瑞芬太尼-丙泊酚在无肌肉松弛剂诱导经鼻气管插管中的应用

目的:观察瑞芬太尼-丙泊酚用于无肌肉松弛剂诱导经鼻气管插管的可行性、安全性。方法:30例ASAⅠ或Ⅱ级的择期妇科腹腔镜手术患者,丙泊酚缓慢静脉注射1.0～1.2mg/kg至患者意识消失后改为3mg·kg-1·h-1维持,瑞芬太尼静脉注射1.5μg/kg(1.5min左右)后以0.05μg·kg-1·min-1维持。待患者下颌较松弛且托起无反应,明视下经鼻气管插管。麻醉诱导前(T0)、意识消失时(T1)、气管插管即刻(T2)、插管后3min(T3)分别记录平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)。记录患者麻醉诱导时瑞芬太尼、丙泊酚用量、插管时间,评价插管条件。结果:与T0比较,T1、T2、T3时MAP明显降低(P<0.05);T1时HR明显降低(P<0.05),T2、T3时差异无统计学意义(P>0.05);T1、T2、T3时SpO2差异无统计学意义(P>0.05)。丙泊酚用量(1.2±0.1)mg/kg,瑞芬太尼用量(1.8±0.2)μg/kg。插管时间(2.4±0.3)min。插管成功率100%。气管插管条件的评价:优21例(70.0%),良8例(26.7%),差1例(3.3%)。结论:瑞芬太尼-丙泊酚无肌肉松弛剂诱导经鼻气管插管可以安全地应用于临床。

盲探气管插管装置在困难气道中的临床应用

目的：观察盲探气管插管装置用于插管困难病人的临床效果。方法：分析63例ASA~级术前预知插管困难行气管插管全麻手术患者的临床资料,预测指标≥1项为阳性。气管插管困难的预测指标为张口度〈3cm,颈部后仰度〈30°,Mallampati试验~级和甲颏间距〈6.5cm。结果：本组患者的气管插管成功率为100%,气管插管的操作时间为3~20min,平均5.6min。所有病例呼吸平稳,血流动力学及SPO2与插管前基础值比较无显著性差异（P〉0.05）,操作中未见严重并发症。结论：盲探气管插管装置具有创伤小、痛苦少、并发症低、成功率高、价格低廉等优点,是处理临床困难气管插管的较好方法,提高了麻醉手术的安全性。

无气管插管无痛胃镜治疗胃疾病202例观察

目的:探讨无气管插管无痛胃镜治疗胃疾病的临床疗效。方法:对202例胃疾病患者采用无气管插管无痛胃镜治疗,分析观察临床疗效。结果:202例患者在无气管插管无痛胃镜下治疗,过程顺利,均得到较好的疗效。结论:无气管插管无痛胃镜下治疗胃疾病疗效较好,安全可行。

INSURE技术治疗早产儿呼吸窘迫综合征60例对比观察

目的:探讨INSURE技术治疗早产儿呼吸窘迫综合征的临床效果。方法:将早产儿呼吸窘迫综合征患者60例根据治疗方法的不同分为治疗组30例与对照组30例,对照组单独应用持续正压通气治疗,治疗组应用INSURE技术治疗。结果:两组治疗后的PO2、PO2/FiO2值较治疗前有明显上升(P<0.05),PCO2较治疗前有明显下降(P<0.05),两组PO2、PO2/FiO2、PCO2在治疗后各个时间点与治疗前比较无显著性差异(P>0.05)。治疗组死亡1例,对照组死亡4例,两组患者病死率对比具有显著性差异(P<0.05),治疗组患者并发症发生率明显少于对照组(P<0.05)。结论:INSURE技术治疗早产儿呼吸窘迫综合征能有效保持动脉血气的稳定,降低早产儿并发症的发生率,其机制可能与减轻气道阻力、减轻肺水肿有关。

