Anesthetic induction and endotracheal intubation in the sitting position due to the fixed forearm caught by a meat grinder

Abstract A male patient was scheduled for urgent amputation of his right forearm. His right forearm was stuck inside the insertion slot of a meat grinder, resulting in severe pain to his injured arm. His upper body could not move to sit in a semi-upright position. An endotracheal tube was successfully placed after rapid sequence intubation using a video laryngoscope from behind the patient on the first attempt. This case report is the first documentation of successful anesthetic induction with subsequent endotracheal intubation using a video laryngoscope from behind an injured patient whose upper body was upright with limited positioning.

COMPARISON OF ESMOLOL, CLONIDINE, AND LIGNOCAINE FOR SUPPRESSION OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION AS AN ADJUVANT TO FENTANYL IN ADULT PATIENTS UNDERGOING ELECTIVE SURGERY

Introduction: Laryngoscopy and endotracheal intubation lead to a strong sympathetic response, this study was done to compare clonidine, esmolol, and lignocaine as an adjuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. To compare clonidine, esmolol, and lignocaine as an a Objectives: djuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. A Randomized prospective study includi Material and Methods: ng 150 normotensive patients undergoing elective surgical procedures were included. Three groups were divided according to drug they received. After 3 minutes of drug , laryngoscopy and endotracheal intubation were done. Vitals (HR,SBP,DBP and MAP) were noted before laryngoscopy and endotracheal intubation and 1,2,4,6 and 8 minute after Laryngoscopy and endotracheal intubation and anaesthesia was continued with O2+N2O+Sevoflurane. Results: Rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at one minute following intubation in all three groups of drugs (p<0.001). SBP both esmolol and clonidine reached equal to baseline in 4 mins with their respective p-value as 0.293 and 0.097 and group lignocaine reached equal to baseline in 6 mins. DBP of group esmolol reached baseline at 4 mins (p-value- 0.090), group clonidine reached baseline in 6 mins. And group lignocaine does not reach baseline even after 8 mins. MAP in esmolol group reached to baseline in 4 mins, group clonidine reached to baseline in 6 mins and group lignocaine does not reach to baseline even after 8 mins. Conclusion: Considering all parameters, it was concluded that esmolol with fentanyl showed better response on all parameters.

Clinical value of neonatal transport team participating in the management of twin neonates before transport / 中国小儿急救医学

Objective:To investigate and analyze the necessity and clinical significance of professional neonatal transport team participating in post-natal resuscitation, management and transport of twin neonates after birth.Methods:A total of 298 cases of twin neonates admitted to the Department of Neonatology at the Fifth Medical Center of PLA General Hospital from January 2017 to December 2021 were selected.According to whether the neonatal transport team participated in birth resuscitation and management, they were divided into participation group ( n=136) and case group ( n=162). The resuscitation measures taken after birth, Apgar score, respiratory support during transport, basic information at admission, the first arterial blood gas after admission, complications during hospitalization, length of stay and outcome of the two groups of twins were retrospectively analyzed. Results:Compared with twins in case group, the proportion of tracheal intubation before transport was significantly higher in participation group(5.88% vs.0.62%, χ2=6.997, P=0.013), hospital admissions were significantly shorter[48(7, 115) min vs.87(47, 425) min, Z=-11.593, P<0.001], and significantly lower rates of hypoxia on admission(9.56% vs.17.90%, χ2=4.250, P=0.039), significantly higher percutaneous oxygen saturation[96(86, 100)% vs.95(85, 100)%, Z=-7.274, P<0.001], and higher blood-gas-oxygen partial pressure on admission[(91.02±25.77)mmHg vs.(87.82±25.23)mmHg, t=1.076, P=0.008] were found.The incidence of hypothermia on admission was significantly lower(36.03% vs.47.53%, χ2=4.008, P=0.045), and the differences between two groups were statistically significant( P<0.05). The proportion of critically ill neonates(40.44% vs.24.07%, χ2=9.172, P=0.002), length of hospital-stay[11(4, 76)d vs.9(3, 72) d, Z=-2.684, P=0.014] as well as the intravenous nutrition time[7(0, 42)d vs.5(0, 40) d, Z=-2.470, P=0.014] in participaton group were significantly higher than those in case group, and there were statistically significant differences between two groups( P<0.05). Conclusion:Professional neonatal transport teams play a positive role in neonatal resuscitation and later hospitalization during the pre-transport management of twin neonates.It can improve success rate of tracheal intubation in asphyxia resuscitation of twin neonates.Neonatal transport to the NICU for management takes less time, reducing the incidence of hypoxemia during transport, hypoxia status and hypothermia after admission.Obstetric pediatric medical staff in midwifery hospitals should strengthen the professional training of neonatal asphyxiation resuscitation, improve the skill of neonatal asphyxiation resuscitation and tracheal intubation, and strengthen the post-birth care for twin neonates.

