Application of minimally invasive intubation in parathyroidectomy during induction of general anesthesia

Abstract

Objective To observe effects of minimally invasive intubation in parathyroidectomy during induction of general anesthesia. Methods One hundred patients with ASA category of Ⅲ or Ⅳ were enrolled for thyroid gland resection under general anesthesia. These cases were randomly divided into minimally invasive group(group L) and control(group C)(n=50). General anesthesia was induced by the combination of midazolam, etomidate, sufentanil and CIS-atracurium. Tracheal intubation was performed under the guidance of laryngoscopy. Two point five min after induction of general anesthesia, group L received 2% lidocaine spray on glottis, and an ID 7 tracheal tube was inserted. But an ID 7.5 tracheal tube was inserted in the group C patients 4 min after the induction of general anesthesia. We continuously pumped remifentanil and propofol, and intermittently infused CIS-atracurium to maintain anesthesia in patients. SBP, DBP, HR, and SpO2 were monitored before anesthesia induction(T0), immediately after induction(T1), before intubation(T2), 1 min after intubation(T3), 3 min after intubation(T4), respectively. At T1 and 10 min after intubation(T5), we extracted vein blood to measure adrenocorticotropic hormone(ACTH) and cortisol corticosteroid(CORT) in serum. Results During the intubation period, SBP, DBP, HR of group C increased significantly more than those of group L(P<0.05), and levels of serum ACTH and CORT in group L remained unchanged instead of increased in group C. Conclusions Minimally invasive catheterization technique can effectively reduce cardiovascular responses to tracheal intubation, and attenuate the release of stress hormones in patients receiving parathyroidectomy. These may improve the safety of the operation. Key words: Anesthesia, general; Endotracheal intubation; Parathyroidectomy