ABSTRACT
Objective To investigate the effect of head extension angle to glottis exposure by using three-dimensional CT reconstruction sagittal plane images of upper airway.Methods There were 80 patients,aged 7-78 years old,who had been scanned by helical CT in the head and neck.Reconstructed images were obtained by AW4.4 workstation and the following parameter was measured:angle α(A0 group),the angle created by the upper central incisor and root of epiglottis(angular vertex) and midpoint of glottis.Reconstructed images were printed according to the actual size of human body in a ratio of 1∶ 1,then the images were cut off from the upper central incisor to root of epiglottis by a section of arcs.Increasing the degree of angle α by clockwise to hypothetically increase the angle of head extension.The glottis was exposed by using a paper-made laryngoscope(Macintosh) model,and the success rate of glottis exposure was recorded when the degree of angle α was respectively increased 10°(A10 group),20°(A20 group),and 30°(A30 group).Results Compared with A0 group,the success rate of glottis exposure increased significantly in A10 group,A20 group and A30 group.The success rate of glottis exposure in A20 group and A30 group was significantly higher than A10 group.Compared with A20 group,the success rate of glottis exposure obviously increased in A30 group.Conclusion Based on CT reconstruction images of upper airway,we can analog study the effect of head extension angle to glottis exposure.
ABSTRACT
Objective To study the efficacy of tourniquet to block the distal of radial styloid on success rate of radial artery catheterization.Methods One hundred and forty ASA Ⅰ-Ⅲ patients, aged 22-88 years,undergoing general anesthesia and requiring radial artery catheterization were in-cluded in this study and were randomly allocated into touch positioning group (group A)or tourni-quet-assisted group (group B).Radial artery catheterization was conducted after induction of general anesthesia in two groups.The invasive systolic blood pressure (ISBP ), invasive diastolic blood pressure(IDBP)and HR of patients were recorded in group B at 1 min before ischemia (T1 ),using pressure pulse blocking after 1 min (T2 ),2 min (T3 ),5 min (T4 )and the complete release of tour-niquet after 1 min (T5 ),5 min (T6 )and 10 min (T7 ).The first and total success rate of radial artery puncture,puncture times,puncture duration and complications were recorded.Results The radial ar-tery diameter was not statistically significant in group B between before and after blocking radial artery .ISBP at T2-T4 in group B was significantly higher than that at T1 (P <0.05).The first time puncture success rate and overall success rate in group B was significantly higher than that of group A,The number of puncture in group B was significantly less than that of group A,and puncture time was significantly shorter in group A (P <0.05).Conclusion Tourniquet-assisted radial artery cathe-terization could improve success rate,decrease puncture times and shorten puncture duration.
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Objective To observe the clinical effect of modified laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways.Methods Forty patients,21 males and 1 9 females,aged 30-55 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective general anes-thesia surgery after failure to direct laryngoscope two attempts were randomly divided into two groups,20 cases in each group.Patients in group LMA-FOB underwent intubation with modified la-ryngeal mask airway combining fiberoptic bronchoscope,and patients in group FOB underwent intu-bation with fiberoptic bronchoscope.The fiberoptic bronchoscope score,the intubation time and the rate of successful intubation at first attempt were recorded.All the patients were followed up postop-eratively for adverse effects.Results The fiberoptic bronchoscope scores (Ⅰ/Ⅱ/Ⅲ/Ⅳ:1 5/4/1/0 vs. 8/4/5/3,P <0.05)and the rate of once successful intubation (90% vs.60%,P <0.05)was signifi-cantly higher,and the intubation time [(75 ± 20)s vs.(105 ± 25 )s,P < 0.05 ]was significantly shorter in group LMA-FOB than that in group FOB.In group LMA-FOB,one patient had blood stain in the LMA and one patient felt slight sore throat.There were no significant adverse effects in the two groups.Conclusion Modified Laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways was effective to improve the grade of the view of the larynn and the success rate of intubation and shorten the intubation time.No significant adverse effect postoperatively was reported. It is relatively safe,effective and promising in patients with difficult airway.
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Objective To evaluate the accuracy of non?invasive blood pressure monitoring in bilat?eral upper and lower extremities in lateral position in patients undergoing surgical procedures. Methods Forty patients of both sexes, aged 24-64 yr, BMI 20-27 kg∕m2 , of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective neurosurgical procedures, were included in this study. Blood pressure of bilateral upper and lower extremities was monitored and recorded using appropriate cuffs. At 5 min after induction of anesthesia ( T0 ) , 10 min after the patients were turned to lateral position ( T1 ) , 30, 60 and 90 min after start of surgery ( T2-4 ) , and 10 min after the patients were turned to supine posi?tion ( T5 ) , non?invasive blood pressure was measured, and invasive blood pressure was recorded. Results Compared with the value measured on the healthy side, systolic blood pressure ( SBP ) and diastolic blood pressure (DBP) of upper extremities on the affected side were significantly decreased at T1-4, and SBP of lower extremities on the healthy side was significantly increased at T0-5 (P0.05) . There was no significant differ?ence between non?invasive SBP and invasive SBP of lower extremities on the healthy side, and between non?invasive DBP and invasive DBP of lower extremities on the healthy side (P>0.05). Conclusion For the patients undergoing surgical procedures, the blood pressure of upper extremities is higher on the healthy side than on the affected side when the patients are in lateral position, and there is no significant difference in the blood pressure between bilateral lower extremities; and there is no significant difference between non?invasive blood pressure and invasive blood pressure of lower extremities on the healthy side.