Accidental bronchial intubation with RAE tubes

Performed tracheal tubes are used frequently in paediatric anaesthesia. A feature which contributes to their popularity is the belief that they can be positioned more reliably than conventional tracheal tubes because of their design. We studied a group of 40 patients in whom the incidence of bronchial intubation was 20%. The tube was too long in 32% of patients, although the tube size was appropriate for the child's age in all patients. The consequences and outcome of this complication are discussed.     

Measurement of the flow-resistive properties of double-lumen bronchial tubes in vitro

This study measures the resistance to gas flow of different double-lumen bronchial tubes used for separate ventilation of each lung in critically ill patients. Different-sized Robertshaw and Carlens' tubes were studied, as well as a new device that consisted of a cuffed bronchial catheter introduced through a standard tracheal tube. The pressure-flow relationship was curvilinear in all cases. Robertshaw and Carlens' tubes were generally found to have bronchial and tracheal channels with almost similar resistance and offered total resistances similar to those of 7.0-8.0 mm internal diameter tracheal tubes. The new device had a higher resistance than others of equal external diameter. This must be taken into account when its use is recommended for prolonged respiratory support.     

One lung anaesthesia

Ten patients about to undergo left-sided thoracotomy for carcinoma of the lung were entered into a crossover trial to compare cardiovascular and respiratory function during high frequency jet ventilation and conventional mechanical ventilation for one lung anaesthesia. All patients were anaesthetised with a standard technique using double lumen tubes and placed in the lateral position with the left chest open. The results showed no significant differences with regard to ventilation sequence but one lung high frequency jet ventilation gave higher values than one lung conventional ventilation for shunt (p less than 0.01) and positive end expiratory pressure (p less than 0.05) and lower peak inflation pressure values (p less than 0.01). There were no significant differences in cardiac output, pulmonary capillary wedge pressure, arterial carbon dioxide or available oxygen. Surgical conditions were satisfactory during both methods of ventilation and satisfactory gas exchange occurred. It was, however, more difficult to assess adequacy of ventilation during high frequency jet ventilation and the routine use of this method of ventilation is not recommended during one lung anaesthesia.     

Disposable double-lumen bronchial tubes. A cost-effectiveness survey

The use of red rubber double-lumen-bronchial tubes was studied in the Regional Cardiothoracic Centre and three large District General Hospitals to assess whether the use of disposable polyvinylchloride tubes was a viable cost-effective alternative. In the Regional Cardiothoracic Centre red rubber tubes were used frequently throughout their predicted lifespan and were cost effective. In the district hospitals red rubber tubes were unlikely to be used sufficiently to justify their cost. Many district general hospitals could reduce capital expenditure and annual costs by changing from red rubber to disposable polyvinyl chloride double lumen tubes.     

Etomidate infusion in thoracic anaesthesia

An etomidate infusion was used in the place of nitrous oxide during one lung anaesthesia for 40 patients undergoing thoracic surgery. Analgesia was provided by fentanyl. A mixture of oxygen and air was used to maintain arterial oxygen tension within normal limits despite one lung anaesthesia and enabled the use of nitrous oxide to be avoided in several patients who had lung cysts. Recovery was fairly rapid (mean (SEM) 11.5 (1.4) minutes). There was no incidence of awareness or dreams. This technique provides satisfactory anaesthesia and oxygenation during thoracic surgery when one lung only is being ventilated.     

A new double lumen tube adaptor

The report describes a new double lumen tube adaptor which provides selective one lung ventilation without external clamping. It also facilitates, without disconnexion and remantling, both correct bronchial cuff inflation and continuous positive airway pressure administration using an underwater seal chest bottle. Oxygenation can be kept optimal during one lung anaesthesia by applying 1.0 kPa continuous positive airway pressure to the nonventilated lung using an oxygen flow of 1-2 litres/minute.     

Video-assisted thoracic surgery for lung cancer

Objective|The objective of this study was to confirm the safety and feasibility of video-assisted thoracic surgery (VATS) for primary lung cancer and to compare prognoses with that of conventional procedures, and then to examine whether VATS would supplant a conventional thoracotomy for stage I lung cancer. Methods: From September 1995 through March 2002, 144 patients with primary lung cancer, included 118 patients with postoperative state I, underwent VATS lobectomy. We reviewed the previous cases whether they could be candidates for VATS lobectomy according to present indications. 166 cases were supposed to be candidates for VATS, and 121 cases of postoperative stage I disease were recruited into the “conventional thoracotomy” group. Results: There was no mortality or major complication except one case, and mean follow-up was 31.8 months in VATS. The number of removed lymph nodes was not significantly less than the number by conventional thoractomy (p=0.061). Five-year survival for patients with pathological stage IA adenocarcinoma was 92.4% (n=66) in VATS and 86.9% (n=50) in conventional thoracotomy, and a statistical significance could not be recognized (p=0.980). The length of hospital stay was significantly short in VATS lobectomy (p<0.0001). Conclusions: VATS lobectomy for stage I lung cancer can be performed safely with minimal morbidity, satisfying survival comparable with that of lobectomy through conventional thoractomy. VATS approach is a feasible surgical technique for patients with stage I lung cancer.     

