Airtraq optical laryngoscope

BACKGROUND: We described an early experience of Airtraq laryngoscope in 20 patients receiving general anesthesia. METHODS: In all, 2 staff anesthesiologists, 3 anesthesia residents and 10 non-anesthesia residents performed endotracheal intubation with 14 polyvinyl chloride tubes with inside diameter of 7-8 mm, 5 double lumen 37-F tubes and 1 preformed nasotracheal tube. RESULTS: Every endotracheal intubation was achieved at the first trial, and the mean time to secure the airway was 46 +/- 18 seconds. CONCLUSIONS: Airtraq laryngoscope is a useful novel device for tracheal intubation.     

A randomised controlled trial comparing the GlideScope® and the Macintosh laryngoscope for double‐lumen endobronchial intubation

Double‐lumen endobronchial tubes are the most common method of achieving lung isolation and one‐lung ventilation during thoracic anaesthesia and surgery. We compared the clinical performance of the Macintosh laryngoscope and the GlideScope^® during endobronchial intubation with a double‐lumen tube. Seventy patients with no predictors for difficult laryngoscopy were allocated randomly to the Macintosh laryngoscope or GlideScope. The time taken for endobronchial intubation with the Macintosh laryngoscope was significantly shorter compared with that taken for the GlideScope, median (IQR [range]) 33 (22–52 [11–438]) s vs 70 (39–129 [21–242]) s, respectively, p = 0.0013. There was no statistical difference in the rate of success at the first attempt (91% vs 83%, respectively). On a numerical rating scale (scored from 0 to 10), the 30 anaesthetists who took part in the study rated endobronchial intubation overall as easier using the Macintosh compared with the GlideScope, 2 (1–3 [0–8]) vs 3 (2–6 [0–10]), respectively, p = 0.003. Postoperative voice changes were also less common in the Macintosh group (8 (22%) vs 17 (58%), p = 0.045). Anaesthetists found the GlideScope more difficult to use than the Macintosh laryngoscope and endobronchial intubation took longer; therefore, we cannot recommend its routine use with double‐lumen tubes in patients who are predicted to have a normal airway.     

Optimal depth of insertion of left-sided double-lumen endobronchial tubes cannot be predicted from body height in below average-sized adult patients

BACKGROUND AND OBJECTIVE: The optimal depth of insertion of left-sided double-lumen endobronchial tubes is strongly correlated with body height in average-sized adults. However, this relationship has not been studied in below average-sized adult patients. We investigated whether or not there is a clinically useful relationship in below average-sized adult patients. METHODS: One hundred and ninety six consecutive adult patients undergoing thoracic surgery under one-lung anaesthesia (body height < or = 155 cm) were included in this study. Left-sided double-lumen tubes were inserted under the guidance of a fibre-optic bronchoscope. Optimal depth was defined as the proximal surface of the bronchial cuff positioned just below the carina. RESULTS: There was a statistically significant positive correlation between body height and the optimal depth of insertion (r = 0.61, P < 0.0001); however, the correlation coefficient was low. The actual optimal depth of insertion of one patient was even 4.5 cm shorter than that obtained from the equation. CONCLUSION: Although there was a statistically significant correlation between body height and the optimal depth of insertion of left sided double lumen tubes in adult patients of short stature (< or = 155 cm), clinical application of the equation is not warranted and these tubes should be inserted under direct vision with a fibre-optic bronchoscope.     

Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures

Introduction and aim

Numbness across the shoulder and upper chest wall is a frequent complication following plate fixation of clavicular shaft fractures. This is usually attributed to damage to branches of the supraclavicular nerve caused by the surgical approach. We investigate whether the use of an incision perpendicular to the long axis of the clavicle (vertical incision) rather than one parallel to it (horizontal incision) is associated with reduced post-operative numbness and improved patient satisfaction.

Methods

We retrospectively assessed a group of patients who underwent plate fixation of a fractured clavicle at our institution. Using a patient-completed questionnaire, we compared differences in numbness, scar satisfaction, pain, and overall satisfaction with the operation, between those who received a horizontal incision (n = 21) versus those treated using a vertical incision (n = 14).

Results

The likelihood of experiencing post-operative numbness was less in the vertical incision group. Those who had undergone vertical incisions also reported a significantly reduced degree of numbness and significantly less awareness of the numbness with clothing and shoulder straps. There was no statistically significant difference between the groups in terms of pain and scar satisfaction. Patients who reported being most bothered by their numbness also tended to report the highest dissatisfaction with the operation.