Analysis of factors leading to tracheostomy in patients receiving invasive mechanical ventilation in emergency intensive care unit / 中华急诊医学杂志

Objective:To analyze the risk factors which may lead to tracheostomy in patients receiving invasive mechanical ventilation (IMV) in emergency intensive care unit (EICU).Methods:A case-control study was adopted to retrospectively analyze the clinical data of patients hospitalized in EICU receiving IMV from August 2016 to August 2019. The clinical data of patients were extracted through the electronic medical record system of the hospital information database. Patients were divided into the tracheostomy group and successful extubation group according to whether they received tracheostomy during hospitalization. The different clinical characteristics of the two groups were compared, and logistic regression was used to analyze the independent risk factors of tracheostomy.Results:A total of 109 patients were included in this study, among which, 53 patients underwent tracheotomy and 56 patients were successfully extubated. Logistic regression showed that GCS score ≤ 8 ( OR=5.10, 95% CI: 1.68-15.42, P < 0.01), cervical spinal cord injury ( OR=10.32, 95% CI: 2.74-38.82, P < 0.01), and sepsis ( OR=3.45, 95% CI: 1.39-8.54, P<0.01) were independent risk factors of tracheostomy for patients receiving IMV in EICU. Conclusions:If patients receiving IMV have GCS score ≤ 8, cervical spinal cord injury, or sepsis, they should be given more attention, because they may need early tracheostomy to save lives and improve the prognosis.

Aerosol box for intubation of patients with suspected COVID-19: simulation study / Caja de aerosol para la intubación de pacientes con sospecha de COVID-19: Un estudio de simulación

Abstract Introduction Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.

Resumen Introducción La intubación endotraqueal es un procedimiento que se relaciona con alto nivel de exposición al virus de COVID-19, llevando a la búsqueda de alternativas para disminuir el riesgo de contaminación, entre ellas la llamada Caja de aerosoles. Objetivo Comparar el tiempo y dificultad en la intubación orotraqueal usando la caja de aerosoles en escenarios simulados. Metodología Estudio observacional, con participación de 33 médicos anestesiólogos y residentes de anestesia; se compararon los grupos en tiempo y dificultad de intubación con uso de laringoscopio convencional Macintosh y videolaringoscopio McGRATH™ MAC (Medtronic) utilizando la caja de aerosoles y sin ella. Para determinar el rendimiento en la maniobra de intubación se calcularon Hazard ratios crudos, se construyó modelo multivariado de Regresion de Cox ajustado por años de experiencia como anestesiólogo y dificultades durante el procedimiento. Resultados La caja de aerosoles aumentó en promedio el tiempo en segundos para la intubación con video-laringoscopio en 7,57 (DE: 8,33) y con Macintosh 6,62 (DE: 5,74). Se llevaron a cabo 132 intubaciones, 121 exitosas en el primer intento y 6 fallidas (4 con el uso de la caja de aerosoles). 16 participantes reconocieron alguna dificultad al manipular la caja (48,48 %). Con el uso de Macintosh se identificó tendencia a la intubación más rápido que con el videolaringoscopio (HRc: 1,36 [IC 95 %: 0,64-2,88]; HR ajustado: 2,20 [IC 95 %: 0,73-6,62]). Conclusiones Utilizar la caja de aerosoles y equipo de protección personal en un escenario simulado dificulta la maniobra de intubación y puede prolongar el tiempo de ejecución.

