照研究，纳入了接受择期颅脑肿瘤切除术的患者。在完成手术操作后，患者使用呼气末七氟醚浓度 2.5%维持麻醉，并且完全恢复肌肉力量（Time Zero），随后将患者随机分配至气管插管组（n=29）进行深拔管或喉罩组（n=29），其中气管插管被喉罩替代。主要结局是麻醉苏醒期间直至 Time Zero 后 30 分钟时的呼吸并发症、气道干预和血流动力学变化。次要结局是 24 小时内再次手术的发生率、重症监护病房停留时间和术后住院天数。
在 Time Zero 前 5 分钟，两组之间的氧分压（PaO）或二氧化碳分压（PaCO）无显著差异。两组在 Time Zero 后 5 分钟时 PaCO 均无明显变化，但气管插管组此时 PaO 显著较低，为 188.9（±71.1）mmHg 比喉罩组的 264.4（±85.4）mmHg。气管插管组咳嗽和鼾声更为频繁，因此需要更多的干预来维持足够的呼吸。从 Time Zero 开始，气管插管组的血压（收缩压、舒张压和平均压）和心率普遍高于喉罩组，但除了 Time Zero 后 10 分钟的心率外，所有时间点的差异均无统计学意义。两组的次要结局相似。
与深拔管相比，喉罩作为一种临时气道替代物，可改善接受颅脑手术患者的麻醉苏醒，使患者的氧饱和度更好、呼吸并发症更少、气道干预更少。
本研究在获得台湾长庚纪念医院林口分院机构审查委员会（注册号 202102115A3；2022 年 1 月 27 日）和临床试验.gov（NCT05253404）的批准后进行（2022 年 2 月 23 日）。