喉罩人工呼吸支持在急诊科心肺复苏中的急救效果分析

目的:比较急诊科心肺复苏中使用喉罩与气管插管的急救效果。方法:按照随机数字表的分组方法将我院急诊科2012年2月至2013年6月行心肺复苏治疗100例患者分为A组和B组各50例,A组患者心肺复苏中使用气管插管,B组患者心肺复苏中使用喉罩。比较两组患者的临床效果。结果:B组插管所需时间、复苏成功、一次性插管成功率等指标均优于A组,两组差异有统计学意义(P<0.05)。结论:喉罩可缩短急诊心肺复苏抢救的插管时间,提高插管的成功率,值得在临床上应用。

小儿食管异物80例取出术两种麻醉方法效果观察

目的:探讨两种不同麻醉方法用于小儿食管异物取出术的麻醉效果。方法:将80例拟行食管异物取出术患儿随机分为不插气管插管(A组)和气管插管(B组)两组,监测术中心率、血压、SpO2变化,麻醉效果及各种不良反应(呼吸抑制、低氧血症、术中体动、恶心呕吐等)发生情况、苏醒和离室时间。结果:A组患儿在苏醒和离室时间方面快于B组(P<0.05)。B组患儿术中呼吸抑制、低氧、体动、术后恶心、呕吐发生率明显低于A组(P<0.05)。结论:气管插管麻醉是一种可以安全应用于小儿食道异物取出术的麻醉方式。

Shikani Optical Stylet–guided Intubation via the Intubating Laryngeal Airway in Patients With Scar Contracture of the Face and Neck

Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.

EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLAMINE RESPONSE TO TRACHEAL INTUBATION

Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

Evolution of continent ileostomy

Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy.Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy.The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980.Despite its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve problems.Operative mortalities have also been reported in the literature.Most of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the technique.Many modifications have been introduced to prevent this problem.Some patients have had their pouch removed because of complications mainly related to valve dysfunction.Although revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life.Today,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA.Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.

“Passive-bending colonoscope”significantly improves cecal intubation in difficult cases

Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and shortens.While non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of pain.Most of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the colon.The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope.The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain.The "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort.Therefore,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.

A comparison of GlideScope videolaryngoscope with Macintosh laryngoscope for laryngeal views

Objective：To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods：Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features （Mallampati oropharyngeal scale, thyromenta distance and mouth opening）. In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn, and the views of the glottis at laryngoscopy （Cormack and Lehane scores） were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or GlideScope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results： There were 200 patients including 107 males and 93 females, with mean age being 52±13 years, height 164.8±11.3 cm, weight 64.0±11. 5 kg, thyromental distance 6. 9± 1.1 cm, and mouth opening 5.7±0.5 cm. There was a significant association between the preoperative view of the oropharynx （Mallampati score） and the view of the glottis at laryngoscopy for both the direct Macintosh laryngoscope （P〈0. 001） and the GlideScope （P〈0. 001）. Among 200 patients, 106 patients had the same C＆L grade, 91 of remaining patients showed improvement in the C＆L grade （P〈0. 001 ） obtained with GlideScope compared with the direct Macintosh laryngoscope. 3 of remaining patients showed better view of the glottis（C＆L grade） with the direct Macintosh laryngoscope （grade 1） than with GlideScope （grade 2）. There were no cases of failure to be intubated. There were no cases of dental or mucosal injury in all patients. Conclusion： GlideScope videolaryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the difficult airway.