Comparison of video laryngoscopy versus conventional laryngoscopy for tracheal intubation in neonatal resuscitation / 中国新生儿科杂志

Objective:To compare the clinical value of video laryngoscopy and conventional laryngoscopy for tracheal intubation in neonatal resuscitation.Methods:From July 2018, 100 cases of premature or asphyxia infants born in our hospital requiring tracheal intubation were enrolled. The infants were randomly assigned into video laryngoscopy group and conventional laryngoscopy group with 50 cases in each group. The time needed for intubation, the first time success rate and complications associated with intubation were compared between the two groups.Results:The time needed for intubation (21.7±2.7)s vs.(23.7±1.8)s and the first time success rate [98.0% (49/50) vs. 86.0% (43/50)] were significantly better in the video laryngoscopy group than the conventional laryngoscopy group ( P<0.05). The incidence of intubation complications showed no significant difference between the two groups ( P>0.05). Conclusions:Using video laryngoscopy, the time needed for tracheal intubation is shorter and the first time success rate is higher, without more complications. Video laryngoscopy can be safely used in tracheal intubation of neonatal resuscitation.

A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates / 中国当代儿科杂志

OBJECTIVES@#To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF).@*METHODS@#A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage.@*RESULTS@#There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05].@*CONCLUSIONS@#Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.

Difficult and failed intubation in Caesarean general anaesthesia: a four-year retrospective review

INTRODUCTION@#General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore.@*METHODS@#All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'.@*RESULTS@#Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m2. Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported.@*CONCLUSION@#The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.

Reconstrucción de estenosis traqueal benigna: experiencia de un hospital de alta complejidad en Colombia / Reconstruction of benign tracheal stenosis: Experience of a high-level complexity hospital in Colombia

Introducción. La causa más común de estenosis laringotraqueal benigna es iatrogénica, secundaria a intubación orotraqueal. El manejo quirúrgico sigue siendo la alternativa que ha mostrado mejores resultados a largo plazo. El objetivo de este estudio fue analizar la experiencia en el manejo quirúrgico de la estenosis laringotraqueal durante 15 años en un hospital de alta complejidad en Colombia.Métodos. En este estudio se revisaron las historias clínicas de todos los pacientes tratados con reconstrucción de estenosis traqueal benigna, entre los años 2005 y 2020. Para el análisis estadístico se usaron métodos de estadística descriptiva, con análisis de frecuencias y medidas de tendencia central o de dispersión.Resultados. Se identificaron 38 pacientes con estenosis laringotraqueal, con un grado variable de estenosis. La nasofibrolaringoscopia fue bien tolerada y segura para determinar el grado y la longitud de la estenosis. El uso de tomografía sirvió para determinar la extensión y las características anatómicas. Los resultados del presente estudio son similares a los de la literatura en cuanto a complicaciones, mortalidad y falla de la anastomosis. Las complicaciones más frecuentemente reportadas son reestenosis, infección del sitio operatorio, lesión nerviosa y fístula, que en general se presentan en un tercio de los pacientes. Conclusiones. La experiencia de manejo quirúrgico de estenosis laringotraqueal en este hospital permite concluir que la reconstrucción traqueal es una opción segura en nuestro medio. Las tasas de éxito y de falla del tratamiento son equiparables a las reportadas en la literatura.

