Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica / Video laryngoscopy for pediatric intubation, compared to classic orotracheal intubation

Introducción: Un aspecto relevante en anestesia pediátrica es el manejo de la vía aérea. Diferencias anatómicas de esta población, hace que sean más susceptibles a dispositivos diseñados para su manejo. La videolaringoscopía mejora la visión panorámica de la glotis. El objetivo del presente estudio fue comparar el uso de la videolaringoscopía con la laringoscopía directa para intubación orotraqueal, en pacientes pediátricos. Métodos: Con un diseño descriptivo observacional, se estudiaron 276 casos, pacientes de 5 a 17 años, sometidos a cirugía planificada, con anestesia general más intubación orotraqueal. El especialista decidió el dispositivo para manejo. Los datos se transcribieron de los formularios y analizados con el programa SPSS 22.0. El análisis descriptivo se basó en mediana, moda, promedio, valor mínimo, valor máximo. Medidas de dispersión desvío estándar y rango. Se condideró un valor de p < 0.05 como estadísticamente significativo. Resultados: La edad promedio del estudio fue 9.83 años. Con laringoscopía directa 97.4% se realizó la intubación al primer intento y con videolaringoscopía el 88,4% (P=0.003). En el 94.2% de casos de laringoscopía directa se realizó una intubación exitosa en menos de 10 segundos, con videolaringoscopía fue del 75.2% (P<0.001). Complicaciones se presentaron en el 6.6% de intubaciones con videolaringoscopía versus el 2.6% con laringoscopía convencional (P=0.103). El 56.2% de especialistas prefieren laringoscopía directa para manejar una vía aérea pediátrica sin predictores de dificultad. Conclusiones: La videolaringoscopía brinda un apoyo adicional en el manejo de la vía aérea de rutina, amerita siempre conocimientos y destrezas previas. La evidencia para avalar una técnica por sobre otra es insuficiente

Introduction:A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value,maximum value. Standard deviation and range dispersion measurements. A value pf p < 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient

Effects of Potassium Supplementation in Patients With Left Ventricular Dysfunction After Coronary Artery Bypass Grafting / 中国循环杂志

Objectives: To investigate the effects of potassium supplementation after coronary artery bypass grafting (CABG) in patients with reduced left ventricular ejection fraction (EF < 50%). Methods: Present study retrospectively analyzed data from 200 CABG patients with cardiopulmonary bypass from January 2015 to June 2017. Patients were divided as heart failure with high ideal potassium supplement group (low EF<50%, potassium supplement to 5.0 mmol/L, n=41); heart failure normal potassium supplement group (low EF<50%, potassium supplement to 4.5 mmol/L, n=46); and normal potassium supplement group (normal EF>50%, potassium supplement to 4.5 mmol/L, n=113). The differences on related parameters during intraoperative and postoperative period were compared among the 3 groups. The primary endpoint was the incidence of atrial and ventricular arrhythmias requiring the use of lidocaine and amiodarone hydrochloride. Results :Atrial and ventricular arrhythmias requiring lidocaine and amiodarone hydrochloride were found in 13 patients (31.7%) in the ideal hyperkalemia group, while 28 (62.2%) in the normal hyperkalemia group needed both drugs (P=0.005). The blood pressure of ideal high potassium supplementation group was significantly higher than that of normal potassium supplementation group ([135.87±11.32] mmHg vs [111.21±31.31] mmHg, P<0.001). In the ideal hyperkalemia group, the time in the ICU was shorter ([3.92±0.98]days vs [5.12±1.12]days, P<0.001) and the hospitalization time was shorter ([10.54±2.14] days vs [13.54±2.01]days, P<0.001). There was no significant difference between the two groups in postoperative 24-hour urine volume, oxygen partial pressure, postoperative 24-hour bleeding volume and postoperative complications (P>0.05). Conclusions:The ideal potassium target of 5.0 mmol/L for patients with LVEF<50% CABG can reduce the incidence of arrhythmias that require the intervention of lidocaine and amiodarone hydrochloride during the perioperative period and shorten the stay time in the ICU.

