Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures

BACKGROUND: The submental route for endotracheal intubation has been proposed as an alternative to tracheotomy in the surgical management of patients with maxillofacial trauma. The purpose of this study was to review our experience with this procedure. METHODS: Medical records of 25 patients who had surgical reduction of midfacial or panfacial fractures while securing their airway with submental intubation were reviewed. After standard orotracheal intubation, a passage was created by blunt dissection with a hemostat clamp through the floor of the mouth in the submental area. The proximal end of the orotracheal tube was pulled through the submental incision. Surgery was completed with minimal interference from the endotracheal tube. At the end of surgery, the tube was pulled back to the usual oral route. RESULTS: Mean duration of surgery was 7.9 hours (range, 2-16 hours). Mean duration of postoperative mechanical ventilation was 5.2 days (range, 1-24 days). Fourteen of these patients required prolonged (>24 hours) postoperative mechanical ventilation because of associated injuries. Two patients later required a tracheotomy because of prolonged respiratory failure. One patient died of multiple organ failure. One complication of the submental intubation was observed: a superficial infection of the submental wound. CONCLUSION: Submental intubation is a simple technique associated with a low morbidity. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.     

气管插管与喉罩对非颅脑手术患者视神经鞘直径影响的比较

目的应用经眼眶超声测量视神经鞘直径(ONSD),比较气管插管与喉罩对全麻非颅脑手术患者ONSD的影响。方法选择全身麻醉下行择期非颅脑手术患者45例,男26例,女19例,年龄18～80岁,随机分为三组:气管插管组(A组),气管内表麻+气管插管组(B组)和喉罩组(C组)。分别在麻醉诱导前5 min(T_0)、插入气管导管或喉罩前(T_1)和插入气管导管或喉罩后1 min(T_2)、5 min(T_3)、10 min(T_4),应用床旁超声经眼眶测量眼球后3 mm处ONSD,并随访术后头痛、头晕、恶心呕吐的发生情况。结果与T_0时比较,T_2—T_3时A组双侧ONSD均明显增加,且明显大于B组和C组(P0.05);B组和C组双侧ONSD变化差异无统计学意义。三组患者在术后24 h内无一例头痛,头晕、PONV发生率差异无统计学意义。结论喉罩置入对ONSD的影响较气管插管小,气管内表麻可以减轻气管插管引起的ONSD升高。     

Dexamethasone reduces the severity of postoperative sore throat

PURPOSE: Dexamethasone may have potential advantages in the prevention of postoperative sore throat. We therefore undertook a study to evaluate the efficacy of intravenously administered dexamethasone in reducing the incidence and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation. METHODS: In a randomized, double-blind and placebo-controlled study, 120 patients receiving general anesthesia with endotracheal intubation were randomly assigned to two groups. Group 1 (control) patients received normal saline 2 mL i.v. and group 2 (D) patients received dexamethasone 8 mg i.v. After surgery, visual analogue scale (VAS) scores at rest and with effort (swallowing movement) for postoperative sore throat were recorded by a blinded observer. RESULTS: The overall incidence of postoperative sore throat during the first 24 hr following surgery was lower in dexamethasone group (D) compared to the control group (C). Eleven (20%) patients in the dexamethasone group had postoperative sore throat, compared to 31 (56.3%) patients in the control group (P<0.01). Postoperatively at one hour, three hours, six hours, 12 hr and 24 hr, the VAS scores for postoperative sore throat at rest and during effort were lower in the dexamethasone group (D) compared to the control group (P<0.01) at corresponding time intervals. CONCLUSION: Preoperative administration of dexamethasone 8 mg iv reduces the incidence and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation.     

Endotracheal Intubation, but Not Laryngeal Mask Airway Insertion, Produces Reversible Bronchoconstriction

Background: Tracheal intubation frequently results in an increase in respiratory system resistance that can be reversed by inhaled bronchodilators. The authors hypothesized that insertion of a laryngeal mask airway would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube.

