Dear Editor,Soldiers or people in battlefield settings are frequently injured with acute trauma, resulting in respiratory depression, hypoxia and associated morbidity and mortality. Traumatic brain injury(TBI) is with...Dear Editor,Soldiers or people in battlefield settings are frequently injured with acute trauma, resulting in respiratory depression, hypoxia and associated morbidity and mortality. Traumatic brain injury(TBI) is with as much as 80%–90% of mild to moderate in combat casualties and contributed significantly to morbidity and mortality in battlefield settings. Correction of hypoxia at as capable as possible is expected to reduce or minimize the morbidity/mortality due to acute brain injury. An easy, quick and safe setup to promote oxygenation/ventilation of injured military personnel or peoples by non-medical personnel in battlefield settings immediately after acute injury before transfer to hospital is expected to reduce the morbidity/mortality due to injury mediated respiratory depression.展开更多
Objective: To investigate the indications of supraglottic laryngectomy. Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottis squamous carcinoma. Thi...Objective: To investigate the indications of supraglottic laryngectomy. Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottis squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. Methods: Between 1990 and 1996, we used supraglottic laryngectomy to treat 40 patients with supraglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were stages T1 (17 cases), T2 (17 cases) and T4 (6 cases) according to the 1987 UICC on cancer staging criteria. Results: 12 ipsilateral and one bilateral functional neck dissection were operated simultaneously. Of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8 (20%) had slight aspiration before the 20th day. All patients had decannulated. 29 cases received radiotherapy and chemotherapy. A follow-up analysis showed survived rate of 74% at 3 years. Conclusion: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.展开更多
Study Objective: We studied the overall efficacy of fiberoptic aided intubation using three different supraglottic airways (SGA) as intubation conduits with a standard endotracheal tube (ETT) to determine which, if an...Study Objective: We studied the overall efficacy of fiberoptic aided intubation using three different supraglottic airways (SGA) as intubation conduits with a standard endotracheal tube (ETT) to determine which, if any, is superior as an intubation conduit. Design: After induction of general anesthesia, subjects were randomized to one of three groups: Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM. Subjects were intubated with a fiberoptic aided technique with continuous ventilation with FiO2 = 1.0 through one of these SGAs. The primary endpoint was the overall efficacy of the intubation procedure. In addition, the following data were collected: demographic data, intubation times, grade of view of the larynx, and a visual analog scale (VAS) score of difficulty as determined by the primary anesthesiologist performing the procedure. Data were analyzed using a Kruskal-Wallis one-way analysis of variance and Post hoc analysis was done using Dunn’s Multiple Comparison Test. Results: 126 total subjects were studied. Intubation success rates were 100%, 87.8%, and 95% with the Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM respectively. There was no significant difference among the three different SGAs when comparing the times to place the SGA (T1), the true intubating time (T2), the time to remove the SGA (T3), or the total time (T4). Data were also stratified by the grade of view of the larynx;all grade I views, grade II views, and grade III views were grouped together regardless of the type of the SGA used. The grade I view of the larynx group had significantly faster true intubation times (T2 = 75.1 sec, p = 0.01) and significantly lower VAS scores (VAS = 1.9, P = TM provides the best view of the larynx and is the easiest one to use as an intubation conduit.展开更多
i-gel (Intersurgical Ltd., Wokingham, UK) is a new supraglottic airway device with a cuff made of thermoplastic elastomer gel. We retrospectively studied easiness of insertion and troubles in ventilation when this dev...i-gel (Intersurgical Ltd., Wokingham, UK) is a new supraglottic airway device with a cuff made of thermoplastic elastomer gel. We retrospectively studied easiness of insertion and troubles in ventilation when this device was used by less experienced anesthesiologists. Consecutive eleven cases undergoing surgery under general anesthesia were studied. i-gel was successfully inserted in 7 cases (63%) at the first attempt, 2 cases at the second attempt without changing the size. In one case, the size was changed at the second attempt, which resulted in the successful insertion. There was one case of failed insertion even at the second attempt. Fiberoptic observation of the glottis showed direct contact of the cuff to the arytenoids cartilage in cases with successful insertion, however, spastic glottis, defined as contact of vocal cords was observed in 4 cases, and down-folding of the epiglottis was observed in 2 cases. During maintenance of anesthesia, ventilation trouble was observed in 3 cases. We conclude that i-gel should only be used with sufficient knowledge, preparations, skills or support from experienced physician to solve problems related to the safe use of supraglottic airway devices.展开更多
Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiat...Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiation therapy. Traditional treatment of combined posterior and supraglottic stenosis (CS) secondary to chemoradiation has been frequently complicated by poor tissue healing. This case study illustrates a novel endoscopic surgical technique employing a large laterally-based flap as a posterior glottic keel by rotating it anteroinferiorly and suturing it in place. As a result of the procedure, the bilateral vocal folds, which were midline and immobile preoperatively, regained normal motion. The supraglottic airway was also restored. Successful endoscopic treatment of CS with bilateral vocal fold immobility is possible using a large laterally-based flap, even in the face of tissue changes secondary to chemoradiation.展开更多
Background: The fluid seal of supraglottic airway devices (SGA) protects the airway from fluid contamination. We evaluated the suitability of indicator dye placement in the upper digestive tract of anesthetized patien...Background: The fluid seal of supraglottic airway devices (SGA) protects the airway from fluid contamination. We evaluated the suitability of indicator dye placement in the upper digestive tract of anesthetized patients combined with fiberoptical tracing to investigate the fluid seal of SGA. Methods: Patients swallowed a capsule of indigo carmine green (ICG) prior to induction of anaesthesia. After induction of anesthesia, one of two different SGA (either an i-GelTM or an LMA-SupremeTM (LMA-S)) was inserted after randomization. Methylene blue stained normal saline was injected through the proximal opening of drainage tube during mechanical ventilation as well as spontaneous breathing. We monitored regurgitation of ICG with a flexible fiberscope (FO) inserted through the drainage tube and checked for the appearance of methylene blue in the mask bowl with the FO inserted through the airway tube. Results: In thirty-six patients with an i-GelTM and 37 with a LMA-S no regurgitation of ICG was observed at the level of the upper oesophageal sphincter (UES). Methylene blue stained saline was not visible in any patient during pressure-controlled ventilation, but was detected in two of the 36 patients with the i-GelTM during spontaneous breathing. Conclusion: Instilling dye through the drainage tube of SGA models with a built-in drainage tube represents a useful method to examine and to compare the fluid seal of different SGA. Our protocol presented in this study proved to be an easy and reproducible approach for future studies. Furthermore, the clinical results gained during this evaluation highlight the necessity for further investigations regarding the fluid seal competencies of SGAs in humans under clinical conditions.展开更多
Background:Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inha...Background:Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction.This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction.Methods:Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study.After adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min.After motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were graded.The anatomic position of SAD was assessed using a fiberoptic bronchoscope.Results:The SAD was successfully inserted at the first attempt in all patients.Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),respectively.The fiberoptic views of SAD position were adequate in 28 patients (93%).Conclusions:Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.展开更多
Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,...Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,such as chemotherapy,is always the first choice to achieve improved QOL.This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S+RT between January 2012 and August 2016.A total of 59 patients were identified,of whom 31 were treated with DRT,and 28 were treated with S+RT.In the 31 cases of DRT,23 cases were treated with concurrent chemoradiotherapy(CRT),one case was treated with DRT plus cetuximab,and seven cases were treated with DRT alone.Of the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent CRT.Survival analysis was used to compare the overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)between DRT and S+RT groups.Results:The median follow-up was 20 months(range,4-67 months).The patients of the two groups were similar with respect to mean age,original sites,and tumor stages.The 1-,2-,and 5-year OS rates were 80.6%,53.4%,and 24.7% for the DRT group and 85.7%,67.1%,and 24.7%for the S+RT group,respectively.There was no significant difference between the two groups(x^2=3.183,P=0.074).The 1-,2-,and 5-year LRFS and DMFS were 90.4%,61.7%,and 18.0%and 87.4%,49.2%,and 9.9%,respectively,and no statistical difference was observed between the two groups(LRFS:x^2=0.028,P=0.868;DMFS:x^2=3.347,P=0.067).No significant difference was found between the two groups in acute radiotoxicity.Conclusions:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.展开更多