Conclusion

Vertical incisions for plate fixation of clavicular shaft fractures may be associated with reduced post-operative numbness and avoid some cases of patient dissatisfaction. Surgeons should consider using this approach in plate fixation of clavicle fractures.     

Fatores de risco para hipoxemia intraoperatória durante ventilação monopulmonar: estudo observacional

BackgroundLeft double‐lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double‐lumen endotracheal tubes based on their experience with 35 and 37 Fr double‐lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube.MethodsWe included 360 patients with a left double‐lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography.ResultPatients with a left main bronchus length of less than 40 mm who underwent intubation with a left double‐lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one‐lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105).ConclusionsWe identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.     

Complication in the use of double-lumen tubes

An unexpected, potentially hazardous complication during the use of Robertshaw double-lumen endobronchial tubes is reported. A material defect causing obstruction of the lumen made endotracheal suction during surgery impossible even with very thin suction catheters. The authors recommend the internal diameter of double-lumen endobronchial tubes checking before intubation.     

Insertion of the double lumen tube in the difficult airway

Isolation of a lung and one-lung ventilation are commonly used during thoracic surgery. Insertion of double lumen tubes requires considerable skill and may be especially challenging in the difficult airway. We describe a method of inserting double lumen tubes in two patients with known difficult airways. This technique involves awake nasotracheal intubation followed by insertion of an oral double lumen tube under general anaesthesia.     

Use of small-bore silastic drains in general thoracic surgery.

STUDY OBJECTIVE: To evaluate the safety and efficacy of small-bore, silastic drains for patients undergoing general thoracic surgery. PATIENTS AND METHODS: Twenty-five patients who received soft, small-bore, silastic drains were compared with 17 patients who received semi-rigid double lumen (DL) tubes retrospectively. RESULTS: The pain score was significantly lower in patients who received the silastic tubes in video-assisted thoracoscopic surgery (VATS) cases on postoperative days 5 and 6 , after continuous epidural analgesia had finished (P=0.018). No specific morbidity was seen in the patients who received silastic tubes. CONCLUSION: We considered that soft, small-bore silastic drains were just as effective as traditional DL tubes, but caused less pain especially in VATS cases.     

Problems of intubation using the flexible LF-1 fiberoptic bronchoscope. Development of an intubation aid

Fiberoptic endotracheal intubation with an endoscope (external diameter 4 mm) especially designed for anesthesiologists proved to be safe providing small-diameter tubes were used. The use of large-diameter tubes (I.D. 7.5-8.5 (mm)) involves a risk of the tip of the tube clinging to the arytenoid cartilages preventing any further advancement. To avoid this complication another special tube has been constructed, which fills the space between the endotracheal tube and the bronchoscope and centers the bronchoscope within the endotracheal tube. When this new tube was used there were no problems either in passing the bronchoscope through this "inner" tube or in withdrawing the inner tube after successful intubation. With the new device it was even possible to pass tubes with wider lumen into the trachea over the fiberscope with minimal difficulty and trauma.     

A comparison of two limited open techniques for carpal tunnel release

Review of the literature shows the effectiveness of limited open carpal tunnel release to be comparable to that of endoscopic carpal tunnel release in respect of recovery of grip strength, time of return to work and complication rate. A randomised, controlled study was designed to compare the effectiveness of a single versus a double limited open technique of carpal tunnel release. Sixty-five patients (73 hands) with a mean age of 48 years were operated on, 40 hands by the single incision and 33 by the double incision method. Grip and pinch strengths, digital sensibility (Filament and 2PD tests) and Levine scores were evaluated throughout 12 months of follow-up. We found that the single incision method offers better results in respect of grip and pinch strengths: less weakness at 1 month after surgery and a faster improvement relative to pre-operative values which is statistically significant. This, however, did not translate directly into Levine functional and symptom scores which, at each assessment, did not differ significantly between the two methods.     

输尿管镜钬激光内切开术治疗输尿管狭窄疗效分析

目的:探讨输尿管镜下钬激光内切开术治疗输尿管狭窄的临床疗效.方法:采用经输尿管镜钬激光内切开术治疗输尿管狭窄患者31例,术中留置F8双J管,术后2～3个月拔取双J管.结果:术后共随访28例,时间3～28个月.23例治愈,治愈率为82.1%(23/28).结论:输尿管镜钬激光内切开术治疗输尿管狭窄是一种疗效确切、安全微创的手术方法.     