Methods: Fifty-two (45 men, 7 women) patients were randomized to receive a 7.5-mm (women) or 8-mm (men) endotracheal tube or a No. 4 (women) or No. 5 (men) laryngeal mask airway. Anesthesia was induced with 2 [micro sign]g/kg fentanyl and 5 mg/kg thiopental, and airway placement was facilitated with 1 mg/kg succinylcholine. When a seal to more than 20 cm water was verified, respiratory system resistance was measured immediately after airway placement. Inhalation anesthesia was begun with isoflurane to achieve an end-tidal concentration of 1% for 10 min. Respiratory system resistance was measured again during identical conditions.

Results: Among patients receiving laryngeal mask airways, the initial respiratory system resistance was significantly less than among patients with endotracheal tubes (9.2 +/- 3.3 cm water [middle dot] 1-1 [middle dot] s (-1) [mean +/- SD] compared with 13.4 +/- 9.6 cm water [middle dot] 1-1 [middle dot] s-1; P < 0.05). After 10 min of isoflurane, the resistance decreased to 8.6 +/- 3.6 cm water [middle dot] 1-1 [middle dot] s-1 in the endotracheal tube group but remained unchanged at 9.1 +/- 3.3 cm water [middle dot] 1-1 [middle dot] s-1 in the laryngeal mask airway group. The decrease in respiratory system resistance in the endotracheal tube group of 4.7 +/- 7 cm water [middle dot] 1-1 [middle dot] s-1 was highly significant compared with the lack of change in the laryngeal mask airway group (P < 0.01).     

High dose epidural morphine for surgical analgesia

A group of 30 patients undergoing various operative procedures were anesthetized using high dose epidural morphine 20 mg in 15 ml of normal saline, thiopentone induction, endotracheal intubation and muscle relaxation with pancuronium 0.1 mg/kg and controlled ventilation with oxygen and nitrous oxide. Operative conditions and patient acceptance of the technique were satisfactory. There was cardiovascular stability and prolonged postoperative analgesia. Pruritus was observed in three patients and urinary retention in one and were adequately treated. Early mild respiratory depression occurred in one patient and this was treated with naloxone. High dose epidural morphine is efficacious and safe in providing intraoperative and postoperative analgesia.     

喉罩用于隆胸手术患者气道管理的效果

[摘要]目的观察喉罩通气全凭静脉麻醉用于隆胸术的临床效果。方法选择ASAI～Ⅱ级女性隆胸手术患者40例,年龄23—42岁;体重45—67kg;随机分为气管内插管组（A组,n=20）与喉罩组（B组,n=20）两组,A组静脉注射芬太尼0．2mg、丙泊酚2．0—2．5mg／kg、阿曲库铵0．15mg／kg诱导,插入气管导管;B组静脉注射芬太尼0．1mg、丙泊酚2．0～2．5mg／kg诱导,插入普通型喉罩,两组均接麻醉机行IPPV模式控制呼吸,两组均以微量泵持续泵入丙泊酚6～9tLg／（kg·min）,瑞芬太尼0．1—0．15μg/（kg·min）维持麻醉,A组间断静脉注射阿曲库铵,手术结束前10min停止用药,待受术者呼之能应,呼吸良好时拔除气管导管或喉罩。观察记录两组患者气管内插管和喉罩置入时间及置人情况、监测病人麻醉前（11D）、插管（插喉罩）后即刻（T1）、分离胸部肌肉时（他）、植入假体时（T3）、喉罩和气管导管拔除后即刻（T4）时的MAP、HR及SpO：的变化、通气状态以及操作时及术后的相关不良反应。结果A组1次成功完成气管内插管率与B组1次成功置入喉罩率无显著性差异（P〉0．05）;A组诱导时芬太尼用量显著多于B组（P〈0．05）;A组气管内插管后即刻（T1）以及拔管后即刻（rr4）的MAP及HR较诱导前显著升高（P〈0．05）,分离胸部肌肉时（T2）与植入假体时（T3）SBP、DBP、MAP和HR值均低于麻醉前,而B组T1、T2、T3时均较诱导前低（P〈0．05）;T4与诱导前相比无明显差异（P〉0．05）。A组插管时发生口腔粘膜出血及术后发生咽喉疼痛及呛咳的患者明显多于B组（P〈0．05）。结论与气管内插管全麻相比,喉罩通气全凭静脉麻醉施行隆胸手术,麻醉效果更满意、循环更稳定、并发症更少,术后恢复更舒适。     