To the Editor:The supraglottic airway device (SAD) with an additional gastric drainage channel may be beneficial for patients needing gastric decompression during surgery, such as laparoscopic cholecystectomy and cesa...To the Editor:The supraglottic airway device (SAD) with an additional gastric drainage channel may be beneficial for patients needing gastric decompression during surgery, such as laparoscopic cholecystectomy and cesarean delivery. Furthermore, addition of gastric drainage channel is a typical feature of second-generation SAD. However, all of second-generation SADs have a gastric tube channel opening at the center of the distal tip. Such a design may cause some difficulty for insertion of the gastric tube if there is an inadequate position of the device tip in the upper esophageal aperture. In normal anatomy, the upper esophageal aperture is actually inclined to the left side of the trachea. Thus, we inferred that it should be much easier to insert a gastric tube into the esophagus, if the gastric drainage channel is placed at the left side of the SAD tip.展开更多
Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO2 as a surrogate measure of circulation, survival...Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO2 as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. After analysis of the first 9 month active period the KA was relegated to rescue airway status. Methods: This was a prospective pre-post study design. Patients >18 years with out-of-hospital cardiac caused arrest were included. Three periods were compared. In the first “non active” period conventional AHA 30/2 compression/ventilation ratio CPR was done with bag mask ventilation (BMV). No ITD was used. After advanced airway placement the compression/ventilation ratio was 10/1. In the second period continuous compressions were done. Primary airway management was a KA with an ITD. After placement of the KA the compression/ventilation ratio was 10/1. In the third period CPR reverted to 30/2 ratio with a two hand seal BMV with ITD. CPR ratio was 10/1 post endotracheal intubation (ETI) or KA. The KA was only recommended for failed BMV and ETI. Results: Survival to hospital discharge was similar in all three study periods. In Period 2 there was a strong trend to CPC scores >2. The study group hypothesized that the KA interfered with cerebral blood flow. For that reason the KA was abandoned as a primary airway. Comparing Period 1 to Period 3 there was a trend to improved survival in the bystander witnessed shockable rhythm (Utstein) subgroup, particularly if a metronome was used. ETCO2 was significantly increased in Period 2 and trended up in Period 3 when compared to Period 1. Advanced airway intervention had a highly significant negative association with survival. Conclusion: The introduction of an ITD into our system did not result in a statistically significant improvement in survival. The study groups were somewhat dissimilar. ETCO2 trended up. When comparing Period 1 to Period 3, the bundle of care was associated with a trend towards increased survival in the Utstein subgroup, particularly with a metronome set at 100. Multiple confounders make a definitive conclusion impossible. Advanced airways showed a significant association with poor survival outcomes. The KA was additionally associated with poor neurologic outcomes.展开更多
Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the A...Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the AuraGain in fresh cadavers compared to that of the Intersurgical i-gel and LMA Supreme New Cuff. Methods: The 3 devices were inserted in random order in 7 fresh cadavers without difficult airway criteria. The assessed items were: Insertion time, number of attempts and ease of insertion, airway seal pressure, ease of gastric tube insertion, endoscopic view of vocal cords, efficacy of guided tracheal intubation through the AuraGain and i-gel, and anatomic fit by lateral X-ray and neck dissections. Results: All devices were successfully inserted within 3 attempts, except for one case of the LMA Supreme. Adjusting manoeuvres were often required to accomplish correct insertion. A 16 G gastric tube was easily advanced through all AuraGain and LMA Supreme devices. Fiberoptic tracheal intubation was effectively achieved through all AuraGain and i-gel devices in less than 60 s. Lateral X-ray and neck dissections confirmed optimal alignment of all devices with the respiratory and digestive tracts. Conclusions: Insertion of the new AmbuAuraGain required adjusting manoeuvres in some cases, as observed with the other two devices, and achieved similar airway seal pressures. Passage of a large bore gastric tube was as fast as with the LMA Supreme and ease of guided intubation was similar to that of the i-gel.展开更多
Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the eso...Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the esophagus blindly or using a laryngoscope. Methods: Our study compared blind versus laryngoscopic-guided esophageal EasyTube insertion. Thirty two anesthesiologists inserted an EasyTube, size 41 Fr, into a mannequin, by using a blind and a laryngoscopic technique in a 2 × 2 crossover design. Results: No statistically significant difference in the time to achieve an effective airway was found: 23.9 ± 6 seconds for the blind and 29.5 ± 7.6 seconds for the laryngoscopic-guided technique. Conclusion: EasyTube insertion was equally successful with or without a laryn-goscope in a mannequin when used by anesthesia providers.展开更多
Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from th...Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.展开更多
Objective: To evaluate the ventilatory effect of normal frequency jet ventilation via Wei jet nasal airway in non-intubated anesthesia in the treatment of the palmar hyperhidrosis (PH). Methods: 62 patients with PH un...Objective: To evaluate the ventilatory effect of normal frequency jet ventilation via Wei jet nasal airway in non-intubated anesthesia in the treatment of the palmar hyperhidrosis (PH). Methods: 62 patients with PH undergoing video-assisted thoracoscopic sympathectomy, aged 18~35 years, ASA I-II, were randomized into two groups: intubated group (group T) and normal-frequency jet ventilation group (group J). After induction tracheal tubes were inserted in Group T and Wei nasal airway were inserted in group J. The heart rate(HR),saturation pulse oxygen (SPO2), mean artery pressure (MAP) and end-tidal carbon dioxide partial pressure (PETCO2) were recorded at following time points: before induction (T0),1 min after induction (T1), 1 min after tube insertion/ intubation (T2), when trocars were inserted and carbon dioxide was inflated (T3), during lung recruitment maneuver and the chest closure (T4), the moment of extubation (T5), 15 min after extubation (T6). Blood samples were taken from left radial artery for blood gas analysis to monitor carbon dioxide partial pressure, arterial oxygen partial pressure, PH ,the BE at T0, T4, T6.The duration of anesthesia, awaking time ,the dosage of the propofol and the remifentanil, the intraoperative and postoperative adverse events were recorded. Results: Compared with group T, the HR and MAP were more stable in group J. The awaking time in the group J were significantly shorter than those in group T (P<0.05), the dosage of the remifentanil in group J was significantly less than that in group T (P<0.05), The incidences of throat discomfort, nausea and vomiting were lower than those in group T (P<0.05). Conclusion: Normal-frequency jet ventilation via Wei jet nasal airway in non-intubated anesthesia in the treatment of the (PH)is feasible, which can reduce stress response and make hemodynamics stable without the complications of tracheal intubation.展开更多
Inflammation of Uvula occurs in isolation or along with supraglottitis. The annual incidence of supraglottitis is described as0.97 to 1.8 per 100,000. The author presents 15 cases of Uvulitis seen in a General hospita...Inflammation of Uvula occurs in isolation or along with supraglottitis. The annual incidence of supraglottitis is described as0.97 to 1.8 per 100,000. The author presents 15 cases of Uvulitis seen in a General hospital of the United Kindgom. Age group ofpatients was between 25-38 years, 9 males and 6 females. One patient developed Uvilitis following inhalation of cannabis and twofollowing the use of marijuana, three were diagnosed to be suffering with bacterial infection. All the patients were treated with steroidsand inhaled adrenaline. Those suffering with bacterial uvilitis required antibiotics.展开更多
文摘Dear Editor,Soldiers or people in battlefield settings are frequently injured with acute trauma, resulting in respiratory depression, hypoxia and associated morbidity and mortality. Traumatic brain injury(TBI) is with as much as 80%–90% of mild to moderate in combat casualties and contributed significantly to morbidity and mortality in battlefield settings. Correction of hypoxia at as capable as possible is expected to reduce or minimize the morbidity/mortality due to acute brain injury. An easy, quick and safe setup to promote oxygenation/ventilation of injured military personnel or peoples by non-medical personnel in battlefield settings immediately after acute injury before transfer to hospital is expected to reduce the morbidity/mortality due to injury mediated respiratory depression.
文摘Objective: To investigate the indications of supraglottic laryngectomy. Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottis squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. Methods: Between 1990 and 1996, we used supraglottic laryngectomy to treat 40 patients with supraglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were stages T1 (17 cases), T2 (17 cases) and T4 (6 cases) according to the 1987 UICC on cancer staging criteria. Results: 12 ipsilateral and one bilateral functional neck dissection were operated simultaneously. Of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8 (20%) had slight aspiration before the 20th day. All patients had decannulated. 29 cases received radiotherapy and chemotherapy. A follow-up analysis showed survived rate of 74% at 3 years. Conclusion: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.