Introduction. The most common cause of benign laryngotracheal stenosis is iatrogenic, secondary to orotracheal intubation. Surgical management continues to be the alternative that has shown better long-term results. The objective of this study was to analyze the experience in the surgical management of laryngotracheal stenosis for 15 years in a high-level complexity hospital in Colombia.Methods. Medical records of patients treated with reconstruction of benign tracheal stenosis between 2005 and 2020 were reviewed. Descriptive statistical methods were used, with frequency analysis and measures of central tendency or dispersion.Results. Thirthy-eight patients with laryngotracheal stenosis were identified, with a variable degree of stenosis. Nasofibrolaryngoscopy was well tolerated and safe to determine the degree and length of the stenosis. The use of tomography served to determine the extension and anatomical characteristics. The results of the present study are similar to those of the literature in terms of complications, mortality and failure of the anastomosis. The most frequently reported complications are restenosis, surgical site infection, nerve injury, and fistula, which generally occur in one third of patients.Conclusions. The experience of surgical management of laryngotracheal stenosis in our hospital allows us to conclude that tracheal reconstruction is a safe option in our environment. Treatment success and failure rates are comparable to those reported in the literature.

Effect of combined teaching of optical laryngoscope and general laryngoscope on anesthesia undergraduate practice / 中华医学教育探索杂志

Objective:To evaluate the effect of combined teaching of optical laryngoscope and general laryngoscope on anesthesia undergraduate practice.Methods:A total of 40 anesthesia undergraduate students were randomly divided into group A (using the optical laryngocope only in the first month and the general laryngoscope only in the second month, n=20), and group B (using the general laryngocope only in the first month and the optical laryngoscope only in the second month, n=20). The teaching effect was evaluated through the first month and the second month of tracheal intubation assessment and questionnaire survey results. SPSS 23.0 was used for t test and chi-square test. Results:In the first month, the success rate was 90% in group A and 60% in group B, which showed that the success rate of group B was lower, with significant differences ( P < 0.05). The time for tracheal intubation in group A was (61.8±5.0) s, and that in the group B was (83.0±4.9) s, showing that the time of group B was longer, with significant differences ( P < 0.05). The complications in group A was 5%, and that in group B was 14%, showing that the group B had more cases of implications, with significant differences ( P < 0.05). In the second month, there was no significant difference in the one-time success rate, the time for tracheal intubation, and complications between the two groups ( P > 0.05). There was no significant difference in one-time success rate and complications between groups. Both groups showed that the time for general laryngoscope intubation was longer, with significant differences ( P < 0.05). All of the students believed that applying optical laryngoscope teaching was beneficial and could enhance the interest of learning, and the combination of the two methods was better. Conclusion:Using the optical laryngoscope first and then the general laryngoscope teaching is more beneficial for students to master the two methods of tracheal intubation, improve the success rate, reduce complications, and cultivates their self-confidence.

Comparison of the emergency effect between visual laryngoscopee and traditional laryngoscope / 中国医师进修杂志

Objective:To investigate the effectiveness and advantage of visual laryngoscope in the treatment of patients with sudden cardiac arrest who need spontaneous respiration tracheal intubation.Methods:Totally 60 patients who suffered from cardiac arrest and needed spontaneous respiration tracheal intubation were enrolled from June 2020 to February 2021 in the Affilicated Hospital of Chifeng University. Theywere randomlydivided into two groups-traditional laryngoscope (TL) group and visual laryngoscope (VL) group, with30 patients in each group. Then the success rate of glottis exposure, the operative time, success rate and complication rate of tracheal intubation were compared between the two groups. Subgroup assessment between the junior emergency resident doctor (A group) and the senior emergency resident doctor (B group) was conducted.Results:According to Cormack Lehan grades, the success rate of glottis exposure in VL group was higher than that in TL group ( P>0.05), and the success rate of Grade I in VL group was significant higer than that in TL group: 56.70%(17/30) vs. 30.00%(9/30), P<0.05. The trial times of successful intubation cases and the operative time of successful intubation cases were significantly less than those in TL group (1.30 vs 1.67, P = 0.049) and (56.37 s vs 67.12 s, P<0.05). In the subgroup, the one-time success rate of tracheal intubation in A-TL group was significantly lower than that in B-TL group (4/15 vs. 11/15, P<0.05), while the one-time success rate of tracheal intubation in A-VL group was 60.00%, which is lower than that in B-VL group ( P>0.05). The operative time consumed for successful intubation in A-TL group was significantly longer than that in B-TL group: 78.00 s vs. 55.57 s, P<0.05, while the operative time in A-VL group was a little longer than that in B-VL group ( P>0.05). Conclusions:Visual laryngoscope used in spontaneous respiration tracheal intubation can not only increase the success rate of glottis exposure, decrease trial times and shorten operative time of intubation, but also improve the success rate and decrease the complication rate of emergency tracheal intubation.

