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>

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>

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>