文摘Study Objective: We studied the overall efficacy of fiberoptic aided intubation using three different supraglottic airways (SGA) as intubation conduits with a standard endotracheal tube (ETT) to determine which, if any, is superior as an intubation conduit. Design: After induction of general anesthesia, subjects were randomized to one of three groups: Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM. Subjects were intubated with a fiberoptic aided technique with continuous ventilation with FiO2 = 1.0 through one of these SGAs. The primary endpoint was the overall efficacy of the intubation procedure. In addition, the following data were collected: demographic data, intubation times, grade of view of the larynx, and a visual analog scale (VAS) score of difficulty as determined by the primary anesthesiologist performing the procedure. Data were analyzed using a Kruskal-Wallis one-way analysis of variance and Post hoc analysis was done using Dunn’s Multiple Comparison Test. Results: 126 total subjects were studied. Intubation success rates were 100%, 87.8%, and 95% with the Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM respectively. There was no significant difference among the three different SGAs when comparing the times to place the SGA (T1), the true intubating time (T2), the time to remove the SGA (T3), or the total time (T4). Data were also stratified by the grade of view of the larynx;all grade I views, grade II views, and grade III views were grouped together regardless of the type of the SGA used. The grade I view of the larynx group had significantly faster true intubation times (T2 = 75.1 sec, p = 0.01) and significantly lower VAS scores (VAS = 1.9, P = TM provides the best view of the larynx and is the easiest one to use as an intubation conduit.
文摘i-gel (Intersurgical Ltd., Wokingham, UK) is a new supraglottic airway device with a cuff made of thermoplastic elastomer gel. We retrospectively studied easiness of insertion and troubles in ventilation when this device was used by less experienced anesthesiologists. Consecutive eleven cases undergoing surgery under general anesthesia were studied. i-gel was successfully inserted in 7 cases (63%) at the first attempt, 2 cases at the second attempt without changing the size. In one case, the size was changed at the second attempt, which resulted in the successful insertion. There was one case of failed insertion even at the second attempt. Fiberoptic observation of the glottis showed direct contact of the cuff to the arytenoids cartilage in cases with successful insertion, however, spastic glottis, defined as contact of vocal cords was observed in 4 cases, and down-folding of the epiglottis was observed in 2 cases. During maintenance of anesthesia, ventilation trouble was observed in 3 cases. We conclude that i-gel should only be used with sufficient knowledge, preparations, skills or support from experienced physician to solve problems related to the safe use of supraglottic airway devices.
文摘Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiation therapy. Traditional treatment of combined posterior and supraglottic stenosis (CS) secondary to chemoradiation has been frequently complicated by poor tissue healing. This case study illustrates a novel endoscopic surgical technique employing a large laterally-based flap as a posterior glottic keel by rotating it anteroinferiorly and suturing it in place. As a result of the procedure, the bilateral vocal folds, which were midline and immobile preoperatively, regained normal motion. The supraglottic airway was also restored. Successful endoscopic treatment of CS with bilateral vocal fold immobility is possible using a large laterally-based flap, even in the face of tissue changes secondary to chemoradiation.
文摘Background: The fluid seal of supraglottic airway devices (SGA) protects the airway from fluid contamination. We evaluated the suitability of indicator dye placement in the upper digestive tract of anesthetized patients combined with fiberoptical tracing to investigate the fluid seal of SGA. Methods: Patients swallowed a capsule of indigo carmine green (ICG) prior to induction of anaesthesia. After induction of anesthesia, one of two different SGA (either an i-GelTM or an LMA-SupremeTM (LMA-S)) was inserted after randomization. Methylene blue stained normal saline was injected through the proximal opening of drainage tube during mechanical ventilation as well as spontaneous breathing. We monitored regurgitation of ICG with a flexible fiberscope (FO) inserted through the drainage tube and checked for the appearance of methylene blue in the mask bowl with the FO inserted through the airway tube. Results: In thirty-six patients with an i-GelTM and 37 with a LMA-S no regurgitation of ICG was observed at the level of the upper oesophageal sphincter (UES). Methylene blue stained saline was not visible in any patient during pressure-controlled ventilation, but was detected in two of the 36 patients with the i-GelTM during spontaneous breathing. Conclusion: Instilling dye through the drainage tube of SGA models with a built-in drainage tube represents a useful method to examine and to compare the fluid seal of different SGA. Our protocol presented in this study proved to be an easy and reproducible approach for future studies. Furthermore, the clinical results gained during this evaluation highlight the necessity for further investigations regarding the fluid seal competencies of SGAs in humans under clinical conditions.
