罗库溴铵和阿曲库铵的预注量对相互起效的影响

目的　研究罗库溴铵和阿曲库铵的预注量对相互起效和插管条件的影响。方法　 6 0例患者随机平均分成六组。麻醉诱导用地西泮、硫喷妥钠和芬太尼。Ⅰ组和Ⅳ组分别静注罗库溴铵0 6mg/kg和阿曲库铵 0 5mg/kg ,Ⅱ组和Ⅴ组预注罗库溴铵 0 0 6mg/kg ,Ⅲ组和Ⅵ组阿曲库铵0 0 5mg/kg。 3分钟后Ⅱ组和Ⅲ组静注罗库溴铵 0 5 4mg/kg ,Ⅴ组和Ⅵ组阿曲库铵 0 4 5mg/kg。观察插管量后的起效时间和气管插管条件。结果　Ⅲ组的起效时间为 (6 7 6± 14 2 )秒稍短于Ⅰ组的(73 1± 13 4 )秒和Ⅱ组的 (76 3± 15 3)秒 (P >0 0 5 )。Ⅴ组和Ⅵ组的起效时间为 (93 8± 2 2 4 )秒和(115 8± 14 9)秒 ,比Ⅳ组 (15 6 0± 37 2 )秒的短 (P <0 0 5和P <0 0 1) ,Ⅴ组的起效时间也显著短于Ⅵ组。气管插管条件Ⅴ组较Ⅳ组明显改善。结论　预注罗库溴铵不能使罗库溴铵的起效增快。预注罗库溴铵使阿曲库铵的起效明显增快 ,插管条件改善 ;预注罗库溴铵比预注阿曲库铵对阿曲库铵起效的增快作用更明显     

罗库溴铵以限时法和预注法行快速气管插管的比较

目的 比较罗库溴铵以限时法和预注法行快速气管插管的条件、肌松效应及对循环系统的影响。方法 限时（Ⅰ、Ⅱ）组诱导前30秒静注0.6mg/kg罗库溴铵,诱导后45秒（I）、60秒（Ⅱ）行气管内插管,预注（Ⅲ）组诱导前2分钟预注0.06mg/kg罗库溴铵（诱导量0.54mg/kg）,诱导后60秒行气管内插管。记录拇内收肌诱发颤搐反应的抑制和恢复过程,评价各组插管效果。结果气管内插管条件各组间无明显差异;气管内插管时T1抑制百分比Ⅲ组明显小于其他各组;各且对循环系统的都很小。结论 罗库溴铵以限时法行快速气管插管较预注法为佳。     

丙泊酚镇静下瑞芬太尼对不同年龄患者抑制气管插管反应的半数有效浓度

目的 测定丙泊酚镇静深度下瑞芬太尼抑制不同年龄患者插管反应的半数有效血浆靶控浓度(Cp50)、半数有效实测浓度(Cm50)值、半数有效效应室浓度(EC50)值.方法 60例上腹部手术患者,男37例、女23例,年龄22岁～82岁,分为:青年组(n=20),22岁～44岁,中年组(n=20),45岁～64岁,老年组(n=20),65岁～82岁.所有患者靶控输注丙泊酚、调节丙泊酚靶控输注血浆浓度将脑电双频指数(bispectral index,BIS)目标值定为45～55,待BIS目标值稳定5 min,靶控输注瑞芬太尼.瑞芬太尼的血浆靶控浓度按序贯法确定,输注5 min给予维库溴铵0.1 mg/kg行气管插管,记录血流动力学变化和计算瑞芬太尼Cp50、Cm50、EC50值.结果 3组患者瑞芬太尼抑制插管反应的Cp50和95%CI分别是5.77 μg/L.,4.76 μg/L～7.01 μg/L;4.80 μg/L,3.56 μg/L～6.48 μg/L;4.06 μg,/L,3.52 μg,/L～4.92 μg/L.青年组与中年组、老年组差异有统计学意义(P<0.01),中年组与老年组差异有统计学意义(P<0.05).EC50和95%CI分别是5.90μg/L,4.47 μg/L～7.68 μg/L;4.60 μg/L,3.03 μg/L～5.90 μg/L;4.06 μg/L,2.97 μg/L～5.42 μg/L.青年组与中年组、老年组差异有统计学意义(P<0.05),中年组与老年组差异有统计学意义(P<0.01).Cm50和95%CI分别是4.25 μg/L,2.04 μg/L～6.47 μg/L;3.62 μg/L,1.70 μg/L～5.54 μg/L;3.09 μg/L,1.3μ/L～4.89 μg/L.青年组与老年组差异有统计学意义(P<0.01).3组患者在达到目标BIS值时丙泊酚靶控浓度分别为(3.6±0.6)mg/L、(3.4±0.8)mg/L、(2.7±0.8)mg/L,青年组与老年组差异有统计学意义(P<0.05).结论 丙泊酚复合瑞芬太尼用于抑制气管插管反应,在维持BIS值为45～55时,各年龄组之间的丙泊酚靶控输注血浆浓度、瑞芬太尼的Cp50、Cm50、EC50差异有统计学意义.     

