BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as ast...BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as asthma in adolescent patients.CASE A 16-year-old adolescent girl admitted to a local hospital with symptoms of an irritating cough and wheezing was diagnosed with bronchial asthma and treated with budesonide and formoterol.Over the next year,the patient's wheezing and coughing symptoms gradually worsened and the antiasthma treatment was ineffective.One week prior to this admission,the patient developed dyspnea after catching a cold and was transferred to our hospital with a diagnosis of severe asthma.However,chest computed tomography and bronchoscopy showed a mass in the trachea.Primary intratracheal schwannoma was diagnosed by biopsy.Her symptoms were relieved by endoscopic resection by electrosurgical snaring combined with argon plasma coagulation.No relapse occurred during an 18 mo follow-up.CONCLUSION Primary intratracheal schwannoma should be considered in the differential diagnosis in adolescents with recurrent asthma-like attacks.展开更多
BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has as...BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has assessed the effect of ETT size on the fl ow rate and airway pressure during CPR.METHODS:We measured changes in peak inspiratory fl ow rate(PIFR),peak airway pressure(Ppeak),and mean airway pressure(Pmean)according to changes in ETT size(internal diameter 6.0,7.0,and 8.0 mm)and with or without CPR.A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator.Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device(LUCAS2,mode:active continuous,chest compression rate:102±2/minute,chest compression depth 2–2.5 inches).RESULTS:The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT(6.0 vs.8.0 mm):PIFR(32.1 L/min[30.5–35.3]vs.28.9 L/min[27.5–30.8],P<0.001),Ppeak(48.84 cmH2O[27.46–52.11]vs.27.45 cmH2O[22.53–52.57],P<0.001),and Pmean(18.34 cmH2O[14.61–21.66]vs.13.66 cmH2O[8.41–19.24],P<0.001).CONCLUSION:The changes in PIFR,Ppeak,and Pmean were related to the internal diameter of ETT,and these values tended to decrease with an increase in ETT size.Higher airway pressures were measured in the CPR group than in the no CPR group.展开更多
Objective： The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine （in different forms） with air and/or normal saline （NS） dur...Objective： The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine （in different forms） with air and/or normal saline （NS） during general anesthesia with tracheal intubation. Methods： Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. Thirteen randomized, controlled trials involving 1 010 patients were ultimately identified. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. Random-effect model and subgroup studies were used when significant heterogeneity existed among those trials. Results： Compared with air and NS, intracufflidocaine could significantly alleviate the severity of sore throat at different time points （15min, 30min, lh, 2h, 3h, 6h, 12h and 24h aiter extubation） and the occurrence of cough, restlessness, postoperative nausea and vomiting, dysphonia and hoarseness. Besides intracufflidocaine brought about a significant prolongation of spontaneous ventilation time. It was worth mentioning that, compared withlidocaine or its hydrochloride form, alkalinized lidocainewas much more efficient in reducing the severity of sore throat and prolonging spontaneous ventilation time. Conclusion： The present meta-analysis indicates that intracuttlidocaine can significantly improve endotracheal tube tolerance and this improvement can be strengthened by alkalinization of lidocaine.展开更多
Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the...Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.展开更多
Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it ...Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it required to be performed by an expert. Nowadays, it remains a useful technique when treating patients with difficult airways, so it is of utmost importance all personnel involved with airway management must know and perfect this technique when scenarios where conventional laryngoscopy or rescue devices for difficult airway are not available or contraindicated. The present work’s main objective is to suggest digital intubation as a safe and effective technique for the management of patients with difficult airways when there are no other devices available. The authors present a successful case of digital intubation on a patient with a difficult airway, demonstrating this technique is useful when performed by expert practitioners and when there is no other equipment available.展开更多
