Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whe...Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.展开更多
Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral...Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this study.Propofol and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened.The anesthesiologist then kept up an on-going neuro- logical examination.After that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.Results:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy pertension.No severe complications occurred during the whole process.Conclusions:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.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
Background： The laryngeal mask airway （LMA） is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients unde...Background： The laryngeal mask airway （LMA） is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery （CD） for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia （GA）. Methods： We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation （ET） group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results： During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications fbr GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases （68.9%） and LMA in 56 cases （31.1%）. The percentage of critical patients above the American Society of Anesthesiologists＇ Grade II was 24/124 in ET group and 4/56 in LMA group （P = 0.036）. The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group （P = 0.001）. None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions： Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.展开更多
文摘Importance:When a ProSeal laryngeal mask airway(PLMA)is removed with the child in a deep plane of anesthesia,the upper airway muscle tone and protective upper airway reflexes may be obtunded.Objective:To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications.Methods:This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020.Forty children of the American Society of Anesthesiologists class I/II of ages 1–12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited.Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position.The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications.Results:The incidence of airway complications was 30%in the supine group and 20%in the lateral group(P=0.6641).Incidence of laryngospasm,immediate stridor,and excessive secretions were similar.Early stridor and oxygen desaturation were higher in the supine group(P=0.0374,P=0.0183 respectively).Interpretation:The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children.The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.
文摘Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this study.Propofol and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened.The anesthesiologist then kept up an on-going neuro- logical examination.After that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.Results:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy pertension.No severe complications occurred during the whole process.Conclusions:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.
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.
文摘Background： The laryngeal mask airway （LMA） is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery （CD） for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia （GA）. Methods： We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation （ET） group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results： During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications fbr GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases （68.9%） and LMA in 56 cases （31.1%）. The percentage of critical patients above the American Society of Anesthesiologists＇ Grade II was 24/124 in ET group and 4/56 in LMA group （P = 0.036）. The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group （P = 0.001）. None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions： Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.
