BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,c...BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.展开更多
The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered...The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.展开更多
Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endo...Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesiologist was satisfied by the quality of patient’s cooperation for laryngoscopy in both groups. Conclusion: Subcutaneous dissociative conscious sedation is comparable with general anesthesia to provide desirable situation for laryngoscopy and tracheal intubation.展开更多
In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had bee...In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.展开更多
目的:研究困难气道中运用CT三维重建技术指导硬质纤维气管镜行气管插管的效果。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级、颈项强直、颈部外伤需制动或严重颈椎病颈椎固定的择期手术患者44例...目的:研究困难气道中运用CT三维重建技术指导硬质纤维气管镜行气管插管的效果。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级、颈项强直、颈部外伤需制动或严重颈椎病颈椎固定的择期手术患者44例,随机分为两组,试验组(E组)24例和对照组(C组)20例。术前采集入组患者上气道CT数据,依据患者的CT三维重建图像及由此获得的参数计算完成对Shikani硬质纤维气管镜(后简称硬质镜)管芯塑型,随机分组后,根据患者所在组别分别选用相应的硬质镜插管,E组采用根据患者CT三维重建图像计算的角度塑型后的硬质镜,C组采用原始角度硬质镜,并记录首次插管成功率及气管插管成功率,气管插管时间,入室(Tb)、插管后即刻(T0)、插管后5 min内(T1~T5)7个时间点血压、心率和脉搏氧饱和度,以及24 h内气管插管相关并发症。结果:两组插管成功率均为100%,E组首次插管成功率为96%,C组首次插管成功率为70%,E组首次插管成功率高于C组。E组插管时间为(20.7±10.6)s,C组插管时间为(21.5±17.6)s,E组优于C组,但差异无统计学意义(P>0.05)。插管操作对血流动力学影响方面,E组心率血压乘积(rate-pressure product,RPP)在T0、T1、T2、T4、T5小于C组,但差异无统计学意义(P>0.05),两组气管插管相关并发症差异无统计学意义(P>0.05)。结论:依据CT三维重建技术图像计算的角度对硬质镜管芯塑型,对提高颈椎固定困难气道患者的首次气管插管成功率具有一定指导意义。展开更多
文摘BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.
文摘The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.
文摘Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesiologist was satisfied by the quality of patient’s cooperation for laryngoscopy in both groups. Conclusion: Subcutaneous dissociative conscious sedation is comparable with general anesthesia to provide desirable situation for laryngoscopy and tracheal intubation.
文摘In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.
文摘目的:研究困难气道中运用CT三维重建技术指导硬质纤维气管镜行气管插管的效果。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级、颈项强直、颈部外伤需制动或严重颈椎病颈椎固定的择期手术患者44例,随机分为两组,试验组(E组)24例和对照组(C组)20例。术前采集入组患者上气道CT数据,依据患者的CT三维重建图像及由此获得的参数计算完成对Shikani硬质纤维气管镜(后简称硬质镜)管芯塑型,随机分组后,根据患者所在组别分别选用相应的硬质镜插管,E组采用根据患者CT三维重建图像计算的角度塑型后的硬质镜,C组采用原始角度硬质镜,并记录首次插管成功率及气管插管成功率,气管插管时间,入室(Tb)、插管后即刻(T0)、插管后5 min内(T1~T5)7个时间点血压、心率和脉搏氧饱和度,以及24 h内气管插管相关并发症。结果:两组插管成功率均为100%,E组首次插管成功率为96%,C组首次插管成功率为70%,E组首次插管成功率高于C组。E组插管时间为(20.7±10.6)s,C组插管时间为(21.5±17.6)s,E组优于C组,但差异无统计学意义(P>0.05)。插管操作对血流动力学影响方面,E组心率血压乘积(rate-pressure product,RPP)在T0、T1、T2、T4、T5小于C组,但差异无统计学意义(P>0.05),两组气管插管相关并发症差异无统计学意义(P>0.05)。结论:依据CT三维重建技术图像计算的角度对硬质镜管芯塑型,对提高颈椎固定困难气道患者的首次气管插管成功率具有一定指导意义。
