新型光棒在气管插管中的应用

目的:探讨新型光棒与传统喉镜在气管插管中的效果比较。方法:随机选择80插管全麻患者分为光棒/导管组(A组)和喉镜/导管组(B组),麻醉后A组:用光棒引导行气管插管,确定气管导管满意后,接麻醉机。B组:常规置入喉镜,窥见声门后插入气管导管。记录操作时间、MAP、HR、SPO2及不良反应。术后24小时内随访,询问患者是否存在咽喉疼痛、声音嘶哑或吞咽困难等并发症。结果:两组患者性别、年龄、体重等无统计学意义。A组患者插管时间明显短于B组,A组咽喉疼痛病例少于B组,A组患者插管前后MAP和HR差异无统计学意义,B组患者插管后1分MAP和HR与诱导前有统计学意义。讨论:光棒插管技术简便实用,容易掌握、安全有效、成功率高,为气管插管提供了新的方法。     

纤维支气管镜引导下气管插管技术在困难气管插管的应用

目的 为困难气管插管病人提供一种安全、有效的建立人工气道方法。方法 采用纤维支气管镜(纤支镜)引导下气管内插管技术。结果 36例困难气管插管病人均一次插管成功。插管时间30s～3min，平均1．6min。结论 纤支镜引导下气管插管技术是一种安全、准确、迅速建立人工气道的新技术，为临床解决困难气管插管提供一种可靠的选择。     

清醒气管插管气道局部麻醉技术的研究进展

对于术前评估为困难气道的患者应当采用清醒镇静表面麻醉下实施气管插管。实施清醒气管插管的关键技术是完善的气道局部麻醉。清醒气管插管是麻醉科医师必须掌握的技能之一。本文通过回顾近十年的文献,旨为麻醉科医师提供清醒气管插管气道局部麻醉技术相关理论参考。     

气管插管新器械和困难气管插管处理

目前临床上广泛使用的气管导管的前端为一个斜面，即使我们是给Cormack-lehaneI和II级的病人插管，有时候尽管我们能够看得见声门却插不进。     

盲探气管插管装置在颈椎损伤病人插管中的应用

颈椎损伤病人的气管插管属困难气道插管之一,文献介绍有多种途径可解决,但各有利弊.我们使用盲探气管插管装置对颈椎损伤病人行经鼻盲探气管插管17例,取得满意效果,现报道如下.     

气管内肿瘤麻醉插管的经验教训

气管内肿瘤直接危及病人通气,其麻醉要求既能迅速建立安全有效的气道,又要防止因气管插管将肿瘤推落导致下气道梗阻而产生致命性后果。术中主要是在行部分气管切除时确保有效通气。2004年1月和3月我院完成2例气管内肿物切除术的麻醉,报道如下。     

新型联体牙垫在气管插管中的应用

目的:探讨新型联体牙垫对气管导管的固定作用及其应用效果。方法:将行经口气管插管的468例患者随机分为观察组和对照组,气管插管后对照组采用胶布固定,观察组采用新型联体牙垫固定,比较两组效果。结果:患者气管插管后采用两种不同的方法,观察组在牙垫松脱8例,导管移位20例,口腔黏膜损伤情况36例,观察组均少于对照组。结论:经口腔气管插管后采用新型联体牙垫固定,导管滑脱率减少,口腔黏膜损伤程度减轻,且固定方法简便。     

声门上气道管理器具的进展

声门上气道管理(supraglottic airway management)的关键内涵是上呼吸道管理,新意在于进一步强调麻醉和药物镇静期间采用各种技术,保持上呼吸道通畅,便于实施人工通气,防止气道误吸,以及避免气管内插管。主要采用新型声门上通气器具,包括各种喉罩和喉管。1引起上呼吸道梗阻的机     

非清醒困难气管插管

1990年,美国协议赔偿案件的资料分析表明,麻醉死亡的30％是由于困难呼吸道管理不当,为此组成的专门工作组于1991年发表权威文章“困难呼吸道管理”,并专门加了副标题“特别强调清醒气管内插管”,在此基础上形成的“困难气道管理规程”于1993年作为美国麻醉医师协会的一项正式操作准则公布。由于专科特点,我院每年有近百例困难气管插管病例,十几年来,所用困难插管技术经历了清醒插管,清醒亚肌松插管,及现在采用的非清醒插管技术的变化。我们现在采用的非清醒插管技术与美国目前提倡的方式不一样,特介绍如下。     

