To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation,indirect laryngoscope (IL ) and direct laryngoscope (DL ) were utilized for the closed...To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation,indirect laryngoscope (IL ) and direct laryngoscope (DL ) were utilized for the closed reduction of the displaced arytenoid under local anesthesia.2 3patients who underwent the reduction for dislocated arytenoid under IL or DL from January1991to June 2 0 0 1were reviewed.The data were collected on the duration of the laryngeal injury,tim es of re- ceiving reduction,side- effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilita- tion was examined.13patients received the reduction under IL and 10 patients under DL .Except the tim es of the reduction,which showed significant difference,no differences were found between IL group and DL group in the course and the period of voice rehabilitation,as well as sore throat after the manipulation.The patients'voice recovery was positively related to their course of dis- ease in both IL and DL group.Itis concluded thatthe recovery of normal voice is obviously affect- ed by the duration of arytenoid dislocation.The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation.Reduction by DL is better suit the patients with long tim e course of disease.展开更多
BACKGROUND: Post operative sore throat (PST) is one of the most common complaints after tracheal intubation. In this study we compared the effects of curved and straight laryngoscope blades on severity and incidence o...BACKGROUND: Post operative sore throat (PST) is one of the most common complaints after tracheal intubation. In this study we compared the effects of curved and straight laryngoscope blades on severity and incidence of PST. METHOD: In this prospective randomized clinical trial we evaluated incidence and severity of PST in 147 ASA physical status I–II, aged 18 – 62 y (group Miller, n = 71), (group Macintosh, n = 76) following intubation with Miller and Macintosh laryngoscope blades by using Visual Analog Scale (VAS). RESULTS: The overall incidence of PST in our study was 35.4% (Macintosh group = 39.5% and in Miller group = 31% and P = 0.829). The incidence of PST was not statistically different between two kinds of laryngoscope blades and the mean rank of pain score was not statistically different in recovery room and up to 48 hours after surgery. CONCLUSIONS: Our study showed these types of laryngoscope blade had not association with incidence and severity of PST. .展开更多
AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwe...AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009("pre-VL" group) and over the same 2-mo period after the introduction of VLs in 2012("postVL" group). Patient records with predicted difficult air-ways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.RESULTS To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually(P = 0.1768), it showed a trend toward significance when covariates were accounted for(P = 0.0910). Several factors predicting a higherlikelihood of awake FOI were found to be statistically significant: Morbid obesity(larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender(P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score(P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.CONCLUSION Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.展开更多
An integrated optical coherence tomography(OCT)and video rigid laryngoscope have been designed to acquire surface and subsurface tissue images of larynx simultaneously.The dual-modality system that is based on a commo...An integrated optical coherence tomography(OCT)and video rigid laryngoscope have been designed to acquire surface and subsurface tissue images of larynx simultaneously.The dual-modality system that is based on a common-path design with components as few as possible effec-tively maintains the light transmittance without compromising the imaging quality.In this paper,the field of view(FOV)of the system can reach 70°by use of a gradient index(GRIN)lens as the relay element and a four-lens group as the distal objective,respectively.The simulation showed that the modulation transfer function(MTF)value in each FOV of the rigid video endoscope at 160 lp/mm is greater than 0.1 while the root mean square(RMS)radii of the OCT beam in the center and edge of the FOV are 14.948μm and 73.609μm,respectively.The resolutions of both OCT and video endoscope meet the requirement of clinical application.In addition,all the components of the system are spherical,therefore the system can be of low cost and easy to assemble.展开更多
McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibilit...McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.展开更多
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 - I scheduled for elective surge...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 - I 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). A-mong 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.展开更多
目的 探讨通过窄带成像(narrow band imaging,NBI)电子喉镜下观察喉黏膜上皮内的毛细血管袢形态,能否指导喉白斑患者治疗方法的选择。方法 选取2019年6月~2021年9月临床诊断为喉白斑的68例患者为研究对象,根据NBI电子喉镜的诊断结果,将...目的 探讨通过窄带成像(narrow band imaging,NBI)电子喉镜下观察喉黏膜上皮内的毛细血管袢形态,能否指导喉白斑患者治疗方法的选择。方法 选取2019年6月~2021年9月临床诊断为喉白斑的68例患者为研究对象,根据NBI电子喉镜的诊断结果,将患者分为两组:良性病变组(52/68)和恶性病变组(16/68)。比较NBI喉镜诊断与病理检查结果的一致性。结果良性病变组中病理确诊为鳞状上皮增生伴角化35例(67.31%),轻度不典型增生9例(17.31%),中度不典型增生3例(5.77%),原位癌5例(9.62%),恶性病变组中病理确诊为中度不典型增生2例(12.50%),重度不典型增生1例(6.25%),原位癌9例(56.25%),浸润癌4例(25.00%)。采用Kappa一致性检验法,k=0.687,P<0.001,说明NBI电子喉镜诊断结果和病理检查结果存在一致性。结论 NBI电子喉镜能很好的分辨喉白斑的性质,对喉白斑治疗方法的选择和随访观察喉白斑的进展有较高的指导意义。展开更多