文摘Background:Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction.This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction.Methods:Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study.After adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min.After motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were graded.The anatomic position of SAD was assessed using a fiberoptic bronchoscope.Results:The SAD was successfully inserted at the first attempt in all patients.Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),respectively.The fiberoptic views of SAD position were adequate in 28 patients (93%).Conclusions:Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.
文摘Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,such as chemotherapy,is always the first choice to achieve improved QOL.This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S+RT between January 2012 and August 2016.A total of 59 patients were identified,of whom 31 were treated with DRT,and 28 were treated with S+RT.In the 31 cases of DRT,23 cases were treated with concurrent chemoradiotherapy(CRT),one case was treated with DRT plus cetuximab,and seven cases were treated with DRT alone.Of the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent CRT.Survival analysis was used to compare the overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)between DRT and S+RT groups.Results:The median follow-up was 20 months(range,4-67 months).The patients of the two groups were similar with respect to mean age,original sites,and tumor stages.The 1-,2-,and 5-year OS rates were 80.6%,53.4%,and 24.7% for the DRT group and 85.7%,67.1%,and 24.7%for the S+RT group,respectively.There was no significant difference between the two groups(x^2=3.183,P=0.074).The 1-,2-,and 5-year LRFS and DMFS were 90.4%,61.7%,and 18.0%and 87.4%,49.2%,and 9.9%,respectively,and no statistical difference was observed between the two groups(LRFS:x^2=0.028,P=0.868;DMFS:x^2=3.347,P=0.067).No significant difference was found between the two groups in acute radiotoxicity.Conclusions:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.
文摘To the Editor:The supraglottic airway device (SAD) with an additional gastric drainage channel may be beneficial for patients needing gastric decompression during surgery, such as laparoscopic cholecystectomy and cesarean delivery. Furthermore, addition of gastric drainage channel is a typical feature of second-generation SAD. However, all of second-generation SADs have a gastric tube channel opening at the center of the distal tip. Such a design may cause some difficulty for insertion of the gastric tube if there is an inadequate position of the device tip in the upper esophageal aperture. In normal anatomy, the upper esophageal aperture is actually inclined to the left side of the trachea. Thus, we inferred that it should be much easier to insert a gastric tube into the esophagus, if the gastric drainage channel is placed at the left side of the SAD tip.
文摘Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO2 as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. After analysis of the first 9 month active period the KA was relegated to rescue airway status. Methods: This was a prospective pre-post study design. Patients >18 years with out-of-hospital cardiac caused arrest were included. Three periods were compared. In the first “non active” period conventional AHA 30/2 compression/ventilation ratio CPR was done with bag mask ventilation (BMV). No ITD was used. After advanced airway placement the compression/ventilation ratio was 10/1. In the second period continuous compressions were done. Primary airway management was a KA with an ITD. After placement of the KA the compression/ventilation ratio was 10/1. In the third period CPR reverted to 30/2 ratio with a two hand seal BMV with ITD. CPR ratio was 10/1 post endotracheal intubation (ETI) or KA. The KA was only recommended for failed BMV and ETI. Results: Survival to hospital discharge was similar in all three study periods. In Period 2 there was a strong trend to CPC scores >2. The study group hypothesized that the KA interfered with cerebral blood flow. For that reason the KA was abandoned as a primary airway. Comparing Period 1 to Period 3 there was a trend to improved survival in the bystander witnessed shockable rhythm (Utstein) subgroup, particularly if a metronome was used. ETCO2 was significantly increased in Period 2 and trended up in Period 3 when compared to Period 1. Advanced airway intervention had a highly significant negative association with survival. Conclusion: The introduction of an ITD into our system did not result in a statistically significant improvement in survival. The study groups were somewhat dissimilar. ETCO2 trended up. When comparing Period 1 to Period 3, the bundle of care was associated with a trend towards increased survival in the Utstein subgroup, particularly with a metronome set at 100. Multiple confounders make a definitive conclusion impossible. Advanced airways showed a significant association with poor survival outcomes. The KA was additionally associated with poor neurologic outcomes.