小儿腹腔镜腹股沟斜疝手术中采用喉罩通气与气管插管麻醉效果观察

目的观察对比在小儿腹腔镜腹股沟斜疝手术中，采用喉罩通气与气管插管的麻醉效果。 方法纳入2019年5月至2020年5月于十堰市妇幼保健院确诊并进行腹腔镜腹股沟疝修补术治疗的患儿100例，按随机数字表法均分为观察组和对照组，每组患儿50例。对照组患儿接受气管插管方式进行麻醉，观察组患儿接受喉罩通气方式进行麻醉。记录所有患儿的基线资料、术中相关指标、血流动力学以及呼吸系统并发症，并进行比较。 结果2组患者临床资料比较，差异无统计学意义（P>0.05）；观察组患儿的麻醉时间、恢复时间、拔管时间[（39.15±6.88）、（4.45±1.85）、（6.15±1.56）min]均短于对照组[（44.95±8.98）、（7.96±1.86）、（13.58±3.28）min]，差异均有统计学意义（P<0.05）；观察组除术前外的各时间点的各项血流动力学指标均明显优于对照组患儿（P<0.05）；观察组患儿的并发症总发生率（10.00%）明显少于对照组（34.00%），差异有统计学意义（P<0.05）。 结论在小儿腹腔镜腹股沟斜疝手术中采用喉罩通气的方式进行麻醉是安全可行的。     

Contribution from upper and lower airways to exhaled endogenous nitric oxide in humans

Endogenous nitric oxide (NO) is thought to regulate many biological functions, including pulmonary circulation and bronchomotion, and it has been found in exhaled air. Our aim was to study the excretion of NO in different parts of the respiratory system.
Exhaled concentrations of NO were measured by chemiluminescence in chronic tracheostomy outpatients (group 1), in patients admitted for minor abdominal surgery (group 2), and in patients with acute respiratory failure (ARF) during mechanical ventilation (group 3). In awake volunteers (group 4), 0.57 L/min gas was aspirated through the nasal cavity into the chemiluminescence device.
In group 1 (tracheostomy, n=5) we detected 16±2 (mean±s.c. mean) parts per billion (ppb) NO when exhaling through the mouth, and a lower ( P <0.05) value of 4.6±0.8 ppb NO when exhaling through the tracheostomy. Before anaesthesia, group 2 (n=11) exhibited 13±2.4 ppb NO in orally exhaled gas, increasing considerably during exhalation through the nose. Upon endotracheal intubation exhaled NO concentration dropped to 1.3±0.2 ppb ( P <0.05). In group 3 (ARF, n=7) tracheal NO concentrations were 0.8±0.2 ppb. In group 4 (volunteers, n=6) 394±23 ppb NO was recorded in air from the nasal cavity.
In both healthy subjects and patients with respiratory failure a significant NO excretion occurs in the lower airways and lungs. The upper airways, expecially the nose, contribute the largest amount of NO (>90%) to exhaled air. The physiological implications of an upper airway source of NO remain to be defined.     

A tube in the pharynx for emergency ventilation

Background:
If the endotracheal placement of a nasal advanced tube fails, ventilation via this tube could bridge the time until a fibreoptic bronchoscope is available. This study investigates the efficiency of ventilation via a tube resting with its tip in the pharynx near the glottis.
Methods: In 20 patients respiratory data during ventilation via a pharyngeally placed tube were recorded by means of pulse oximetry, capnometry and side-stream spirometry. Results were compared with those measured previously in the same patients during conventional facemask ventilation.
Results: Oxygen saturation and end-tidal carbon dioxide concentration remained unchanged using ventilation via facemask (SO₂ 98.5±0.9%, FECO₂ 4.5±0.7 vol%) or pharyngeal tube (SO₂ 98.6±0.7%, FECO₂ 4.8±0.4 vol%). No significant differences were found between the two groups with regard to peak airway pressure, tidal volume leakage, compliance and resistance of the respiratory system.
Conclusions: Our results suggest an effective ventilation and oxygenation via a tube placed with its tip in the pharynx. This technique may be helpful during difficult and prolonged nasal intubation.     

