Study on the use of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the significance of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway.@*METHODS@#In this study, 44 patients undergoing selective operation of ASA (American Society of Anesthesiologists physical status) I to II, neck stiffness, neck trauma needed braked, or severe cervical spondylosis were selected. The patients were randomly divided into two groups: 24 cases in the experimental group (group E) and 20 cases in the control group (group C). The stylets of the rigid fiber bronchoscopes were shaped according to the CT three-dimensional reconstruction images and parameters obtained before surgery. The rigid fiber bronchoscopes shaped according to the CT three-dimensional reconstruction images were used in group E, while the rigid fiber bronchoscopes with the original angles were used in group C. Tracheal intubation operations were all performed by an anesthesiologist who had more than 10 years' clinical experience and mastered in rigid endoscopic intubation techniques. The first attempt success rate and the total success rate of tracheal intubation, intubation time, blood pressure, heart rate and pulse oxygen saturation at different time points including pre-induction, immediately after intubation, 1-5 minutes after intubation, and intubation related complications within 24 hours were recorded.@*RESULTS@#The total success rate of intubation in the two groups were both 100%. The first attempt success rate of intubation was 96% in group E, and 70% in group C. The first attempt success rate of group E was higher than that of group C. The intubation time of group E was (20.7± 10.6) s, and (21.5 ± 17.6) s of group C. Group E was shorter than that of group C, but there was no significant difference (P > 0.05). RPP equaled the product of heart rate and systolic pressure, which represented the stress reaction of intubation on hemodynamics, was lower in group C at T0, T1, T2, T4 and T5 separately than that in group E, but there was no significant difference (P>0.05). There was no significant difference in tracheal intubation related complications between the two groups (P>0.05).@*CONCLUSION@#CT three-dimensional reconstruction technique has certain guiding significance in difficult tracheal intubation with rigid fiber bronchoscope in patients with fixed cervical spine.

Comparison of the Effectiveness of Different Supraglottic Ventilation Methods during Bronchial Thermoplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness of high-frequency jet ventilation via Wei jet nasal airway and controlled ventilation with improved laryngeal mask airway during bronchial thermoplasty.</p><p><b>METHODS</b>Twenty-eight patients undergoing bronchial thermoplasty were equally divided into two groups: group A (high-frequency jet ventilation through Wei jet nasal airway) and group B (controlled ventilation with improved laryngeal mask airway). Pulse oxygenation,heart rate,and mean arterial blood pressure were recorded after entering the operating room (T0), 1 minute after administration/induction (T1), bronchoscope inserting (T2), 15 minutes (T3)/30 minutes (T4)/45 minutes (T5) after ventilation,at the end of the operation (T6), and at the recovery of patients' consciousness (T7). The pH,arterial oxygen partial pressure,and arterial carbon dioxide partial pressure were recorded at T0, T4, and T6. The endoscope indwelling duration,operative time,patients' awakening time,adverse events during anesthesia,satisfactions of patients and operators, anesthesic effectiveness were also recorded.</p><p><b>RESULTS</b>The arterial carbon dioxide partial pressur in group A at T4 and T6 were significantly higher than in group B (P<0.05). The pH in group A at T4 and T6 was significantly lower than in group B (P<0.05). The endoscope indwelling duration and the operative time in group B were significantly shorter than in group A (P<0.05) while the recovery of consciousness in group B was significantly longer than in group A (P<0.05). The satisfaction for operators and the efficacy of anesthesia in group B were better than in group A (P<0.05). The number of adverse events in group B was significantly smaller than in group A (P<0.05).</p><p><b>CONCLUSION</b>The improved laryngeal mask airway with controlled ventilation is more suitable for bronchial thermoplasty.</p>

