Esophageal and tracheal distortion by the Esophageal-Tracheal Combitube: a cadaver study

PURPOSE: To understand the anatomical relationships of the Esophageal-Tracheal Combitube (ETC) with the larynx, pharynx, esophagus and trachea. METHODS: An extensive dissection of the neck and thorax of a 70-yr-old caucasian male cadaver was done to expose the larynx, pharynx, trachea and esophagus. The ETC was inserted following the manufacturer's recommendations. Effects of the ETC on the surrounding structures were observed with the ETC first inserted in the esophagus and then, in the trachea. RESULTS: When inserted in the esophagus, the ETC produced marked bulging of the anterior wall of the esophagus and anterior displacement (4.5 cm) of the trachea. Inflation of the distal cuff of the ETC produced distension of the esophagus. When inserted in the trachea, the ETC also caused anterior protrusion. CONCLUSION: Protrusion of the anterior wall of the esophagus and distension resulting from inflation of the distal cuff could lead to esophageal injuries. These observations may explain the previously reported complications associated with the use of the ETC.     

A randomised trial comparing the i-gel (TM) with the LMA Classic (TM) in children

We performed a prospective, randomised trial comparing the i-gel(TM) with the LMA Classic(TM) in children undergoing general anaesthesia. Ninety-nine healthy patients were randomly assigned to either the i-gel or the LMA Classic. The outcomes measured were airway leak pressure, ease of insertion, time taken for insertion, fibreoptic examination and complications. Median (IQR [range]) time to successful device placement was shorter with the i-gel (17.0 (13.8-20.0 [10.0-20.0]) s) compared with the LMA Classic (21.0 (17.5-25.0 [15.0-70.0]) s, p = 0.002). There was no significant difference in oropharyngeal leak pressure between the two devices. A good fibreoptic view of the glottis was obtained in 74% of the i-gel group and in 43% of the LMA Classic group (p < 0.001). There were no significant complications. In conclusion, the i-gel provided a similar leak pressure, but a shorter insertion time and improved glottic view compared with the LMA Classic in children.     

食管气管联合导管在抢救急性重症口服中毒患者中的应用

目的观察食管气管联合导管用于急性重症口服中毒患者抢救的临床效果。方法将107例急性重症口服中毒患者随机分为观察组（54例）和对照组（53例）．观察组用食管气管联合导管插管．从导管管腔中插入胃管洗胃；对照组在普通气管插管成功后，从口腔或鼻腔插入胃管洗胃。结果观察组一次插胃管成功率、抢救成功率均显著高于对照组（P〈0．01，P〈0．05）：观察组插胃管所需时间明显少于对照组（P〈0．05）。结论对急性口服中毒并发呼吸衰竭患者使用食管气管联合导管洗胃效果良好，且操作简便、快捷。     

食管气管联合导管在抢救急性重症口服中毒患者中的应用

目的观察食管气管联合导管用于急性重症口服中毒患者抢救的临床效果。方法将107例急性重症口服中毒患者随机分为观察组(54例)和对照组(53例),观察组用食管气管联合导管插管,从导管管腔中插入胃管洗胃;对照组在普通气管插管成功后,从口腔或鼻腔插入胃管洗胃。结果观察组一次插胃管成功率、抢救成功率均显著高于对照组(P<0.01,P<0.05);观察组插胃管所需时间明显少于对照组(P<0.05)。结论对急性口服中毒并发呼吸衰竭患者使用食管气管联合导管洗胃效果良好,且操作简便、快捷。     

