Changes in topological properties of brain functional network after induction of general anesthesia in patients with glioma / 中华麻醉学杂志

Objective:To evaluate the changes in topological properties of brain functional network after induction of general anesthesia in the patients with glioma.Methods:Twenty-two patients scheduled for elective intracranial glioma resection were selected.Resting-state functional magnetic resonance imaging was performed during wakefulness and general anesthesia with endotracheal intubation in patients with glioma. Large-scale functional brain networks of each patient were constructed based on 123 regions of interest in non-surgical hemisphere. Global properties (local efficiency, clustering parameter, shortest path length, global efficiency, small world) and nodal properties (nodal degree, nodal efficiency, and between centrality) in brain functional networks were then compared between wakefulness and general anesthesia.Results:Eighteen patients were finally enrolled. Compared with the status during wakefulness, the local efficiency and clustering parameter on non-surgical side significantly decreased ( P<0.05), no significant change was found in the shortest path length and global efficiency ( P>0.05), and small world was greater than 1 throughout the entire density range; the nodal degree, nodal efficiency and between centrality of nodes located in the medial/mesal regions, such as the medial prefrontal cortex, posterior cingulate gyrus/precuneus, medial temporal lobe, anterior cingulate gyrus, thalamus, amygdala, were significantly reduced ( P<0.05); however, these node parameters increased significantly in the lateral brain regions ( P<0.05) except for the primary auditory and somatosensory cortex, which also decreased significantly after induction of general anesthesia( P<0.05). Conclusions:The functional segregation of brain functional network is widely inhibited after induction of general anesthesia, but the functional integration is still retained. The lateral brain regions show no anticorrelation with the medial brain region during general anesthesia.

Cuestionario sobre el uso de técnicas y manejo de presión del cuff en usuarios adultos con vía aérea artificial por parte de profesionales de la salud en Chile / Questionnaire on the techniques and cuff pressure management in artificial airway patients performed by Chilean health professionals

La evidencia internacional recomienda diferente presión de 'cuff' a utilizar en usuarios con vía aérea artificial. En Chile,algunas instituciones sanitarias han creado protocolos internos referenciando dicha evidencia. Sin embargo, no existe una guía nacional, por lo que distintos profesionales utilizan diferentes criterios. El objetivo de este trabajo fue crear un cuestionario válido y confiable sobre el uso de técnicas y manejo de la presión del 'cuff' en usuarios adultos con vía aérea artificial por parte de profesionales de salud en Chile. Para ello, se utilizó un diseño cualitativo-cuantitativo, descriptivo y longitudinal. El proceso fue dividido en tres fases. En la fase A sedesarrolló un cuestionario en inglés que fue traducido al español con ayuda de tres hablantes hispanos nativos. En la fase B diez expertos chilenos en el manejo de usuarios con vía aérea artificial analizaron la herramienta y recomendaron modificaciones de algunos componentes del cuestionario. Después dedichos cambios, la herramienta fue validada a través de un Índice de Validez de Contenido. En la fase C treinta y tres profesionales de la salud chilenos respondieron voluntariamente el cuestionario en dos ocasiones con un lapso de treinta días entre respuestas, con el fin de medir la confiabilidad a través de 'test-retest'. El cuestionario desarrollado tuvo una validez de 0,93 mientras que 72,73% y 27,27% de sus ítems tuvieron excelente y buena confiabilidad respectivamente. Lo anterior permite concluir que este cuestionario cumple con su objetivo y servirá para conocer las técnicas y presiones del 'cuff' que profesionales de la salud en Chile utilizan para el manejo de usuarios adultos con vía aérea artificial.

International evidence recommends different cuff pressure to use with patients with an artificial airway. In Chile, some health institutions have created internal protocols referencing this evidence. However, there is no national guidelines, thus different health professionals use different criteria to manage these patients. The present researched aimed at creating a valid and reliable questionnaire on the use and management of the cuff pressure in adult patients with an artificial airway for health professionals in Chile. A qualitative-quantitative, descriptive and longitudinal design was implemented. This process was divided in three phases. In phase A, a draft of the questionnaire was developed in English and then translated to Spanish by three native Spanish speakers. In phase B, ten Chilean, ten clinical experts in the management of users with artificial airway analysed the tool and recommended modifications of some of the questionnaire. After the modifications, the tool was validated through a Content Validity Index form. In phase C, thirty-three Chilean health professional voluntarily responded the questionnaire twice, with a period of thirty days between responses, to measure the reliability of the tool through 'test-retest'. The questionnaire had a validity of .93, while 72.73% and 27.27% of the items had an excellent reliability and good reliability, respectively. This allows us to conclude that this questionnaire meets its objectives and will serve to know the techniques and pressure of the cuff that health professionals in Chile use for the management of adult patients with an artificial airway.

Tracheal stenosis due to endotracheal tube cuff hyperinflation: a preventable complication

Endotracheal intubation injuries are rare, but may be devastating­mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication.

Effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation response in patients undergoing Han-uvulopharyngoplasty / 中华麻醉学杂志

Objective To evaluate the effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation response in patients undergoing Han-uvulopharyngoplasty (H-UPPP).Methods Eighty-four patients,aged 28-48 yr,weighing 91-108 kg,scheduled for elective H-UPPP,requiring tracheal intubation under general anesthesia,were equally and randomly divided into 2 groups:compound lidocaine cream group (group L) and control group (group C).The compound lidocaine cream 2-3 g were coated on the tracheal tube cuff and exterior before induction of anesthesia in group L,while the paraffin oil was coated in group C.Mean arterial pressure (MAP),HR and pulse oxygen saturation were recorded before induction of anesthesia,at the end of infusion of anesthetics,during extubation and 5 min after extubation (T1-4).Blood samples were taken from the forearm veins on the noninfusion side at T1-4 for detection of plasma adrenergic and norepinephrine concentrations.Cardiovascular events during extubation were recorded.Results Compared with group C,MAP and HR were significantly decreased at T3,4,the incidences of hypotension and tachycardia were decreased,the plasma adrenergic and norepinephrine concentrations were significantly decreased at T2-4 in group L (P ＜ 0.05).Conclusion Topical anesthesia with compound lidocaine cream coated on the tracheal tube can effectively reduce the extubation response in the patients undergoing H-UPPP.

Evaluación de competencias de intubación traqueal mediante un escenario simulado en internos de medicina / Evaluation of competencies for tracheal intubation among medical students

Background: Chilean medical schools curricula are focused on the acquisition of competencies. Tracheal intubation is considered a terminal competence. Aim: To evaluate the competencies related to airway management including tracheal intubation in undergraduate medical students. Material and Methods: Prospective observational study. Thirty medical students in the sixth year of a seven years undergraduate program (25.2 percent of the cohort) were randomly chosen and invited to participate in a simulated environment of elective tracheal intubation using a manikin. The students were assessed according to a checklist validated with the Delphi technique and a written self-assessment questionnaire. Results: Seventeen students (57 percent) accepted to participate, corresponding to 14.3 percent of the cohort. Tracheal intubation was achieved by 64 percent, with 60 seconds as the mean time of apnea. Less than half of the students checked the instruments, performed pre-oxygenation or evaluated the airway. Eighty-seven percent of the students said that the current curriculum offers them minimal competencies for airway management in a real clinical situation and all prefer simulated scenarios for the acquisition of clinical skills. Conclusions: The methodology currently used to teach tracheal intubation is not assuring the acquisition of the competencies to the students in this curriculum stage. More effective teaching methods are required, and the use of simulated scenarios can be a useful tool.

Clinical analysis with 72 cases of respiratory failure rescued by nasotracheal intubation / 中国基层医药

Objective To investigate the clinical application and significance of nasotracheal intubation (NTI)on patients with respiratory failure.Methods 72 cases of post-operative and non-operative patients with respiratory failure were performed with urgent NTI or blind nasotracheal intubation(BNTI)and then mechanical venfilation.Results In all of the cases NTI were successful.32 cases received direct vision NTI;26 cases were BNTI:9 case8 were NTI through fibrobronchoscope and 5 cases were NTI under awake surface anesthesia.Operation were performed within 20 second to 11 minutes[(5.1±3.1)min].The remaining time of tracheal catheter were 2～21d [(9.3±5.9)d].Conclusion NTI was an important measure in rescuing the patients with respiratory failures.It is an essential rescue technique under the condition without fibrobronchoseope.

Effect of rocuronium on entropy to endotracheal intubation during propofol anesthesia induction / 中国医师进修杂志

Objective To evaluate the effect of rocuronium on entropy to endotracheal intubation during anesthesia induction with propofol. Methods Forty patients anesthetized induction with propofol using a target-controlled infusion were randomly divided into two groups: rocuronium group (R group, 20 cases) received 0.6 mg/kg rocuronium or saline group (S group, 20 cases) received saline. 2-3 min later, endotracheal intubation was performed. Response entropy(RE) and state entropy(SE) were recorded during baseline(Ta), at steady state(Tb), 2 min after rocuro nium or saline administration (Tc) and 0, 1, 2 and 3 min after endotracheal intubation (T0, T1, T2, T3). Results At T2, the RE-SE was higher in S group than that in R group. Endotracheal intubation induced increasing in RE and SE. Comparing T2 and T0 values in R group and S group, SE increased from 42 ± 7 to 50 ± 8 and 43 ± 13 to 55 ± 12, and RE increased from 45 ± 6 to 54 ± 9 and 48 ± 16 to 66 ± 15, respectively. At T0, RE and RE-SE were higher in S group. Conclusion Rocuronium affects RE-SE and RE and RE-SE responses to endotracheal intubation and may confound interpretation of entropy monitoring.

Incidence of gastro-esophageal and-hypopharyngeal reflux during gynecological laparoscopy: laryngeal mask vs tracheal tube / 中华麻醉学杂志

Objective To compare the incidence of gastro-esophageal and -hypopharyngeal reflux during gynecological laparoscopy performed under general anesthesia and mechanical ventilation with tracheal intubation (TT) and laryngeal mask airway (LMA) .Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yrs with BMI 0.05 ) . Conclusion In low risk patients the incidence of gastro-esophageal regurgitation is comparable in patients undergoing gynecological laparoscopy in head-down position under general anesthesia and mechanical ventilation using either LMA or TT.