Efficacy of intravenous scopolamine for preventing postoperative nausea and vomiting after cesarean section / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the efficacy of intravenous scopolamine in the prevention of postoperative nausea and vomiting (PONV) after cesarean section (CS).</p><p><b>METHODS</b>A total of 260 pregnant women with American Society of Anesthesiologists (ASA) Physical Status Classification class I-II who underwent elective CS under combined spinal-epidural anesthesia (CSEA) were randomly divided into four groups (n = 65): at the end of surgery, 0.3 mg/5 ml scopolamine (scopolamine group), 4 mg/5 ml ondansetron (ondansetron group), 0.3 mg scopolamine plus 4 mg ondansetron per 5 ml (combination group), or 0.9% normal saline 5 ml (control group) were intravenously infused, respectively. The episodes of PONV and adverse effects were observed within 24 hours after operation.</p><p><b>RESULTS</b>The incidences of PONV within 24 hours after surgery were 87.7%, 89.2%, and 92.3%, respectively, in scopolamine group, ondansetron group, and combination group, which were all significantly higher than that in control group (73.8%) (all P < 0.05). However, the incidences of PONV showed no significant difference among these three groups (P > 0.05). No significant difference in the incidence of adverse effects was observed among the four groups (P > 0.05).</p><p><b>CONCLUSION</b>Intravenous scopolamine (0.3 mg), with a comparable efficacy as ondansetron 4 mg, can effectively decrease the incidence of PONV after CS.</p>

Morphologic and functional characteristics of the immortalized human liver sinusoidal endothelial cell line / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the morphologic and functional characteristics of the immortalized human liver sinusoidal endothelial cell line (LSEC line).</p><p><b>METHODS</b>Immunofluorescence staining and fluorescence microscopy were used to detect the classic endothelial cell markers in LSEC line, and flow cytometry was used to analyze the purity of the human LSEC line. The morphology (including W-P bodies and surface fenestrations) and phagocytotic capacity of the human LSEC line were observed by transmission and scanning electron microscope. The proliferation curve of the human LSEC line was analyzed by MTT assay. The functional differences between the human LSEC line and human primary LSEC in expression of ELAM-1 and ICAM-1, activities of fibrinolysis (PAI-1, t-PA, u-PA), releasing of IL-6 and IL-8 were compared respectively by enzyme linked immunosorbent assay. Comparison of the susceptibility to hypoxia-reoxygenation induced apoptosis between the human LSEC line and human primary LSEC were investigated by TUNEL.</p><p><b>RESULTS</b>The established human LSEC line maintained a high proliferative ability and has been passaged for more than 80 times in the absence of any growth factors. Immunofluorescence staining showed that the human LSEC line could express classic endothelial cell marks including von Willebrand Factor (vWF), and could take up acetylated low-density lipoproteins (Ac-LDL). The purity of the human LSEC line was confirmed over 95% by flow cytometric analysis. The W-P bodies and the phagocytosis of Dynabeads was demonstrated by transmission electron microscope. And fenestrations could be found cellular surface with scanning electron microscopy. When compared with human primary LSEC, the human LSEC line has an equivalent responsiveness to tumor necrosis factor in up-regulation of ELAM-1 and ICAM-1. The human LSEC line can also release PAI-1, t-PA, u-PA but can not release IL-6 and IL-8 to TNF-alpha. In contrast, human primary LSEC could release IL-6. The human LSEC line showed higher susceptibility to hypoxia-reoxygenation-induced apoptosis, and the percentage of apoptotic cells was as high as (38.4 +/- 6.7)%, while (28.6 +/- 4.5)% and (7.8 +/- 1.2)% respectively in primary LSEC and in human umbilical vein endothelial cells.</p><p><b>CONCLUSIONS</b>The established human LSEC line maintains the special phenotypes and the major functional characteristics, and especially maintains the high susceptibility to hypoxia-reoxygenation-induced apoptosis. Therefore it is feasible to use this cell line for the study of liver ischemia-reperfusion injury.</p>