Comparison of the reinforced laryngeal mask airway and tracheal intubation for nasal surgery

Airway maintenance and protection during anaesthesia and recovery provided by the reinforced laryngeal mask airway was compared with the sequential use of a tracheal tube followed by the Guedel airway in 66 patients having anaesthesia for nasal surgery. One patient was withdrawn from the laryngeal mask group because the airway was difficult to position. All patients had an oropharyngeal pack inserted and Moffett's solution instilled into the nasal cavities. At the end of surgery the nasal cavities were packed. During operation airway maintenance was good and airway protection was equally effective in both groups. Contamination of the lower airway occurred in only five patients. During recovery from anaesthesia the laryngeal mask and Guedel airway were well tolerated by most patients, but only the mask laryngeal provided an unobstructed airway in all patients. The laryngeal mask protects the larynx from contamination during and after operation until the return of the patient's own protective reflexes.     

Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J-shaped catheter tip and guide mark

We developed a technique for blind bronchial suction using a curved-tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J-shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.     

Spinal anaesthesia for outpatient surgery

In a prospective study of 51 young male outpatients given spinal anaesthesia through a 25-gauge needle, we found a 37.2% incidence of postdural puncture headache. In addition, 54.9% complained of backache after surgery. Occurrence of headache significantly prolonged the sick-leave from work. General anaesthesia would be preferred by 31.4% of patients for a similar procedure in the future. These patients had a higher incidence of postoperative backache and pain during lumbar puncture. It is concluded that spinal anaesthesia is not a satisfactory technique for outpatient procedures in young men.     

High-frequency percussive ventilation during surgical bronchial repair in a patient with one lung

We report the case of a patient that had undergone a left pneumonectomyduring which a double-lumen tube was used and an undetectedright bronchial laceration occurred. After diagnosis the patientunderwent a second operation to repair the tear. The role ofhigh-frequency percussive ventilation in enabling adequate gasexchange during the bronchial repair is described and discussed.     

全身麻醉插管患者提升肺内氧浓度时适宜新鲜氧流量的探讨

目的 探讨提升气管插管全身麻醉患者肺内氧浓度的适宜新鲜氧流量. 方法 选择择期患者60例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄18岁～ 60岁,体重指数18.5 kg/m2～25.0 kg/m2.采用全凭静脉麻醉,行容量控制机械通气.首先调节吸入氧浓度(inspired oxygen fraction,FiO2)为30％,分钟新鲜气体流量0.1 L/kg.当患者呼出氧浓度(fractionalconcentration of expired oxygen,FeO2)为30％时,开始提升患者肺内的氧浓度:依次调节分钟新鲜氧气流量(oxygen flow rate,FO2)为0.02、0.04、0.06、0.08、0.10、0.12、0.14、0.16 L/kg,同时将FiO2调至100％,比较不同FO2时患者FeO2从30％升至50％所需要的时间(t30％～50％),并计算每次所需要的新鲜氧气量(oxygen uptake,VO2),将FO2与VO2行Pearson相关分析. 结果 ①当FO2分别以0.02、0.04、0.06、0.08、0.10、0.12、0.14、0.16 L/kg提升患者肺内氧浓度时,t30％～50％分别为181、97、68、58、53、49、47、44s.②当FO2分别为0.02、0.04、0.06 Ukg时,t30％～50％减少明显,两两比较差异有统计学意义(P＜0.01).FO2 0.08 L/kg～0.16 L/kg与FO20.02 L/kg～0.06 L/kg比较,以及FO2 0.16 L/kg与FO20.08 L/kg比较,t30％-50％均明显减少(P＜0.01).③FO2与VO2相关性显著,相关系数r=0.864(P＜0.01). 结论 当气管插管全身麻醉患者FeO2为30％时,选择FO2 0.08 L/kg～0.10 L/kg可快速提升FeO2至50％,同时又避免了新鲜氧气的过多浪费.     

Anaesthesia for carbon dioxide laser laryngeal surgery in infants

Problems associated with the presence of a tracheal tube during anaesthesia for infant laryngeal surgery using the carbon dioxide laser are described. This paper discusses alternatives and describes an effective anaesthetic technique and a new tracheal tube.     

Local anaesthesia for eye surgery The peri-ocular technique

A technique of peri-ocular infiltration of local anaesthetic for eye surgery is described. The ease of administration of this form of local blockade is highlighted and its low propensity for complication compared with retrobulbar blockade. The involvement of anaesthetists in the performance of local anaesthesia for ophthalmic surgery that utilises this technique is encouraged.