困难气道老年患者视频喉镜与直接喉镜下经口气管插管应激反应比较

目的比较用Glide Scope视频喉镜和Macintosh直接喉镜经口气管插管的老年困难气道患者应激反应发生情况。方法选择拟在全身麻醉下实施择期手术的老年困难气道患者40例,ASA分级Ⅰ～Ⅲ级、年龄65岁以上、Cormack-Lehane分级Ⅲ～Ⅳ级,随机分为Glide Scope视频喉镜组(G组)和Macintosh直接喉镜组(M组),各20例。麻醉诱导后分别使用Glide Scope视频喉镜和Macintosh直接喉镜显露声门行气管插管。记录各组患者的插管时间及基础值(T0)、诱导后插管前即刻(T1)、及插管后1 min(T2)、5 min(T3)、10 min(T4)、30 min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)数值;并于T0、T3、T4、T5时检测血浆肾上腺素(E)、去甲肾上腺素(NE)、肾素、血管紧张素Ⅱ(ATⅡ)的浓度。结果与T0相比,T2、T3时两组及T4时M组HR、SBP、DBP均升高(P<0.05),T5时M组的SBP升高(P<0.05),T3、T4时两组血浆EN、E、肾素、ATⅡ浓度升高(P<0.05),T5时M组血浆肾素、ATⅡ浓度升高(P<0.05);与G组比较,M组T3、T4时HR、SBP、DBP及T5时SBP升高(P<0.05),T4时血浆EN、E、肾素浓度及T5时肾素、ATⅡ浓度升高(P<0.05)。G组插管时间明显短于M组(P<0.05)。结论与Macintosh直接喉镜相比,应用Glide Scope视频喉镜行经口气管插管可以减轻老年困难气道患者血流动力学变化,降低应激反应的程度。     

Airtraq可视喉镜在困难气道全麻患者气管插管中的应用

目的观察应用Airtraq可视喉镜对困难气道患者全麻中行气管插管的临床效果。方法选择拟经口气管插管全身麻醉下实施择期手术的困难气道患者60例,MallampatisⅢ～Ⅳ级,随机分为Airtraq组、Macintosh组,每组各30例。两组均采用慢诱导气管插管,诱导后分别采用Airtraq可视喉镜及Macintosh喉镜进行气管插管操作,比较两组气管插管一次成功率、插管时间和麻醉诱导前（T1）、诱导后（T2）、气管插管后即刻（T3）及气管插管后3 min（T4）的HR、SBP、DBP,观察两组声门暴露及并发症情况。结果 Airtraq组气管插管一次成功率高于Macintosh组,插管时间短于Macintosh组,T3、T4时HR、SBP、DBP低于Macintosh组,并发症发生率低于Macintosh组（P均〈0.05）。Airtraq组Ⅰ级气管插管声门暴露的比例高于Macintosh组（P〈0.05）。结论 Airtraq可视喉镜具有快速、声门暴露好、气管插管时血流动力学变化幅度小、插管损伤小的优点,适合于困难气道患者的气管插管。     

GlideScope视频喉镜在气管插管患者的临床运用

GlideScope视频喉镜为一种新型视频气管插管器械,前端安装有高清晰度微型摄像头,通过纤维光缆传递,咽部结构可以被清晰放大到显示器上.摄像头距镜片前端仅3cm,避免了舌咽部结构对声门的阻挡,使声门结构清晰可见.另外,其镜片厚度仅为1.8cmn,并且前端弯曲60度,有利于声门显露及气管插管操作,可以减少对咽喉部的刺激和减轻血流动力学影响.我们对本院呼吸重症监护病房需经口气管插管患者分别使用GlideScope视频喉镜和直接喉镜进行气管插管进行比较.     

