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51.
A modified lightwand-guided nasotracheal intubation technique for oromaxillofacial surgical patients
Kuang-I Cheng MD Assistant Professor Ming-Chih Chang DDS MDS Visiting Staff Ta-Wei Lai MD Visiting Staff Ya-Chun Shen BD Nurse-Anesthetist David-vi Lu MD Visiting Staff Shang-Tsung Lai DDS MDS Associate Professor Chung-Ho Chen DDS PhD Professor 《Journal of clinical anesthesia》2009,21(4):258-263
Study ObjectiveTo investigate the efficiency of a double curve nasotracheal tube on lightwand-guided nasotracheal intubation.DesignProspective, randomized, controlled trial.SettingUniversity medical center hospital.Patients60 ASA physical status I and II patients undergoing oromaxillofacial surgery.Interventions and MeasurementsPatients undergoing surgery with nasotracheal intubation and general anesthesia were randomly enrolled in the laryngoscopy group or the lightwand group. The same type of double curve nasotracheal tube was used in both groups. In the laryngoscopy group, intubation was assisted with a Macintosh No. 3 standard curved blade and Magill forceps. In the lightwand group, intubation was aided with a flexible lightwand device (without the inner stiff stylet). Intubation time was divided into two parts: Part one, from selected naris to oropharynx; Part two, from oropharynx into trachea. Part one, Part two, and total intubation time, hemodynamic responses to nasotracheal intubation, and adverse events or complications were recorded.Main ResultsTotal intubation times in the lightwand group and the laryngoscopy group were 22.8 ± 8.0 sec vs 30.3 ± 8.2 sec (P < 0.001), respectively. The lightwand group had comparable hemodynamic responses to those of the laryngoscopy group. Adverse events and complications were all self-limited, with similar occurrence in both groups.ConclusionFor patients undergoing oromaxillofacial surgery, modified lightwand-guided nasotracheal intubation is feasible with a double curve nasotracheal tube and is an efficient alternative technique. 相似文献
52.
Pearce A 《Best Practice & Research: Clinical Anaesthesiology》2005,19(4):559-579
Preoperative airway evaluation is essential to consider which is the best method of maintaining and protecting the airway during surgery and whether problems with airway management are likely. In general surgical patients, the prevalence of difficult intubation is low and tests have poor predictive power. This means that the patient may be evaluated as normal but prove to be difficult. The absence of reliable prediction in general surgical patients means that airway strategy holds the key to successful management. Where there are obvious abnormalities in the history, examination or imaging the preoperative evaluation will allow choice of the most appropriate airway strategy which may include preparation of the patient, assembling of alternative airway equipment, advice and help from a more senior or skilled anaesthetist or aid from a surgical colleague or assistant. 相似文献
53.
Fiberoptic intubation of the spontaneously breathing patient is the gold standard and technique of choice for the elective management of a difficult airway. In the hands of the properly trained and experienced user, it is also an excellent 'plan B' alternative when direct laryngoscopy unexpectedly fails. Fiberscope-assisted intubation through an endoscopy face mask, laryngeal mask airway or intubating laryngeal mask airway secures ventilation and oxygenation, and permits endotracheal intubation in airway emergency situations. Portable fiberscopes can be used in remote settings, increasing patient safety. This review discusses current fiberoptic intubation techniques and their applications in the management of both the anticipated and unanticipated difficult airway. 相似文献
54.
