Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general ane...Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general anesthesia in the hospital between January 2017 and December 2017 were divided into the control group (n=109) and the dexmedetomidine group (n=109) by random number table method. Control group underwent routine propofol anesthesia induction and dexmedetomidine group underwent dexmedetomidine anesthesia induction on the basis of propofol. The differences in the severity of inflammatory response and stress response were compared between the two groups of patients after general anesthesia induction (T0), 1 min after endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and 10 min after endotracheal intubation (T3).Results:At T0, there was no statistically significant difference in serum levels of inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum inflammatory factors CRP, IL-1, IL-6, IL-8 and TNF-α levels of dexmedetomidine group were lower than those of control group;serum stress hormones ACTH, Cor, NE, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: Dexmedetomidine + propofol general anesthesia induction can effectively reduce the inflammatory stress response caused by endotracheal intubation.展开更多
BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses...BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for diffi cult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41(26.8%), 50(32.7%), 51(33.3%), 38(24.8%) and 25(16.3%) patients respectively. Cricoid pressure was not applied at all for 17(11.1%) patients and 53(34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55(35.9%) patients desaturated during RSII(SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6(3.9%), 7(4.6%), 5(3.3%), 10(6.5%), 13(8.5%) and 14(9.2%) patients respectively.CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.展开更多
Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians ...Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.展开更多
Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, ...Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, 75 children undergoing minor surgery were investigated in this prospective observational study. Patients were divided into three groups: group 1 was aged two to three years old, group 2 was aged four to six years old and group 3 was aged from seven to ten years old. The following three characteristics were evaluated: 1) the pulse rate at four points (the ward, the entrance at the operating room, mask notification and the mask fit);2) the behavioral score in the operating room;3) the amount of pain killers after the operation. Results: In group 1 (N = 20), there was a significant difference between the control group and the video assisted group regarding the percentage change in pulse rate based on the children’s ward when the patients looked at the mask. In group 2 (N = 26), there was no significant difference regarding any points. In group 3 (N = 29), there was a significant difference between control and video assisted group regarding the percentage change in pulse rate based on the children’s ward for all points. Also, regarding to the behavioral score, there was a significant difference between the control group and the video assisted group of all ages. However, there was no significant difference regarding the use of NSAIDs in the postoperative period between the control and the video assisted group. Conclusion: These results show that the video assisted anesthesia induction is effective for pediatric patients.展开更多
Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- at...Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.展开更多
文摘Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general anesthesia in the hospital between January 2017 and December 2017 were divided into the control group (n=109) and the dexmedetomidine group (n=109) by random number table method. Control group underwent routine propofol anesthesia induction and dexmedetomidine group underwent dexmedetomidine anesthesia induction on the basis of propofol. The differences in the severity of inflammatory response and stress response were compared between the two groups of patients after general anesthesia induction (T0), 1 min after endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and 10 min after endotracheal intubation (T3).Results:At T0, there was no statistically significant difference in serum levels of inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum inflammatory factors CRP, IL-1, IL-6, IL-8 and TNF-α levels of dexmedetomidine group were lower than those of control group;serum stress hormones ACTH, Cor, NE, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: Dexmedetomidine + propofol general anesthesia induction can effectively reduce the inflammatory stress response caused by endotracheal intubation.
文摘BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for diffi cult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41(26.8%), 50(32.7%), 51(33.3%), 38(24.8%) and 25(16.3%) patients respectively. Cricoid pressure was not applied at all for 17(11.1%) patients and 53(34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55(35.9%) patients desaturated during RSII(SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6(3.9%), 7(4.6%), 5(3.3%), 10(6.5%), 13(8.5%) and 14(9.2%) patients respectively.CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.
文摘Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.
文摘Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, 75 children undergoing minor surgery were investigated in this prospective observational study. Patients were divided into three groups: group 1 was aged two to three years old, group 2 was aged four to six years old and group 3 was aged from seven to ten years old. The following three characteristics were evaluated: 1) the pulse rate at four points (the ward, the entrance at the operating room, mask notification and the mask fit);2) the behavioral score in the operating room;3) the amount of pain killers after the operation. Results: In group 1 (N = 20), there was a significant difference between the control group and the video assisted group regarding the percentage change in pulse rate based on the children’s ward when the patients looked at the mask. In group 2 (N = 26), there was no significant difference regarding any points. In group 3 (N = 29), there was a significant difference between control and video assisted group regarding the percentage change in pulse rate based on the children’s ward for all points. Also, regarding to the behavioral score, there was a significant difference between the control group and the video assisted group of all ages. However, there was no significant difference regarding the use of NSAIDs in the postoperative period between the control and the video assisted group. Conclusion: These results show that the video assisted anesthesia induction is effective for pediatric patients.
文摘Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.