Background Inhalational anesthesia with sevoflurane for endotracheal intubation without muscle relaxant is now used widely for pediatric patients. This study assessed the efficacy and safety of induction with high con...Background Inhalational anesthesia with sevoflurane for endotracheal intubation without muscle relaxant is now used widely for pediatric patients. This study assessed the efficacy and safety of induction with high concentration sevoflurane and of nasotracheal intubation without muscle relaxant in infants with increased or decreased pulmonary blood flow （PBF） and undergoing surgery for congenital heart diseases. Methods Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled for congenital cardiac surgery were enrolled. Subjects were divided into those with increased （IPBF group, n--29） and decreased （DPBF group, n=26） pulmonary blood flow. All infants received inhalational induction with 8% sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal intubation was performed 4 minutes after induction. Sevoflurane vaporization was decreased to 4.0% for placement of a peripheral intravenous line and invasive hemodynamic monitors. Five minutes later, sedatives and muscle relaxant were administered and the vaporizer was adjusted to 2% for maintenance of anesthesia. Bispectral index （BIS） scores, circulatory parameters, satisfactory and successful intubation ratios, adverse reactions, and complications of intubation were recorded. Results Times to loss of lash and pain reflexes were longer for the DPBF group （P 〈0.01）. Satisfactory intubation ratios were 93.1% and 61.5% for the I PBF and DPBF groups, respectively （P=0.008）. Successful intubation ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively （P=0.044）. Following sevoflurane inhalation, blood pressures decreased significantly in the IPBF group but remained stable in the DPBF group. BIS scores declined to similar stable values, and a ＂nadir BIS＂ was recorded for both groups. No obvious adverse reactions or complications of intubation were noted perioperatively. Conclusions Induction with high concentration sevoflurane, although faster for infants with IPBF, is safe for infants with IPBF or DPBF. However, nasotracheal intubation without muscle relaxant after induction with high concentration sevoflurane is less successful and less satisfactory for infants with DPBF and should be used with caution in this patient group.展开更多
Polylactide(PLA) microspheres were prepared using the solid-in-oil(S/O) spray-drying method to achieve the sustained release of a hydrophilic drug for the treatment of tuberculosis, via intratracheal instillation. Iso...Polylactide(PLA) microspheres were prepared using the solid-in-oil(S/O) spray-drying method to achieve the sustained release of a hydrophilic drug for the treatment of tuberculosis, via intratracheal instillation. Isoniazid(IN), a low-molecular-weight hydrophilic drug, was used as a model drug. The effects of various sizes of micronized IN powder, different drug/polymer ratios, spray-drying process parameters, and drug-release characteristics were studied to optimize the manufacturing parameters. A high entrapment efficiency(87.3%) was obtained using this method; furthermore, the microspheres were spherical and smooth. They were individually and homogenously distributed, with a mean diameter of 5.6 μm; furthermore, they showed a satisfactory extended sustained-release phase. After administration of the microspheres to rats, pulmonary drug concentrations were maintained at a relatively stable level for up to 4 weeks.展开更多
基金Natural Science Foundation of Gansu Province,China,No.20JR5RA335.
文摘BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as asthma in adolescent patients.CASE A 16-year-old adolescent girl admitted to a local hospital with symptoms of an irritating cough and wheezing was diagnosed with bronchial asthma and treated with budesonide and formoterol.Over the next year,the patient's wheezing and coughing symptoms gradually worsened and the antiasthma treatment was ineffective.One week prior to this admission,the patient developed dyspnea after catching a cold and was transferred to our hospital with a diagnosis of severe asthma.However,chest computed tomography and bronchoscopy showed a mass in the trachea.Primary intratracheal schwannoma was diagnosed by biopsy.Her symptoms were relieved by endoscopic resection by electrosurgical snaring combined with argon plasma coagulation.No relapse occurred during an 18 mo follow-up.CONCLUSION Primary intratracheal schwannoma should be considered in the differential diagnosis in adolescents with recurrent asthma-like attacks.
基金supported by the Chungnam National University Hospital Research Fund,2016
文摘BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has assessed the effect of ETT size on the fl ow rate and airway pressure during CPR.METHODS:We measured changes in peak inspiratory fl ow rate(PIFR),peak airway pressure(Ppeak),and mean airway pressure(Pmean)according to changes in ETT size(internal diameter 6.0,7.0,and 8.0 mm)and with or without CPR.A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator.Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device(LUCAS2,mode:active continuous,chest compression rate:102±2/minute,chest compression depth 2–2.5 inches).RESULTS:The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT(6.0 vs.8.0 mm):PIFR(32.1 L/min[30.5–35.3]vs.28.9 L/min[27.5–30.8],P<0.001),Ppeak(48.84 cmH2O[27.46–52.11]vs.27.45 cmH2O[22.53–52.57],P<0.001),and Pmean(18.34 cmH2O[14.61–21.66]vs.13.66 cmH2O[8.41–19.24],P<0.001).CONCLUSION:The changes in PIFR,Ppeak,and Pmean were related to the internal diameter of ETT,and these values tended to decrease with an increase in ETT size.Higher airway pressures were measured in the CPR group than in the no CPR group.
