BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the ...BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.展开更多
BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we de...BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.展开更多
Objective: To investigate the continuous humidification tube insertion depth of endotracheal intubation and the flow rate of the wetting effect. Methods: From October 2008 to May 2010, among 132 patients of oral and m...Objective: To investigate the continuous humidification tube insertion depth of endotracheal intubation and the flow rate of the wetting effect. Methods: From October 2008 to May 2010, among 132 patients of oral and maxillofacial surgery with tracheal intubation, continuous infusion can be adjusted to the wet method;according to the wet pipe, insertion depth of the flow rate is divided into four groups, by four different depths and velocities of the wetting effect, to be analyzed. Results: B group was significantly lower than other groups satisfied with indicators of four significantly different effects of humidification. Conclusion: When continuous humidification tube insertion depth of endotracheal intubation is 10 - 12 cm, and flow rate is 15 - 20 ml/h, the wetting effect will achieve greater satisfaction.展开更多
AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from Sept...AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.展开更多
The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2 O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importanceof trache...The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2 O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importanceof tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations.展开更多
Background: Comparison of the tracheal tube depth over the same body height of men and women based upon intubation depth markings. Methods: Kashan University of Medical Sciences ethics committee approved the study and...Background: Comparison of the tracheal tube depth over the same body height of men and women based upon intubation depth markings. Methods: Kashan University of Medical Sciences ethics committee approved the study and written informed consent was taken for each patient. Patients undergoing surgery requiring general anesthesia with oro-tracheal intubation were included in a prospective observational study. After induction of general anesthesia, the endotracheal tube was secured at the point at which the cuff was just below the vocal cord on laryngoscopy. Results: In a statistical study of 682 intubated patients which consisted of 499 women and 183 men, 28 cases of laryngoscopic view grade III and IV were excluded from the study. The measurement markings on the ETT at the level of right corner of the mouth were 20.65 ± 0.13 and 18.52 ± 0.08 for men and women respectively (CI 95%). Patient’s height has a meaningful correlation with the measurement of the fixation point of the ETT. Pearson correlation coefficient between the securing point of the tube and height was 0.2 and 0.357 for men and women respectively. In most cases of men and women of the same height, Mann-Whitney U test rejected the hypothesis that the tube can be fixed in the particular point. Conclusions: In general, men are taller than women. Comparing the fixation depth of the tube, even when man and woman have the same body height, the endotracheal tube might be placed in a deeper level for men rather than women.展开更多
目的分析胸腔镜手术应用胸段椎旁置管阻滞联合非插管麻醉的临床应用效果。方法选择2018年4月-2020年6月在某院行胸腔镜手术患者117例,按随机数字表法分为2组,研究组76例,采用胸段椎旁置管阻滞复合非气管插管麻醉下进行,对照组41例,采用...目的分析胸腔镜手术应用胸段椎旁置管阻滞联合非插管麻醉的临床应用效果。方法选择2018年4月-2020年6月在某院行胸腔镜手术患者117例,按随机数字表法分为2组,研究组76例,采用胸段椎旁置管阻滞复合非气管插管麻醉下进行,对照组41例,采用气管插管麻醉下进行。比较两组的临床手术指标、血流动力学指标以及并发症情况。结果研究组患者的麻醉优良率89.47%高于对照组的73.17%,手术时间、麻醉时间、术后禁食时间、开始进食时间、术后住院时间、下地活动时间均短于对照组(P<0.05),术后护理强度、术后6 h VAS评分低于对照组(P<0.05);观察组在T_(1)-T_(7)时间点的SBP、DBP、MAP、HR水平明显低于对照组(P<0.05),PET_(CO2)水平(除在T_(7)时间点)明显高于对照组(P<0.05),且与T_(0)时间点比较,两组在T_(1)-T_(6)时间点的以上指标,差异有明显统计学意义(P<0.05);研究组患者的并发症发生率明显低于对照组(P<0.05)。结论胸段椎旁置管阻滞麻醉复合非气管插管应用于胸腔镜手术具有麻醉效果好,生命体征稳定,且保留患者自主呼吸,术后恢复快。展开更多
文摘BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.
文摘BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.
文摘Objective: To investigate the continuous humidification tube insertion depth of endotracheal intubation and the flow rate of the wetting effect. Methods: From October 2008 to May 2010, among 132 patients of oral and maxillofacial surgery with tracheal intubation, continuous infusion can be adjusted to the wet method;according to the wet pipe, insertion depth of the flow rate is divided into four groups, by four different depths and velocities of the wetting effect, to be analyzed. Results: B group was significantly lower than other groups satisfied with indicators of four significantly different effects of humidification. Conclusion: When continuous humidification tube insertion depth of endotracheal intubation is 10 - 12 cm, and flow rate is 15 - 20 ml/h, the wetting effect will achieve greater satisfaction.
文摘AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.
文摘The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2 O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importanceof tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations.
文摘Background: Comparison of the tracheal tube depth over the same body height of men and women based upon intubation depth markings. Methods: Kashan University of Medical Sciences ethics committee approved the study and written informed consent was taken for each patient. Patients undergoing surgery requiring general anesthesia with oro-tracheal intubation were included in a prospective observational study. After induction of general anesthesia, the endotracheal tube was secured at the point at which the cuff was just below the vocal cord on laryngoscopy. Results: In a statistical study of 682 intubated patients which consisted of 499 women and 183 men, 28 cases of laryngoscopic view grade III and IV were excluded from the study. The measurement markings on the ETT at the level of right corner of the mouth were 20.65 ± 0.13 and 18.52 ± 0.08 for men and women respectively (CI 95%). Patient’s height has a meaningful correlation with the measurement of the fixation point of the ETT. Pearson correlation coefficient between the securing point of the tube and height was 0.2 and 0.357 for men and women respectively. In most cases of men and women of the same height, Mann-Whitney U test rejected the hypothesis that the tube can be fixed in the particular point. Conclusions: In general, men are taller than women. Comparing the fixation depth of the tube, even when man and woman have the same body height, the endotracheal tube might be placed in a deeper level for men rather than women.
文摘目的分析胸腔镜手术应用胸段椎旁置管阻滞联合非插管麻醉的临床应用效果。方法选择2018年4月-2020年6月在某院行胸腔镜手术患者117例,按随机数字表法分为2组,研究组76例,采用胸段椎旁置管阻滞复合非气管插管麻醉下进行,对照组41例,采用气管插管麻醉下进行。比较两组的临床手术指标、血流动力学指标以及并发症情况。结果研究组患者的麻醉优良率89.47%高于对照组的73.17%,手术时间、麻醉时间、术后禁食时间、开始进食时间、术后住院时间、下地活动时间均短于对照组(P<0.05),术后护理强度、术后6 h VAS评分低于对照组(P<0.05);观察组在T_(1)-T_(7)时间点的SBP、DBP、MAP、HR水平明显低于对照组(P<0.05),PET_(CO2)水平(除在T_(7)时间点)明显高于对照组(P<0.05),且与T_(0)时间点比较,两组在T_(1)-T_(6)时间点的以上指标,差异有明显统计学意义(P<0.05);研究组患者的并发症发生率明显低于对照组(P<0.05)。结论胸段椎旁置管阻滞麻醉复合非气管插管应用于胸腔镜手术具有麻醉效果好,生命体征稳定,且保留患者自主呼吸,术后恢复快。