ABSTRACT
Objective:To investigate the efficiency of the ultrasonic-assisted positioning technique for lumbar anesthesia in elderly patients with hip fractures through the paramedian approach compared with body surface labeling.Methods:Patients(aged ≥65 years)with hip fractures were randomized(1∶1)to receive either ultrasound-assisted or landmark-guided paramedian spinal anesthesia in a lateral position.The primary outcome was the number of needle passes needed for a successful dural puncture.The secondary outcomes included one-pass success rate, number of needle attempts, one-attempt success rate, total time of spinal anesthesia and adverse effects.Results:A total of 88 subjects were randomized.The ultrasound-assisted approach significantly reduced the number of needle passes, compared with the landmark-guided approach[2.0(1.0-3.0) vs.5.0(3.0-8.8); Z=-4.708, P<0.001]. The one-pass success rate was higher in the ultrasound-assisted approach than in the landmark-guided approach[40.9%(18/44) vs.4.5%(2/44); χ2=16.565, P<0.001]. There was no statistical difference in the number of needle attempts and one-attempt success rate between the two groups( P>0.05 for both). The total time of spinal anesthesia was longer in the ultrasound-assisted group than in the landmark-guided group[252(218-317) s vs.168(143-195) s; Z=-5.592, P<0.001]. In the ultrasound-assisted group, fewer patients developed bloody cerebral spinal fluid taps than in the landmark-guided group[0%(0/44) vs.18.2%(8/44); χ2=6.738, P=0.009]. Conclusions:In elderly hip fracture patients, ultrasound-assisted paramedian spinal anesthesia is superior to the landmark-guided approach in reducing the number of needle passes and should be recommended for these patients.
ABSTRACT
Objective To evaluate the feasibility of ETView visual endotracheal intubation in elderly patients with a potentially difficult airway under general anesthesia.Methods A total of 80 patients scheduled for elective surgery,with at least three characteristics indicative of an increased risk for difficult tracheal intubation and aged 65-86 years with American Society of Anesthesiologists (ASA) grade [Ⅱ or Ⅲ,were selected and randomly assigned into 2 groups:the control group (Group C) and the ETView visual endotracheal intubation group (Group E) (n=40 for each).After induction with propofol 0.5-1.5 mg/kg,sufentanil 0.2 μg/kg,and rocuronium 0.6mg/kg,regular tracheal intubation and ETView visual endotracheal intubation were conducted in Group C and Group E respectively.Blood pressure and heart rate were recorded before induction (T0),before initial intubation (T1),at successful intubation (T2),and 5min after successful intubation (T3).Duration of catheterization,number of intubation attempts,rate of successful intubation at first attempt and complications within 2 days of intubation were also recorded.Results The duration of catheterization and the number of intubation attempts were lower in Group E than in Group C[(34±6) s vs.(48± 22) s,(1.0±0.0) vs.(1.4±0.4),t=2.484 and 2.373,respectively,P=0.017 and 0.023,respectively].The rate of successful intubation at first attempt was higher in Group E than in GroupC (100％ or 40 cases vs.75％ or 30 cases),x2=5.714,P=0.017).There was no significant difference in hemodynamic changes and the rate of postoperative hoarseness between the two groups (P＞0.05 for both).Conclusions ETView visual endotracheal intubation shows excellent safety in elderly patients with a difficult airway under general anesthesia,with shorter catheterization duration and a higher rate of successful intubation at first attempt than regular intubation.