ObjectiveTo explore the methods to improve the success rate of intubation and reduce the intubation time consuming in emergency orotracheal intubation by improving the method of holding laryngoscope. MethodsA total of 146 patients needed orotracheal intubation were randomly divided into a traditional group who was intubated with traditional method of holding laryngoscope and an improved group who was intubated with improved method of holding laryngoscope. The success rate of intubation for the first time, success rate in difficult intubation, intubation time consuming, the incidence of complications by mechanical injury between two groups were compared. ResultsSixty-nine petients received traditional method of holding laryngoscope and 77 petients received improvement method of holding laryngoscope. The success rate for the first time intubation [71(92.2%) vs. 56(81.2%)] and success rate in difficult intubation [13(72.2%) vs. 3(23.1%)] of the improved group were higher than those of the traditional group. The differences were statistically significant (all P < 0.05). The intubation time consuming [(28.3±3.5)s vs. (35.6±4.1)s] and the incidence of complications by mechanical injury [1(1.3%) vs. 6(8.7%)] of the improved group were lower than those of the traditional group with statistical significance (all P < 0.05). ConclusionThe success rate of intubation for the first time and the difficult intubation can be improved effectively, and the intubation time consuming and the incidence of complications by mechanical injury can be reduced effectively by improving the method of holding laryngoscope.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo investigate the clinical effect of No. 8 blood collection needles in connecting broken balloon tubes. MethodsThirty-six patients who underwent mechanical ventilation in the Intensive Care Unit between January 2010 and December 2013 were included as the study subjects. We divided them into two groups. Patients who had accidental rupture of balloon tube during intubation were regarded as the trial group, while those with normal ventilation were regarded as the control group, with each group having 18 patients. The trial group used No. 8 disposable blood collection needles to connect the balloon tubes. Pressure gauge produced in Germany was used to measure the balloon pressure continuously for four hours. Balloon pressure level, balloon leakage and tube dislocation within 24 hours were observed. ResultsThe balloon pressure at different time periods was not significantly different between the two groups (P > 0.05). The leakage rate and complication rate were also not significantly different between the two groups (P > 0.05). ConclusionsUsing No. 8 blood collection needles for connecting broken balloon tubes is effective, easy, and convenient, and the balloon can be maintained at a constant pressure. It solved many previous clinical problems such as high cost, high complication rate, high death rate and medical disputes.
ObjectiveTo investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery.MethodsFrom September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared.ResultsThere was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05).ConclusionThe non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.
ObjectiveTo compare the postoperative enhanced recovery outcomes of lobectomy performed under non-intubated video-assisted thoracic surgery (NIVATS) versus intubated video-assisted thoracic surgery (IVATS). Methods Computerized searches were performed in the following databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Information, China Biomedical Literature Database (CBMdisc), Web of Science, Clinicaltrials.gov, The Cochrane Library, EMbase, and PubMed. We collected randomized controlled trials (RCTs) and observational studies comparing NIVATS and IVATS. The search period extended from the inception of each database to April 1, 2023. Two independent researchers screened the literature and assessed study quality. ResultsA total of 14 studies were included, comprising 4 RCTs, 7 retrospective cohort studies, and 3 propensity score matching studies, involving 1 840 patients. Meta-analysis results indicated that, compared to IVATS, NIVATS was associated with significantly shorter operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.001], shorter length of hospital stay [MD=–0.81, 95%CI (–1.39, –0.22), P=0.005], shorter chest tube duration [MD=–0.73, 95%CI (–1.36, –0.10), P=0.02], shorter postoperative anesthesia recovery time [MD=–20.34, 95%CI (–26.83, –13.84), P<0.001], and shorter time to oral intake after surgery [MD=–5.68, 95%CI (–7.63, –3.73), P<0.001]. Furthermore, NIVATS showed a lower incidence of postoperative airway complications [OR=0.49, 95%CI (0.34, 0.71), P<0.001] and less total chest tube drainage volume [MD=–251.11, 95%CI (–398.25, –103.98), P<0.001], all contributing to significantly accelerated postoperative enhanced recovery for patients. Conclusion NIVATS is a safe and technically feasible anesthesia method in thoracoscopic lobectomy, which can to some extent replace IVATS.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
目的:观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法:40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录心率、收缩压和舒张压。结果:两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低(Plt;0.05或Plt;0.01),心率均减慢(Plt;0.05或Plt;0.01);瑞芬太尼组T2.T3时收缩压、舒张压降低(Plt;0.05或Plt;0.01),心率减慢(Plt;0.05);芬太尼组T2、T3时收缩压、舒张压升高(Plt;0.05),心率增快(Plt;0.05)。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低(Plt;0.05),心率减慢(Plt;0.05)。结论:瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.
ObjectiveTo investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia.MethodsFrom January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared.ResultsThe baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05).ConclusionThe "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.