Tracheal intubation by non-anesthesia residents using the Pentax-AWS airway scope and Macintosh laryngoscope

Study ObjectiveTo evaluate the performance of the Pentax-AWS airway scope for tracheal intubation compared with the Macintosh laryngoscope by non-anesthesia residents.DesignProspective, randomized, cohort study.SettingUniversity-affiliated hospital.Patients520 patients who underwent tracheal intubation for general anesthesia.Interventions48 non-anesthesia residents performed tracheal intubation using either the Pentax-AWS or the Macintosh laryngoscope.MeasurementsTime to complete tracheal intubation, number of attempts until successful intubation, and number of intubations of the esophagus were recorded.ResultsTime to secure the airway (sec; mean ± SD) was shorter with the Pentax-AWS than with the Macintosh laryngoscope (44 ± 19 vs. 71 ± 44 sec; P < 0.001). Of the 264 tracheal intubations with the Pentax-AWS, 239 (91%) were completed within 60 seconds, while only 148 (58%) of the 256 tracheal intubations performed with the Macintosh laryngoscope were completed within the same period. The rate of successful intubations on the first attempt was higher with the Pentax-AWS than the Macintosh laryngoscope (P < 0.001). No esophageal intubation was experienced with the Pentax-AWS approach, while 18 occurred with the Macintosh laryngoscope (P < 0.001).ConclusionThe Pentax-AWS appears to require less operator skill than the Macintosh laryngoscope. Use of the Pentax-AWS may reduce the time to secure the airway and the incidence of failed tracheal intubation by non-anesthesia residents.     

Flexible fibreoptic intubation

Flexible fibreoptic intubation offers options of airway control in awake and asleep patients, in cases with limited or absent mouth opening and complex anatomy. It may be used as a first choice or a rescue technique. Despite its limitations, for example in situations with significant airway blood or secretions, and airway obstruction, it is a valuable core skill for every anaesthetist.     

Fibreoptic intubation

A flexible fibreoptic scope can be used to facilitate tracheal intubation in both awake and asleep patients, in those with limited or absent mouth opening and complex anatomy. It may be used as a first choice for airway management or as a rescue technique. Despite its potential limitations, e.g. in situations with significant blood or secretions in the airway, fibreoptic intubation remains an invaluable core skill for every anaesthetist. Awake tracheal intubation must be considered in the presence of predictors of difficult airway management.     

Flexible fibre-optic intubation

Flexible fibre-optic intubation offers options of airway control in awake and asleep patients, in cases with limited or absent mouth opening and complex anatomy. It may be used as a first choice or a rescue technique. Despite its limitations, e.g. in situations with significant airway blood or secretions, and airway obstruction, it is a valuable core skill for every anaesthetist.     

Light-guided intubation via the intubating laryngeal mask using a prototype illuminated flexible catheter. Clinical experience in 400 patients

BACKGROUND: The transillumination of the soft tissues of the neck using lighted stylets has been used as an aid for tracheal intubation. We evaluated the efficacy and safety of a prototype illuminated flexible catheter to facilitate light-guided intubation through the intubating laryngeal mask. METHODS: The illuminated flexible catheter consists of a completely flexible thin plastic catheter with a bulb attached to its distal end. The device was placed into a silicone tracheal tube in such a way that the bulb was adjusted at the distal end of the tracheal tube. The tracheal tube preloaded with the device was inserted through the intubating laryngeal mask and, by observing the glow on the neck, was advanced into the trachea. We report our experience with light-guided intubation through the intubating laryngeal mask in 400 ASA grade 1-3 patients undergoing general anaesthesia. RESULTS: The intubating laryngeal mask was inserted successfully in all patients. The overall intubating success rate was 99.8% (399/400); in 367 (91.8%) cases at the first attempt, in 28 (7%) at the second, in 4 (1%) at the third and in one case (0.2%) at the fifth attempt. There were 27 patients with potentially difficult airways. All these cases were intubated successfully; in 23 of 27 (85.2%) at the first attempt, in 3 of 27 (11.1%) at the second and one of 27 patients (3.7%) at the third attempt. CONCLUSION: We conclude that the use of the illuminated flexible catheter facilitates the intubation through the intubating laryngeal mask. The suggested light-guided intubating method proved to be a simple, safe and effective technique.     