Warm water infusion versus air insufflation in the application of difficult colonoscopy / 中国内镜杂志

Objective To explore the effects of warm water insufflation applied in difficult colonoscopy on its success rate, insertion time, operation difficulty level and tolerance of patients. Method 200 cases of the difficult defecation of non-narcotic colonoscopy, IBS and always has a history of pelvic/abdominal surgery patients, were randomly divided into warm water infusion group (experimental group) and traditional method of air insufflation group (control group), then compare the differences of the success rate of the two groups of patients, the insertion time and degree of tolerance in patients. Results All the patients completed the investigation in this study, neither bowel perforation nor other complications occurred. Experimental group success rate of the whole colon examination, the insertion time, the operator satisfaction and check again wishes were significantly higher than that of control group (P 0.05) in Polyp detection rate. Conclusion Warm water insufflation colonoscopy can effectively improve the tolerance and accelerating the colonoscopy in patients with difficult insertion process, improve work efficiency, and is an ideal method, which is worth of promoting.

Effects of transparent cap-fitted colonoscope combined with carbon dioxide injection on the cecal intubation time and detection of colonicpolyps / 中国内镜杂志

Objective To observe and explore the effects of transparent cap-fitted colonoscope combined with carbon dioxide injection on the cecal intubation time and detection of colonic polyps during enteroscopy. Methods 216 patients underwent colonoscopy from January 2014 to June 2016 were selected and randomly divided into A, B, C groups according to random number table, 72 cases in each. Group A with transparent cap-fitted colonoscopy, group B with CO2 injection before colonoscopy, and group C combined with the above two methods and then underwent colonoscopy, cecal intubation time and colonic polyp detection rate were compared among the three groups during the inspection. Results A, B, C groups with cecal intubation ratio showed no significant differences (95.8% vs 90.3% vs 98.6%) (χ2 = 5.34, P = 0.069); the sequence of mean cecal intubation time was group Cgroup A>group B (38.9% vs 34.7% vs 23.6%) (χ2 = 4.10, P = 0.129). The sequences of visual analogue scale score after 10 min [(4.35 ± 0.62) vs (4.88 ± 0.85) vs (5.57 ± 1.05)] and 30 min [(3.04 ± 0.37) vs (3.30 ± 0.56) vs (4.41 ± 0.84)] of coloscope withdraw were both group C

Obesity and Cecal Intubation Time

BACKGROUND/AIMS: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. METHODS: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests. RESULTS: A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively. CONCLUSIONS: BMI had a positive association with CI time for women, but had a negative association with CI for men.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Comparison of the Pentax AWS and the Glidescope with the Macintosh laryngoscope for tracheal intubation in patients with Mallampati classification I or II

BACKGROUND: The Pentax AWS and the Glidescope are new intubating devices.They were designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axis. The purpose of this study was to evaluate the effectiveness of the Pentax AWS and the Glidescope in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with mallampati classification I or II. METHODS: Ninety patients presenting for surgery requiring tracheal intubation, and who were deemed easy for tracheal intubation of mallampati classification I or II were randomly assigned to undergo intubation using a Macintosh (Group M, n = 30), Pentax AWS (Group P, n = 30) or Glidescope (Group G, n = 30). Time to complete tracheal intubation and number of attempts until successful intubation were recorded. Noninvasive blood pressure and heart rate recorded before induction (PI), just before intubation (PT), 1 min and 5 min after intubation. Patients were assessed for postoperative sore throat at 6-12 h after surgery. RESULTS: Time to secure the airway with the Macintosh 13.0 (min 7, max 23.0) s was lesser than with the Pentax AWS 20.4 (8, 51.2) s and Glidescope 22.1 (10, 42.0) s. There were no significant differences in the rate of successful intubations and sore throat among the groups. There were significant increases in both mean arterial pressure and heart rate 1 min after intubation in all groups compare with PI. CONCLUSIONS: The Pentax AWS and the Glidescope had no specific advantage over the Macintosh laryngoscope for the patients with normal airway.