持续软组织扩张术护理及并发症控制

目的：探讨持续软组织扩张的护理技术。方法：选择78例患者做软组织扩张术，用4种灌注设备作注水（气）扩张，对手术后伤口，负压引流管，注水（气）过程和出现的并发症进行护理观察。结果：78例患者手术切口顺利愈合。4种持续扩张方法均能达到快速扩张效果，扩张时间8天－21天。有9个部位出现并发症，经对症护理全部得到控制，并发症发生率占总扩张部位的4．13％。结论：采用持续扩张法能减轻护理工作量，护理重点在手术切口观察，负压引流管和灌注设备的管理。     

Comparison of the Surgical Outcomes of Punch Incision and Elliptical Excision in Treating Epidermal Inclusion Cysts: A Prospective, Randomized Study

BACKGROUND: Punch incision has been introduced as an alternative method to surgical excision for troublesome epidermal inclusion cysts. To date, there is no randomized study directly comparing the long-term results of these two methods. OBJECTIVE: To compare the surgical outcomes of these two procedures and to identify the characteristics of a lesion most suitable for the punch incision technique. METHODS: In a 16-month period, 60 patients with noninfected epidermal inclusion cysts were randomly treated with either punch incision or elliptical excision. Demographic data, size, and location of lesion, length of wound, operative time, complications, recurrence, and patient satisfaction were compared statistically. RESULTS: The mean lengths of the wounds in the punch incision and elliptical excision groups were 0.73 and 2.34 cm, respectively (p<.001). Mean operative time was significantly shorter in the punch group (12.7 minutes) as compared with the surgical group (21.6 minutes) (p<.001). No complication occurred in the punch incision group. There was no significant difference in the recurrence rate. CONCLUSION: Punch incision produces a superior cosmetic result while keeping a low recurrence rate of cysts. Epidermal inclusion cysts measuring 1 to 2 cm that are located on the face or in an area of cosmetic concern are best treated with punch incision.     

Pericardio peritoneal window

Transdiaphragmatic approach to the pericarium through the use of the laparoscope is a safe and rapid way to obtain biopsy of the pericardium and create a window. No drainage tubes are needed: pericardial fluid is absorbed by the peritoneum; there is no need for double lumen tubes for one lung ventilation; and the laparoscopy incisions are small and almost painless. Received: 5 December 1997/Accepted: 17 June 1998     

无切口腹腔镜直肠癌根治术的临床效果分析

目的探讨无腹部辅助切口腹腔镜直肠癌根治术治疗直肠癌患者的临床疗效。方法选取2013年1月至2014年8月择期行腹腔镜直肠癌根治术的79例患者进行回顾性分析,其中28例患者采用无腹部辅助切口腹腔镜直肠癌根治术治疗(无切口组)、51例患者采用传统的腹腔镜直肠癌根治术治疗(传统组),两组患者数据分析采用SAS10.0进行处理,术中、术后临床资料、VAS评分等计量指标采用均数±标准差(x珋±s)进行描述,比较采用两独立样本t检验;并发症发生率等计数资料比较采用χ2检验;P值0.05为差异具有统计学意义。结果无切口组的手术时间、手术出血量、术后肛门排气时间、住院时间均显著低于传统组(P0.05),两组患者清扫淋巴结数目相比较无统计学意义(P0.05);术后2 h、6 h、12 h、24 h,无切口组的VAS评分均显著低于传统组(P0.05);无切口组的并发症率10.7%、传统组的并发症率15.7%,两组间比较差异无统计学意义(P0.05);无切口组的排便习惯改变率32.1%、2年复发率25.0%、2年生存率85.7%,传统组分别为41.2%、19.6%、86.3%,两组间比较差异无统计学意义(P0.05)。结论无腹部辅助切口腹腔镜直肠癌根治术治疗直肠癌与传统的腹腔镜手术效果无明显差异,但具有创伤更小、术后恢复更快、疼痛程度更低的优势。     

Growth factor enhancement of peripheral nerve regeneration through a novel synthetic hydrogel tube

