Résumé
Objective To investigate the effectiveness of different dose dexmedetomidine ( DEX) combined with video laryngoscopy during orotracheal Intubation for patients with spontaneous breathing. Methods A total of 87 emergency or intensive care unit ( ICU) patients with spontaneous breathing was in-cluded (age range:18 to 75 years).The patients were randomly divided into three groups with 29 cases each:midazolam combined with fentanyl group ( A) , low dose DEX group ( B) , and high dose DEX group (C).Mean arterial pressure (MAP),heart rate (HR), and SpO2 were detected before injecting different dosage drugs (T0), during intubation (T1),after intubation immediately (T2), at 3 min after intubation ( T3 ) .The amount of intubation time and side effects in each group were assessed.Results Compared to A group, the changes of hemodynamics in group B and C were more stable after injecting drugs.The doctors spend less time for intubation in group B and C.The rate of significant bradycardia in group C was higher than other groups.Conclusions If you can assess indications, doses and timings strictly, it was safety and availability to control intubation response in the patients with spontaneous breathing by injected of DEX.
Résumé
Objective To observe the changes of haemodynamics and cerebral state index during double-lumen endobronchial intubation with glidescope ranger video laryngoscope (GSVL) and macintosh direct laryngoscope (MDLS). Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 35 ～ 67 yrs were enrolled in this study, who were scheduled for elective pulmonary cancer or cancer of esophagus radical correction tients were random divided into 2 groups( n =24 each), GSVL group and MDLS group. After anesthesia was induced, all patients were given a score of Cormack grading under MDLS and GSVL, and then endobronchial intubation was performed. Noninvasive BP and HR were recorded before and after induction of anesthesia, during endobronchial intubation and after endobronchial intubation was completed for 1,2, 3, 4,5 min. The CSI was continuously monitored and recorded before and after induction of anesthesia, and after endobronchial intubation for 1 ～ 2 min and 3 ～ 5 min. Results Compared with MDLS group, the rate of Cormack grade 1 was significant higher in GSVL group (91% vs 58% ) ( P ＜0. 01 ). BP of two groups at T1 and T5 ～ T7 were significantly decreased compared to T0 values ( P ＜0. 01 ). Endobronchial intubation (T2 ～T4) caused significant increase in BP and HR compared to post-induction values(T1 ) ( P ＜0. 01).The highest values of HR after intubation exceeded even their baseline values before induction of anesthesia.The haemodynamic responses to endobronchial intubation in GSVL group at T2 ～ T4 were significantly different from those in MDLS group( P ＜0. 05). CSI of two groups at T1 was significantly decreased compared to To values( P ＜0. 01 ), CSI of two groups at T2 induced significant increase compared to T1 values, and the increase of CSI in MDLS group was stronger than that in GSVL group( P ＜0.01). Condusion The haemodynamic responses produced by orotracheal intubation using GSVL had more obvious advantages than MDLS, but GSVL seemed to provide a clear view of glottis and a little change CSI effect.