A comparative study of laryngeal mask and tracheal intubation anesthesia for "three-port" thymectomy without myasthenia / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia. Methods    From January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared. Results    The baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05). Conclusion    The "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.

Design and Feasibility Study of Tracheal Intubation Device Based on Magnetic Navigation Technology / 中国医疗器械杂志

OBJECTIVE@#In the context of coronavirus disease 2019 (COVID-19) pandemic, the subject was designed to develop a new tracheal intubation device based on magnetic navigation technology to improve the success rate of tracheal intubation and reduce the risk of occupational exposure of medical staff.@*METHODS@#The new tracheal intubation device was designed with the uniqueness of the magnetic field environment and magnetic steering of magnetic navigation technology. And preliminary magnetic navigation tracheal intubation experiments were performed on the tracheal intubation simulator.@*RESULTS@#Magnetic navigation tracheal intubation can successfully implement tracheal intubation, and the time required is lower than that of traditional laryngoscopy.@*CONCLUSIONS@#The tracheal intubation based on magnetic navigation technology is feasible, with high efficiency and easy operation. That is expected to be widely used for tracheal intubation during treatment of patients outside the hospital in the future. At the same time, magnetic navigation endotracheal intubation technology will be the key technology for the development of endotracheal intubation robots.

Successful rescue with videolaryngoscopy after failed fibroscopy in anticipated difficult airway: case series / Rescate exitoso con videolaringoscopia luego de fibroscopia fallida en vía aérea difícil anticipada: serie de casos

Abstract Introduction: In the management of the anticipated difficult airway (DA), awake intubation is the strategy of choice. In this context, flexible fibroscopy is the tool most widely used as the first choice. However, there is always the rare case where it may fail. Important findings: Six successful rescue cases using videolaryngoscopy following failed fibroscopy in patients with anticipated DA, and 1 case of rescued extubation of an airway previously secured with fiberoptic bronchoscopy. Conclusion: Videolaringoscopy may be an adequate tool to use as a backup plan for the management of an anticipated DA.

Resumen Introducción: En el manejo de vía aérea difícil anticipada la estrategia de elección es la intubación con el paciente despierto. En este contexto, la fibroscopia flexible es la herramienta más utilizada como plan A; sin embargo, en raras ocasiones puede fallar. Hallazgos importantes: Se presentan seis casos de rescates exitosos con videolaringoscopia luego de fibroscopia fallida en pacientes con vía aérea difícil anticipada, y un caso de rescate de extubación de vía aérea asegurada previamente con fibrobroncoscopio. Conclusión: La videolaringoscopia puede ser una adecuada herramienta como plan B para el manejo de la vía aérea difícil anticipada.