OBJECT: The authors' long-term goal is repair of peripheral nerve injuries by using synthetic nerve guidance devices that improve both regeneration and functional outcome relative to an autograft. They report the in vitro processing and in vivo application of synthetic hydrogel tubes that are filled with collagen gel impregnated with growth factors. METHODS: Poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) (PHEMA-MMA) porous 12-mm-long tubes with an inner diameter of 1.3 mm and an outer diameter of 1.8 mm were used to repair surgically created 10-mm gaps in the rat sciatic nerve. The inner lumen of the tubes was filled with collagen matrix alone or matrix supplemented with either neurotropin-3 at 1 microg/ml, brain-derived neurotrophic factor at 1 microg/ml, or acidic fibroblast growth factor (FGF-1) at 1 or 10 microg/ml. Nerve regeneration through the growth factor-enhanced tubes was assessed at 8 weeks after repair by histomorphometric analysis at the midgraft level and in the nerve distal to the tube repair. The tubes were biostable and biocompatible, and supported nerve regeneration in more than 90% of cases. Nerve regeneration was improved in tubes in which growth factors were added, compared with empty tubes and those containing collagen gel alone (negative controls). Tubes filled with 10 microg/ml of FGF-1 dispersed in collagen demonstrated regeneration comparable to autografts (positive controls) and showed significantly better regeneration than the other groups. CONCLUSIONS: The PHEMA-MMA tubes augmented with FGF-1 in their lumens appear to be a promising alternative to autografts for repair of nerve injuries. Studies are in progress to assess the long-term biocompatibility of these implants and to enhance regeneration further.     

老年人开腹和腹腔镜胆囊切除术临床对照分析

目的:比较老年人开腹(OC)和腹腔镜胆囊切除术(LC)的并发症和术后康复状况,评价老年人腹腔镜胆囊切除术的优越性。方法:前瞻性设计,随机将诊断为胆囊结石的老年患者分为两组,开腹组(OC)和腹腔镜组(LC)。对并发症和术后康复状况进行统计学处理。结果:OC组切口感染8例(28.6％),肺部感染7例(25.0％),低蛋白血症14例(50.0％)。LC组无切口及肺部感染,低蛋白血症5例(17.2％),胆漏1例(3％),皮下气肿2例,术中高碳酸血症3例,胆囊癌切口种植1例。结论:与OC相比老年胆结石患者施行LC具有并发症发生率低,住院时间短,康复快等优点。     

Bronchial intubation. A comparison between polyvinyl chloride and red rubber double lumen tubes

Red rubber and polyvinyl chloride bronchial double lumen tubes were compared. Polyvinyl chloride tubes are easier to pass quicker to position and cause less damage to the mucosa of the respiratory tract than the red rubber equivalents.     

Early tracheostomal healing in rabbits with use of various tracheal incisions

Various tracheal incisions (vertical, horizontal, or window) are used by surgeons for creation of a tracheostomy. The inflammatory response and healing varies with each incision and may contribute to complications such as tracheal stenosis. This study evaluates the effect of these tracheotomies on early stomal wound healing in a rabbit model. Male juvenile New Zealand rabbits underwent tracheotomy, with each animal randomized to the type of tracheal incision used (vertical, horizontal, or window). After recovery, they were killed on postoperative days 2, 4, 6, and 8, with tissue removed for histologic examination. Paraffin-embedded stomal sections were analyzed quantitatively for amounts of granulation tissue, fibrosis, and epithelization. Groups were compared statistically using chi-square, ANOVA, Spearman's rho, and Mann-Whitney U tests with p less than 0.05 considered significant. Fibrosis was significantly increased in the vertical and horizontal groups when compared with the window group. This increase was statistically significant between postoperative days 2 and 4 (p < 0.05). The amount of granulation tissue was only significantly increased in the window group, whereas no difference was seen in the rate at which epithelization occurred with the various incisions. Vertical and horizontal tracheal wounds have less granulation tissue formation and more fibrosis compared with window tracheotomies during initial wound healing. This could lead to a "safer" tracheostomy tract in the early postoperative period.     

改良三点式重睑术在上睑皮肤松弛患者中的应用效果

探究改良三点式重睑术治疗上睑皮肤松弛的临床价值。方法 选取2021年1月-2022年12月 长春市盈康医院收治的60例上睑皮肤松弛患者作为研究对象，采用随机数字表法分为对照组与观察组， 每组30例。对照组实施传统重睑术治疗，观察组实施改良三点式重睑术进行治疗，比较两组手术时间及 恢复时间、切口愈合率、并发症发生率以及治疗满意度。结果 观察组手术时间及恢复时间短于对照组， 差异有统计学意义（P ＜0.05）；观察组切口愈合率为100.00%，高于对照组的86.67%，差异有统计学意 义（P ＜0.05）；观察组并发症发生率为3.33%，低于对照组的26.67%，差异有统计学意义（P ＜0.05）；观 察组治疗满意度为96.67%，优于对照组的70.00%，差异有统计学意义（P ＜0.05）。结论 通过对上睑皮肤 松弛患者实施改良三点式重睑术，能够有效缩短手术时间，加快患者的康复速度，提高患者的切口愈合 率，防止并发症的发生，提升患者满意度，在临床上具有较高的应用价值。