优化术中护理措施对全腔镜食管癌手术患者快速康复的作用

目的探讨在全腔镜食管癌患者的手术过程中快速康复理念指导下优化护理措施的价值。 方法选择食管癌手术患者80例,随机分为实验组(n＝42)和对照组(n＝38),实验组采用预置营养管和术中预防低温的护理措施;对照组采用常规术后放置鼻空肠营养管的方法。比较两组患者置入营养管时间、术后鼻腔出血和会厌部水肿、肺部感染、肺不张、呼吸功能衰竭发生情况以及炎症因子(肿瘤坏死因子α、C反应蛋白、白介素6)水平的差异。 结果实验组所需插管时间(5.1±0.8)min,明显短于对照组的(8.2±1.3)min(P<0.05);术后鼻腔出血、会厌部水肿、肺部感染、肺不张和呼吸功能衰竭的发生率均显著低于对照组(P<0.05),术后24 h炎症因子水平也明显低于对照组(P<0.05)。 结论通过预置营养管、术中保温的方法可以缩短营养管插管时间,降低术后鼻腔出血和会厌部水肿、肺部感染、肺不张和呼吸功能衰竭的发生率,降低术后炎症因子水平,促进患者快速康复,值得临床推广使用。     

面罩双水平气道正压无创通气在腹腔镜胆囊切除术中的应用

【摘要】〓目的〓探讨面罩双水平气道正压(BiPAP)无创通气在腹腔镜胆囊切除手术全身麻醉中应用的安全可行性。方法〓40例行腹腔镜胆囊切除手术的患者,随机分为面罩BiPAP通气组(I组)和气管内插管间歇正压通气(IPPV)组(Ⅱ组),每组20例,术中监测平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO₂)以及Narcotrend指数(NI),并在麻醉前(T0)、麻醉诱导后(T₁)、插管或上面罩后(T₂)、机械通气后5 min(T₃)、气腹后5 min(T₄)、手术结束(T₅)、拔管或去面罩后(T₆)时点记录其数值;两组患者在T₀、T₃、T₄、T₅时点做血气分析,记录PaO₂、PaCO₂、pH值。结果〓I组MAP、HR在T₂和T₆时点低于Ⅱ组(P<0.05),而I组NI在T₁时点高于Ⅱ组(P<0.05);组内比较Ⅱ组在T₂、T₆时点MAP、HR显著升高(P<0.05),而I组在这两个时点无变化。PaO₂、PaCO₂、pH值在T₀、T₃、T₄、T₅时点组间比较差异均无统计学意义。结论〓面罩BiPAP无创通气应用于腹腔镜胆囊切除手术全身麻醉能够进行有效通气,且能维持患者血流动力学平稳,是一种安全有效的通气方式。     

Inhalational induction of anaesthesia with 8% sevoflurane in children: conditions for endotracheal intubation and side-effects

BACKGROUND AND OBJECTIVE: This study was designed to assess the conditions for endotracheal intubation or insertion of a laryngeal mask airway following an inhalational induction using 8% sevoflurane and nitrous oxide without the use of muscle relaxants or opioids. METHODS: There were two groups: 30 children had endotracheal intubation and 30 children had a laryngeal mask airway inserted. Induction of anaesthesia was accomplished using an inspiratory concentration of sevoflurane 8% in a nitrous oxide and oxygen mixture. After an end-expiratory concentration of sevoflurane of at least 4% had been reached, when the pupils were miotic and centred, the trachea was intubated or a laryngeal mask inserted. The time to loss of consciousness and successful airway management was recorded. Jaw relaxation, movements, visibility, and position of the vocal cords and vital parameters were monitored. RESULTS: Jaw relaxation was complete in all children. The vocal cords were completely visible in all patients of the tracheal intubation group, whereas vocal cord relaxation was incomplete in five children. Nevertheless, all children had an atraumatic intubation or insertion of the laryngeal mask without the use of a muscle relaxant. Vital signs were stable in both groups. There were no cases of restlessness and/or postoperative shivering. Four patients in the endotracheal group (13.3%) were nauseous and three (10%) vomited, while two children (6.6%) in the laryngeal mask group experienced nausea and vomiting. CONCLUSIONS: Induction with sevoflurane in nitrous oxide and oxygen leads to fast loss of consciousness and provides ideal conditions for managing the airway without supplemental opioids or muscle relaxants. Furthermore, sevoflurane using this technique was very well tolerated, indicated by high haemodynamic stability and a reduced rate of postoperative restlessness, shivering, nausea and vomiting.     

