Improving mucosal anesthesia for awake endotracheal intubation with a novel method using dyclonine hydrochloride: A prospective, assessor-blinded, randomized controlled trial
Improving mucosal anesthesia for awake endotracheal intubation with a novel method using dyclonine hydrochloride: A prospective, assessor-blinded, randomized controlled trial
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DOI：
10.21203/rs.3.rs-39592/v2
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Chun-Xia Han;Peng Li;Zhenggang Guo;Ying Guo;Li Sun;Gang Chen;Xiao-di Qiu;W. Mi;Changsheng Zhang;L. Berra
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文献类型：
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作者：
Chun-Xia Han;Peng Li;Zhenggang Guo;Ying Guo;Li Sun;Gang Chen;Xiao-di Qiu;W. Mi;Changsheng Zhang;L. Berra
背景：表面麻醉是清醒气管插管中提供良好插管条件的关键步骤。在我们的机构，清醒插管的标准护理技术包括口咽丁卡因喷雾，可能导致粘膜麻醉不足。因此，我们试图比较盐酸达氯地平胶浆与标准丁卡因在清醒气管插管时实现上气道麻醉的有效性。方法：这是一项随机、评估者设盲、前瞻性研究。2019年6月1日至2019年8月1日，入选计划进行内镜黏膜下剥离术或经口内镜肌切开术的患者，并在获得书面知情同意后随机分为两组：分配至新型清醒插管护理的患者（N-AIC组）接受单次口服盐酸达氯地平胶浆，而分配到标准清醒插管护理组（S-AIC组）的患者在清醒插管前接受三次口咽丁卡因喷雾，然后注射环己丁卡因。在整个手术过程中记录平均动脉压（MAP）（本研究的主要结局）以及心率（HR），并在两组之间进行比较。还评估了表面麻醉后的麻木感、恶心和插管情况。结果：60例患者入组并完成研究。两组之间的基线MAP和HR相似。然而，N-AIC组对插管和胃肠道内窥镜检查的血流动力学反应，尤其是MAP，显著降低。表面麻醉后口咽粘膜的麻木程度在两组之间没有差异，喉镜检查期间的恶心感也没有差异。N-AIC组插管前咽部分泌物量较少。N-AIC组总插管时间明显短于S-AIC组（18.4 ± 2.86 vs. 22.3 ± 6.47，P < 0.05）。N-AIC组拔管呛咳发生率显著较低（13.3% vs. 76.7%）。N-AIC组患者的拔管后咽喉痛发生率低于S-AIC组（6.7% vs. 43.3%）。结论：在清醒气管插管中，与使用口咽丁卡因喷雾剂的标准护理实践相比，使用口腔不良粘液的新型护理可提供更有利的粘膜麻醉和更好的插管条件。
Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). Conclusions: In awake endotracheal intubation, novel care using oral dyclonine mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.