Safe anesthesia for endoscopic laryngeal laser surgery

Anesthesia safety for endoscopic laryngeal laser surgery has been a major limiting factor for laser applications in the larynx and the hypopharynx. Several anesthesia techniques have been proposed and each technique appears to have its own limitations. This paper will deal with the distinct advantages offered by the malleable copper tube which is used for delivery of the open Venturi system anesthesia for endoscopic laser surgery. A retrospective study of 100 patients who have undergone this modality of anesthesia at our institution will be presented. Our conclusion from this study shows clearly the superiority of the copper tube over the conventional aluminium-foil-wrapped endotracheal tube in safety and the exposure of the larynx during surgery.     

Suction devices

Suction devices are integral to the safe delivery of anaesthesia and critical care. They are involved in clearing and aspirating body fluids, blood and debris, as well as employed in scavenging waste gases and diathermy fumes, intraoperative cell salvage systems, and tertiary devices such as vacuum mattresses and specialized wound dressings. All suction devices require three essential components, namely a source of vacuum, a reservoir/collection vessel and suction tubing. Other components of a suction device include an on/off switch, a vacuum regulator, vacuum gauge, filters, an overflow safety trap, an overfill protection device in the collection vessel, and a catheter. Several different types of catheter are available for use in different clinical situations. Vacuum and flow are the main physical principles underlying suction devices. The source of vacuum may be a fixed centrally piped system or a portable device using electrical, pneumatic or manual power. Pneumatically powered suction devices utilize the Bernoulli principle and Venturi effect. The efficiency of each system depends upon principles of displacement, degree of negative pressure and time taken to reach this, the internal resistance of the suction apparatus and the viscosity of the material to be aspirated.     

The Magill-Venturi attachment: studies in volunteers and patients

Including a venturi injector in a Magill breathing attachment reduces the requirement of compressed gases to 40% of that normally used: 100-120 ml x kg-1 x min-1. The entrainment of ambient air through the venturi injector enables the supply of an adequate flow of gas mixture to the patient. In 10 awake volunteers and 12 patients under N2O/halothane anaesthesia, it was demonstrated that a fresh gas flow from the anesthetic machine of 40 ml x kg-1 x min-1 is sufficient to prevent rebreathing during spontaneous respiration, when the venturi injector is included in the Magill attachment.     

Suction devices

Suction devices are integral to the safe delivery of anaesthesia and critical care. They are involved in clearing and aspirating body fluids, blood and debris, as well as employed in scavenging waste gases and diathermy fumes, intraoperative cell salvage systems, and tertiary devices such as vacuum mattresses and specialized wound dressings. All suction devices require three essential components, namely a source of vacuum, a reservoir/collection vessel and suction tubing. Other components of a suction device include an on/off switch, a vacuum regulator, vacuum gauge, filters, an overflow safety trap, an overfill protection device in the collection vessel, and a catheter. Several different types of catheter are available for use in different clinical situations. Vacuum and flow are the main physical principles underlying suction devices. The source of vacuum may be a fixed centrally piped system or a portable device using electrical, pneumatic or manual power. Pneumatically powered suction devices utilize the Bernoulli principle and Venturi effect. The efficiency of each system depends upon principles of displacement, degree of negative pressure and time taken to reach this, the internal resistance of the suction apparatus and the viscosity of the material to be aspirated.     

Enhanced Non-Contact Grip Force and Swirl Stability by a Combined Venturi–Vortex Air Head

A combination of the venturi module and the vortex cup was proposed to solve vortex instability and to enhance grip capacity. Mounting a venturi suction pad inside the vortex cup improved vacuum generation efficiency. When the vortex cup properly maintained the non-contact air gap and generated an equivalent vacuum to achieve a sealing effect around the open gap of the suction pad, the combined head improved grip capacity and stabilized the non-contact environment. Furthermore, the flow patterns around the venturi chamber and the swirl inside the vortex cup were analyzed based on the design elements of each module. In a module that integrated some of the venturi’s features internally, increased air consumption of the vortex cup was required than that of the venturi. However, it supported a wide range of non-contact grips. The coupled model effectively protected the vacuum suction features of the venturi suction pad in all non-contact environments in that range.     