Comparison of hemodynamic responses to orotracheal intubation with shikani laryngoscope or macintosh direct laryngoscope / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the hemodynamic responses to orotracheal intubation using a Shikani Optical Stylet (SOS) laryngoscope or a Macintosh direct laryngoscope (MDLS).</p><p><b>METHODS</b>Totally 41 patients with American Society of Anesthesiologists ASA physical status -aged 20-60 years and scheduled for elective surgery under general anesthesia requiring orotracheal intubation, were randomly allocated to either the SOS group (n=21) or MDLS group (n=20). After an intravenous anesthetic induction the orotracheal intubation was performed using a SOS laryngoscope or a MDLS. Blood pressure and heart rate (HR) were recorded before and after anesthetic induction immediately after intubation, and 5 minutes after intubation. Rate pressure product RPP were calculated.</p><p><b>RESULTS</b>Blood pressures and RPP in both two groups significantly decreased after anesthetic induction (P<0.05) while blood pressures HR, and RPP significantly increased after orotracheal intubation (P<0.05). HR in both groups after intubation were significantly higher than the pre-induction level (P<0.05)and such an increase lasted for 3 min. HR immediately after intubation was also significantly higher in MDLS group than in SOS group (P<0.05); however, such difference was not observed in other time points (P>0.05). In the MDLS group when compared with the occurrence time required for the maximum values of systolic blood pressure (SBP)the occurrence time required for the maximum values of HR after the start of intubation and success of intubation during the observation were significantly delayed (P<0.05). Compared with the MDLS group, the occurrence time required for the maximum values of SBP after the start of intubation and the success of intubation were significantly delayed in the SOS group (P<0.05). The incidences of SBP more than 130% of baseline value and RPP more than 22 000 were not significantly differently(P>0.05). Also, the intubation time was not significantly different (P>0.05).</p><p><b>CONCLUSION</b>The hemodynamic responses to orotracheal intubation is milder in SOS laryngoscope than in MDLS.</p>

The hemodynamic effects during thoracic epidural anesthesia combined with general anesthesia in patients undergoing major abdominal operations / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the hemodynamic effects between the two established anesthetic managements: thoracic epidural anesthesia combined with general anesthesia (TEA + GA) as well as total intravenous anesthesia (TIVA).</p><p><b>METHODS</b>Forty-four patients undergoing major abdominal operation were randomized to TEA + GA (n = 22) group or TIVA (n = 22) group. After thoracic epidural catheterization, the anesthesia induction and endotracheal intubation was made and a standard anesthesia procedure was administered for both groups. In TEA + GA group, the patients received thoracic epidural anesthesia (TEA) with 0.25% bupivacaine (bolus 0.5 mg/kg firstly and then infused continuously with 0. 2 ml x kg(-1) x h(-1)). While in TIVA group, the patients received 0.9% saline via epidural catheter just with the same bolus volume and same infusion rate as in TEA + GA group. The parameters monitored were as follows: ECG, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), central venous pressure, cardiac index (CI), systemic vascular resistance (SVR), pulse oximetry and PetCO2. Blood gas analysis was made as needed. The observation time for both groups was 90 min.</p><p><b>RESULTS</b>After epidural infusion of bupicacaine (TEA + GA group) or saline (TIVA group), SAP, DAP, HR and SVR in TEA + GA group were statistically decreased in comparing with the baseline, and SAP, DAP, MAP and SVR were also decreased significantly when compared with those in TIVA group (P < or = 0.05). However, CI and SV in TEA + GA group changed little and showed no statistical differences in comparing with those in TIVA group.</p><p><b>CONCLUSIONS</b>This study gives evidences that TEA in combination with GA had no negative effects on cardiac functions. The decrease of blood pressure may possibly be caused by the reduction of systemic vascular resistance.</p>

Analysis of anesthetic methods for tracheal resection and reconstruction with artificial trachea: a report of 25 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze and discuss the anesthetic methods and processes for the operations including long-segment resection of the trachea and one-stage anastomosis or reconstruction with artificial trachea.</p><p><b>METHODS</b>The clinical data of 25 cases from January 1987 to August 2007 with trachea diseases were analyzed retrospectively. There were 10 cases with benign diseases and 15 cases with malignant diseases. All cases represented tracheal stenosis. Some cases represented severe dyspnea. The length of the tracheal lesions was from 2.5 to 7.5 cm. The longest resection of the trachea was 8.0 cm. Direct reanastomosis were carried out in 14 cases. Reconstruction with artificial trachea were carried out in 7 cases. Thirteen cases underwent general anesthesia with endotracheal intubation only, while 2 cases were assisted with artificial cardiopulmonary bypass. Eight cases were intubated via existed tracheotomy. Two cases received bedside tracheotomy with local anesthesia. Two cases were assisted with high frequency jet ventilation. During the operation, a tube was inserted into the distal trachea or contralateral main bronchus to maintain anesthesia and ventilation after the trachea resection.</p><p><b>RESULTS</b>All of the 25 patients had good outcome. There was no death caused by anesthesia or operation. However, transient lower SaO2 was found in 2 cases because of the difficult intubation of left main bronchus after the resection of the trachea. One case was ventilated with only lower lobe because of the extra-deep intubation of the left main bronchus. Anastomosis dehiscence happened in 1 case when the non-balloon trachea tube was used immediately after the operation.</p><p><b>CONCLUSIONS</b>The mortality of anesthesia for tracheal operation are quite high. Therefore, individual treatment with carefully-designed anesthetic and operative protocol, and good communications and cooperation between anesthesiologists and surgeons is the key factor for the success of anesthesia and operation.</p>

