Abstract:

Objective To evaluate the clinical efficacy and safety of the anterior approach for ultrasound-guided superior laryngeal nerve (SLN) block combined with remimazolam for awake tracheal intubation in patients with hypertension and difficult airways. Methods A total of 60 patients with difficult airways and hypertension scheduled for general anesthesia surgery, SBP/DBP≤140/90 mmHg, aged 18-65 years, 18.5≤BMI<28 kg/m², ASA physical statusⅡ-Ⅲ were selected. These patients were randomly divided into a control group(group C) and an observation group(group S) by random number table, 30 patients in each group. The control group received cricothyroid membrane puncture anesthesia, while the observation group received the anterior approach for ultrasound-guided SLN block combined with cricothyroid membrane puncture anesthesia. Both groups of patients received intravenous remimazolam at a dose of 0.1 mg/kg, nasal surface anesthesia and then underwent fiberoptic bronchoscope-guided awake tracheal intubation through the nasal route. MAP and HR were recorded at baseline(T₀), immediately after the tracheal tube enters the glottis(T₁), immediately after the tracheal tube enters the trachea(T₂), 3 min after the tracheal tube enters the trachea(T₃), immediately after extubation(T₄). The Ramsay sedation score was recorded before intubation along with the occurrence of hypoxemia, cough, nausea during intubation, as well as hoarseness and sore throat after extubation. Results Compared with T₀, the increase of MAP at each time point in group S was not statistically significant and HR increased significantly at T₁,T₂, T₃, T₄(P<0.05). In group C, MAP and HR increased significantly at T₁, T₂, T₃ and T₄. There was no statistically significant difference in MAP and HR between the two groups at each time point. The incidence of cough during intubation in group S was significantly lower than that of group C(P<0.05). There was no statistically significant difference in other adverse reactions between the two groups. Conclusion The anterior approach for ultrasound-guided SLN block combined with remimazolam can reduce hemodynamic fluctuations during awake tracheal intubation in patients with hypertension, lower the incidence of coughing during intubation, help control the stress response and improve patient comfort.

Key words: superior laryngeal nerve block, ultrasound-guided, hypertension, remimazolam, difficult airway