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
目的比较不同剂量阿芬太尼对老年患者快速顺序诱导气管插管心血管反应的影响。方法选择2022年3—9月行气管插管全麻老年患者96例,男47例,女49例,年龄65~80岁,BMI 18~24 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法分为四组:阿芬太尼10μg/k...目的比较不同剂量阿芬太尼对老年患者快速顺序诱导气管插管心血管反应的影响。方法选择2022年3—9月行气管插管全麻老年患者96例,男47例,女49例,年龄65~80岁,BMI 18~24 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法分为四组:阿芬太尼10μg/kg组(A组)、阿芬太尼15μg/kg组(B组)、阿芬太尼20μg/kg组(C组)和阿芬太尼25μg/kg组(D组),每组24例。记录麻醉诱导前、气管插管后1、5 min的HR、MAP,同时抽取患者静脉血3 ml,检测血浆中去甲肾上腺素(NE)和皮质醇(Cor)的浓度、超声测量心脏指数(CI)、心脏射血分数(EF)。记录麻醉诱导后至气管插管后5 min高血压、低血压、心动过缓、心动过速的发生情况。结果与麻醉诱导前比较,A组和B组在气管插管后1、5 min HR明显增快,MAP、NE和Cor浓度明显升高,CI和EF明显降低(P<0.05);C组和D组气管插管后1 min HR明显增快,MAP明显升高,D组插管后5 min HR明显减慢,MAP、血浆NE和Cor浓度、CI和EF明显降低(P<0.05)。与A组比较,C组和D组气管插管后1、5 min HR明显减慢,血浆NE和Cor浓度明显降低,气管插管后1 min CI和EF明显升高,高血压和心动过速发生率明显降低(P<0.05);D组插管后5 min CI和EF明显降低,低血压和心动过缓发生率明显升高(P<0.05)。结论阿芬太尼20μg/kg用于老年患者快速顺序诱导气管插管,可有效抑制插管引起的剧烈心血管反应,同时避免心血管系统的抑制,血流动力学更平稳。展开更多
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.
文摘目的比较不同剂量阿芬太尼对老年患者快速顺序诱导气管插管心血管反应的影响。方法选择2022年3—9月行气管插管全麻老年患者96例,男47例,女49例,年龄65~80岁,BMI 18~24 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法分为四组:阿芬太尼10μg/kg组(A组)、阿芬太尼15μg/kg组(B组)、阿芬太尼20μg/kg组(C组)和阿芬太尼25μg/kg组(D组),每组24例。记录麻醉诱导前、气管插管后1、5 min的HR、MAP,同时抽取患者静脉血3 ml,检测血浆中去甲肾上腺素(NE)和皮质醇(Cor)的浓度、超声测量心脏指数(CI)、心脏射血分数(EF)。记录麻醉诱导后至气管插管后5 min高血压、低血压、心动过缓、心动过速的发生情况。结果与麻醉诱导前比较,A组和B组在气管插管后1、5 min HR明显增快,MAP、NE和Cor浓度明显升高,CI和EF明显降低(P<0.05);C组和D组气管插管后1 min HR明显增快,MAP明显升高,D组插管后5 min HR明显减慢,MAP、血浆NE和Cor浓度、CI和EF明显降低(P<0.05)。与A组比较,C组和D组气管插管后1、5 min HR明显减慢,血浆NE和Cor浓度明显降低,气管插管后1 min CI和EF明显升高,高血压和心动过速发生率明显降低(P<0.05);D组插管后5 min CI和EF明显降低,低血压和心动过缓发生率明显升高(P<0.05)。结论阿芬太尼20μg/kg用于老年患者快速顺序诱导气管插管,可有效抑制插管引起的剧烈心血管反应,同时避免心血管系统的抑制,血流动力学更平稳。