I-gel喉罩辅助纤维支气管镜引导经口气管插管对全麻手术患者血流动力学的影响

目的观察I-gel喉罩辅助纤维支气管镜(FOB)引导经口气管插管对全麻手术患者血流动力学的影响。方法将40例择期全麻手术患者随机分为M组和O组各20例,常规麻醉诱导后,M组采用Macintosh直接喉镜经口气管插管,O组采用I-gel喉罩辅助FOB引导经口气管插管。观察麻醉插管不同时间点血压(BP)和心率(HR)、喉部暴露情况的Cormack/Lehane(C/L)分级、插管时间,并计算收缩压(SBP)与HR乘积(RPP)。结果 O组C/L分级为(1.30±0.47)级,低于M组的(1.80+0.62)级(P<0.01)。O组气管插管时间为(74.2±11.1)s,建立有效气道通气时间为(18.2±4.9)s,M组分别为(34.4±10.5)、(34.4±10.5)s,两组比较,P均<0.01。两组诱导后的BP、HR和RPP值均较诱导前的基础值下降(P均<0.05),插管即刻和气管插管后3 min内BP、HR和RPP较诱导后增高(P均<0.05),但O组插管即刻和气管插管后1 min的BP、HR和RPP比M组低(P均<0.05),且M组气管插管后4 min的BP、HR和RPP较诱导后仍较高(P均<0.05)。结论 I-gel喉罩辅助FOB引导经口气管插管对全麻手术患者血流动力学的影响轻于Macintosh直接喉镜气管插管。     

Shikani喉镜和Macintosh喉镜经口气管插管临床比较

目的比较Shikani喉镜和Macintosh喉镜经口气管插管所用时间和对血流动力学的影响。方法择期腹部外科手术患者40例，随机分为Shikani组和Macintosh组各20例。常规静脉麻醉诱导后实施气管插管，监测麻醉诱导前后、气管插管时和气管插管后的血压和心率变化。结果Shikani组与Macintosh组气管插管时间无统计学差异。Shikani组气管插管时患者的血压和心率与麻醉诱导后比较未见明显变化，Macintosh组则显著升高（P〈0．05）。气管插管后两组患者的血压和心率均比麻醉诱导后明显升高（P〈0．05），两组间比较则无统计学差异。结论采用Shikani喉镜经口气管插管时引起的血流动力学反应比Macintosh喉镜轻，插管后的反应则基本相同。     

不同气管插管对颈椎脊髓受压患者颈椎屈曲度及血流动力学的影响

目的探究不同气管插管对颈椎脊髓受压患者颈椎屈曲度及血流动力学的影响。方法颈椎脊髓受压患者34例,根据气管插管方式分为实验组(12例)、对照A组(11例)、对照B组(11例)。对照A组予以Macintosh直接喉镜插管,对照B组予以光导纤维支气管镜(FOB)插管,实验组予以GlideScope视频喉镜插管。统计3组一次插管成功率、插管操作时间,并对比入室后(T0)、面罩通气时(T1)、暴露声门时(T2)、插管后(T3)颈椎屈曲度变化,诱导前(t0)、诱导后(t1)、插管时(t2)、插管后1 min(t3)、插管后3 min(t4)心率(HR)及平均动脉血(MAP)变化。结果与对照A、B组比较,实验组插管操作时间较短,一次插管成功率较高(P0.05);T2、T3时颈椎屈曲度变化低于对照A组,波动幅度优于对照A组(P0.05);t1时3组MAP、HR水平较t0时降低(P0.05),t3、t4时3组HR较t0时升高(P0.05)。结论FOB插管、Macintosh直接喉镜插管、Glide Scope视频喉镜插管均能稳定颈椎脊髓受压患者血流动力学,Glide Scope视频喉镜插管一次穿刺成功率高,穿刺时间短,且对颈椎屈曲度影响较小。     

