Discussion
bleeding, reflux, liver cirrhosis, adenoma, coughing and cardiovascular reactions
VASODILATION, BLEEDING, REFLUX, LIVER CIRRHOSIS, ADENOMA, COMPLICATIONS
This study provides evidence that the JEA is a viable option for airway management during EVL procedures under general anesthesia. In this respect, we observed that the success rate of EVL with the JEA was 98.8% (95% CI 96.6–100) and that first-attempt success rate was 96%. These results were consistent with previous studies on the LMA® Gastro™ airway (one similar airway device) for esophagogastroduodenoscopy (EGD)/ERCPTechnical parameters of JEA and variceal banding kit, which was shot and edited by Lu Li. (List of physical characteristics and specifications for Jcerity endoscoper airway and LMA Gastro airway.In this study, there was no bleeding, reflux or other severe complications in the JEA group. Due to the high risks of perioperative bleeding and refluxNonoperating anesthesia is recommended to be efficient, timely, and safeOur study showed that JEA placement resulted in significantly shorter anesthesia durations, extubation times, and recovery times than ETT placement, potentially improving patient turnover efficiency. Furthermore, we observed more hemodynamic stability, lower anesthesia costs, and shorter hospital stays in the JEA group, which may be due to the LMA reducing the dosage of anesthetics needed, which subsequently shortens the recovery time following endoscopic procedures. In addition, muscle relaxants that may affect recovery time are not required when LMA is used. It is now understood that anesthetics can trigger vasodilation and negative inotropic effects, thereby affecting blood pressure and heart rate. Use of the JEA during anesthesia induction can potentially lead to several benefits, such as reducing the volume of anesthetic agents needed to maintain anesthesia, thus resulting in faster extubation, a shorter recovery time, better hemodynamic stability, and potentially lower anesthesia costs. The relatively high cost of the JEA device, which is approximately 310 yuan (equivalent to $45), could potentially be compensated by the decreased usage of anesthetic and vasoactive drugs and the elimination of the need for disposable laryngoscope lenses and muscle relaxant antagonists. Ultimately, the total anesthesia costs in the JEA group were lower than those in the ETT group. Furthermore, JEA could ease the transition between sleep and wakefulness in the EVL without stimulating the airway. Significantly lower rates of coughing and cardiovascular reactions have been reported during LMA® Gastro™ airway insertion and removal in endoscopic submucosal dissection (ESD) than during ETT insertion and removalPatients with liver cirrhosis often have multiple serious health conditions in addition to poor liver function. Therefore, reducing the volume of anesthetics used can help reduce the metabolic burden on the liver, prevent drug accumulation, and improve postoperative recovery while minimizing the incidence of complications. In this study, we observed a shorter recovery time in the JEA group but no significant differences in the incidence of complications between the two groups. Additionally, neither group experienced any instances of aspiration during the procedure. Deep anesthesia may be beneficial for reducing body movement during EVL and decreasing the risk of bleeding, thereby improving the procedure's success rate. Previous studies suggest that propofol-based TIVA can improve the adenoma detection ratePatients undergoing endoscopic variceal sclerotherapy were excluded from our study because there was a risk of glue sticking to the JEA.Our study suggests that the JEA may be a safe alternative for patients undergoing EVL. Before final recommendations are made, it is necessary to conduct large multicenter trials to assess the impact of JEA on liver function and the clinical outcomes of EVL.In conclusion, this study substantiated that JEA placement is effective and safe in EVL procedures, thus offering benefits such as a faster operating room turnover, better maintenance of hemodynamic stability, reduced patient anesthesia costs, and shorter hospital stays.