ABSTRACT
Objective:To evaluate the clinical efficacy of dezocine, fentanyl and sufentanil at the equivalent dose on hemodynam-ics, sedation and analgesia in fibrobronchoscope-guided. Methods:A total of ninety patients with anticipated difficult airways expected to be nasally intubated using fibrobronchoscope were enrolled and randomly divided into three groups:dezocine group ( group D) , fent-anyl group ( group F) and fentanyl group ( group S) . Ten minutes before the intubation, each group was intravenously given dezocine 0. 15mg ·kg-1 , fentanyl 3μg ·kg-1 and sufentanil 0. 2μg·kg-1 , respectively. The values of HR, MAP and SPO2 were recorded respectively at the time when the patients entered the operation room ( T0 ) , before the bronchoscopy-guided tracheal intubation ( T1 ) , after the intubation ( T2 ) and 5 minutes after the intubation ( T3 ) . The Ramsay sedation score before the intubation and adverse reac-tions during the intubation were also observed. Results: In group F and group S, HR and MAP decreased significantly at T1 ( P<0. 05). The levels of SPO2 decreased significantly at T1 and MAP increased significantly at T2 in the three groups (P<0. 05). The levels of HR, MAP and SpO2 in group F and group S were lower than those in group D (P<0. 05). The levels of HR and MAP in group F at T2 were higher than those in group D and group S, and SPO2 was dropped significantly in group F and group S (P<0. 05). The levels of HR in group S dropped significantly, and were lower than those in the other two groups. MAP in group F was higher than those in the other two groups (P<0. 05). From the Ramsay sedation analysis, the scores of the three groups increased significantly and the score in group S was higher than that in group F (P <0. 05). The incidence of nausea and respiratory depression in group F was significantly higher than that in group D (P<0. 05). The incidence of agitation in group F was significantly higher than that of group S (P<0. 05). The incidence of respiratory depression in group S was significantly higher than that of group D and group F (P<0. 05). Conclusion:Dezocine combined with surface anesthesia has a slight effect on hemodynamics during the tracheal intubation guided by bronchoscopy in the patients with difficult airways. The incidence of reverse reactions of dezocine is lower than that of fenta-nyl and sufentanil.
ABSTRACT
Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. We report the case of a 24-h-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
A síndrome de Goldenhar é um quadro de polimalformação que consiste em uma disostose craniofacial que determina uma via respiratória difícil em até 40% dos casos. Nós descrevemos um caso de um recém-nascido com síndrome de Goldenhar com atresia de esôfago e fístula traqueoesofágica para a qual foi feita cirurgia de reparo. Apresentamos o caso de um recém-nascido de 24 horas de vida com síndrome de Goldenhar. Ele apresentava atresia de esôfago, com fístula traqueoesofágica distal. Decidiu-se por uma cirurgia de emergência para reparo. Ela foi feita sob sedação, intubação com fibrobroncoscópio distal à fístula, para limitar passagem do ar para o esôfago e possível distensão abdominal. Após o reparo completo da atresia de esôfago e ligadura da fístula, o paciente foi transferido para a unidade de terapia intensiva e intubado com sedoanalgesia. O achado de um paciente com síndrome de Goldenhar e atresia de esôfago supõe uma situação excepcional e um desafio para os anestesiologistas, pois o manejo anestésico depende da comorbidade do paciente, do tipo de fístula traqueoesofágica, da prática hospitalar habitual e das habilidades do anestesiologista responsável, sendo que a peculiaridade principal é manter uma ventilação pulmonar adequada na presença de uma comunicação entre a via respiratória e o esôfago. A intubação com fibrobroncoscópio distal à fístula resolve o manejo da via respiratória provavelmente difícil e limita a passagem de ar para o esôfago através da fístula.
