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Objective:To compare the efficacy of left parapharyngeal pressure (PLP) combined with cricoid pressure in preventing gastric insufflation during positive pressure ventilation by facemask.Methods:Two hundred and forty patients of both sexes, aged 18-75 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing surgery under general anesthesia requiring endotracheal intubation, were selected and randomly divided into 4 groups ( n=60 each) using a random number table method: cricoid pressure group (group CP), left PLP group (group LP), cricoid pressure combined with left PLP7 group (group CP+ LP), and control group (group C). The gastric antrum cross-sectional area (CSA) was measured by ultrasound in all the patients before induction of anesthesia, and facemask ventilation in pressure-controlled mode with suction pressure of 25 cmH 2O was applied, the patients in 4 groups were treated with different manipulations, and 3 min later the CSA of gastric antrum was measured again.The gastric antrum CSA before and after ventilation and the difference were recorded.The occurrence of gastric insufflation was examined by ultrasound after ventilation. Results:Compared with the baseline before ventilation, the CSA of gastric antrum was increased after ventilation in C, CP and LP groups ( P<0.01), and no significant change was found in the CSA after ventilation in CP+ LP group ( P>0.05). The difference of gastric antrum CSA was decreased in turn in C, CP, LP and CP+ LP groups ( P<0.05 or 0.01). The incidence of gastric insufflation were 53%, 30%, 12% and 0 in C, CP, LP and CP+ LP groups, respectively.Compared with group C, the incidence of gastric insufflation was significantly decreased in LP and CP+ LP groups ( P<0.05), and no significant change was found in group CP ( P>0.05). Compared with group CP, the incidence of gastric insufflation was significantly decreased in group CP+ LP ( P<0.05), and no significant change was found in group LP ( P>0.05). Conclusion:The combination of left PLP and cricoid pressure can effectively prevent gastric insufflation during positive pressure ventilation by facemask.
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Objective:To evaluate the accuracy of ultrasonic localization of cervical anatomy in predicting difficult laryngoscopy.Methods:A total of 91 patients, with body mass index of 18.2-25.7 kg/m 2, aged 18-75 yr, regardless of gender, with a head and neck mobility>90°, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective surgery requiring oral tracheal intubation under general anesthesia, were included in the study.The position of cervical transverse process corresponding to vocal cords (T x), distance from combination of vocal cords to connecting wire of two anterior tubercles of transverse processes (DVA), length of genitoglossus muscle, and distance from skin to combination of vocal cords(DSV)were localized by ultrasound before anesthesia induction.Laryngoscopy was used to expose the glottis, and then endotracheal intubation was performed.Patients were divided into 2 groups according to Cormack-Lehane classification: non-difficult laryngoscopy group (group N) and difficult laryngoscopy group (group L). The areas under the receiver operating characteristic curve (AUC) were used to evaluate the accuracy of T x, DVA, length of genitoglossus muscle and DSV in predicting difficult laryngoscopy. Results:The AUC of T x, DVA, length of genitoglossus muscle and DSV in predicting difficult laryngoscopy was 0.748, 0.851, 0.839 and 0.845, respectively, the sensitivity was 70.83%, 75.00%, 79.17% and 87.50%, respectively, and the specificity was 89.55%, 89.55%, 86.57% and 83.58%, respectively, and the cut-off values were T 4, 4.43 cm, 3.81 cm and 0.72 cm, respectively.There was no statistically significant difference in the AUC of T x, DVA, length of genitoglossus muscle and DSV in predicting difficult laryngoscopy ( P>0.05). Conclusion:T x, DVA, length of genitoglossus muscle and DSV localized by ultrasound all can predict difficult laryngoscopy accurately.
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Objective To evaluate the effect of sevoflurane preconditioning on intestinal injury in the patients undergoing resection for liver cancer.Methods Forty patients of both sexes,aged 20-60 yr,weighing 5075 kg,of ASA physical status Ⅱ or Ⅲ (liver function Child-Pugh grade A),undergoing resection for right liver cancer,were randomly divided into 2 groups (n =20 each):sevoflurane preconditioning group (S group) and control group (C group).Anesthesia was induced with target-controlled infusion of propofol and remifentanil.Tracheal intubation was facilitated with cisatracurium.Anesthesia was maintained with target-controlled infusion of propofol and remifentanil.S group inhaled sevoflurane with the end-tidal concentration of 2.0％ for 30 min starting from the end of intubation,followed by washout.Before induction (T0),immediately after hepatic portal was clamped (T1),at 1,3 and 6 h after occlusion of hepatic portal was released (T2-4) and at 24 h after operation (T5),arterial blood samples were obtained for determination of serum tumor necrosis factor-alpha (TNF-α),intestinal fatty acids binding protein (Ⅰ-FABP) and D-lactate levels.Results The concentrations of serum TNF-α and D-lactate started to rise at T2,peaked at T4,and started to decline at T5,and the serum Ⅰ-FABP concentrations started to rise at T2,peaked at T3,and started to decline at T4 in the two groups.The concentrations of serum TNF-α,Ⅰ-FABP and D-lactate were significantly lower in S group than in C group.Conclusion Sevoflurane preconditioning can inhibit inflammatory responses and reduce intestinal injury in the patients undergoing resection for liver cancer.