The Callender modification of the Macintosh laryngoscope blade reduces the risk of tooth-blade contact in children

Background: Dental injury is well recognized as a potential complication of laryngoscopy and tracheal intubation. The flange of the Macintosh blade may contact teeth during laryngoscopy causing damage. The Callander modification of the Macintosh blade (Callander blade) with a shortened heel at the proximal end has been shown to increase the blade–tooth distance and reduce contact rates in adults. Aim: This study was designed to evaluate the effectiveness of the Callander blade on reducing dental contact in children. Methods: One hundred children, aged 4–14 years, scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. The children were preoperatively evaluated for Mallampati score and dental defects, looseness, and avulsions. Following induction of anesthesia, laryngoscopy was performed twice on each child in succession, once with a standard Macintosh blade and once with a Callander blade of the same size in a random order. The blade–tooth distance and contact rate were compared between the two blades. Results: With the Callander blade, the blade–tooth distance was greater than with the Macintosh (1.78 ± 1.77 vs 0.28 ± 0.76 mm, P = 0.001). The frequency of direct contact was less with the Callander blade than it was with the Macintosh blade (33% vs 86%, respectively, P = 0.008). However, difficult laryngoscopy rate did not differ between the blades. Tracheal intubation was successful in all children and there was no dental injury. Conclusion: Our findings suggest that the Callander blade decreases the risk for dental injury and provides tracheal intubating conditions in children with normal airways similar to those obtained with a traditional Macintosh blade.     

Nasotracheal intubation using the Airtraq versus Macintosh laryngoscope: a manikin study

The Airtraq laryngoscope is a new intubation device that provides a non-line-of-sight view of the glottis. We evaluated this device by comparing the ease of nasotracheal intubation on a manikin with the use of Airtraq versus the Macintosh laryngoscope with and without Magill forceps. Nasotracheal intubation on a manikin was performed by 20 anesthesiologists and 20 residents with the Airtraq or Macintosh laryngoscope. The mean (+/- SD) time required for nasotracheal intubation by the residents was significantly shorter with the Airtraq laryngoscope than with the Macintosh laryngoscope (16 +/- 7 sec vs 22 +/- 10 sec; P < .001), but no difference in intubation time was observed between Airtraq (15 +/- 11 sec) and Macintosh (13 +/- 6 sec) laryngoscopy by the anesthesiologists. The Magill forceps was used more frequently to facilitate intubation with the Macintosh laryngoscope than with the Airtraq laryngoscope in both groups of operators 7(P < .001). The Airtraq laryngoscope scored better on the visual analog scale than did the Macintosh laryngoscope in both groups of operators (P < .05). The Airtraq laryngoscope offers potential advantages over standard direct laryngoscopy for nasotracheal intubation.     

