Application of FloTrac/Vigileo system in monitoring hemodynamics of single lung ventilation / 临床麻醉学杂志

Objective To explore the feasibility of FloTrac/Vigileo System in hemodynamic monitoring during the surgery of single-lung ventilation patients.Methods Twenty-five patients with thoracoscopic lobectomy under general anesthesia,aged 35-65 years,ASA physical status Ⅰ or Ⅱ, preoperative showed no application taboo of FloTrac/Vigileo system or transesophageal echocardio-graphy (TEE).The radial artery puncture catheter was inserted after getting into the operating room, then connect the FloTrac/Vigileo system,after that the TEE was inserted following the induction of general anesthesia.Using the FloTrac/Vigileo system to record the stroke volume (SVF),cardiac output (COF),stroke volume variation (SVV),at the moment of after turning over (T0),opening chest and single-lung ventilation(T1),single-lung ventilation for 15 minutes (T2),single-lung venti-lation for 30 minutes (T3),single-lung ventilation for 45 minutes (T4)single-lung ventilation for 60 minutes (T5).Using TEE to monitor the index and record the the stroke volume (SVT)cardiac out-put(COT)and inferior vena cava collapse index(cIVC)of the same patient at same time as Group F. Results There was no statistically significant different between SVFand SVTat T0-T5in both groups,Overall correlation analysis,r=0.84,P<0.01.There is no statistically significant different between COFand COTat T0-T5in both groups,Overall correlation analysis,r=0.92,P<0.01. Correlation analysis of SVV of group F and cIVC of group T,the results were positively correlate,r=0.80,P<0.01.Conclusion FloTrac/Vigileo system can be used as a monitoring method for mo-nitoring hemodynamics in thoracic surgery.

Development of catheter of movable tracheal cannula / 中国医学装备

Objective:To develop a catheter of movable tracheal cannula for single lung ventilation so as to compensate the existed disadvantages of using double-lumen bronchial catheter and bronchial occlusive device in single lung ventilation in present.Methods: A long tracheal catheter was installed into a short endotracheal catheter so as to form a complete catheter of tracheal cannula. The internally installed catheter could be rotated and moved in the cannula. After then, the front-end direction of internally installed catheter was chose through rotated the catheter according to the requirement of operation, and the single lung ventilation could be achieved when the internally installed catheter was pushed forward and was inserted in left or right bronchus. After the operation, the internally installed catheter exited out from bronchus to trachea and was used to implement double lung ventilation, or it was pulled out from outer cannula and the double lung ventilation was implemented by using outer cannual.Results: The ventilation effect of single-lung was doubtless when the catheter of movable tracheal cannula was inserted in left or right bronchus by using internally installed catheter. The technique of intubation tube was simpler than that of double-lumen bronchial catheter and bronchial occlusive device. The internally installed catheter could rotate in the outer cannula so as to protect tracheal wall and avoid oxygen deficit of patient during the processes of replacing tracheal catheter and the difficulty of replacing tracheal catheter post-operation of double-lumen bronchial catheter. Besides, it also could avoid the injury risk of anastomotic stoma of esophageal surgery caused by mis-insertion of tracheal catheter in esophagus.Conclusion: This kind of removable tracheal cannula has reasonable design, simple operation of intubation and better clinical practicability, and its feasibility is better that the product is transformed.

Development of catheter of movable tracheal cannula / 中国医学装备

Objective:To develop a catheter of movable tracheal cannula for single lung ventilation so as to compensate the existed disadvantages of using double-lumen bronchial catheter and bronchial occlusive device in single lung ventilation in present.Methods: A long tracheal catheter was installed into a short endotracheal catheter so as to form a complete catheter of tracheal cannula. The internally installed catheter could be rotated and moved in the cannula. After then, the front-end direction of internally installed catheter was chose through rotated the catheter according to the requirement of operation, and the single lung ventilation could be achieved when the internally installed catheter was pushed forward and was inserted in left or right bronchus. After the operation, the internally installed catheter exited out from bronchus to trachea and was used to implement double lung ventilation, or it was pulled out from outer cannula and the double lung ventilation was implemented by using outer cannual.Results: The ventilation effect of single-lung was doubtless when the catheter of movable tracheal cannula was inserted in left or right bronchus by using internally installed catheter. The technique of intubation tube was simpler than that of double-lumen bronchial catheter and bronchial occlusive device. The internally installed catheter could rotate in the outer cannula so as to protect tracheal wall and avoid oxygen deficit of patient during the processes of replacing tracheal catheter and the difficulty of replacing tracheal catheter post-operation of double-lumen bronchial catheter. Besides, it also could avoid the injury risk of anastomotic stoma of esophageal surgery caused by mis-insertion of tracheal catheter in esophagus.Conclusion: This kind of removable tracheal cannula has reasonable design, simple operation of intubation and better clinical practicability, and its feasibility is better that the product is transformed.