Study on the effects of controlling hepatitis A epidemics by building the colony immune defence / 中华流行病学杂志

<p><b>OBJECTIVE</b>To build the colony immune defence and to control the periodic epidemics of hepatitis A after a mass vaccination of live attenuated hepatitis A vaccine.</p><p><b>METHODS</b>Through yearly observing the correlation of the accumulative inoculation rates of live attenuated hepatitis A vaccine, the crowd immune standard and the morbidity of hepatitis A after administered live attenuated hepatitis A vaccine among susceptible population and surveilling anti-HAV IgG in the different epidemic areas.</p><p><b>RESULTS</b>(1) The accumulative inoculation rates of live attenuated hepatitis A vaccine was 34.15% in 8 years from 1993 to 2000, among which they were 84.46%, 82.23% and 15.14% in the preschool children, primary and middle school student and 15 - 45 age groups respectively. The morbidity of hepatitis A decreased to 8.26/100,000 in 2000. (2) The crowd positive rates of anti-HAV IgG were 74.24% in 1998 and 83.68% by 2000. Among which they were 74.02%, 68.49%, 79.41%, 85.71% and 90.80% in 2 - 4, 6 - 8, 13 - 15, 20- and 30 - 39 age groups respectively. (3) The accumulative inoculation rates were 37.36%, 51.08% and 28.68% in the inspection areas of Tongtai, Binhai and Yandu respectively. The crowd positive rates of anti-HAV IgG in three inspect area were 85.71%, 85.94% and 78.63% respectively. It was noticed the correlation between the accumulative inoculation rates and the crowd positive rates of anti-HAV IgG was (r(city) = 0.91, F = 15.10, P < 0.03).</p><p><b>CONCLUSION</b>The results showed that the crowd positive rates of anti-HAV IgG had increased to 85% while, the colony immune defence of hepatitis A was effectively built to break the periodic epidemics of hepatitis A. The morbidity of hepatitis A decreased to the lowest level in the history.</p>

Detection of esophageal intubation-assessment of several methods in clinical anesthesia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the sensitivity and reliability of several widely used tests for prompt detection of inadvertent esophageal intubation.</p><p><b>METHODS</b>Both endotracheal and esophageal intubations were made on 40 adult patients undergoing general anesthesia. The tests such as auscultation of bilateral apex of lungs and epigastrium by inexperienced examiners, capnography, SpO2, chest and upper abdomen movements, and airway resistance were evaluated.</p><p><b>RESULTS</b>90% and 96.25% cases in esophageal intubation were correctly diagnosed via auscultation of bilateral apex of lungs or epigastrium respectively. During esophageal ventilation, abdominal distension was found in 87.5% of cases, but none of them showed chest movements. Meanwhile, PetCO2 fluctuated between 1-2 mmHg, in association with a quick decline of SpO2 in 156 +/- 11 seconds. The airway mean resistance increased, whereas the period of plateau decreased significantly.</p><p><b>CONCLUSIONS</b>(1) Auscultation of epigastrium in combination with bilateral apex of lungs is recommended because of the improved accuracy in tube positioning. (2) Capnography is the most reliable technique for the prompt detection of esophageal intubation, whereas other parameters do not seem to be of comparable value.</p>