Difficulties with tooth protectors in endotracheal intubation

The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. The less experienced anaesthesiologists especially had difficulties with the protectors: 20% of patients in the Camo group were considered impossible to intubate unless the protector was removed. The silicone inlay of the Camo protector melts and becomes adhesive at body temperature, which makes its prolonged use hazardous. Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination.     

Anaesthesia for Cockayne's syndrome. Contemporary solutions to an old problem

The management of a failed intubation in a nineteen-year-old patient suffering from Cockayne's syndrome is described. Use of a laryngeal mask prevented major anaesthetic morbidity. Tracheal intubation was subsequently facilitated by a fibreoptic bronchoscope passed through the laryngeal mask. Cockayne's syndrome is reviewed including recent important developments in its aetiology and pathogenesis.;     

末梢血管收缩反应预测气管插管血液动力学变化

目的通过末梢血管收缩反应预测气管插管引起的血液动力学变化,提供个体化气管插管所需的麻醉深度。方法末梢血管收缩反应通过强直电刺激(50 Hz、50 mA持续5 s)诱发的末梢灌注指数(tip perfusion index,TPI)变化进行监测。24例ASAⅠ~Ⅱ级颅脑外科择期手术患者,麻醉诱导:咪唑安定0.06 mg/kg、芬太尼4μg/kg,丙泊酚0.25 mg.kg-1.min-1恒速输注。意识消失后每间隔1分钟电刺激一次,记录每次电刺激前后TPI的减少值(△TPI)和插管前后SBP、DBP和HR的增加值(△SBP、△DBP和△HR)。观察组(n=12),△TPI<10%刺激前值时行气管插管;对照组(n=11),不考虑△TPI的变化而根据操作者的经验决定插管时机。记录诱导前、插管前、插管后即刻、1、2和3 min时BIS、SBP、DBP和HR的值。结果插管即刻,观察组比对照组丙泊酚输注时间长(P<0.01)、用量大(P<0.01);插管后每一时间点,对照组SBP、DBP和HR都比观察组高(P<0.01)。组内比较:对照组插管前后SBP、DBP和HR明显增高(P<0.01);观察组插管前后各指标无明显变化。电刺激诱发的△TPI分别与插管引起的△SBP、△DBP和△HR成正相关(r=0.672、0.434和0.236,P<0.01)。结论电刺激诱发的末梢血管收缩反应性可有效预测气管插管引起的血液动力学变化幅度。     

腹腔镜门静脉插管皮下泵植入术(附4例报告)

目的:探讨腹腔镜门静脉插管皮下泵植入术的手术方法与技巧。方法:回顾分析4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术的临床资料。结果:4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术均获成功,无中转开腹、手术死亡及手术并发症发生,患者均于术后3d接受经皮下泵门静脉灌注化疗。结论:腹腔镜门静脉插管术安全可行,丰富的腹腔镜手术经验、手术组医师之间的协调配合与合适的病例选择是保证手术成功的关键。     

The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation

The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.     

Techniques of nasotracheal intubation with the fiberoptic bronchoscope

When nasotracheal intubation with a fiberoptic bronchoscope is performed, the tube may be blocked in the nasal cavity or larynx, resulting in several complications including epistaxis and hoarseness. We review the causes and complications of tube blockage and discuss optimal techniques for minimizing it.     

控制性降压结合急性高容血液稀释在脑膜瘤手术中的应用

目的　观察控制性降压结合急性高容血液稀释 (AHH)对脑膜瘤手术的安全性及减少出血量和术后血红蛋白 (Hb)、红细胞比积 (Hct)的影响。　方法　择期脑膜瘤手术病人 2 0例 ,随机分成控制性降压结合AHH组 (Ⅰ组 ,n =10 )和对照组 (Ⅱ组 ,n =10 ) ,两组均采用气管内全麻。Ⅰ组病人于气管插管后手术开始前完成AHH并进行控制性降压。比较两组病人术中出血量、输血量和术后Hb、Hct变化。　结果　Ⅰ组病人术中平均出血量 (5 44± 92 )ml ,比Ⅱ组病人的 (10 72± 182 )ml减少 49 7% ;Ⅱ组病人平均输血量 (62 0± 112 )ml ,Ⅰ组病人则完全避免输异体血。两组病人术毕均有轻度贫血 ,但仍在安全水平范围内。　结论　控制性降压结合急性高容血液稀释可安全应用于脑膜瘤手术 ,对有指征病人的使用可避免术中输异体血