Intravenous preemptive analgesia modifies the distribution of lymphocyte subsets after radical mastectomy

Objective: In this study, we evaluated the effect of preemptive analgesia of flurbiprofen axetil (FA) and tramadol on immune response in patients undergoing radical mastectomy. Methods: In this prospective randomized, double-blind, placebo-controlled study, 80 patients were randomly assigned to one of four groups (n = 20). The FA group (group A) patients received FA before tracheal intubation and at the end of surgery. The tramadol group (group B) patients received tramadol before tracheal intubation and at the end of surgery. The control group (group C) patients received saline before tracheal intubation and at the end of surgery. The combination group (group D) patients received FA and tramadol before tracheal intubation and at the end of surgery. Cluster of differentiation and lymphocytes were measured. Results: The CD3, CD4, CD8 and lymphocytes decreased postoperatively of all groups except of group A and D at 0.5 h postoperatively (P < 0.05). The CD3, CD4, CD8 and lymphocytes of group D were higher than those of group C at 0.5 h and 4 h postoperatively (P < 0.05). Conclusion: Preemptive analgesia using flurbiprofen axetil (FA) and tramadol may protect the immune system. The immune protective effect of FA may be better than that of tramadol. The combination of FA and tramadol may be the most effective among all the strategies.

Submental tracheal intubation for resection of recurrent giant pituitary tumor:a case report

Airway management in the patients who receive transmaxillary approach for resection of giant pituitary tumor presents a clinical challenge to the anesthesiologists. Oral or nasal route for tracheal intubation can interfere with surgical procedures. This report describes submental tracheal intubation for airway management in a patient who underwent resection of recurrent giant pituitary tumor via transmaxillary approach. Submental tracheal intubation is an adaptable and safe alternative technology for airway management during operation.

A case of radiation-induced difficult airway in a patient with nasopharyngeal carcinoma

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.

A RETROSPECTIVE STUDY OF ARYTENOID DISLOCATION AFTER ENDOTRACHEAL INTUBATION

Five cases of arytenoid dislocation after intubation under general anesthesia are reported in this article. The anatomical and anesthetic causes of this complication were studied restrospectively, and the methods of treatment were discussed. The result showed that the incidence of arytenoid dislocation was about 0. 09% (5/5 826). Hoarseness, dysphonia and difficulty in feeding were the prevalent symptoms, and poor mobili- ty of the vocal fold was the most common sign. The treatment included closed reduction of the displaced arytenoid under local anesthesia, steroid and physical therapy. The possible causes of arytenoid dislocation were summarized as follows: (1) trauma produced by the blade tip of laryngoscope, (2) the use of stylet, (3) overstretching of aryepiglottic fold and vocal cord during laryngoscopy and intubation, and (4) cough- ing and movement of the endotracheal tube on the larynx during the endotracheal tube in place. It was sug- gested that correct technique and gentle manipulation during intubation could reduce the incidence of the complication. Timely postoperative follow-up and early reduction of arytenoid cartilage should be empha-sized in the diagnosis and treatment of the complication.

Improving endotracheal tube tolerance with intracufflidocaine: a meta-analysis of randomized controlled trials

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.

CLINICAL APPLICATION OF ACUPUNCTURE ON ALLEVIATION OF STRESS REACTION INDUCED BY TRACHEAL INTUBATION IN GENERAL ANESTHESIA

By summarizing the formation of stress reaction induced by tracheal intubation and method of medicinal control, the recognition of Chinese medicine in treatment of cardiac arrhythmia and hypertension with acupuncture and the clinical application of acupuncture on stress reaction induced by tracheal intubation, it is concluded that the side effects of tracheal intubation are inevitable, even though there are many methods presented for the prevention and treatment for it. In recent years, the functions of acupuncture in anesthesia, especially in regulation of circulatory properties have been developed gradually and have been applied by many physicians in controlling the stress reaction induced by tracheal intubation in general anesthesia. Being a kind of dual-directional and positive regulation and stimulation, acupuncture provides definite and safe effects on controlling the stress reaction induced by tracheal intubation.

Difficult Endotracheal Intubation -Scales and Causes

The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.

A 92-year-old man with retropharyngeal hematoma caused by an injury of the anterior longitudinal ligament

Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography （CT） with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging （MRI） revealed an anterior longitudinal ligament （C4-5 levels） injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidenee of injury.