Background： Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Styler （SOS） has become increasingly popular ...Background： Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Styler （SOS） has become increasingly popular in difficult airway. We compared the effects ofintubation with SOS versus Macintosh laryngoscope （MLS） in patients undergoing surgery for cervical spondylosis. Methods： A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades IlI IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results： The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively （P = 0.605）. lntubation with SOS took longer compared with MLS （normal airway： 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway： 38.5± 8.5 s vs. 36.1 ±8,2 s, P = 0.389）. Intubation with SOS required less assistance in patients with difficult airway （5.9% vs. 100%, P 〈 0.001 ）. The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway （22.0% vs. 34.5%, P =0.034）. Conclusions： SOS is a sale and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway. Trial Registration： Chinese Clinical Trial Registry, ChiCTR-IOR- 16007821 ; http：//www.chictr.org.cn/showproj.aspx？proj-13203.展开更多
Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam （DM...Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam （DM） and sufentanil with midazolam （SM） for sedation for awake fiberoptic nasotracheal intubation. Methods： Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups （n = 25 per group） by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified ＂spray-as-you-go＂ technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infllsion of 0.25 μg.kg^-1.h ^-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 rain followed by a continuous infusion of 0.1 μg.kg^-1.h ^-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose ofmidazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers＇Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed.Results： The scores of ease of the AFOI procedure, patient＇s reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups （z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P 〉 0.05）. Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO, after intubation was higher in Group SM than that in Group DM （45.2 ± 4.2 mmHg vs. 42.2 ±4.3 mmHg, t = 2.495, P 〈 0.05）. Conclusions： Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.展开更多
文摘Background： Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Styler （SOS） has become increasingly popular in difficult airway. We compared the effects ofintubation with SOS versus Macintosh laryngoscope （MLS） in patients undergoing surgery for cervical spondylosis. Methods： A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades IlI IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results： The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively （P = 0.605）. lntubation with SOS took longer compared with MLS （normal airway： 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway： 38.5± 8.5 s vs. 36.1 ±8,2 s, P = 0.389）. Intubation with SOS required less assistance in patients with difficult airway （5.9% vs. 100%, P 〈 0.001 ）. The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway （22.0% vs. 34.5%, P =0.034）. Conclusions： SOS is a sale and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway. Trial Registration： Chinese Clinical Trial Registry, ChiCTR-IOR- 16007821 ; http：//www.chictr.org.cn/showproj.aspx？proj-13203.
文摘Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam （DM） and sufentanil with midazolam （SM） for sedation for awake fiberoptic nasotracheal intubation. Methods： Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups （n = 25 per group） by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified ＂spray-as-you-go＂ technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infllsion of 0.25 μg.kg^-1.h ^-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 rain followed by a continuous infusion of 0.1 μg.kg^-1.h ^-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose ofmidazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers＇Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed.Results： The scores of ease of the AFOI procedure, patient＇s reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups （z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P 〉 0.05）. Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO, after intubation was higher in Group SM than that in Group DM （45.2 ± 4.2 mmHg vs. 42.2 ±4.3 mmHg, t = 2.495, P 〈 0.05）. Conclusions： Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.