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study / Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Abstract Background and objectives: Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. Methods: Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. Results: Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. Conclusion: The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Resumo Justificativa e objetivos: O controle inadequado da pressão dos balonetes dos tubos traqueais pode resultar em complicações. A técnica objetiva com uso de manômetro é a recomendada para manutenção de valores seguros de pressão (20-30 cm H2O). Mas como ese instrumento é pouco disponível, os anestesiologistas recorrem a técnicas subjetivas. O objetivo deste estudo foi avaliar a adequação da técnica subjetiva para obtenção das pressões dos balonetes e o nível de experiência com uso do manômetro entre médicos especialistas e residentes de anestesiologia de um Hospital Universitário. Método: Estudo observacional prospectivo, com participantes que realizaram intubação traqueal e técnica subjetiva para insuflação dos balonetes. Pacientes com via aérea difícil, anormalidades anatômicas de laringe e traqueia, risco de broncoaspiração e os casos de emergência não foram incluídos. Até 60 minutos após a intubação, um investigador registrava a pressão do balonete utilizando um manômetro aneroide (AMBU®) conectado ao balonete guia do tubo. Resultados: Quarenta e sete anestesiologistas foram incluídos no estudo - 24 residentes e 23 especialistas. As pressões (cm H2O) média (DP) e mediana (IQR) encontradas foram, respectivamente, 52,5 (27,1) e 50 (30-70). Da amostra, 83% estavam fora da faixa adequada de pressão, sem diferença entre especialistas e residentes. O nível de experiência com a técnica objetiva também foi semelhante entre os grupos. Correção da pressão foi realizada em 76,6% dos casos. Conclusões: A técnica subjetiva para insuflar os balonetes dos tubos traqueais resultou em alta prevalência de pressões inadequadas, sem diferença no desempenho entre especialistas e residentes.

Model of single-sized endotracheal tube for adults / Modelo de tubo endotraqueal de tamanho único para adultos

ABSTRACT Objective To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. Methods Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. Results The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. Conclusion This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.

RESUMO Objetivo Simular diferentes diâmetros de tubos endotraqueais e verificar os aspectos fluidinâmicos, considerando medições de fluxo e resistência. Métodos Foi utilizado um software de fluidinâmica para calcular o fluxo médio e a resistência das vias aéreas nos tubos endotraqueais com diâmetro de 6,0, 7,0, 7,5, 8,0, 9,0 e 10,0mm, em temperatura corporal normal e pressão constante. As mesmas medidas foram realizadas na fusão dos primeiros 22cm de um tubo endotraqueal de 9,0 e 10,0mm de diâmetro, com a parte terminal em 12cm de um tubo endotraqueal de 6,0 e 7,0mm de diâmetro. Resultados A fusão dos primeiros 22cm de um tubo endotraqueal de diâmetro 10,0 mm com a parte terminal em 12cm de um tubo endotraqueal de 6,0mm de diâmetro, preservando o comprimento total de 34cm, gerou fluxo médio e resistência de vias aéreas semelhantes aos de um tubo endotraqueal convencional de 7,5mm. Conclusão Um tubo endotraqueal de tamanho único pode facilitar a intubação endotraqueal, sem causar aumento de resistência na via aérea.

Application of enhanced recovery after surgery in perioperative period of liver transplantation / 器官移植

Enhanced recovery after surgery (ERAS) refers to adopting a series of perioperative optimization measures to prevent or reduce the inflammatory stress response, promote rapid postoperative recovery of patients, shorten the length of hospital stay, reduce the incidence of postoperative complications, readmission rate and mortality rate. As the only effective treatment for end-stage liver disease, liver transplantation is characterized with difficult operation, long operation time, large amount of blood transfusion during operation and complicated postoperative management, etc. Postoperative recovery of liver transplantation is facing great challenges. In this article, research progresses on the application of ERAS in the perioperative period of liver transplantation and the suggestions for the implementation of ERAS during this period were introduced.

Attenuation of Extubation Response in Patients Undergoing Abdominal and Lower-Limb Surgeries under General Anesthesia – A Comparative Study between Dexmedetomidine and Esmolol