喉罩与气管插管在全麻或复合硬膜外阻滞时的心率和血压改变

目的比较喉罩与气管插管用于全麻或全麻复合硬膜外阻滞患者的HR和BP变化.方法妇科手术80例,随机分为全麻气管插管(T)组、全麻喉罩(L)组、硬膜外阻滞 全麻气管插管(ET)组、硬膜外阻滞 全麻喉罩(EL)组,每组20例.硬膜外阻滞用1%利多卡因 0.15%丁卡因.全麻诱导咪唑安定2 mg、芬太尼0.2 mg、丙泊酚1.5 mg/kg、琥珀胆碱1.5 mg/kg后插气管导管或喉罩.全麻维持50%N2O O2 异氟醚,静注阿曲库铵、芬太尼.于麻醉前(基础,入室静卧10 min后)、插管后1 min、切皮、进腹探查后5 min、拔管后1 min记录MAP、SpO2、HR、PETCO2.结果插管时HR和MAP均低于基础值,而两组喉罩HR低于插气管导管者,硬膜外复合全麻喉罩组MAP低于气管插管组.切皮时两组全麻MAP高于复合硬膜外组.探查时两组复合硬膜外者HR和MAP均低于基础值,且MAP低于单纯全麻者(P＜0.05).拔管时各组HR均显著高于基础值,MAP未复合硬膜外者显著高于基础值.结论(1)插喉罩对BP和HR的影响不如气管导管剧烈;(2)复合硬膜外阻滞时气管插管或喉罩置入应激反应轻,也可减轻探查时的BP波动.     

Inhalation anesthesia or "balanced anesthesia"? A comparative perioperative study in geriatric patients

During a prospective randomized trial, 50 geriatric patients underwent surgery for a fractured femoral neck. The perioperative circulatory and respiratory effects of anesthesia with enflurane or balanced anesthesia with enflurane and fentanyl were compared. We were particularly looking for postoperative respiratory depression after a standard dose of fentanyl given during balanced anesthesia. Method. In 25 patients anesthesia was induced with 0.2 mg/kg etomidate and 1 mg/kg succinylcholine and maintained with 0.15 mg/kg alcuronium and enflurane. Twenty-five patients received a additional dose of 5 micrograms/kg fentanyl divided into 0.1 mg/kg 2 min before endotracheal intubation and the remainder 5 min before the start of surgery. Systolic and diastolic arterial pressures, heart rate, central venous pressure, hemoglobin, hematocrit, and electrolytes were measured and arterial blood gases were analyzed. Results. There was no important difference between the two methods: during careful use of both techniques circulation remained stable. No marked postoperative respiratory depression occurred even after 5 micrograms/kg fentanyl. Conclusions. Both anesthetic procedures are suitable for hip surgery in elderly patients. In the early postoperative period geriatric patients should be observed carefully in the recovery room for at least 2 h. In some patients--especially if fentanyl is used intraoperatively--this time must be prolonged.     

