Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial.

BACKGROUND: There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery. METHODS: Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student's t-test, Mann-Whitney U-test, or Chi-square test. RESULTS: The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02). CONCLUSION: Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj.aspx?proj=13183.

[Clinical observation of remifentanyl and propofol injection in total intravenous anesthesia for percutaneous radiofrequency ablation].

OBJECTIVE: To explore the efficacy and safety of remifentanyl and propofol injection in total intravenous anesthesia for percutaneous radiofrequency ablation. METHODS: 60 patients scheduled for PRFA were divided randomly into two groups:group A and group B. Each group contained 30 patients. Those in group A received remifentanyl and propofol injection, and the patients in group B were given oxycodone hydrochloride. The mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SPO2) were measured and recorded by monitor during the operation. The chest muscle rigidity, respiratory depression, nausea and vomitting, hypotensio and VAS were also recorded. RESULTS: Compared with the preoperative,MAP, HR in group A decreased significantly during the operation, increased in group B (P < 0.05). VAS was significantly lower in group A than that in group B (P < 0.05). 2 patients had respiratory depression, 1 patient had nausea and vomiting reaction in group A.2 patients had vagus reflex, 3 patient had nausea and vomitting reaction in group B. CONCLUSION: Total intravenous anesthesia with remifentanyl and propofol for PRFA is safe and reliable. Respiratory and circulation should be monitored instantly and strictly.