Airway management in children and infants, especially in those with a difficult airway, presents a major challenge for every anaesthesiologist, paediatrician, paediatric intensivist and emergency physician. The most important differences, as compared to adult airway management, result from the specific aspects of paediatric anatomy and physiology, which are more important to consider the younger the child is. A number of inherited and acquired pathological syndromes have significant impact on the airway management in this age group. During past years several new devices have been introduced into clinical practice, intended to improve airway management in this age group. Important new studies have gathered evidence about risks and benefits of certain confounding variables for airway problems and specific techniques for solving them.Several risk factors for airway-related problems during anaesthesia in children having a ‘cold’ have been identified, and the use of propofol in combination with the LMA is suggested if anaesthesia cannot be postponed in children with a recent upper airway infection. The use of cuffed endotracheal tubes appears to be advantageous in certain clinical situations, and may be safe in infants if the appropriate tube size is carefully determined and continuous monitoring of the cuff pressure is performed to avoid post-intubation tracheal stenosis. Promising novel video-assisted systems comprising appropriately sized and redesigned fibre-optic endoscopes have been introduced for the management of the difficult airway in small children, infants and even premature newborns. Today, the laryngeal mask airway is a well-accepted extra-tracheal airway device in paediatric anaesthesia, and the flexible LMA allows for its use during ENT and dental surgery procedures. However, LMA-associated partial obstruction of the airway in infants requires great caution when these devices are used in this age group. The recently introduced Proseal LMA for children may allow higher airway pressures and improved protection from gastric inflation, e.g. in paediatric ambulatory anaesthesia. The LMA may also serve well to guide the endoscope during fibre-optic intubation in children and infants.Prediction of the unexpected difficult airway in infants and children remains really difficult, as the respective screening systems have been developed in adults and are, for a variety of reasons, not applicable to young children and infants. A thorough determination of the individual risk of developing airway complications, as well as continuous attention to airway patency during the procedure, are prerequisites for reducing airway-related morbidity and mortality in children and infants during anaesthesia. Appropriate preparation of the available equipment and frequent training in management algorithms for all personnel involved appear to be very important. 相似文献
55.
56.
Biswas BK Agarwal B Bhattacharyya P Badhani UK Bhattarai B 《British journal of anaesthesia》2005,95(5):715-718
Background. The intubating laryngeal mask has been used forthe emergency management of the airway in patients placed inthe lateral decubitus position. We have conducted this prospectivestudy to compare the feasibility of placement of an intubatinglaryngeal mask and blind tracheal intubation guided by the intubatinglaryngeal mask in patients placed in the right and the leftlateral positions. Methods. A total of 82 adults of both sexes with normal airways,scheduled for cholecystectomy, were allocated randomly to beplaced in either the right (n=41) or left (n=41) lateral positionfor the insertion of an intubating laryngeal mask and blindtracheal intubation guided by the intubating laryngeal maskunder balanced general anaesthesia. A sequence of standard manoeuvreswas performed after each failed attempt at intubating laryngealmask placement and intubation. Results. The intubating laryngeal mask was placed in all patientsat the first attempt. Ventilation of the lungs through the intubatinglaryngeal mask was possible in 40 patients (97.5%) from eachgroup after the first attempt at insertion (P=1). Followingadjustments, adequate ventilation could be achieved in all patients.The first attempt success rates of blind tracheal intubationwere 85.3% (35/41) and 87.8% (36/41) in the right and left lateralgroups, respectively (P=1). The remaining patients from bothgroups (except for one patient in the left lateral group whohad a failed intubation) were intubated at the second attempt. Conclusion. Insertion of the intubating laryngeal mask and blindtracheal intubation through it in the lateral position is feasiblein patients with normal airways. These procedures have a highand comparable success rate when patients are placed in theright and left lateral positions. 相似文献
57.
目的观察全麻下应用GlideScope视频喉镜进行气管插管的成功率及插管时的心血管反应,评价其在颈椎外伤患者中的应用价值。方法168例择期或急诊颈椎手术患者,美国麻醉医师协会(ASA)分级I-Ⅱ级,随机分为2组(n=84):Glidescope喉镜组(G组)和纤维支气管镜组(F组)。在快速静脉全麻诱导后分别用GlideScope视频喉镜和纤维支气管镜经口腔插管,记录插管操作时间、次数和并发症,并测量诱导前(T1)、诱导后(T2)、插管时(L)、插管后lmin(T4)、气管插管后3min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)。结果G组84例患者中,78例一次插管成功,4例二次插管成功,2例插管失败,改为纤维支气管镜插管,插管成功率为97.6%;F组84例均成功插管。气管插管过程中2组的HR、SBP、DBP、MAP平稳,而且2组间差异无统计学意义(P〉0.05)。结论GlideScope视频喉镜插管迅速,成功率高,心血管反应轻微,操作简便,便于携带,适合颈椎外伤患者应用管理气道。 相似文献
58.
