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Objective To discuss the practicability and safety of 3.5 mm superfine bronchoscope in children's difficult airway.Methods Twenty-eight children with difficult airway,aged 4 months to 8 years were selected.Intravenous anesthesia was used and autonomous respiration was maintained.The 3.5 mm superfine bronchoscope was used to guide tracheal intubation by nose(mouth).Results Among 28 cases, 1 case had oral bleeding and succeeded after suction and pressurized oxygen supply, and the rest was successful in the first time.The intubation time was(1.50 ± 0.25)min.There was no damage to the whole airway.Success rate was 100%.Conclusions The 3.5 mm superfine bronchoscope in guiding tracheal intubation of children's difficult airway has obvious advantages and security, and it deserves clinical attention and promotion.
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Objective To discuss the feasibility and safety of sevoflurane inhale anesthesia with portable combined inhalation anesthesia induction device in solving the difficulty of children entering the operation room.Methods One hundred pediatric patients were enrolled into the study.The pediatric patients were randomly divided into two groups,50 cases in each group.Group A was fraught with a new mode of administration,using portable combined inhalation anesthesia induction device with sevoflurane 2 ml before entering the operation room;group B was fraught with a traditional mode of administration,using in-tramuscular injection with ketamine 4-5 ml/kg before entering the operation room.The analog scale of anes-thetic effect,the number of body movement,adverse reaction were compared between the two groups. Results Compared with group B,time of falling asleep and retention time in the operating room was signif-icantly shorter (P <0.01).And body movement during vein puncture decreased significantly (P <0.01). Moreover,the incidence of adverse affect showed significant reduce compared with group B (P < 0.05 ). Conclusion The combined inhalation anesthesia induction device is simple to produce and easy to carry.To solve the difficulty of convoying children into the operating room,combined inhalation anesthesia induction device with sevoflurane is more effective, safer and more humanized way when compared with the traditional one.
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Objective To investigate the effects of different doses of dexmedetomidine and propofol on electrocorticography (ECoG)during epileptic resection.Methods One hundred cases of epileptic patients undergoing epileptic resection were randomized into five groups (n=20 cases).Af-ter exposure of the cortex,patients were allocated to propofol group or dexmedetomidine group,the propofol were injected intravenously with different target-controlled-infusion (TCI)concentrations at 1.5 μg/ml (group C1),5.0 μg/ml (group C2)respectively.The dexmedetomidine were injected with a loading dose of 0.5 μg/kg within 1 5 min,then followed by a speed of 0.25 μg·kg-1 ·h-1 (group D1 ),0.5 μg·kg-1 ·h-1 (group D2),and 1.0 μg·kg-1 ·h-1 (group D3)respectively.After 1 5 min of steady infusion,the characteristics of ECoG were recorded.Results Compared with the other four groups,the epileptic spike-wave,αandβwaves were significantly decreased,whileδwave was significantly increased in group C2 (P < 0.05 ).Sometimes burst-suppression-patterns were recorded under propofol. With the dose of dexemedetomidine increasing in groups D1,D2,D3,the epileptic spike-wave,αwave andβwave gradually decreased,while δwave gradually increased (P <0.05).Conclusion Propofol produces dose-dependent inhibition on ECoG,but the epileptic spike-wave still can be differentiated if the plasma con-centration lower than 1.5 μg/ml.Compared with propofol,dexmedetomidine injected with 0.25-0.5 μg· kg-1 ·h-1 ,has few disturbance on epileptic spike-wave differentiation and location during ECoG monito-ring,and is more eligible for epileptic resection anesthesia.
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Three ASA Ⅱ male patients aged 22-46 yr weighing 50-75 kg underwent operation on language areas from June to September 2009 in our hospital. Anesthesia was induced with propofol 2-2.5 mg/kg, fentanyl 4-5 μg/kg and atracurimm 0.6 mg/kg. The esophago-pharyngeal tube was inserted into esophagus and oropharynx under direct vision. The esophageal balloon was inflated with 10-15 ml of air and the pharyngeal balloon with 40-60 ml of air. After the correct position of the tube was confirmed, the patients were mechanically ventilated.Anesthesia was maintained with propofol 50-70 μg · kg- 1 · min- 1 , remifentanil 0.15-0.25 μg· kg- 1 · min- 1 and atracurium 0.3-0.4 μg·kg-1·h-1. The pharyngeal balloon was deflated during wake-up test. The patients were asked to count continuously and answer question as instructed to locate the language areas. After the language areas had been located, the pharyngeal balloon was inflated again. The tidal volume was set at 500-510 ml and measured 500-512 ml. The airway pressure measured 16-18 cm H2O. The hemodynamics was stable and blood gas indexes were within the normal range. The language in response to questions was clear in one patient, not very clear in the second patient and vague in the third patient. Hypoxemia hypercapnea and intracranial hypertension were not observed during operation and wake-up test. After the patients became conscious, the balloons were deflated and the vital signs were stable. The patients were transferred to ICU after removal of esophago-pharyngeal tube. No postoperative complications occurred.
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Objective To compare the effects of combined epidural-spinal anesthesia and different doses ropivacaine anesthesia for the lower limb operations. Methods One hundred and thirty-six patients for elected operations and 83 emergency operation patients receiving lower limbs operations were enrolled for the comparative study. Patients receiving spinal analgesia were divided into 3 groups with 0.1%, 0.15% and 0.2% ropivacaine, respectively. The dosage was increased from 3mg to 7mg with 1mg increase stepwise for each group, and a total of 15 groups and 219 cases were studied with this regime. For the patients undergoing epidural block anesthesia, 0.2% ropivacaine was used. Patients were placed in lateral recumbent position with the affected limb on the top. Puncture was done at the level of L2-3 interspace with a fine trocar, keeping the anesthetic level at T9-10. The anesthetic effect, BP, HR, SpO2 and Bromage score were then recorded. Results The effective rate was 95% in 6mg and 7mg group, 50%-55% in 5mg group, and 30% in 4mg group. The dosage of 3mg failed to achieve anesthesia. There was no failure in 7mg groups. During the operations the BP, HR and SpO2 were stable. No nausea and vomiting occurred, except 1 patient complaining of headache and 2 patients with urine retention. The intraoperation Bromage score of the affected limbs were 2-3, and for the unaffected limbs it was 0-1. Conclusions It is suggested that 0.1-0.2% ropivacaine in a dosage of 6-7mg for spinal anesthesia combined with 0.2% ropivacaine for epidual block can be used in the limb operation. It overcomes many side effects of traditional lumbar anesthesia. This method may be of great advantage to patients with complete analgesia, less anesthetic agent used, earlier ambulation, stable circulation and respiration, and fewer side-effects.