Jacobs Journal of Anesthesiology and Research

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

*Li Jun
Department Of Thoracic Surgery, Taizhou Enze Hospital , Wenzhou Medical University, Wenzhou Zhejiang, China

*Corresponding Author:
Li Jun
Department Of Thoracic Surgery, Taizhou Enze Hospital , Wenzhou Medical University, Wenzhou Zhejiang, China

Published on: 2019-03-02


Objective: The aim is to investigate the feasibility and advantages of intra tracheal 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. Method: 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 of T0, ten minutes after installation, T1 before topical anesthesia, T2 peak of topical anesthesia, T3 before ISO inhalation, T4 peak of ISO inhalation, T5 before tracheal intubation, T6 immediately after tracheal intubation, T7 before tracheal extubation,T8 ten minutes after extubation, 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 comfort ability, 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), the cough score during ISO induction was lower (P<0.05), better glottic opening during intubation(P<0.05),better mandibular slackness(P<0.05), better intubation comfort ability(P<0.05),immediate intubation response was gentler(P<0.05), postoperative throat pain score was lower(P<0.05). 


Topical Anesthesia; Unconscious; Spontaneous Breathing; Giant Goiter; Endotracheal Intubation


According to WHO World Health Statistics 2015; the total per capita health expenditure in Mali in west Africa was calculated at the average exchange rate (US$) in 2012 at US$ 42 ; compared with US$8;445 in the United States and US$ 4;464 in France; which is a huge gap with developed countries. The backward medical conditions and the weak medical awareness of the people have led to the inability to achieve early detection and early treatment of many common diseases. The ‘Hospital of Mali’ in the capital of Bamako has a large number of patients with giant goiter. The giant goiter is easy to oppress or invade the trachea; causing tracheal stenosis; softening and displacement. The artificial airways are established by retaining spontaneous breath to prevent the risk in ventilation or tracheal intubation.