Supreme TM喉罩在腹腔镜腹股沟疝手术中的麻醉效果及对应激指标的影响

目的探究Supreme^TM喉罩与气管插管在腹腔镜腹股沟疝手术中的效果及对应激指标的影响。 方法将2021年2至10月于徳驭医疗马鞍山总医院接受治疗的62例腹股沟疝患者随机分为对照组和观察组,每组患者31例。对照组采用气管插管进行腹腔镜腹股沟疝手术,观察组采用Supreme^TM喉罩进行腹腔镜腹股沟疝手术,对比2组各时间点[麻醉诱导前（T0）、插入气管或喉罩时（T1）、插入5 min时（T2）、拔除气管或者喉罩时（T3）]血流动力学指标,麻醉质量（睁眼时间、拔管时间及完全清醒时间）,各时间点气道峰压及气道密闭压变化情况,不良反应发生率。 结果（1）T1、T2、T3时间点,2组患者平均动脉压（MAP）和心率水平较T0时间点明显升高,且观察组MAP、心率水平低于对照组（P<0.05）;（2）观察组睁眼时间、拔管时间和完全清醒时间均低于同期对照组（P<0.05）;（3）与对照组相比,观察组患者在T1~T3时气道峰压以及气道密闭压方面均显著下降（P<0.05）;（4）观察组的不良反应总发生率低于对照组（P<0.05）。 结论Supreme^TM喉罩较气管插管在腹腔镜腹股沟疝手术中的麻醉效果更好,且不良反应少、安全性高。     

可视喉镜联合管芯和电子软镜引导经鼻气管插管用于口腔科手术患者的效果

目的 评价可视喉镜联合管芯与UE电子软镜引导经鼻气管插管用于口腔科手术患者的效果.方法 选取择期行全麻下经鼻气管插管手术的口腔科患者60例,ASA Ⅰ～Ⅱ级,年龄18～65岁,BMI＜30kg/m2.按随机数字表法分为可视喉镜联合管芯组(K组)和UE电子软镜组(U组),每组30例.记录2组一次置入导管成功率、气管插管时...     

切断术治疗多汗症的随机对照试验

目的介绍多汗症快速康复外科治疗的新方法,并探讨麻醉监护下非气管内插管局部麻醉胸腔镜交感神经切断术治疗多汗症的可行性、安全性及有效性。方法纳入广东省人民医院124例中度以上多汗症患者,采用SPSS18．0软件计算机生成随机序列,将患者分成非气管内插管局部麻醉组及气管内插管全身麻醉组,每组各62例,局部麻醉组男43例、女19例,年龄（22．25±6．22）岁;全身麻醉组男42例、女20例,年龄（23．98±6．67）岁。局部麻醉组不需气管内插管,仅予鼻导管或面罩吸氧,行麻醉监护;全身麻醉组常规气管内插管下完成手术,比较两组临床效果。结果所有患者均安全顺利完成手术。局部麻醉组无1例转为气管内插管全身麻醉。局部麻醉组和全身麻醉组的手术时间[（47．18±12．06）minVS．（39．33±13．21）min,P=0．002]、总操作时间[（84．52±22．56）minVS．（134．68±26．12）min,P=0．000]差异有统计学意义。两组出血量、术中脉搏血氧饱和度（SpO：）〈95％例数（2例VS．0例）,术后住院时间、术后代偿性多汗发生率（86．50％VS．89．00％）,术后患者满意率（94．59％VS．95．12％）差异均无统计学意义;两组均无术中疼痛不适、手术并发症、术后复发发生。两组麻醉准备时间[（20．52±10．55）minVS．（36．47±12．16）min],术后清醒出手术室时间[（11．26±7．09）minVS．（59．39±19．89）min],住院费用[（6376．86±746．00）元VS．（8812．044-867．93）元]差异有统计学意义（P均为0．000）。局部麻醉组术后咽喉部不适等（0％VS．100％）,术后监护时间（4hVS．12h）,术后进食时间（2hVS．6h）均优于全身麻醉组。结论非气管内插管麻醉监护下局部麻醉胸腔镜双侧交感神经切断术安全可行,有效,避免了气管内插管全身麻醉的危害,更微创,是一种较好的治疗多汗症的快速康复外科方法。     

A comparison of blind and lightwand-guided tracheal intubation through the intubating laryngeal mask