Goitre and difficulty of tracheal intubation

Objectives

To assess the difficulty in both laryngoscopy and tracheal intubation related to goitre and to identify factors predictive of difficult intubation due to this condition.

Study design

Prospective observational.

Methods

We used the Intubation Difficulty Scale (IDS) in 80 consecutive patients with large goitre (defined by the inability to palpate the cricoid cartilage, the presence of endothoracic goitre, tracheal deviation of more than 1 cm or tracheal stenosis on the chest x-ray) and 77 control patients.

Results

Cormack grades 3–4 were more frequent at initial laryngoscopy in patients with goitre (23/80 vs. 9/77; p < 0.05), but the difference was no longer significant after application of an external laryngeal pressure (8/80 vs. 5/77). IDS scores (median [25th–75th percentiles]) were higher in the goitre group (1 [0 – 4]) than in the control group (0 [0 – 1]; p = 0.001), corresponding to an increase in slightly difficult intubation (IDS 1–5: 36/80 vs. 15/77; p < 0.05). However, incidence of moderate to major difficulty in intubation (IDS > 5: 8/80 vs. 7/77) as well as time to completion of intubation were similar in both groups. Tracheal stenosis (≥ 30%) and reduced mouth opening (< 4.4 cm) were the only significant predictors of increased difficulty in intubation in patients with a goitre.

Conclusion

Large goitres are usually associated with slight difficulty in intubation only. Increased difficulty should be expected when severe tracheal stenosis is present on chest x-ray, especially when associated with a reduced mouth opening.     

瑞芬太尼在纤维支气管镜清醒气管插管中的应用进展

背景 困难气道患者的围术期气道管理是临床麻醉关注的热点问题.纤维支气管镜清醒气管插管(awake fibreoptic intubation,AFO1)技术是处理预见性困难气道的公认方法.然而实施AFOI的难点在于给患者提供充分镇静、镇痛的同时,又要保证患者有效的自主通气功能.瑞芬太尼作为一种较理想的麻醉性镇痛药,一定剂量下能有效抑制气管插管的应激反应,故已有用于AFOI的报道. 目的 概述及评价瑞芬太尼在AFOI中的有效性及安全性,为临床应用和进一步研究提供参考. 内容 分析瑞芬太尼用于AFOI的剂量对机体的影响、不同给药方案的优劣以及在特殊患者中的应用. 趋向 瑞芬太尼在AFOI中的应用具有诸多优势,但最佳方案仍需进一步临床研究.     

超声技术应用于气道管理的研究进展

背景 目前气道评估及管理仍然是一门不断更新的临床科学.近些年超声可视化技术的应用为围手术期、急诊及重症医学科患者的气道管理提供了一个动态的监测工具. 目的 针对超声技术在气道管理中的应用情况进行综述. 内容 描述呼吸道超声解剖结构,并概括超声在围手术期气道管理中的应用. 趋向 超声的应用使围手术期气道管理发生里程碑式的发展,未来将有更广阔的应用前景.     

曲吗多静脉诱导时对心血管反应的影响

采用经食管无创伤超声血流测定仪监测４５例择期手术病例，随机分三组：巨组，安定０．４ｍｇ／ｋｇ； Ⅱ组，咪唑安定０．３ｍｍ／ｋｍ；Ⅲ组，依托咪酯０． ３ｍｍ／ｋｍ。三组病例均静注曲吗多４ｍｇ／ｋｇ、阿曲可林０．５ｍｇ／ ｋｇ，观察插管前、插管时、插管后心排血量（ＣＯ）、心脏指数（ＣＩ）、周围血管阻力（ＳＶＲ）、平均动脉压（ＭＡＰ）、心率（ＨＲ）的变化。结果表明用曲吗多后 ＨＲ减慢， Ⅰ、Ⅱ组 ＣＯ、ＣＩ、ＭＡＰ下降，Ⅲ组 ＭＡＰ、ＣＯ、ＣＩ、无明显变化，插管时，插管后ＣＯ、ＣＩ、ＭＡＰ、ＨＲ无显著变化（Ｐ＞０．０５）。提示曲吗多有预防插管时的心血管副反应作用。