湿化经鼻高流量氧疗对肺癌手术患者呼吸功能的影响

目的:探讨湿化经鼻高流量氧疗对肺癌根治术后患者呼吸功能的影响。方法:选取我院2016年 5月至 2018年4月实施的肺癌根治术患者112例。使用随机数字法分为对照组和观察组,每组各56例。对照组:气管插管脱机后常规文丘里面罩吸氧,观察组:行HFNC。结果:两组氧合指数、PaO2、PaCO2在吸氧前差异无统计学意义（P＞0.05）,吸氧24 h后观察组氧合指数和PaO2为348.15±46.43和（88.91±15.27）mmHg,显著高于对照组的307.54±40.22和（78.13±13.05）mmHg（P＜0.05）,观察组PaCO2为（32.16±4.24）mmHg,显著低于对照组的（40.13±6.51）mmHg（P＜0.05）。观察组舒适度评分、耐受性评分、气道湿化情况评分分别为(1.54±0.26)分、(1.23±0.21)分和(1.88±0.16)分,均显著低于对照组的(2.72±0.43)分、(2.87±0.36)分和(2.92±0.54)分（P＜0.01）。观察组再次插管机械通气率和CAM-ICU阳性率分别为8.9%（5/56）和5.4%（3/56）,显著低于对照组的21.4%（12/56）和14.3%（8/56）（P＜0.05）。观察组住院时间为（13.42±2.13）d,显著短于对照组的（16.23±2.75）d（P＜0.05）。结论:湿化经鼻高流量氧疗可以显著改善肺癌根治术后患者呼吸功能,有利于患者术后的恢复。     

现代超声乳化仪的原理与选型

阐述了现代超声乳化仪的组成和原理,描述了蠕动泵、文丘里泵、双线性模式、冷超乳等先进技术的特点;在超声乳化仪的选型方面,重点介绍了国际上公认的眼科器械生产商的最新机型,即美国博士伦公司的Stellaris机型、美国眼力健公司的Signature机型以及美国爱尔康公司的Infiniti机型,为临床科室采购超声乳化设备提供了很好的选型依据。     

文丘里装置与恒温加热湿化法在气管切开未行机械通气患者中的应用

目的探讨文丘里装置与恒温加热湿化法在气管切开未使用机械通气患者中的应用效果。方法选择气管切开未使用机械通气的患者80例,随机分为观察组和对照组,各组40例,观察组使用文丘里装置与恒温加热湿化法,对照组使用微量泵持续湿化法,两组湿化液均使用灭菌注射用水。观察患者治疗过程中的刺激性咳嗽、气道黏膜出血、气道痰痂、肺部感染发生率及术后堵管时间。结果观察组患者刺激性咳嗽、气道黏膜出血、气道痰痂、肺部感染的发生率明显低于对照组,两组比较差异有统计学意义(P0.05)。结论文丘里装置与恒温加热湿化法更适用于气管切开未使用机械通气的患者,是理想的气道湿化方法。     

Foreign bodies in the tracheobronchial tree. Special references to experience in 97 children

The case records of 110 patients (97 children and 13 grown-ups) with foreign bodies in the tracheobronchial tree during a period of 14 years (1970-1983) are reviewed. Atypical histories, misleading clinical and radiological findings and delayed diagnoses due to misinterpretations by the patients or their physicians were seen from time to time. Other findings in this survey were that organic material prevailed, with the majority of the objects in the right bronchial tree; there was a male predominance and the most common age for inhalation of a foreign body was about two years. Bronchoscopic extraction was the routine and only in one boy had the object to be removed by the transthoracic route. The venturi technique with oxygenation through the bronchoscope was applied at the extraction procedures. This principle for ventilation during general anaesthesia creates excellent working conditions for the endoscopist. The hazard at the removal of a foreign body is thereby reduced.