Postoperative sore throat: cause, prevention and treatment

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.     

Experimental study of human tracheal heterografts in pigs

Summary In 12 three-months-old pigs a window-shaped tracheal defect was made and the defect closed by a precisely fitting Cialit-fixed, human tracheal heterograft. The macroscopic, microscopic, scanning and transmission electron microscopic investigation of the grafted area revealed that the tracheal epithelium was formed by microvillous epithelial cells primarily. 3 months after grafting cartilage of the tracheal transplant survived but after 9 months was replaced by a tight scar. The connective tissue plate thus formed was sufficiently stable to maintain normal respiration in the pigs.This work was supported by the Fonds zur Förderung der wissenschaftlichen Forschung (Project no. 3494)The authors thank A. Laminger and G. Sulzer for photographic work     

Anesthetic management of a patient with Hallermann-Streiff syndrome

Key words  airway management - difficult intubation - Hallermann-Streiff syndrome     

高血压病史对体外循环冠脉搭桥术后早期预后的影响

目的 :了解高血压病史对体外循环下冠脉搭桥术后早期预后的影响。方法 :对高血压和非高血压行体外循环下冠脉搭桥术年龄大于60岁的冠心病患者65例术前和术后早期的临床资料进行分析。结果 :与非高血压患者相比 ,患高血压的病人冠脉搭桥术后心律失常的发生率增高 ,术后30min动脉氧分压与吸入氧浓度 (PaO2/FiO2)比值明显低下 ,机械通气时间明显延长 ,术后24h内胸腔引流量明显增加 ,术后大剂量多巴胺 (>10μg·kg-1·min -1)应用率及重症监护时间无显著性差异。结论 :高血压病史使患者冠脉搭桥术后早期肺功能下降、心律失常发生率增高、出血倾向增加 ,提示维持高血压患者围手术期血压的正常有利于改善患者预后     

可乐定对气管拔管患者应激反应的影响

目的探讨可乐定对气管拔管应激反应的预防作用.方法22例气管插管全麻手术病人,随机分为对照组和可乐定组(每组11例).可乐定组病人于麻醉前 60 min 加服可乐定 5 μg*kg-1,其它麻醉前用药两组病人相同.分别在麻醉前、拔管前、拔管后1、2、5、10 min 采集动脉血标本,测定血浆儿茶酚胺、血管紧张素Ⅱ、皮质醇、血糖、血乳酸浓度,做血气分析,计录各时点的血流动力学参数.结果两组病人气管拔管期间血浆儿茶酚胺、皮质醇、血糖、血乳酸浓度均明显增高,可乐定组增高程度明显低于对照组.结论麻醉前服用可乐定能明显减轻气管拔管引起的应激反应.     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

Comparison of a new video-optical intubation stylet versus the conventional malleable stylet in simulated difficult tracheal intubation

Handling and efficacy of a new video-optical intubation stylet were assessed in a simulated difficult tracheal intubation setting and compared with a conventional malleable stylet. Forty-five anaesthetists performed 10 tracheal intubations using both techniques. Laryngoscopy was performed by the observer, who created a grade 3 view according the classification by Cormack and Lehane. The time taken to place the tracheal tube and the final tracheal tube positions were documented. Mean (SD) intubation time for the video-optical stylet was 20.4 (7.7) s and for the malleable stylet 10.2 (3.3) s (p<0.01). With the video-optical stylet the trachea was correctly intubated in all 225 attempts; with the malleable stylet 44 (19.6%) oesophageal and 44 (19.6%) endobronchial intubations occurred (p<0.01). The video-optical intubation stylet enabled us to recognise inappropriate tracheal tube positions and to correct them immediately. This equipment can be considered a reliable and effective tool for management of the difficult airway.     

A literature review of the prehospital use of neuromuscular blocking agents by air medical personnel to facilitate endotracheal intubation

Air medical personnel in the United States have used neuromuscular blocking agents to facilitate endotracheal intubation in the field for more than a decade. This literature review examines 15 studies to investigate their experience and explores the following specific areas: the intubation success rate in patients who did or did not receive these agents, the intubation success rate of air medical personnel before and after they incorporated these agents into their practice, the neuromuscular blocking agents and adjunct medications used by air medical personnel, and the disposition of patients who could not be intubated after an agent was given. The data suggest that, overall, air medical personnel use these agents safely and effectively. Suggestions are offered for future studies, including examining ground time when agents are used to facilitate intubation, complications of their use in this setting, and the use of simulators to train personnel in the administration of these medications.     

不同麻醉诱导下小儿气管插管时的心血管应激反应

目的用随机对照前瞻性研究方法,比较小儿气管插管时心血管反应,评价不同麻醉诱导方式对插管时应激反应的抑制作用.方法68例1～6岁的患儿被随机分成P、PF及PFI组,P组静脉注射硫喷妥钠5 mg/kg;PF组先静脉注射芬太尼3 μg/kg,再静脉注射硫喷妥钠5 mg/kg;PFI组先静脉注射芬太尼3μg/kg,再静脉注射硫喷妥钠5 mg/kg,同时吸入3%异氟醚.所有患儿由同一位医师进行气管插管,记录其麻醉前以及插管前后的心率和血压.结果插管后P组的心率和血压最高,不仅显著高于插管前,还显著高于基础值（P＜0.05）.PF组插管后的心率和血压虽然也高于插管前,但低于P组,而且与基础值比较没有显著性差异.PFI组插管后的血压仅略高于插管前,但比基础值低（P＜0.05）,在3组中最低（P＜0.05）,且升幅最小（P＜0.05）,其收缩压和舒张压的升幅分别为11%和26%.结论给患儿插管时联合应用硫喷妥钠、芬太尼和异氟醚,心血管反应最小,提示其可以较好地抑制插管所至的应激反应.     

光导纤维支气管镜经口和经鼻气管插管患儿心血管反应的比较

目的比较小儿光导纤维支气管镜(FOB)经口和经鼻气管插管的心血管反应。方法选择美国麻醉医师协会(ASA)身体状态分级为Ⅰ级、在全身麻醉下施择期整形外科手术的患儿65例,随机分为经口组(n=36)和经鼻组(n=29)。在常规静脉麻醉诱导后实施FOB气管插管。测定麻醉诱导前(基础值)、后,气管插管时和气管插管后5 min内(测定间隔为1 min)血压(BP)和心率(HR),记录气管插管时间。结果经鼻组气管插管时间显著长于经口组(P<0.05)。FOB气管插管导致两组BP和HR均比麻醉诱导前基础值显著升高(P均<0.05)。与经口组相比,气管插管致BP增高和HR增快反应在经鼻组较轻,持续时间较短。经口组气管插管时BP和HR及观察过程中BP和HR最大值均显著高于经鼻组(P均<0.05)。结论FOB经口和经鼻气管插管均可引起小儿BP和HR显著升高,但FOB经鼻气管插管时心血管反应较FOB经口气管插管时轻。