Influence of perioperative factors on postoperative pulmonary infection in patients with esophageal cancer / 临床麻醉学杂志

Objective To explore the influence of perioperative factors on postoperative pulmonary infection in patients with esophageal cancer.Methods According to the inclusion criteria in the present study, clinical data of 150 patients undergoing radical prostatectomy for esophageal cancer in our hospital was retrospectively analyzed.In accordance with whether the occurrence of pulmonary infection or not, 32 patients were regarded as pulmonary infection group and 118 patients were designated as no-pulmonary infection group.The dosage of anesthesia drug, intubation time, single lung ventilation time, operation time, anesthesia time, extubation time, intraoperative blood loss, crystal transshipment, colloid transshipment, intraoperative total amount of rehydration, anesthesia methods and one-lung ventilation way were recorded.The indexes of anesthesia factors were compared between the two groups.Multivariable logistic regression analysis was performed to predict the risks of postoperative pulmonary infection for anesthesia factors.Results Total sufentanil and propofol dose, single lung ventilation time, operation time, anesthesia time, extubation time and the percentage of uninterrupted expansion of lung, nose sputum suction catheter and pethidine postoperative analgesia in pulmonary infection group were respectively significantly higher than that of non-pulmonary infection group (all P<0.05).There were no statistical differences of dosage of midazolam and atracurium, intubation time, intraoperative blood loss, crystalloid volume, colloid volume, the total infusion volume, anesthesia methods and intraoperative one-lung ventilation mode between the two groups.Multivariable logistic regression analysis revealed that each increase of sufentanil total dose of 7.5 μg (OR=1.65, 95%CI 1.24-2.85), each increase of 10 min in single lung ventilation time (OR=2.14, 95%CI 1.32-3.62), each increase of 20 min in anesthesia time (OR=1.87, 95%CI 1.46-3.15), nose sputum suction catheter (OR=2.03, 95%CI 1.27-3.46)as well as pethidine postoperative analgesia (OR=3.44, 95%CI 2.25-5.13) were all risk factors for postoperative pulmonary infection (P<0.05).Conclusion Appropriate amount of sufentanil usage reduces single lung ventilation time and anesthesia time as well as implementing fiber bronchoscope for sputum suction, and postoperative use of self-control vein analgesia can decrease the incidence of postoperative pulmonary infection in esophageal cancer patients.

Protective effect of matrine on lung injury associated with single lung ventilation during thoracic surgery / 局解手术学杂志

Objective To investigate the protective effect of matrine on lung injury associated with single lung ventilation during thorac-ic surgery,and to explore and consummate the prevention and control measures of single lung ventilation related lung injury.Methods To-tally 97 cases of non small cell lung cancer patients were randomly divided into the observation group ( 50 cases ) and the control group (47 cases) .The two groups of patients were given the same way of anesthesia.Patients of the observation group received intravenous drip of 2 mL matrine injection which were dissolved in 100 mL saline solution 30 min before anesthesia, while patients of the control group were merely given 100 mL saline solution 30 min before anesthesia.The pulmonary shunt fraction( Qs/Qt) ,xanthine oxidase( XOD) ,myeloperoxi-dase(MPO),superoxide dismutase(SOD) and nitric oxide(NO) of the following points in time were compared:before anesthesia induction (T0),the instant of OLV (T1),60 minutes after OLV(T2),120 minutes after OLV(T3),after lung inflation (T4),and 24 hours after opera-tion ( T5) .Results At the time of T1 to T4,pulmonary shunt fraction of the two groups were both significantly higher than that at T0 with sig-nificant difference ( P0.05) .The PMN counts of the two groups at the time of T2 to T5 were significantly higher than that of T0 with significant difference (P<0.05),and the PMN counts at the time of T2 to T5 in the control group were significantly higher than that in the observation group with significant difference (P<0.05).The levels of serum XOD,MPO,and SOD at T2 to T4 in both of the two groups were significantly higher than that at T0 with signif-icant difference (P<0.05),and the serum levels of XOD,MPO and SOD at T2 to T4 in the control group were significantly higher than those in the observation group with significant difference (P<0.05).The levels of serum NO at T2 to T4 in both of the two groups were significantly higher than that at T0 with significant difference (P<0.05),and it was significantly lower than that in the observation group with significant difference (P<0.05).Conclusion The matrine pretreatment of lung injury in the patients with single lung ventilation has a protective effect, which can reduce the levels of oxidative stress and promote the NO release in patients by reducing PMN,XOD and MPO levels.