RAJIV CHAUDHARY MBBS MRCPCH SATHEESH CHONAT MBBS HARSHA GOWDA MBBS MRCPCH † PAUL CLARKE MD FRCPCH MRCP DCH DCCH † ANNA CURLEY MBBS MD MA MRCPI 《Paediatric anaesthesia》2009,19(7):653-658
Background: Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication.
Aims: To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units.
Methods: Telephone questionnaire survey of all 50 tertiary neonatal units in the UK.
Results: Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation.
Conclusions: In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose. 相似文献
Aims: To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units.
Methods: Telephone questionnaire survey of all 50 tertiary neonatal units in the UK.
Results: Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation.
Conclusions: In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose. 相似文献
59.
JOSEF HOLZKI MD MICHAEL LASCHAT MD † CHRISTIAN PUDER MD ‡ 《Paediatric anaesthesia》2009,19(S1):180-197
Since about a decade cuffed intubation is becoming more popular in pediatric anesthesia. Studies supporting cuffed intubation compared cuffed and uncuffed intubation by using stridor as main outcome measure after extubation. No differentiations were made between benign (oedema) and severe (ulceration of mucosa) lesions. Stridor was considered to represent all relevant injuries. Far reaching conclusions for daily practice were drawn from these studies. Pediatric endoscopists and – ENT-surgeons with extensive experience in this field have warned against this opinion because significant injury of the airway is not always accompanied by stridor! The symptom of stridor might develop weeks and months after injury when silent ulcerations of the mucosa retract to significant stenosis. Only endoscopy can evidently detect all airway injuries. Studies describing airway injury by endoscopic control are urgently needed to find the best way of preventing airway injury by intubation. 相似文献
60.
Hemodynamic and catecholamine responses during tracheal intubation using a lightwand device (Trachlight) in elderly patients with hypertension 总被引:1,自引:0,他引:1
Kanaide M Fukusaki M Tamura S Takada M Miyako M Sumikawa K 《Journal of anesthesia》2003,17(3):161-165
Purpose.Tracheal intubation using a lightwand device (Trachlight) should minimize hemodynamic change by avoiding direct-vision laryngoscopy. We evaluated hemodynamic and catecholamine responses during tracheal intubation using a Trachlight in elderly patients with hypertension.Methods.Twenty-six hypertensive patients aged over 65 years undergoing orthopedic surgery were randomly divided into two groups, group L (n = 13) and group T (n = 13). Anesthesia was induced with fentanyl (2g·kg–1) and propofol (1.5mg·kg–1), and then muscle relaxation was obtained with vecuronium (0.15mg·kg–1). The trachea was intubated with either a Macintosh laryngoscope (group L) or a Trachlight (group T). Hemodynamics, plasma catecholamine concentrations, and arterial blood gases were measured before the induction of anesthesia (T0), before tracheal intubation (T1), immediately after tracheal intubation (T2), and 3min after tracheal intubation (T3).Results.The intubation time was shorter in group T than in group L (12.6 ± 1.7 vs 23.5 ± 2.9s, mean ± SE; P 0.01). Compared with the preinduction (T0) value, systolic blood pressure (SBP) showed a significant decrease at T1 and T3 in group L and at T1, T2, and T3 in group T. The heart rate (HR) and plasma norepinephrine (NE) concentration showed no change in either group throughout the time course, whereas the plasma epinephrine (E) concentration showed a significant decrease at T2 and T3 in both groups. The mean values of the rate-pressure product (RPP: HR × SBP) were less than 15 000 after tracheal intubation in both groups. There was no significant difference in hemodynamic or catecholamine responses between groups at any point. No patient had ischemic ST-T changes in either group.Conclusion.A lightwand has no advantage over a laryngoscope in terms of hemodynamic and plasma catecholamine responses to tracheal intubation in elderly patients with hypertension, despite a shorter intubation time. 相似文献