文摘Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the AuraGain in fresh cadavers compared to that of the Intersurgical i-gel and LMA Supreme New Cuff. Methods: The 3 devices were inserted in random order in 7 fresh cadavers without difficult airway criteria. The assessed items were: Insertion time, number of attempts and ease of insertion, airway seal pressure, ease of gastric tube insertion, endoscopic view of vocal cords, efficacy of guided tracheal intubation through the AuraGain and i-gel, and anatomic fit by lateral X-ray and neck dissections. Results: All devices were successfully inserted within 3 attempts, except for one case of the LMA Supreme. Adjusting manoeuvres were often required to accomplish correct insertion. A 16 G gastric tube was easily advanced through all AuraGain and LMA Supreme devices. Fiberoptic tracheal intubation was effectively achieved through all AuraGain and i-gel devices in less than 60 s. Lateral X-ray and neck dissections confirmed optimal alignment of all devices with the respiratory and digestive tracts. Conclusions: Insertion of the new AmbuAuraGain required adjusting manoeuvres in some cases, as observed with the other two devices, and achieved similar airway seal pressures. Passage of a large bore gastric tube was as fast as with the LMA Supreme and ease of guided intubation was similar to that of the i-gel.
文摘Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the esophagus blindly or using a laryngoscope. Methods: Our study compared blind versus laryngoscopic-guided esophageal EasyTube insertion. Thirty two anesthesiologists inserted an EasyTube, size 41 Fr, into a mannequin, by using a blind and a laryngoscopic technique in a 2 × 2 crossover design. Results: No statistically significant difference in the time to achieve an effective airway was found: 23.9 ± 6 seconds for the blind and 29.5 ± 7.6 seconds for the laryngoscopic-guided technique. Conclusion: EasyTube insertion was equally successful with or without a laryn-goscope in a mannequin when used by anesthesia providers.
文摘Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.
基金Science Foundation of Putian.Project No:2018S3Y006.
文摘Objective: To evaluate the ventilatory effect of normal frequency jet ventilation via Wei jet nasal airway in non-intubated anesthesia in the treatment of the palmar hyperhidrosis (PH). Methods: 62 patients with PH undergoing video-assisted thoracoscopic sympathectomy, aged 18~35 years, ASA I-II, were randomized into two groups: intubated group (group T) and normal-frequency jet ventilation group (group J). After induction tracheal tubes were inserted in Group T and Wei nasal airway were inserted in group J. The heart rate(HR),saturation pulse oxygen (SPO2), mean artery pressure (MAP) and end-tidal carbon dioxide partial pressure (PETCO2) were recorded at following time points: before induction (T0),1 min after induction (T1), 1 min after tube insertion/ intubation (T2), when trocars were inserted and carbon dioxide was inflated (T3), during lung recruitment maneuver and the chest closure (T4), the moment of extubation (T5), 15 min after extubation (T6). Blood samples were taken from left radial artery for blood gas analysis to monitor carbon dioxide partial pressure, arterial oxygen partial pressure, PH ,the BE at T0, T4, T6.The duration of anesthesia, awaking time ,the dosage of the propofol and the remifentanil, the intraoperative and postoperative adverse events were recorded. Results: Compared with group T, the HR and MAP were more stable in group J. The awaking time in the group J were significantly shorter than those in group T (P<0.05), the dosage of the remifentanil in group J was significantly less than that in group T (P<0.05), The incidences of throat discomfort, nausea and vomiting were lower than those in group T (P<0.05). Conclusion: Normal-frequency jet ventilation via Wei jet nasal airway in non-intubated anesthesia in the treatment of the (PH)is feasible, which can reduce stress response and make hemodynamics stable without the complications of tracheal intubation.
文摘Inflammation of Uvula occurs in isolation or along with supraglottitis. The annual incidence of supraglottitis is described as0.97 to 1.8 per 100,000. The author presents 15 cases of Uvulitis seen in a General hospital of the United Kindgom. Age group ofpatients was between 25-38 years, 9 males and 6 females. One patient developed Uvilitis following inhalation of cannabis and twofollowing the use of marijuana, three were diagnosed to be suffering with bacterial infection. All the patients were treated with steroidsand inhaled adrenaline. Those suffering with bacterial uvilitis required antibiotics.
