Clinical Application of Upper Airways Topical Anesthesia in Endotracheal Intubation in Awake Patients of Giant Goiters

Abstract

Background: The aim is to investigate the feasibility and advantages of intratracheal topical anesthesia with self-made tracheal topical anesthesia tube combined with isoflurane (ISO) inhalation in the intubation under unconscious and spontaneous breath in patients with giant goiter. Methods: A total of forty-four patients undergoing general anesthesia during elective thyroidectomy were enrolled in our hospital. The patients with ASA grade I~II, aged 21~65 years, were randomly divided into group A (the self-made tube topical anesthesia group) and group B (those with the traditional topical anesthesia group). Each group was 22 cases. The SBP, DBP, MAP, HR, and SpO2 data and the indexes of evaluation during induction and postoperative intubation time, tidal volume (VT) during ISO induction, respiratory rate during ISO induction, level 4 score of cough during ISO induction, glottal score during intubation, score of mandibular slackness, score of difficulty in placement of laryngoscope, level 4 score of assessment of airway patency during ISO induction, level 5 score of tracheal intubation comfortability, level 3 score after endotracheal intubation, the different complications in the second day after surgery, postoperative memory sore and postoperative throat pain score were recorded. Results: In the comparison of vital signs between the 2 groups: SBP, DBP, MAP and HR of group B were significantly higher than those of group A (P<0.05). In the comparison of vital signs in the same groups between before and after operation: SBP, DBP, MAP and HR of T2 in group A and group B were higher than those at T1 (P<0.05), and DBP and MAP in group A were higher than those at T3 (P<0.05). The SBP, DBP, MAP and HR in group B were higher than those at T3 (P<0.05). The SBP, DBP, MAP and HR of group B were higher than those at T5 (P<0.05). The hemodynamics during induction and intubation in group A are more stable than in group B. In comparison with the group B, the intubation time of group A was shorter (P<0.05), the tidal volume (VT) during ISO induction was larger (P<0.05), postoperative throat pain score was lower (P<0.05). Conclusions: The self-made tube topical anesthesia is more complete than that on the traditional glottic and upper glottic area. The incidence and score of postoperative throat pain were lower in patients, which was higher in comfort and satisfaction than traditional methods.