Introduction: Laryngoscopy and tracheal intubation cause significant changes in the hemodynamics of patients. Manypharmacological methods have been devised to reduce the extent of hemodynamic events. This study compares the efficacyof two such agents, dexmedetomidine and esmolol, for the attenuation of response to extubation.Materials and Methods: This study was carried out on 100 patients aged 18–60 years, belonging to the American Society ofAnesthesiologists Grades I and II, having no major systemic comorbidities, and undergoing abdominal or lower-limb surgeriesunder general anesthesia. They were randomly divided into two groups: Group D (dexmedetomidine) and Group E (esmolol).Pre-operative, intraoperative, and post-operative vitals and side effects were monitored.Results: Both the groups were comparable in terms of demographic variables, physical attributes, and baseline vitalparameters. It was observed that dexmedetomidine is better at controlling heart rate and systolic, diastolic, and mean bloodpressures during extubation than esmolol. There was no significant respiratory depression. No significant side effects wereobserved.Conclusion: Dexmedetomidine is an effective and safe drug to provide stable hemodynamics and protects against the stressresponse to extubation in patients undergoing abdominal and lower-limb surgeries under general anesthesia.

Comparison between Airtraq Optical Laryngoscope and Conventional Macintosh Laryngoscope for Intubation in Adult Surgical Patients: A Prospective Randomized Controlled Study

Introduction: Intubating trachea and securing the airway remain a challenge although it is a routine practice for theanesthesiologist. Failure to successfully intubate the trachea remains a leading cause of morbidity and mortality in anestheticand emergency setting.Aim: This study aims to compare the intubating conditions in adult surgical patients using Airtraq optical laryngoscope withMacintosh laryngoscope with respect to ease of intubation, the time taken for intubation, airway trauma, and hemodynamicresponse to laryngoscopy.Methods: In a single-center, prospective, randomized, parallel group, open-label, interventional study, 40 adult patients postedfor surgery under general anesthesia need of endotracheal intubation were recruited and allocated into two groups: Group A(n = 20) intubated with Airtraq laryngoscope and Group B (n = 20) intubated with conventional Macintosh laryngoscope instandard intravenous induction.Results: Mean duration of intubation with the Airtraq group was 15.93 s, whereas in the Macintosh group, it was found to be38.70 s (P < 0.0001). The increase in mean heart rate from the pre-induction to post-intubation in Airtraq group was 20.9/min,whereas in Macintosh group was 31.9/min. The increase in mean arterial pressure from pre-intubation to post-intubation inAirtraq group was 12.6 mmHg, whereas in Macintosh group was 30.3 mmHg. Three patients in the Macintosh group and twopatients in the Airtraq group experienced trauma to the airways (P = −0.958).Conclusion: A study concluded that endotracheal intubation is easier, less time is taken for intubation, less trauma, and lesshemodynamic response when using Airtraq laryngoscope than Macintosh laryngoscope.

Comparative Evaluation of Dexmedetomidine and Esmolol for Attenuation of Intubation Stress Response in well Controlled Hypertensive Patients – A Double-Blind Randomized Control Study

Introduction: Laryngoscopy and tracheal intubation provokesa transient and marked sympathetic response that manifests asan increase in BP and HR, with the potential for developmentof arrhythmias. Study aimed to compare the efficacy ofintravenous Dexmedetomidine and Esmolol in attenuating thecardiovascular stress responses accompanying laryngoscopyand endotracheal intubation in well-controlled hypertensivepatients.Material and Methods: 60 hypertensive patients undergoingelective non cardiac surgery were included in the study.Patients were divided into 2 groups, Group D receivedDexmedetomidine 1µg/kg and Group E received esmolol 1.5mg/kg. HR, SAP, DAP, MAP were recorded.Results: There is statistical significant lower HR, SAP,DAP and MAP in group D compared to group E at T4 to T7.Intragroup analysis showed there is no statistically significantchange of HR, SAP, DAP and MAP compared to baseline inGroup D and returns to baseline at 10 minutes. Intragroupanalysis showed there is statistically significant (Higher)change of HR, SAP, DAP and MAP compared to baseline inGroup E at T5 to T8 and returns to baseline at 15 minutes.Conclusion: In controlled hypertensive patients,administration of dexmedetomidine infusion before inductionof anaesthesia blunts the haemodynamic response tolaryngoscopy and endotracheal intubation.