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Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.
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ObjectiveTo explore a minimally invasive,reliable,and efficient method for endotracheal intubation to instill lipopolysaccharide (LPS) for preparation of acute lung injury (ALI) in mice.MethodsA total of 80 BALB/C mice was randomly selected into LPS group ( n =40) and control group (Normal saline,NS; n =40).After a successfully endotracheal intubation,each mouse was instilled by LPS (3 mg/kg) in LPS group,and NS ( 1.5 ml/kg) in NS group,respectively.The one-time success rate and final success rate of the endotracheal intubation,and survival rate were recorded.After 24 hours,the total number of cells in bronchoalveolar lavage fluid (BALF) of left lung was counted with light microscope.The cells were classified and counted after Wright's stain.Total protein concentration in BALF was assayed with a BCA kit.Wet/dry value was calculated after the lung became dry.Artery blood PaO2 was tested and the oxygenation index was counted.ResultsCompared to NS group,the LPS group had the one-time success rate 92.5％,and the final success rate 100％,survival rate 100％,the total number of cells [ ( 10.82±3.51) ×105/mlvs (0.72±0.52)×105/ml.t =-6.294 P ＜0 01]the rate of polymorphonulear leukocytes in total cells [ (93.93 ± 1.77) ％ vs (2.2 ± 0.91 ) ％,t =- 105.565,P ＜ 0.01 ],the rate of mononuclear leukocytes in total cells[ (6.07 ± 1.77)％ vs (97.8 ±0.91 )％,t =- 105.565,P ＜0.01 ],total protein concentration[ (0.49 ± 0.13 ) mg/ml vs (0.29 ± 0.11 ) mg/ml,t =- 2.823,P ＜ 0.05 ],W/D ratio(4.60 ±0.18 vs 4.16 ±0.25,t =-4.793,P ＜0.01 ),PaO2[ (68.57 -±7.23)％ vs(87.00 ±6.33 )％,t =4.571,P ＜ 0.01 ],and oxygenation index [ (326.53± 34.43 )mmHg vs (414.29 ± 30.16)mmHg,t =4.571,P ＜0.01 ].ConclusionsImproved method for endotracheal intubation has high success rate and minimal injury,and instillation of LPS (3 mg/kg)can induce mice ALI successfully.
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Durante muito tempo, a anestesia em cirurgia cardíaca baseou-se em altas doses de opioides e outras drogas de meia-vida prolongada. Associada à circulação extracorpórea (CEC), heparinização e hipotermia, a recuperação anestésica mostrava-se extremamente prolongada, com uso de próteses ventilatórias e ventilação controlada por longo período após o término da cirurgia. Nos últimos anos, com a tendência à redução de custos e morbidade relacionada a essa recuperação prolongada e uso de agentes anestésicos de meia-vida mais curta, passou-se a considerar a possibilidade de despertar precoce, com extubação e retorno à ventilação espontânea em curto período de tempo após o término da cirurgia.
For a long time, cardiac anesthesia was based upon the use of high doses of opioids and long half-time drugs. Associated to the heart-lung by-pass, full heparinization and hypothermia, post-anesthetic recovery was extremely long, with the use of respiratory protesis and mechanical ventilation. During the last few years, the need to reduce intrahospitalarcosts and the morbidity related to those long recovery times, associated with the new coming of short half-time drugs, fast wake up times, with extubation and return to normal breathing are now being considered.
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Objective To explore a safe and efficient method for endotracheal intubation in mice.Methods A small longitudinal incision was made in the middle of the neck in rats.After the trachea was exposed,the rats were undergone endotracheal intubation and the operation was completed in about 1 min.Results The success rate of intubation was 100% in over 1300 cases.Conclusion The whole procedure can be finished by one person without extra equipment and special mouse position.This novel and efficient method can significantly improve the success rate in using mice as animal models for in vivo studies.