Shikani与Macintosh两种喉镜在胸科手术患者双腔支气管插管中的比较

目的:比较Shikani喉镜和Macintosh喉镜,在胸科手术患者双腔支气管插管的临床效果。方法:选择需行单肺通气的胸外科手术患者60例,随机均分为两组,Shikani喉镜组(S组)和Macintosh喉镜组(M组)各30例。麻醉诱导后分别采用Shikani喉镜或Macintosh喉镜,实施经口双腔支气管插管操作。记录并比较麻醉诱导前(T1)、气管插管前(T2)、气管插管后即刻(T3)、气管插管后5 min(T4)的平均动脉压(MAP)值、心率(HR)值和脑电双频指数(BIS)值。观察比较2组插管时间、置入目标支气管的成功率及口腔损伤出血情况。结果:在T3点,M组患者的平均动脉压(MAP)和心率(HR)均明显高于S组患者(P<0.05),其余各时间点两组患者的血流动力学指标,差异均无统计学意义。各点脑电双频指数(BIS)值,两组间比较差异均无统计学意义。S组患者的插管时间明显相似文献   

光棒与直接喉镜对静脉全麻诱导时血流动力学及应激激素浓度的影响

目的评价光棒和直接喉镜对全凭静脉麻醉（TIVA）患者诱导时血流动力学和应激激素浓度的影响。方法纳入研究72例择期TIVA患者,分为光棒组和直接喉镜组,分别于麻醉诱导前（T0）、气管插管前（T1）、气管插管即刻（T2）、气管插管后3 min（T3）记录收缩压（SBP）、舒张压（DBP）、心率（HR）,并于各时点采静脉血检测血浆去甲肾上腺素（NE）、肾上腺素（E）、血浆皮质醇（cort）及血管紧张素Ⅱ（ATⅡ）浓度变化水平。结果麻醉诱导后两组患者SBP、DBP、HR均降低（P〈0.05）;气管插管即刻和气管插管后两组NE、E、cort和ATⅡ水平升高（P〈0.05）,光棒组上述激素水平较气管插管组减少（P〈0.05）。结论光棒比直接喉镜能更有效地抑制TIVA患者气管插管的应激反应,维持血液动力学稳定。     

Glidoscope视频喉镜在心肺复苏患者的应用

目的观察Glidoscope视频喉镜气管插管和直接喉镜气管插管在心肺复苏中的应用及其对心肺复苏效果的影响。方法 48例心肺复苏患者按其就诊顺序分为视频喉镜组及直接喉镜组,记录每例患者插管所用时间、患者1次吃插管成功率、记录每例患者因配合气管插管胸外按压中断时间、插管成功2、5、10分钟呼气末二氧化碳分压数值及恢复自主循环例数并作统计学分析。结果两组患者使用视频喉镜组明显缩短平均插管时间、一次插管成功率明显提高、由插管所造成的按压中断明显减少、视频喉镜组插管成功2、5、10分钟呼气末二氧化碳分压平均数值明显高于直接喉镜组、恢复自主循环例数视频喉镜组明显多于直接喉镜组。结论视频喉镜在心肺复苏中有重要应用价值。     

光棒联合直接喉镜在急诊抢救紧急气管插管的应用价值

目的  评价光棒联合直接喉镜在急诊抢救紧急气管插管中的应用价值。 方法  将60例急诊抢救患者随机分为3组,每组20例,分别应用光棒联合直接喉镜（联合组）、直接喉镜（喉镜组）和光棒（光棒组）进行气管插管,比较3组间插管所需时间、首次插管成功率及插管后并发症发生率。 结果  联合组插管时间低于光棒组和喉镜组（P <0.05）。3组患者首次插管成功率差异无统计学意义（P >0.05）,改良Mallampati分级1、2级患者首次插管全部成功,联合组改良Mallampati分级3、4级患者首次插管成功率高于喉镜组（P <0.05）。联合组插管后并发症发生率显著低于直接喉镜组（P <0.05）。 结论  光棒联合直接喉镜插管时间短、插管成功率高、插管后并发症少,在急诊抢救紧急气管插管中具有较大应用价值。     

Improvement in GlideScope® Video Laryngoscopy performance over a seven-year period in an academic emergency department