We have tested the hypothesis that intubation success rates, haemodynamic changes, airway complications and postoperative pharyngolaryngeal morbidity differ between blind and lightwand-guided intubation through the intubating laryngeal mask airway. One hundred and twenty paralysed anasthetised adult patients (ASA I-II, no known or predicted difficult airways) were assigned in a random manner to one of two equal-sized groups. In the blind group, patients were intubated blindly through the intubating laryngeal mask airway. In the lightwand group, patients were intubated through the intubating laryngeal mask airway assisted by transillumination of the neck with a lightwand. A standard sequence of adjusting manoeuvres was followed if resistance occurred during intubation or if transillumination was incorrect. The number of adjusting manoeuvres, time to intubation, intubation success rates, haemodynamic changes (pre-induction, pre-intubation, postintubation), oesophageal intubation, mucosal trauma (blood detected), hypoxia (oxygen saturation < 95%) and postoperative pharyngolaryngeal morbidity (double-blinded) were documented. Overall intubation success was similar (blind, 93%; lightwand, 100%), but time to successful intubation was significantly shorter (67 vs. 46 s, p = 0. 027) and the number of adjusting manoeuvres was significantly fewer (p = 0.024) in the lightwand group. There were no significant differences in blood pressure or heart rate between the groups at any time. Oesophageal intubation occurred more frequently in the blind group (18 vs. 0%, p = 0.002). The incidence and severity of mucosal injury, sore throat and hoarseness were similar between the groups. We conclude that lightwand-guided intubation through the intubating laryngeal mask is superior to the blind technique.     

Full face mask for noninvasive positive-pressure ventilation in patients with acute respiratory failure

BACKGROUND: Noninvasive positive-pressure ventilation (NPPV) is commonly used to improve ventilation and oxygenation in patients with acute respiratory failure (ARF). Mask leak and intolerance due to facial discomfort or claustrophobia often occur with NPPV and are frequently cited reasons for treatment failure. METHODS: Retrospective review of patient records from a tertiary-care referral hospital. Results: We report the effectiveness of a full face mask in the application of NPPV for 10 nonambulatory patients (mean [SD], 61 [9] years) who had a combined total of 13 episodes of ARF. After these patients were unable to receive NPPV therapy via the more commonly available nasal or oronasal masks, care was provided using full face masks. Eight of 10 patients had hypercapnic respiratory failure; 2 patients, hypoxemic respiratory failure. All patients were placed on ventilation initially using a bi-level positive airway pressure device. Subsequently, patient ventilation was achieved using a Puritan Bennett 7200a ventilator for on-line respiratory monitoring. The mean (SD) duration of treatment with NPPV was 9.7 (2.7) hours per day for 3.0 (1.6) days. Following NPPV via full face mask, the patients' Paco(2) decreased (65 [20] vs 82 [27] mm Hg, P=.09) and pH increased significantly (7.36 [0.07] vs 7.26 [0.07], P<.05) in less than 2 hours. Moreover, the patients demonstrated decreased respiratory rate (18 [7] vs 32 [8] breaths/min, P<.01), heart rate (106 [13] vs 124 [16] beats/min, P=.008), and Acute Physiology and Chronic Health Evaluation II scores (12 [3] vs 17 [4], P<.005) after NPPV via full face mask. These cardiorespiratory alterations occurred as early as 1 hour after NPPV initiation and were maintained throughout treatment. Two patients required endotracheal intubation because of copious purulent secretions. CONCLUSION: For individuals with hypercapnic respiratory failure who cannot tolerate NPPV using nasal or oronasal masks, use of full face masks may improve outcomes, allowing physicians to avoid ordering endotracheal intubation and mechanical ventilation.     

羟考酮联合右美托咪定在纤维支气管镜清醒气管插管中的应用

目的观察羟考酮复合右美托咪定在清醒气管插管中的镇痛镇静效果以及对呼吸和循环功能的影响。方法选择术前预计困难气道的择期手术患者40例,随机分为舒芬太尼组和羟考酮组。两组患者静脉泵注右美托咪定1μg/kg后以0.2μg·kg~(-1)·h~(-1)维持,舒芬太尼组静注舒芬太尼0.2μg/kg,羟考酮组静注羟考酮0.08mg/kg。监测患者用药及插管期间HR、MAP和SpO_2变化,并记录插管前Ramsay评分以及插管后PETCO_2和舒适度评分。结果两组患者用药及插管期间的血流动力学变化、镇静及舒适度差异无统计学意义。羟考酮组患者静注后SpO_2明显高于舒芬太尼组(P0.05),气管插管后PETCO_2明显降低(P0.05)。结论羟考酮复合右美托咪定可安全地用于清醒气管插管,镇痛、镇静效果良好,与舒芬太尼相比,呼吸抑制轻,不良反应少。