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Objective To compare the intubating conditions between dexmedetomidine and remifentanil when combined with sevoflurane-nitrous oxide (N2O) for anesthesia induction in the pediatric patients.Methods A total of 122 pediatric patients,aged 4-10 yr,of American Society of Anesthesiologists physical status Ⅰ,undergoing elective plastic surgery,were randomly divided into dexmedetomidine group (group D,n =61) and remifentanil group (group R,n=61).Eight percent sevoflurane and 60％ N2O were inhaled for induction of anesthesia,and the fresh gas flow was set at 6 L/min.After disappearance of eyelash reflex,dexmedetomidine 1 μg/kg and remifentanil 1 μg/kg were intravenously injected over 50-60 s in D and R groups,respectively,and 1 min later tracheal intubation was performed.The intubating conditions were graded,and the satisfactory intubating conditions and successful intubation were recorded.The development of adverse cardiovascular reactions and complications such as hyoxemia and laryngospasm before and after intubation and postoperative pharyngodynia was recorded.Results Compared with group D,no significant change was found in the success rate of intubation,rate of satisfactory intubation,intubating condition grade or incidence of postoperative pharyngodynia (P＞ 0.05),and the incidence of hypertension and sinus tachycardia after intubation was significantly increased in group R (P＜0.05).No pediatric patients developed hyoxemia,laryngospasn or sinus tachycardia in two groups.Conclusion When 8％ sevoflurane and 60％ N2O are inhaled for anesthesia induction,combing with dexmedetomidine 1 μg/kg produces better clinical efficacy than combing with remifentanil 1 μg/kg in improving the intubating conditions for pediatric patients.
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Objective To evaluate the feasibility of blind intubation via Cookgas intubating laryngeal airway (CILA) in patients under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 11-65 yrs scheduled for elective plastic surgery under general anesthesia were randomly allocated into 2 groups ( n = 30 each): blind intubation group (B) and fiberoptic bronchoscope group (FOB) . All patients were evaluated before operation to identify patients with difficult airway. Anesthesia was induced with midazolam 0.05 mg?kg-1 , fentanyl 2 ?g?kg-1 , propofol 2 mg?kg-1 and vecuronium 0.1 mg?kg-1 . CILA was inserted in all patients. The patients in group B were blindly intubated via CILA, while in group FOB tracheal intubation was guided with fiberoptic bronchoscope via CILA. The time spent in intubation and the success rate of tracheal intubation were recorded. SBP, DBP, HR and SpO2 were recorded immediately before and after induction of anesthesia, immediately after insertion of CILA, immediately after tracheal intubation and immediately after CILA was withdrawn. Results CILA was inserted successfully in all patients. In group B tracheal intubation was accomplished at first attempt in 26 patients, at 2nd or 3rd attempt in 2 patients and failed in 2 patients. In group FOB tracheal intubation was much easier and accomplished at 1st attempt in 29 patients and at 2nd attempt in 1 patient. Twenty four of 25 patients expected to be difficult intubation were intubated successfully. The two groups were comparable with respect to hemodynamic changes during intubation. Conclusion It is possible to intubate via CILA. The success rate is high with minimal cardiovascular response.