To evaluate the outcomes in first pass success (FPS) of GlideScope (GVL) intubations over a seven-year period in an academic ED. Data were prospectively collected on all patients intubated in an academic ED with a level 1 trauma center over the seven-year period from July 1, 2007 to June 30, 2014. Following each intubation, the operator completed a standardized data collection form that included information on patient, operator and procedure characteristics. The primary outcome was first pass success, defined as successful intubation with a single laryngoscope blade insertion. The secondary outcome was the Cormack–Lehane (CL) view of the airway. To adjust for important confounders, a logistic regression model was used to determine the association between academic year and first pass success. In the first year of the study, the first pass success with the GVL was 75.6 % (68/90; 95 % CI 65.4–84.0 %) and the percentage of patients with CL I/II views was 95.6 % (86/90; 95 % CI 89.0–98.8 %). By the seventh year of the study, the first pass success with the GVL increased to 92.1 % (128/139; 95 % CI 86.3–96.0 %) and the percentage of patients with CL I/II views was 94.2 % (131/139; 95 % CI 89.0–97.5 %). In the logistic regression model, first pass success improved during the seven-year period (aOR 3.1; 95 % CI 1.3–7.1; p = 0.008). Over the seven-year period, there was significant improvement in the first pass success of the GVL, without any change in the Cormack–Lehane view, suggesting that there was improvement in the skill of tube delivery with use of the GVL over time.     

Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis

Background:It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope.Methods:We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data.Results:The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval −3.43 to 3.88 vs −0.82 to 5.93; P = .90 vs 0.14; I² = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point.Conclusions:Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.     

Massive upper airway bleeding after thrombolytic therapy: successful airway management with the Combitube.

We present the case of a patient who required immediate intubation because of increasing upper airway bleeding. Endotracheal intubation failed because the glottis could not be visualized. An airway control device designed for cases of difficult emergency intubations was used successfully. This device can be inserted without the use of a laryngoscope.     

Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists: A Randomized Study

Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack–Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack–Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation.     

可视喉镜在困难气管插管中的应用价值

目的探讨视可尼可视喉镜(SOS)在困难气管插管中的应用价值。方法 54例拟行困难气管插管患者随机分为2组,S组(n=27例)采用视可尼可视喉镜行气管插管,M组(n=27例)采用Macintoch直接喉镜行气管插管。监测两组患者诱导前、插管开始时和插管完成时的平均动脉压(MAP)和心率(HR),并记录插管时间和插管相关并发症。结果与诱导前比较,插管开始时两组患者MAP、HR均明显降低(P<0.05);插管完成时M组MAP、HR较S组明显升高(P<0.05);S组插管时间明显短于M组(P<0.05);S组插管后并发症发生率明显低于M组(P<0.05)。结论视可尼可视喉镜用于困难气管插管对患者循环功能影响较小,并发症少,插管时间缩短。     

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation

STUDY OBJECTIVE: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. METHODS: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. RESULTS: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. CONCLUSION: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear.     

Management of the difficult airway

For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. The intubation should be attempted in the awake state, preferably using the fiberoptic bronchoscope. The more challenging situation is when the difficult airway is confronted unexpectedly. After the first failed attempt at laryngoscopy, head position should be checked and the patient ventilated with oxygen by mask. A smaller styletted tube and possibly a different laryngoscope blade should be selected for a second attempt at intubation. The fiberoptic bronchoscope and other equipment for difficult intubation should be obtained. A second attempt should then be made. If this is unsuccessful, the patient should be reoxygenated, and assistance including a skilled anesthesiologist and surgeon should be summoned. On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed.     

Anesthesia and airway managements for emergency removal of esophageal foreign body in a trisomy 21 patient with mental retardation and predicted difficult airway: A case report

Introduction:The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery.Patient concerns:A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck.Diagnoses:Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways.Interventions:Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction.Outcomes:Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication.Lessons subsections as per style:When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.     

经鼻气管插管治疗COPD呼吸衰竭（附58例）

目的探讨经鼻气管插管治疗COPD呼吸衰竭应用技巧,建立一种有效的人工气道技术。方法采用盲插和喉镜明视下插管两种插管方法,插管后呼吸机辅助通气。结果全组病人盲插成功41例,经喉镜明视插管成功17例,均治愈出院,无严重并发症发生。结论经鼻气管插管易耐受、留置时间长、不影响进食,适用于COPD呼吸衰竭患者。