Comparison of different anesthesia method-induced endotracheal intubation in endoscopic diagnosis and treatment of acute massive upper gastrointestinal hemorrhage

Abstract

Objective To compare the anesthetic induction effects of remifentanil alone and propofol combined with fentanyl in left lateral endotracheal intubation for endoscopic diagnosis and treatment of acute massive upper gastrointestinal hemorrhage. Methods A retrospective analysis was performed on the clinical data of 45 patients undergoing left lateral endotracheal intubation for endoscopic treatment of acute massive upper gastrointestinal bleeding in the First Affiliated Hospital with Nanjing Medical University from October 2017 to May 2021. There were 31 males and 14 females, aged 25-65 years, with BMI＜30 and American Society of Anesthesiologists (ASA) physical status Ⅱ or Ⅲ. According to the method of anesthesia induction, the patients were divided into group A(with remifentanil alone used for induced intubation, n=20) and group B(with propofol-fentanyl for endotracheal intubation, n=25). Before induction(T0), immediately before endotracheal intubation(T1) and immediately after endotracheal intubation(T2), the values of heart rate(HR), mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) were recorded to compare the incidences of respiratory depression and endotracheal intubation-related complications between two groups. Results Compared with those at T0, MAP significantly decreased at T1 in group B(P＜0.05) and significantly increased at T2 in group A(P＜0.05), and SpO2 significantly decreased at T2 in both groups(P＜0.05). Compared with those in group A, MAP and SpO2 significantly decreased at T1 and T2 in group B(P＜0.05). The rate of SpO2vs 15.0%, P＜0.01). The incidence of aspiration in group B was significantly higher than that in group A(28.0% vs 0,P＜0.05). The degree of aspiration was slight, and no aspiration pneumonia or hoarseness occurred in both groups. There was no significant difference in the incidence of postoperative sore throat and hoarseness between two groups(P＞0.05). Conclusion In the endoscopic diagnosis and treatment of acute upper gastrointestinal hemorrhage, both remifentanil alone and propofol-fentanyl can be used safely and effectively for left lateral endotracheal intubation. Compared with propofol combined with fentanyl, remifentanil alone for awake tracheal intubation can prevent aspiration and respiratory depression more effectively and provide more stable hemodynamics.

Keywords

• remifentanil
• anesthesia induction
• left lateral position
• awake endotracheal intubation
• endoscope
• acute massive upper gastrointestinal bleeding