文摘Objective： The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine （in different forms） with air and/or normal saline （NS） during general anesthesia with tracheal intubation. Methods： Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. Thirteen randomized, controlled trials involving 1 010 patients were ultimately identified. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. Random-effect model and subgroup studies were used when significant heterogeneity existed among those trials. Results： Compared with air and NS, intracufflidocaine could significantly alleviate the severity of sore throat at different time points （15min, 30min, lh, 2h, 3h, 6h, 12h and 24h aiter extubation） and the occurrence of cough, restlessness, postoperative nausea and vomiting, dysphonia and hoarseness. Besides intracufflidocaine brought about a significant prolongation of spontaneous ventilation time. It was worth mentioning that, compared withlidocaine or its hydrochloride form, alkalinized lidocainewas much more efficient in reducing the severity of sore throat and prolonging spontaneous ventilation time. Conclusion： The present meta-analysis indicates that intracuttlidocaine can significantly improve endotracheal tube tolerance and this improvement can be strengthened by alkalinization of lidocaine.
文摘Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.
文摘Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it required to be performed by an expert. Nowadays, it remains a useful technique when treating patients with difficult airways, so it is of utmost importance all personnel involved with airway management must know and perfect this technique when scenarios where conventional laryngoscopy or rescue devices for difficult airway are not available or contraindicated. The present work’s main objective is to suggest digital intubation as a safe and effective technique for the management of patients with difficult airways when there are no other devices available. The authors present a successful case of digital intubation on a patient with a difficult airway, demonstrating this technique is useful when performed by expert practitioners and when there is no other equipment available.
文摘Background Inhalational anesthesia with sevoflurane for endotracheal intubation without muscle relaxant is now used widely for pediatric patients. This study assessed the efficacy and safety of induction with high concentration sevoflurane and of nasotracheal intubation without muscle relaxant in infants with increased or decreased pulmonary blood flow （PBF） and undergoing surgery for congenital heart diseases. Methods Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled for congenital cardiac surgery were enrolled. Subjects were divided into those with increased （IPBF group, n--29） and decreased （DPBF group, n=26） pulmonary blood flow. All infants received inhalational induction with 8% sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal intubation was performed 4 minutes after induction. Sevoflurane vaporization was decreased to 4.0% for placement of a peripheral intravenous line and invasive hemodynamic monitors. Five minutes later, sedatives and muscle relaxant were administered and the vaporizer was adjusted to 2% for maintenance of anesthesia. Bispectral index （BIS） scores, circulatory parameters, satisfactory and successful intubation ratios, adverse reactions, and complications of intubation were recorded. Results Times to loss of lash and pain reflexes were longer for the DPBF group （P 〈0.01）. Satisfactory intubation ratios were 93.1% and 61.5% for the I PBF and DPBF groups, respectively （P=0.008）. Successful intubation ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively （P=0.044）. Following sevoflurane inhalation, blood pressures decreased significantly in the IPBF group but remained stable in the DPBF group. BIS scores declined to similar stable values, and a ＂nadir BIS＂ was recorded for both groups. No obvious adverse reactions or complications of intubation were noted perioperatively. Conclusions Induction with high concentration sevoflurane, although faster for infants with IPBF, is safe for infants with IPBF or DPBF. However, nasotracheal intubation without muscle relaxant after induction with high concentration sevoflurane is less successful and less satisfactory for infants with DPBF and should be used with caution in this patient group.
基金supported by the 12th Five-Year Important National Science & Technology Specific Projectsthe National Science & Technology Major Special Project on the Prevention and Cure of Acquired Immune Deficiency Syndrome and Virus Hepatitis (2012ZX10003009-001-002)
文摘Polylactide(PLA) microspheres were prepared using the solid-in-oil(S/O) spray-drying method to achieve the sustained release of a hydrophilic drug for the treatment of tuberculosis, via intratracheal instillation. Isoniazid(IN), a low-molecular-weight hydrophilic drug, was used as a model drug. The effects of various sizes of micronized IN powder, different drug/polymer ratios, spray-drying process parameters, and drug-release characteristics were studied to optimize the manufacturing parameters. A high entrapment efficiency(87.3%) was obtained using this method; furthermore, the microspheres were spherical and smooth. They were individually and homogenously distributed, with a mean diameter of 5.6 μm; furthermore, they showed a satisfactory extended sustained-release phase. After administration of the microspheres to rats, pulmonary drug concentrations were maintained at a relatively stable level for up to 4 weeks.
