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
Fiberoptic bronchoscope （FOB） is an important instrument for respiratory, disorder examination and difficult airway can avoid management. The fiberoptic intubation the mechanical stimulus to oropharyngolaryngeal str...Fiberoptic bronchoscope （FOB） is an important instrument for respiratory, disorder examination and difficult airway can avoid management. The fiberoptic intubation the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic responses during orotracheal intubation. However, the relevant studies showed conflicting results. In this study, we observed the hemodynamic responses to orotracheal intubation using an FOB and a direct laryngoscope （DLS） in healthy adults under general anesthesia to examine the efficacy of the FOB in attenuating the hemodynamic responses to orotracheal intubation.展开更多
Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsisten...Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.展开更多
目的:对比观察胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响。方法:选择40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级、年龄19~66岁拟在经口双腔气管插管全身麻醉下施择期手术的...目的:对比观察胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响。方法:选择40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级、年龄19~66岁拟在经口双腔气管插管全身麻醉下施择期手术的胸外科患者,分别为常规全身麻醉诱导下直接喉镜双腔气管插管组(T组,20例)和常规全身麻醉诱导复合胸部硬膜外给予利多卡因后实施双腔气管插管组(E组,20例)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作,观察两组患者麻醉诱导前后及气管插管时和气管插管后5 min内的血压(blood pressure,BP)、心率(heart rate,HR)、二重指数(rate pressure product,RPP)和脑电双频指数(bispectral index ,BIS)的变化,并记录气管插管时间。结果:麻醉诱导后,两组患者的BP和RPP均较麻醉诱导前明显降低。与麻醉诱导后相比较,气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较,气管插管后E组患者BP明显降低,T组患者收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和平均动脉压(mean arterial pressure,MAP)明显升高,且持续时间约1 min。两组患者气管插管后HR均明显升高,T组患者HR增快持续约4 min,E组患者HR增快持续约1 min。与E组相比较,观察期内气管插管后T组SBP、DBP、MAP、HR和RPP均明显升高。与基础值相比,两组患者麻醉诱导后和气管插管后的BIS值均明显降低,且两组之间差异无统计学意义。与E组比较,观察期T组SBP大于基础值30%和RPP大于22 000的发生率明显较高,且E组中未见SBP大于基础值30%和RPP大于22 000的患者。结论:在双腔气管插管期间,硬膜外给予利多卡因可明显减轻插管导致的剧烈血流动力学变化,但对唤醒反应无影响。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Fiberoptic bronchoscope （FOB） is an important instrument for respiratory, disorder examination and difficult airway can avoid management. The fiberoptic intubation the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic responses during orotracheal intubation. However, the relevant studies showed conflicting results. In this study, we observed the hemodynamic responses to orotracheal intubation using an FOB and a direct laryngoscope （DLS） in healthy adults under general anesthesia to examine the efficacy of the FOB in attenuating the hemodynamic responses to orotracheal intubation.
文摘Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.