El síndrome de Goldenhar es un cuadro polimalformativo consistente en una disostosis craneofacial que condiciona una vía aérea difícil hasta en el 40% de los casos. Describimos un caso de un neonato con síndrome de Goldenhar con atresia de esófago y fístula traqueoesofágica al que se practicó cirugía de reparación de la misma. Presentamos un caso de un neonato con síndrome de Goldenhar de 24 h de vida. Presentaba atresia esofágica con fístula traqueoesofágica distal. Se decidió una intervención quirúrgica urgente para la reparación de la misma. Se realizó bajo sedación, intubación con fibrobroncoscopio distal a la fístula, para limitar el paso de aire a esófago y la posible distensión abdominal. Tras la completa reparación de la atresia esofágica y la ligadura de la fístula, el paciente fue trasladado a la unidad de cuidados intensivos con sedoanalgesia e intubado. el hallazgo de un paciente con síndrome de Goldenhar y atresia de esófago supone una situación excepcional y un reto para los anestesiólogos, por lo que el manejo anestésico depende de la comorbilidad del paciente, del tipo de fístula traqueoesofágica, de la práctica hospitalaria habitual y de las habilidades del anestesiólogo responsable, siendo la principal particularidad el mantenimiento de una adecuada ventilación pulmonar en presencia de una comunicación entre la vía aérea y el esófago. La intubación con fibrobroncoscopio distal a la fístula solventa el manejo de la vía aérea probablemente difícil y limita el paso de aire al esófago a través de la fístula.
Subject(s)
Humans , Male , Infant, Newborn , Tracheoesophageal Fistula/surgery , Esophageal Atresia/surgery , Goldenhar Syndrome/surgery , Anesthetics/administration & dosage , Bronchoscopy/methods , Tracheoesophageal Fistula/etiology , Tracheoesophageal Fistula/pathology , Clinical Competence , Esophageal Atresia/etiology , Esophageal Atresia/pathology , Airway Management/methods , Goldenhar Syndrome/physiopathology , Intubation, Intratracheal/methodsABSTRACT
Objective To explore the nursing method during bedside fibrobronehoseope to patients with inhalation injury and ensure the safety of the procedures. Methods 58 patients with inhalation injury with bed-side flbrobronehoseope treatment from 2005 to 2008 were retrospectively analyzed. Results 3 eases showed a-cute respiratory distress syndrome, 3 cases died of respiratory failure, 2 patients died of multiple organ failure,dyspnea, cough symptoms improved in others after sputum aspiration. Conclusions To master the preoperative,intraoperative, postoperative nursing methods during fibmbronehoscope can improve clinical efficacy.
ABSTRACT
OBJECTIVE:To evaluate the effects of propofol in relieving pain during fibrobronchoscopy when it is used in general intravenous anesthesia.METHODS:160patients undergoing fibrobronchoscopy were randomly divided into propofol group and control group.90patients in the propofol group were anesthetized intravenously by injection of propofol at the dosage of1.5mg/kg and speed of30mg/10s and then underwent fibrobronchoscopy;While70patients in the control group underwent regular fibrobronchoscopy.RESULTS:The lash reflex disappeared within(40.73?7.91)seconds after propofol injection,and patients became conscious within(5.39?1.85)minutes after stopping injection,full consciousness occurred at(10.82?2.73)minutes.Electrocardiogram did not show any signs of change in blood pressure,myocardial ischemia and cardiac dysrhythmia,the post-operative satisfaction rate was96%as compared with81%in the control group.The patients in the propofol group showed extensive willingness for second fibrobronchoscopy,while the patients in the control group presented cough,struggle,and20%of them refused the second fibrobronchoscopy.CONCLUSION:It is safe and effective to apply propofol in painless fibrobronchoscopy.
ABSTRACT
To evaluate the clinical therapeutic effect of limited bronchus granuloma caused by foreign body with medication in trachea, 6F tube was put in sick trachea under fibrobronchoscopy in 26 patients with bronchus granuloma due to foreign body, and 5ml of 2% lidocaine + 10ml of sterile Saline + 5mg dexamethasone +antibiotics (Amikacin0 2g or ceftriazone1 0g) were injected into sick trachea through 6F tube twice a day. 25 were cured, the cure rate was 96 2%,and the other one had to be operated; the course was 6～15d. Other 29 patients were treated with routine antibiotics intravenation+aerosol inhalation or medication in trachea under fibrobronchoscopy every other day, and 24 were cured, the cure rate was 82 8%; the other 5 had to be operated, the course was 6～32d. It is suggested that the former method has good effect in local anti inflammation, and can decrease the intravenous antibiotics dosage and side effect.