Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.

Lateral position intubation followed by endoscopic ultrasoundguided angiotherapy in acute esophageal variceal rupture: A case report

BACKGROUND Massive esophageal variceal bleeding can be catastrophic,leading to high morbidity and mortality.Patients experiencing massive esophageal variceal bleeding are at high risk of aspiration and hemorrhagic shock in acute episodes.Intubation and bleeding control are the two essential steps for resuscitation of these patients.CASE SUMMARY A 47-year-old male patient was admitted to our hospital with upper digestive tract bleeding.He was diagnosed with alcohol-induced liver cirrhosis and consequent esophagogastric varices.As he did not show a good response to somatostatin and Sengstaken-Blakemore tube placement,the patient was scheduled for endoscopic angiotherapy under anesthesia.Preoperative assessment showed an ASA physical status of III and Child-Pugh classification B.However,massive hemorrhage occurred just after induction of anesthesia.Intubation by video-guided laryngoscopy in the lateral decubitus position was attempted twice and was successful.After that,an experienced endoscopic ultrasound(EUS)specialist performed angiotherapy and occluded the culprit vessel.An ultra-thin gastroscope was then inserted into the endotracheal tube to extract the blood observed in the lobar bronchi.The patient suffered hemorrhagic shock with an estimated blood loss of 1500 mL in 20 min and remained in the intensive care unit for two days.The patient was discharged from our hospital eight days later without major complications.CONCLUSION Intubation in the lateral decubitus position and EUS-guided treatment can be lifesaving procedures in patients with massive upper gastrointestinal hemorrhage.

An effective and safe gastric endoscopic submucosal dissection in the right lateral position using an inverted overtube

Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection(ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.

Successful fiberoptic orotracheal intubation by lifting large thyroid mass and tongue protrusion in left lateral position:a case report

Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position,the decision to switch to the left lateral position was made.We present this case to propose the utilization of the lateral position for awake intubation.Case presentation:We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision.The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue.The breathing difficulties subsided in the lateral position.Conclusion:We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.

Amiodaron in atrial fibrillation:post coronary artery bypass graft

BACKGROUND:Atrial fibrilation(AF) is the most common complication following heart surgeries;it often occurs in patients after coronary artery bypass graft(CABG).The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG.DATA RESOURCES:We searched google scholar,pubmed,and Cochrane Library databases(the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery.A total of 1 561 articles were identified,and 30 articles met the criteria and were enrolled in this review.RESULTS:Most studies supported Amiodarone for prophylaxi purpose in patients who were performed with CABG;few papers supported Amiodaron as a drug for treating CABG.The prophylaxis can decrease the incidence rate of AF in CABG,but if it uses as a treatment,the side effect of Amiodaron will decrease because all of the patients will not get Amiodarone.In the other hand use of Amiodarone as a treatment does not influence the length of hospital stay significantly but these kinds of study are so few.CONCLUSION:No appropriate therapeutic method has been defined for AF.At present,the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.

Effect of Right Supine Tracheal Extubation on Respiratory Complications and Airway Pressure in the Waking Period of General Anesthesia in Pediatric Stomatology

Objective: The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. Methods: Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO2 of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. Results: The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH2O. Conclusion: For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.