Climate change,now the foremost global health hazard,poses multifaceted challenges to human health.This editorial elucidates the extensive impact of climate change on health,emphasising the increasing burden of diseas...Climate change,now the foremost global health hazard,poses multifaceted challenges to human health.This editorial elucidates the extensive impact of climate change on health,emphasising the increasing burden of diseases and the exacerbation of health disparities.It highlights the critical role of the healthcare sector,particularly anaesthesia,in both contributing to and mitigating climate change.It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.展开更多
文摘To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation,indirect laryngoscope (IL ) and direct laryngoscope (DL ) were utilized for the closed reduction of the displaced arytenoid under local anesthesia.2 3patients who underwent the reduction for dislocated arytenoid under IL or DL from January1991to June 2 0 0 1were reviewed.The data were collected on the duration of the laryngeal injury,tim es of re- ceiving reduction,side- effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilita- tion was examined.13patients received the reduction under IL and 10 patients under DL .Except the tim es of the reduction,which showed significant difference,no differences were found between IL group and DL group in the course and the period of voice rehabilitation,as well as sore throat after the manipulation.The patients'voice recovery was positively related to their course of dis- ease in both IL and DL group.Itis concluded thatthe recovery of normal voice is obviously affect- ed by the duration of arytenoid dislocation.The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation.Reduction by DL is better suit the patients with long tim e course of disease.
文摘BACKGROUND: Post operative sore throat (PST) is one of the most common complaints after tracheal intubation. In this study we compared the effects of curved and straight laryngoscope blades on severity and incidence of PST. METHOD: In this prospective randomized clinical trial we evaluated incidence and severity of PST in 147 ASA physical status I–II, aged 18 – 62 y (group Miller, n = 71), (group Macintosh, n = 76) following intubation with Miller and Macintosh laryngoscope blades by using Visual Analog Scale (VAS). RESULTS: The overall incidence of PST in our study was 35.4% (Macintosh group = 39.5% and in Miller group = 31% and P = 0.829). The incidence of PST was not statistically different between two kinds of laryngoscope blades and the mean rank of pain score was not statistically different in recovery room and up to 48 hours after surgery. CONCLUSIONS: Our study showed these types of laryngoscope blade had not association with incidence and severity of PST. .
基金Department of Anesthesiology at Rush University Medical Center for support
文摘AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009("pre-VL" group) and over the same 2-mo period after the introduction of VLs in 2012("postVL" group). Patient records with predicted difficult air-ways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.RESULTS To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually(P = 0.1768), it showed a trend toward significance when covariates were accounted for(P = 0.0910). Several factors predicting a higherlikelihood of awake FOI were found to be statistically significant: Morbid obesity(larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender(P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score(P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.CONCLUSION Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.
基金funded by the National Key Research and Development Program of China(No.2017YFC0112401)the National Natural Science Foundation of China(Nos.61975246,61505267)the Science and Technology Program of Guangzhou(Nos.201607010167 and 201903010065)
文摘An integrated optical coherence tomography(OCT)and video rigid laryngoscope have been designed to acquire surface and subsurface tissue images of larynx simultaneously.The dual-modality system that is based on a common-path design with components as few as possible effec-tively maintains the light transmittance without compromising the imaging quality.In this paper,the field of view(FOV)of the system can reach 70°by use of a gradient index(GRIN)lens as the relay element and a four-lens group as the distal objective,respectively.The simulation showed that the modulation transfer function(MTF)value in each FOV of the rigid video endoscope at 160 lp/mm is greater than 0.1 while the root mean square(RMS)radii of the OCT beam in the center and edge of the FOV are 14.948μm and 73.609μm,respectively.The resolutions of both OCT and video endoscope meet the requirement of clinical application.In addition,all the components of the system are spherical,therefore the system can be of low cost and easy to assemble.
文摘McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.
文摘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 - I 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). A-mong 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.
文摘Climate change,now the foremost global health hazard,poses multifaceted challenges to human health.This editorial elucidates the extensive impact of climate change on health,emphasising the increasing burden of diseases and the exacerbation of health disparities.It highlights the critical role of the healthcare sector,particularly anaesthesia,in both contributing to and mitigating climate change.It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.