Efficacy of Hood-cap Assisted Colonoscopy; Comparison with Conventional Colonoscopy

BACKGROUND/AIMS: A few studies showed that hood-cap assisted colonoscopy (CAC) had improved cecal intubation rate and cecal intubation time but did not help in finding colon polyps in comparison with conventional colonoscopy (CC). However, other studies have shown different results. Therefore, we investigated the efficacy of CAC for the cecal intubation time and polyp detection rate. METHODS: Patients for colonoscopy in Busan St. Mary's Medical Center were enrolled to this randomized controlled trial between July 2010 and September 2010. The evaluated outcomes were polyp detection rate, adenoma detection rate, and cecal intubation time in all patients, in difficult cases (history of previous abdominal or pelvic surgery, obesity, old age), and in the expert and non-expert groups. RESULTS: A total of 260 patients enrolled in this study were randomly allocated to the CAC group (n=130), or CC group (n=130). The overall cecal intubation time was shorter in the CAC group (5.7+/-3.4 min vs. 7.8+/-5.7 min, P<0.001). The polyp detection rate was higher in the CAC group (58.4% vs. 43%, P=0.008). The cecal intubation time in the expert and non-expert groups were shorter in the CAC group (expert: 4.1+/-2.2 min vs. 5.5+/-2.0 min, P=0.001; non-expert: 6.7+/-3.7 min vs. 9.4+/-5.9 min, P=0.001). CONCLUSIONS: The use of CAC improved the detection rate of colon polyps and shortened the cecal intubation time for both the expert and non-expert groups.

Efficacy of Transparent Cap-attached Colonoscopy: Does It Improve the Quality of Colonoscopy?

PURPOSE: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. METHODS: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient's pain were compared. RESULTS: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation, diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3+/-4.0 min vs. 7.6+/-4.3 min, P<0.001), as well as for female (6.1+/-2.8 min vs. 9.1+/-4.7 min, P<0.001) patients. There were no statistically significant differences in the total colonoscopy time (13.1+/-6.3 min vs. 14.5+/-5.2 min, P=0.066), the polyp detection rate (38.6% vs. 33.3%, P=0.408), the adenoma detection rate (28.1% vs. 25.4%, P=0.654), and the VAS scale of pain (2.48 vs. 2.74, P=0.353) between the CAC and the CC groups. CONCLUSION: The transparent cap is effective in shortening the cecal intubation time, especially in female patients.

Intubating Conditions and Hemodynamic Changes according to Induction Agent and Tracheal Intubation Time after Rocuronium / 대한마취과학회지

BACKGROUND: Intubating conditions would be excellent and hemodynamic variables would be relatively stable during rapid- sequence anesthesia induction if tracheal intubation was performed at a proper time. The purpose of this study was to identify the ideal intubation time after rocuronium with either thiopental or propofol. METHODS: 113 patients, ASA physical status I or II, were randomly divided into four groups. Patients in group TR60 (thiopental-rocuronium) and in group PR60 (propofol-rocuronium) were intubated within 60 s, while groups TR90 and PR90 were intubated within 90 s after the administration of rocuronium. Intubating conditions were graded by an experienced anesthesiologist, and hemodynamic variables were noted just before induction (baseline), immediate after induction, immediate after intubation, and 5 min after intubation. RESULTS: Clinically acceptable intubating conditions (good or excellent) were not statistically different among the four groups. However, 55 and 64% of patients in groups TR90 and PR90, respectively, had excellent intubating conditions compared to only 39 and 38% in groups TR60 and PR60 (P < 0.05). Mean arterial pressure and rate pressure product (RPP) immediately after intubation were relatively stable in groups TR90 and PR90 compared to those in groups TR60 and PR60 (P < 0.05). CONCLUSIONS: The intubation time after rocuronium, rather than the choice of induction agent, is the deciding factor affecting intubating conditions and hemodynamic variables during rapid-sequence anesthesia induction. Ninety seconds after the administration of rocuronium with either thiopental or propofol might be an ideal intubation time.

