Emergency ventilation using the Combitube in cases of difficult intubation

Summary The esophageal-tracheal Combitube (Sheridan, Argyle, NY) is a new device for emergency intubation, which can be inserted blindly without the use of a laryngoscope. Ventilation is independent of the position of the Combitube in either the esophagus or the trachea, since ventilation is always provided by the tube's double channel. The tracheal channel acts as a conventional endotracheal airway and has an open distal end. The esophageal channel has a blocked distal end, so that together with the inflated distal cuff it acts as an esophageal obturator in cases of esophageal intubation. Perforations at the pharyngeal section direct the airflow to the trachea. At the oropharyngeal section a large elastic balloon is positioned in order to obturate the oral cavity and the nasopharynx. Two patients are described to exemplify the Combitube's clinical use. Both had rapidly enlarging cervical hematomas causing upper airway obstruction and thus requiring immediate intubation. Endotracheal intubation failed because the glottis could not be visualized with a laryngoscope. In both cases the Combitube was applied successfully and adequate ventilation was provided via the Combitube placed esophageally. To better secure each patient's airway, tracheotomy was performed during ventilation without any complications.     

Two cases of asymptomatic epiglottic cyst confirmed by lateral cervical roentgenogram

Key words  complications - intubation - epiglottic cyst     

Laryngotracheal stenosis in children

The diagnosis of laryngotracheal stenosis should be suspected in children with stridor, feeding difficulties, or atypical croup. Only half of the children with congenital laryngotracheal stenosis require tracheotomy, and many of these children can be decannulated following uncomplicated surgical therapy. In contrast, tracheotomy-dependent patients with acquired laryngotracheal stenosis require more extensive surgical intervention, which should be carried out as early as possible to provide the best opportunity for developing normal oral communication. Received: 8 March 1977 / Accepted: 31 July 1997     

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.     

插管联合丝裂霉素C治疗老年人泪道阻塞及慢性泪囊炎

目的观察插管联合丝裂霉素C治疗老年人泪道阻塞及慢性泪囊炎的效果。方法对45例57眼用甲硝唑注射液冲洗泪道和行泪道探通后,将硬膜外麻醉导管插入泪道,并将0.4 mg/ml丝裂霉素C与等剂量透明质酸钠混合的胶体注入阻塞部位。术后用甲硝唑注射液(一般临床供静脉注射所用)及α-糜蛋白酶进行泪道冲洗。视病情15~45 d拔管。结果随访6~12个月,本法治疗泪道阻塞和慢性泪囊炎有效率均达到85%以上,两者疗效差异无统计学意义。结论插管联合丝裂霉素C能较有效治疗老年人泪道阻塞及慢性泪囊炎。     

喉罩通气全麻在腹腔镜胆囊切除手术中的应用

目的比较普通型喉罩（LMA）和气管插管（IT）在腹腔镜下胆囊切除术的应激反应,观察置人喉罩或气管导管的血流动力学变化,观察拔除喉罩或气管导管的血流动力学变化。方法选择拟行腹腔镜下胆囊切除手术患者60例,随机分为两组LMA组和IT组,LMA组为3或4号普通型喉罩IT组应用7．5或8．0号气管导管,记录插管前,插入后1min,拔除后1min的HR、SBP、DBP、结果插入拔除喉罩或气管导管时,IT组血流动力变化较LMA组明显（P〈0．05）。结论LMA全麻通气完全适用腹腔镜下胆囊切除术麻醉,应激反应小及并发症少。     

靶控输注瑞芬太尼改善七氟醚吸入诱导插管条件的临床观察

目的评价靶控输注瑞芬太尼改善七氟醚诱导用于无肌松药气管插管的临床效果。方法将拟行择期手术全身麻醉的患者46例随机分为2组,复合瑞芬太尼组(Ⅰ组)靶控输注1 ng/mL瑞芬太尼,单纯吸入组(Ⅱ组)输注等量生理盐水。进行七氟醚吸入诱导,气体监测仪监测出呼吸末七氟醚达2.5 MAC,稳定3 min后行气管插管。分别记录诱导前(T0)、诱导后插管前(T1)、插管后1 min(T2)、插管后2 min(T3)和插管后5 min(T4)的MAP、HR和SpO2。结果Ⅰ组患者意识消失时间和插管时间显著短于Ⅱ组,Ⅰ组呼气末七氟醚浓度达2.5 MAC时间较Ⅱ组延长(P<0.05)。Ⅰ组插管条件评分优于Ⅱ组(P<0.05)。Ⅰ组诱导后MAP和HR显著下降。Ⅱ组诱导后MAP下降,插管后1 min,MAP、HR较基础值显著升高,与Ⅰ组比较差异有统计学意义(P<0.05)。结论瑞芬太尼1 ng/mL靶控输注复合七氟醚吸入诱导,能较好地控制气管插管的血流动力学反应,在无肌松药条件下,可达到满意的气管插管条件。     

可视喉镜下手工中立位气管插管对颈髓损伤患者的影响

目的：观察可视喉镜下手工中立位全麻气管插管对颈椎颈髓手术患者术中血流动力学以及术后并发症的影响。方法：选择60例全麻手术患者,随机分为两组,每组30例,即直视喉镜组（对照组）,手工中立位可视喉镜组（研究组）。对两组患者分别使用直视喉镜、手工中立位可视喉镜进行气管插管,比较两组患者首次插管成功率、围插管期血流动力学及术后24h咽喉部并发症发生率。结果：与直视喉镜组比较,可视喉镜组首次插管成功率明显提高（P〈0．05）、围插管期血流动力学波动幅度更小（P〈0．05）,术后咽喉部并发症发生率降低（P〈0．05）。结论：与直接喉镜相比,手工中立位可视喉镜可以缩短气管插管的用时,改善围插管期血流动力学波动,减轻咽喉部的损伤。     

重症先天性膈疝患儿的临床治疗策略

目的 探讨重症先天性膈疝(CDH)患儿的临床治疗策略.方法 选择2015年1月至2019年10月,西北妇女儿童医院小儿外科收治的7例重症CDH患儿为研究对象.采用回顾性研究方法收集受试儿一般临床资料、治疗、转归及术后随访结果等进行分析.本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求.结果 本组7...     

急诊插管后呼吸机相关性肺炎的危险因素及对策

目的探讨急诊插管后呼吸机相关性肺炎的危险因素及处理对策,以降低呼吸机相关性肺炎的发生率和病死率。方法回顾性分析医院2009年1月-2010年6月125例急诊机械通气治疗患者的临床资料,分析呼吸机相关性肺炎发生的危险因素、病原菌分布和预后。结果 125例患者中,发生呼吸机相关性肺炎者36例,发生率为28.8%;年龄、机械通气时间、留置胃管、心肺脑复苏、再插管和抗菌药物的应用等与呼吸机相关性肺炎的发生有明显的相关性(P<0.05),缩短上机时间和合理应用抗菌药物可以有效预防呼吸机相关性肺炎的发生。结论急诊插管后呼吸机相关性肺炎的危险因素复杂,缩短上机时间和预防性应用抗菌药物,可以减少其发生。