A NEW APPROACH TO SUPPRESS BUCKING BEFORE EXTUBATION - LIDOCAINE THROUGH MODIFIED ENDOTRACHEAL TUBE

抑制拔管前病人咳嗽（Bucking）的新方法－以改良型氣管內給Lidocaine

林仙養(Shian-Ycang Lin) ； 吳宗正(Tzong-Jeng Wu) ； 劉健強(Kien-Cuong Lun) ； 林祐生(Youh-Sheng Lin) ； 黃琴喨(Chung-Leung Hwang) ； 鄭雅蓉(Ya-Jung Cheng) ； 王國清(Kou-Ching Wang) ； 尤鴻隆(Hong-Long Yu) ； 趙繼慶(Chi-Ching Chao)

《Acta Anaesthesiologica Sinica》 28卷1期 (1990/03) Pp. 23-30

摘要

The conventional endotracheal tube was modified with an epidural catheter adhered on the concave aspect of it. The opening of the catheter is at the proximal margin of the cuff. Local anesthetic can be injected into the trachea, then desensitize the tracheal mucosa nearby the cuff. Thirty-four female gynecological patients underwent abdominal total hysterectomy were studied and divided into three groups. In group 1, anesthesia was maintained without special management. In groups 2 and 3, 2 mL gentian violet stained 4% lidocaine solution was administered intratracheally by two different methods 60-120 minutes before the conclusion of the surgery. The peak cuff pressures generated by the awakening patients were 53.8±2.2 cm H_2O (mean±SE) in group 1, 47.3±2.5 cmH_2O (Group 2) and 36.4±1.6 cmH_2O Group 3) respectively. Bucking before awakening was also evaluated clinically and showed 100%, 73% and 0% in each group. Intratracheal administration of lidocaine in dose of 2 mL 4% showed significant effect for the suppression of bucking during the recovery of general anesthesia in the group 2 and 3 compared with the group 1. Lidocaine administered through the catheter of modified endotracheal tube also resulted in less increase in the peak cuff pressure and even no clinically observed bucking than direct administered through the endotracheal tube. Gag reflex was preserved in all patients and none had suffered from aspiration postoperatively.

關鍵字

Lidocaine ； Endotracheal tube ； Peak cuff pressure ； Bucking

並列摘要

經氣管插管施行全身麻醉的病人，在手術終止後，麻醉恢復漸醒而尚未拔管前，常會發生咳嗽（Bucking），而bucking對神經外科，眼科及疝氣等手術的某些病患，卻是絕對的禁忌。本實驗使用的改良型氣管内管，是將條細導管黏在傳統的氣管内管上，開口在氣囊的近端上方，經此導管可將局部麻醉劑如Lidocaine，注人氣囊的周圍，以減少氣囊對氣管的刺激本實驗將三十四位婦科病人外爲三組：第一組爲對照組；第二組在手術結束前大約60-120分鐘，經氣管給予4％Lidocaine 2 mL；第三組在手術結束前大約60-120分鐘，經導管給予4％Lidocaine 2 mL，手術結束後，在病人清醒前連續測量氣管内管上氣囊的壓力以代表咳嗽（Bucking）的程度。結果顯示，清醒前的咳嗽程度，第二及第三組比對照組統計上有意義的減低。第三組比第二組病人的咳嗽程度，統計上亦有意義的減低。而且三組病人，都仍然保有咽喉反射（Gain reflex）的能力，拔管後都没有發生Aspiration。