A Comparative Study for Usefulness of a Variable-Stiffness Colonoscope to a Conventional Colonoscope / 대한소화기내시경학회지

BACKGROUND/AIMS: Loop formation during colonoscopy can adversely effect on completion rates, speed of intubation and patient tolerance of the procedure. The ability to vary endoscope shaft flexibility may help insertion to the cecum. The aim was to compare a variable colonoscope with adjustable shaft stiffness to a conventional colonoscope (CC). METHODS: Consecutive patients attending for day case colonoscopy were randomized for examination with either the conventional colonoscope (Olympus CF200Z) or a variable stiffness (VS) colonoscope (CFQ240AL). The time to the cecum, inserted length of scope at cecum, need for abdominal compression, need for rotation of body position and pain scores of patient were analyzed. RESULTS: Of 158 cases, 69 were performed with the CC, and 89 with VS. There was no difference in intubation time between VS (mean 5.15+/-2.61 min) and CC (6.01+/-3.31 min) in experienced group. However, intubation time was quicker with VS than with CC (VS: 8.48+/-5.59, CC: 11.58+/-4.70, p=0.039) and number of loop formation was less with VS (mean 1.20) than with CC (mean 1.84) (p=0.043) in trainee group. There were no significant differences in inserted length of scope at cecum, need for abdominal compression, pain score or need for patient rotation between VS and CC in two groups. CONCLUSIONS: There was no significant difference in cecal intubation time between two groups in experienced group. However, in trainee group, the intubation time was quicker and the number of loop formation were lower in VS group than CC group.

The Comparison of Vecuronium with Succinylcholine for Endotracheal Intubation / 대한마취과학회지

Depolarizing muscle relaxant, succinylcholine, has a rapid onset of action, allowing early endotracheal intubation. Succinylcholine, however, has a number of undesirable side effects. Therefore, some methods using nondepolarizing muscle relaxants for rapid endotracheal intubation have been tried, i.e. single large bolus, priming principle, timing principle, but their results were not enough to satisfy. In this study, there were administered vecuronium prior to anesthetic induction in order to shorten the intubation time, and compared intubation time and intubating condition in succinylcholine and vecuronium groups respectively. Sixty adult patients were adminstered succinylcholine 1mg/kg(group 1, 30 patients) or vecuronium 0.15 mg/kg(group 2, 30 patients), and measured intubation time and intubating condition. As a result, intubation time and intubation condition was not different in both groups significantly. It is concluded that vecuronium administered prior to induction agent for the endotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.

The Comparison of Vecuronium with Succinylcholine for Endotracheal Intubation / 대한마취과학회지

Depolarizing muscle relaxant, succinylcholine, has a rapid onset of action, allowing early endotracheal intubation. Succinylcholine, however, has a number of undesirable side effects. Therefore, some methods using nondepolarizing muscle relaxants for rapid endotracheal intubation have been tried, i.e. single large bolus, priming principle, timing principle, but their results were not enough to satisfy. In this study, there were administered vecuronium prior to anesthetic induction in order to shorten the intubation time, and compared intubation time and intubating condition in succinylcholine and vecuronium groups respectively. Sixty adult patients were adminstered succinylcholine 1mg/kg(group 1, 30 patients) or vecuronium 0.15 mg/kg(group 2, 30 patients), and measured intubation time and intubating condition. As a result, intubation time and intubation condition was not different in both groups significantly. It is concluded that vecuronium administered prior to induction agent for the endotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.