胃镜喉罩无肌松正压通气在肥胖患者内镜黏膜下剥离术中的应用OA

Objective To evaluate the effect of positive pressure ventilation with laryngeal mask airway without muscle relaxant under gastroscope in obese patients undergoing endoscopic submucosal dissection(ESD).Methods Obese patients who planned to undergo painless ESD in our hospital from June 2024 to December 2024 were divided into three groups:group C(nasopharyngeal airway catheter,n=61),group L1(gastroscopic laryngeal mask combined with cisatracurium,n=58),and group L2(gastroscopic laryngeal mask,n=60).In group C,midazolam,sufentanil and propofol were given intravenously,and then a nasopharyngeal airway catheter was placed to maintain spontaneous breathing.In group L1,on the basis of the induction drug in group C,cisatracurium was added,then a gastroscopic laryngeal mask was inserted,and positive pressure ventilation was performed by an anesthesia machine.In group L2,muscle relaxants were not used,and the other drugs were the same as those in group L1.In group C,propofol 2～4 mg/(kg·h)was pumped during the operation,and sufentanil 5～10 μg was added 60 min after induction.In L1 and L2 groups,propofol 2～4 mg/(kg·h)and remifentanil 2 to 3 μg/(kg·h)were pumped.The changes in circulation and respiration during operation were recorded.The relevant indicators of arterial blood gas analysis were monitored.The intraoperative body movement and postoperative complications were recorded.The satisfaction of endoscopists and patients was recorded.Results The coefficient of variation of systolic blood pressure and diastolic blood pressure in the L1 and L2 groups during the anesthesia maintenance period(T2)was lower than that in group C,and the differences were statistically significant(P<0.05).The incidence of hypoxemia and respiratory depression in group L1 and group L2 was lower than those in group C,and the differences were statistically significant(P<0.05).At 60 min after induction,the pH value in group C decreased,while the arterial partial pressure of carbon dioxide(PaCO2)and lactate(Lac)increased,which were significantly different from those before induction and those in group L1 and L2(P<0.05).The incidence of intraoperative movement in group L1 and L2 was significantly lower than that in group C,while the incidence of postoperative throat pain was significantly higher than that in group C,the differences were statistically significant(P<0.05);the incidence of postoperative fatigue in group L1 was significantly higher than that in group C and L2,and the differences were also statistically significant(P<0.05).The overall satisfaction of patients in group L2 was higher than that in group L1,the overall satisfaction of endoscopists in group L1 and L2 was higher than that in group C,the differences were statistically significant(P<0.05).Conclusion Positive pressure ventilation with laryngeal mask airway without muscle relaxant for ESD in obese patients,it can maintain hemodynamic stability,reduce the incidence of respiratory complications,and has a high overall satisfaction.It is a safe and effective anesthesia method.