腹腔镜门静脉插管皮下泵植入术(附4例报告)

目的:探讨腹腔镜门静脉插管皮下泵植入术的手术方法与技巧。方法:回顾分析4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术的临床资料。结果:4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术均获成功,无中转开腹、手术死亡及手术并发症发生,患者均于术后3d接受经皮下泵门静脉灌注化疗。结论:腹腔镜门静脉插管术安全可行,丰富的腹腔镜手术经验、手术组医师之间的协调配合与合适的病例选择是保证手术成功的关键。     

Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children

BACKGROUND: The purpose of our study was to determine whether a smaller dose of rocuronium than previously reported could provide similar intubating conditions to suxamethonium during rapid-sequence induction of anaesthesia in children. METHODS: One hundred and twenty ASA I, unpremedicated children, aged 1-10 years, who were undergoing elective surgery, were randomized into three groups to receive rocuronium 0.6 mg.kg-1, rocuronium 0.9 mg.kg-1 or suxamethonium 1.5 mg.kg-1. The study was double-blinded, anaesthesia and timing of injection was standardized to alfentanil 10 microg.kg-1, thiopentone 5 mg.kg-1 and the study drug. Intubation was attempted at 30 s after injection of neuromuscular relaxant and intubating conditions graded as excellent, good, poor or impossible. RESULTS: All 120 children were successfully intubated within 60 s without need for a second attempt after administration of neuromuscular relaxant. Differences between suxamethonium and rocuronium 0.6 mg.kg-1 and between the two doses of rocuronium were statistically significant (P=0.016 and 0.007, respectively). CONCLUSIONS: Rocuronium 0.9 mg.kg-1 provides similar intubating conditions to suxamethonium 1.5 mg.kg-1 during modified rapid-sequence induction using alfentanil and thiopentone in children (P=0.671). Rocuronium 0.6 mg.kg-1 was inadequate.     

择期颈椎手术患者困难气道的研究

目的对择期颈椎手术患者困难气道的发生率以及困难气道和颈椎疾病的相关性进行前瞻性研究。方法172例拟在全身麻醉下择期行颈椎手术的患者于手术前日或麻醉诱导前进行气道评估。困难气道评估指标为：张口度、颈部活动度、甲颏距离、Mallampati分级和Cormack分级等。结果颈椎择期手术的患者中困难气道的比例为30．2％。张口度较差的占2．4％，甲颏距离较短的占7．2％，Mallampati分级为Ⅲ～Ⅳ级的占19．8％，Cormack分级为Ⅲ级的占12．2％。困难气道的发生与患者的年龄和性别无显著相关；但与患者的颈部活动度密切相关，颈椎滑脱和颈椎骨折的患者困难气道的发生率显著升高。结论颈椎择期手术患者困难气道的发生率要远高于普通人群，并且与颈部活动度、颈椎滑脱和颈椎骨折密切相关。     

Emergency Medical Service (EMS) systems in developed and developing countries

OBJECTIVES: To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. METHOD: We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries. RESULTS: A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively). CONCLUSION: This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.     

Rapid sequence intubation without a neuromuscular blocking agent in a 14-year-old female patient with myasthenia gravis

The anesthesia care of a 14-year-old female patient with an acute exacerbation of myasthenia gravis (MG) and a full stomach who required emergency surgery for placement of a hemodialysis catheter is described. A nonventilated rapid sequence induction was successful with the use of propofol, lidocaine, remifentanil, cricoid pressure and no neuromuscular blocking agent. Although the use of combinations of i.v. anesthetic agents have been suggested for tracheal intubation without the need for neuromuscular blocking agents, none of these techniques has been advocated for rapid sequence intubation. We review existing literature on the topic of tracheal intubation using remifentanil and propofol without a neuromuscular blocking agent and on the topic of tracheal intubation of patients with MG using i.v. anesthesia and no neuromuscular blocking agents.