Etidocaine (Duranest®): A Clinical and Laboratory Evaluation

Es wird über die Ergebnisse einer klinischen und Laboratoriumsauswertung des neuen Lokalanaesthetikums Etidocain zur Leitungsanaesthesie in einer Serie von über 2200 Fällen im Detail berichtet. Seine Wirkungsfrequenz ist hoch, der Wirkungseintritt rasch, der Wirkungsverlust langsam. Die Dauer der sensorischen und motorischen Blockade übertrifft die des Bupivacains. Die Spitzenwerte der venösen Blutplasmakonzentrationen nach Periduralanaesthesien sind niedriger als nach wirkungsgleichen Mengen von Bupivacain. Es wird auf pharmakokinetische Untersuchungen verwiesen, die ergaben, daß dieses Agens eine niedrigere systemische Toxizität, bzw. therapeutischen Index hat als andere Lokalanaesthetika. Gecignete Konzentrationen für verschiedene Methoden der Leitungsanaesthesie liegen zwischen 0,5 und 1,5%. Es wird betont, daß die geringe systemische Toxizität und längere Wirksamkeit von Etidocain auf seiner hohen Plasmaprotein-Bindungskapazität und vermehrten Lipoidlöslichkeit beruht. Die Strukturformel und die chemischen Eigenschaften dieses stabilen Amids sind ganz ähnlich denen des Lidocains.     

A randomised comparison of the self-pressurised air-Q(TM) intubating laryngeal airway with the LMA Unique(TM) in children*

We conducted a randomised trial comparing the self‐pressurised air‐Q^TM intubating laryngeal airway (air‐Q SP) with the LMA‐Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air‐Q SP (12 (10–15 [5–18])) s than with the LMA‐Unique (14 (12–17 [6–22]) s; p = 0.05). There were no statistically significant differences between the air‐Q SP and LMA‐Unique in initial airway leak pressures (16 (14–18 [10–29]) compared with 18 (15–20 [10–30]) cmH₂O, p = 0.12), an airway leak pressures at 10 min (19 (16–22 [12–30]) compared with 20 (16–22 [10–30]) cmH₂O, p = 0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air‐Q SP is an alternative to the LMA‐Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.     

Success of Tracheal Intubation with Intubating Laryngeal Mask Airways: A Randomized Trial of the LMA Fastrach(TM) and LMA CTrach(TM)

Background: The LMA CTrach(TM) system (The Laryngeal Mask Company, Singapore) is a development of the LMA Fastrach(TM) system (The Laryngeal Mask Company, Singapore), with integrated fiberoptic bundles and a detachable liquid crystal display viewer. This randomized study of 271 patients compared tracheal intubation with these two systems.

Methods: In both groups, ventilation was optimized after insertion of the laryngeal mask conduit before proceeding further: intubation with the LMA Fastrach(TM), and optimizing the conduit placement and view and then intubation with the LMA CTrach(TM). The first-attempt and overall success rates of tracheal intubation, and the times required, were recorded.

Results: Tracheal intubation was successful on the first attempt in 93.3% of patients with the LMA CTrach(TM) and 67.9% of patients with the LMA Fastrach(TM) (P < 0.001). The success rates within three attempts were 100% with the LMA CTrach(TM) and 96.4% with the LMA Fastrach(TM) (P = 0.06). The median (interquartile range) time for the complete tracheal intubation process was 116 (82-156) s with the LMA CTrach(TM) and 100 (74-121) s with the LMA Fastrach(TM) (P = 0.002). There was no correlation between the grade of conventional laryngoscopy and success of intubation with either system.     

Current status of the Combitube: a review of the literature

The Combitube (Tyco-Healthcare-Kendall-Sheridan, Mansfield, MA) is an easily inserted and highly efficacious device to be used as an alternative airway whenever conventional ventilation fails. The Combitube allows ventilation and oxygenation whether the device locates in the esophagus (very common) or the trachea (rare). In this report, we review studies that suggest the Combitube is a valuable and effective airway in the emergency and prehospital settings, in cardiopulmonary resuscitation, in elective surgery, and in critically ill patients in the intensive care unit. Also reviewed are studies that demonstrate the superiority of the Combitube over other supraglottic ventilatory devices in resuscitation with respect to success rates with insertion and ventilation. Contrary to the Laryngeal Mask Airway, the Combitube may help in patients with limited mouth opening. The Combitube may be of special benefit in patients with massive bleeding or regurgitation, and it minimizes the risk of aspiration.     

