[The clinical application of monitored anesthesia care in percutaneous dilatational tracheostomy]

To investigate the changes in hemodynamics and depth of anesthesia under monitored anesthesia care (MAC) in patients undergoing percutaneous dilatational tracheostomy (PDT).

Forty-six patients with oral cancer were divided into two groups with 23 cases each: Local anesthesia group (group L) and MAC group (group M). Local and intratracheal surface anesthesia were performed with 2% lidocaine in group L. Midazolam, propofol and fentanyl were added to group M after local and intratracheal surface anesthesia, then PDT was carried out. During the induction, observer's assessment of alertness/sedation(OAA/S) scale was used to assess the depth of sedation. Mean arterial blood pressure (MAP), heart rate (HR), state entropy (SE) and response entropy (RE) were recorded before anesthesia (basal value, T1), after local anesthesia (T2), after intravenous administration/before incision (T3), during incision (T4), during dilating with stretching pliers (T5) and endotracheal intubation (T6). A postoperative follow-up was taken in group M.

MAP and HR increased significantly at T4-T6 in group L and decreased at T3 (P < 0.05) with no change at T4-T6 in group M compared with those in T1. MAP and HR at T3-T6 in group M were obviously lower than those in group L. SE and RE at T3-T6 in group M were obviously lower than those at T1 or in group L (P < 0.01) and decreased significantly with the reduction of OAA/S scale (P < 0.05) during the induction. Intraoperative awareness in group M was not found through postoperative follow-up.

Patients undergoing PDT under MAC has more comfortability, more stable hemodynamics and no memory, so MAC is a better anesthesia for PDT than local anesthesia.