Experiencia clínica con el bloqueador bronquial de ARNDT en pacientes pediátricos / Clinical experience with Arndt bronchial blocker in pediatric patients

Describir la experiencia con el bloqueador bronquial de Arndt (BBA) y determinar los efectos de la ventilación monopulmonar (VMP) en el intercambio gaseoso en pacientes pediátricos. Método: El BBA se utilizó en 11 pacientes que requirieron VMP. Cuando el diámetro del tubo traqueal impedía el uso del BBA como originalmente estaba descrito, éste fue colocado en la tráquea previo a la intubación traqueal quedando por fuera del tubo traqueal. El BBA fue posicionado con ayuda de un fibrobroncoscopio introducido a través del adaptador del bloqueador. Se estandarizaron la modalidad deventilación y las maniobras destinadas a restablecer la oxigenación en caso de desaturación. Se controlaron gases arteriales, presión de vía aérea y CO2 de fin de espiración (EtCO2) ventilando ambos pulmones y en VMP. Resultados: El BBA fue correctamente posicionado en todos los pacientes, obteniéndose un pulmón desinflado en todos ellos. La relación pO2 /FiO2 promedio en decúbito lateral ventilando ambos pulmones y en VMP fue 287 (rango 100-424) y 199 (rango 62-332), p = 0,0108. La diferencia pCO2-EtCO2 mostró un comportamiento variable, aumentando en algunos e incluso haciéndose negativa en otros. Conclusión: El BBA permitió realizar VMP en todos los pacientes. La relación paO2/FiO2 disminuyó en todos los pacientes pero la saturación arterial de oxígeno pudo ser mantenida en niveles seguros. La capnografía mostró ser un indicador poco confiable de la efectividad de la ventilación durante VMP...

Single lung ventilation (SLV) and knowledge of its effects in pediatric patients has been limited by the lack of suitable double lumen tubes (DLT). The bronchial blocker (BB) described by Arndt allows SLV without a DLT, even in small children. Objective: Describe the experience with the Arndt’s BB, and the effects of SLV on gas exchange in children. Design: Observational study. Setting and patients: Eleven children requiring SLV using a BB were studied at a University Hospital. Interventions: A BB was used for SLV. When the internal diameter of the ET didn’t allow the use of the BB as originally described, it was inserted into the trachea before tracheal intubation, leaving the BB next to the ET. A FOB inserted through the multi-portal adapter of the BB guided it to the desired position. Ventilatory pattern and maneuvers to restore arterial oxygen saturation (SatO2) were standardized. Main outcome measures: Arterial blood gases, airway pressure, and EtCO2 were obtained in lateral decubitus position while both lungs were ventilated and during SLV. Results: Ages were between seven months and four years. In 10 patients, the BB was inserted alongside the tracheal tube. In all cases the lung was quiet and deflated. In 2 patients, surgical manipulation dislodged the BB. In one it could not be replaced and thoracotomy was required. Arterial pO2decreased in all patients, but SatO2was maintained above 90%. No significant changes in pCO2 and airway pressure were observed, and pCO2 -EtCO2 relationship was unpredictable. Conclusion: Arndt’s BB allowed SLV in all patients. Even though arterial pO2 decreased in all children, SatO2 could be maintained at an acceptable level...

Effect of single lung ventilation for pneumoresection on blood gas / 中国癌症杂志

Purpose:To study the effect of single lung ventilation for pneumoresection on blood gas. Methods:20 patients with lung cancer whose lung function were normal or reduced slightly before the operation were divided into 2 groups (A and B),of 10 cases each.The patients in group A underwent single lung ventilation with an endobronchial tube during the operation ,and two lung ventilation with an endotracheal in group B.Blood gas analysis was measured in every patient before, during and after the operation.Results:The values of blood gas analysis during the operation in all patients were normal and no significant difference was found between the two groups during the same time. Conclusions:The patients with lung cancer whose lung function were normal or reduced slightly before the operation can receive single lung ventilation safely for pneumoresection.[