伸展型食管支架治疗食管良恶性狭窄

报告两种伸展型支架治疗食管、贲门良恶性狭窄１２２例次结果。其中包括食管、贲门术后吻合口狭窄、晚期食管癌贲门癌、食管癌放疗后狭窄、食管化学烧伤后狭窄、食管癌性食管气管瘘和贲门失弛症者，效果良好。置管术可在内镜、Ｘ线下或剖胸探查术中进行，能有效地解除梗阻，提高病人生活质量。结论：伸展型支架较传统置管术操作简单，疗效肯定，并发症少，是食管外科的有效方法之一。     

侧俯卧位全腔镜食管癌手术淋巴结清扫的临床分析

目的总结侧俯卧位全腔镜食管癌切除术清扫胸腹二野淋巴结的临床经验。方法回顾性分析2009年9月-2011年2月82例全腔镜食管癌切除术与78例常规颈、胸、腹三切口食管癌切除术的临床资料。比较2组手术的胸腹部各区域淋巴结清扫数目、淋巴结转移度、生存率及术后并发症发生率。结果2组均顺利完成手术,2组清扫左右喉返神经旁淋巴结数目分别为（4．1±3．4）枚及（1．1±1．7）枚,上纵隔淋巴结数目分别为（6．8±5．O）枚及（4．9±4．0）枚,腔镜组均多于开放组（P〈0．05）。腔镜组3年生存率（65．4％）与开放组（62．3％）相似（10g—rank检验,X2=0．022,P=0．886）。结论侧俯卧位全腔镜食管癌切除淋巴结清扫疗效肯定,尤其是清扫上纵隔及左右喉返神经旁淋巴结方面,更为有效及彻底。     

The Combitube in elective surgery: a report of 200 cases

BACKGROUND: The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. METHODS: Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. RESULTS: In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. CONCLUSIONS: The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.     

The Combitube in Elective Surgery: A Report of 200 Cases

Background: The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation.

Methods: Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min.

Results: In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min.     

Esophageal Position Affects Short-Term Outcomes After Minimally Invasive Esophagectomy: A Retrospective Multicenter Study

Background

Anatomical esophageal position may affect the short-term outcomes after minimally invasive esophagectomy (MIE). A previous single-institutional retrospective study suggested that the presence of a left-sided esophagus (LSE) made MIE more difficult and increased the incidence of postoperative complications.

Methods

The current study was a multicenter retrospective study of 303 patients with esophageal cancer who underwent MIE at six esophageal cancer high-volume centers in Kyushu, Japan, between April 2011 and August 2016. The patients were divided into the LSE (66 patients) and non-LSE groups (237 patients) based on the esophageal position on computed tomography images obtained with the patients in the supine position.

Results

Univariate analysis showed that patients with LSE were significantly older than those with non-LSE (69 ± 8 vs. 65 ± 9 years; P = 0.002), had a significantly greater incidence of cardiovascular comorbidity (65.2% vs. 47.7%; P = 0.013), and a significantly longer operating time (612 ± 112 vs. 579 ± 102 min; P = 0.025). Logistic regression analysis verified that LSE was an independent risk factor for the incidence of pneumonia (odds ratio 3.3, 95% confidence interval 1.254–8.695; P = 0.016).

Conclusions

The presence of a LSE can increase the procedural difficulty of MIE and the incidence of morbidity after MIE. Thus, careful attention must be paid to anatomical esophageal position before performing MIE.

     

Bacteremia after Esophageal Dilation: A Clinical and Experimental Study

Patients with esophageal stricture caused by caustic ingestion, reflux esophagitis, or esophageal anastomosis often require repeated dilation. These patients frequently have a short febrile course after dilation. After development of brain abscess following esophageal dilation in 1 patient, positive blood cultures were obtained in 4 patients immediately following esophageal dilation. Caustic strictures were produced in cats and esophageal dilations performed. Blood cultures were positive at one minute after dilation in 6 cats and at five minutes in 2 of those cats. The organism responsible in all clinical and three of four experimental examples was Staphylococcus aureus. It is suggested on the basis of this clinical and experimental data that patients undergoing esophageal dilation should have prophylactic coverage if they are immunosuppressed, if endocarditis prophylaxis is necessary, if they are infants, if they are diabetic, or if they had severe bacteremia following dilation.