Application of Gum Elastic Bougie to Nasal Intubation

Gum elastic bougie (GEB), a useful device for difficult airway management, has seldom been used for nasotracheal intubation. Among 632 patients undergoing dental procedures or oral surgery, GEB was used successfully in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or maldirection of the tip of the tracheal tube. We recommend that GEB should be applied from the first attempt for nasal intubation in patients with difficult airways.     

Safe Esophageal Bougie Placement for Laparoscopic Hiatal Hernia Repair

The increased use of laparoscopy for treatment of reflux esophagitis has been associated with a 1-8% complication rate. Perforation of the esophagus from bougie placement, wrap breakdown or too tight a wrap are some of the complications seen from this surgery. An esophageal dilator system was developed to overcome these problems. Thirty patients had an esophageal dilator system used whereby a 48F or 58F dilator was placed over a 18F orogastric tube. Intraoperative gastroscopy documented a properly created wrap. There were no esophageal perforations or morbidity associated with the dilator.     

弹性橡胶探条用于引导双腔支气管导管插管的对比研究

目的探讨弹性橡胶探条应用于引导双腔支气管导管插管的可行性。方法选择2010年2～8月需行双腔支气管导管插管、直接喉镜显露Cormack-Lehane气道分级Ⅱ～Ⅲ级的胸科手术60例,随机分为常规双腔支气管导管插管组（SI）和经弹性橡胶探条引导双腔支气管导管插管组（BI）,每组各30例。吸纯氧5 min后,静脉顺序给予咪达唑仑0.05mg/kg、芬太尼3μg/kg、利多卡因40 mg、丙泊酚1.5～2 mg/kg和罗库溴铵0.6 mg/kg麻醉诱导,肌松完善后直接喉镜下分别经铝制管芯（SI组）或弹性橡胶探条（BI组）引导双腔管插管。观察诱导插管期间心率（HR）和平均动脉压（MAP）变化,记录2组完成诱导时间和气管插管一次成功率,比较2组术后气管插管相关并发症发生率。结果与诱导前比较,2组HR和MAP在麻醉诱导后均明显下降（P〈0.01）,插管后1 min,2组HR和MAP上升（P〈0.05）,插管后3 min恢复至诱导前水平。2组完成诱导时间分别为：SI组（5.1±0.8）min,BI组（5.9±0.9）min（t=3.423,P=0.542）。BI组气管插管一次成功率（96.7%）明显高于SI组（80.0%）（χ2=4.043,P=0.044）。术后SI组有14例出现喉痛,而BI组仅为6例（χ2=4.800,P=0.028）。结论弹性橡胶探条可安全应用于引导双腔支气管导管插管。     

Anal condyloma: its management is still difficult

Anal condylomas result from papillomavirus infection, the most common sexually transmitted disease. The principal risk is the development of cancer of the anal canal. The risk of contamination is high, even after a single sexual contact. No specific antiviral treatment is available and no consensus has been reached on the appropriate treatment of anal condylomas. Despite the development of various methods (interferon, imiquimod), electrocoagulation remains the treatment of choice. Finally, regular follow-up and treatment of the partner(s) are essential.     

Bougie insertion: A common practice with underestimated dangers

IntroductionEsophageal perforation after bariatric operations is rare. We report two cases of esophageal perforation after bariatric operations indicating the dangers of a common practice – like insertion of esophageal tubes – and we describe our management of that complication.Presentation of caseA 56 year old woman who underwent laparoscopic sleeve gastrectomy and a 41 year old woman who underwent laparoscopic adjustable gastric banding respectively. In both operations a bougie has been used and led to esophageal perforation.DiscussionThe insertion of bougie and especially of inflated bougie is a common practice. It is an invasive procedure that in most cases is performed by the anesthesiologist team.ConclusionBougie insertion is an invasive procedure with risks and should always be attempted under direct supervision of surgical team or should be inserted by a surgeon.     

Microsurgery in microgravity is possible

The aim of this experiment was to evaluate the feasibility of a microsurgical procedure in the context of microgravity during parabolic flights. The surgical procedure included the sectioning and repair of a rat sciatic nerve and tail artery with 10/0 monofilament sutures. Both procedures were successful. To date, telesurgery cannot be considered during interplanetary spaceflights. If a surgeon is able to perform microsurgery in microgravity, a physician with basic surgery training will be able to perform basic surgical procedures in space flights.