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Objective To discuss the practicability and safety of 3.5 mm superfine bronchoscope in children's difficult airway.Methods Twenty-eight children with difficult airway,aged 4 months to 8 years were selected.Intravenous anesthesia was used and autonomous respiration was maintained.The 3.5 mm superfine bronchoscope was used to guide tracheal intubation by nose(mouth).Results Among 28 cases, 1 case had oral bleeding and succeeded after suction and pressurized oxygen supply, and the rest was successful in the first time.The intubation time was(1.50 ± 0.25)min.There was no damage to the whole airway.Success rate was 100%.Conclusions The 3.5 mm superfine bronchoscope in guiding tracheal intubation of children's difficult airway has obvious advantages and security, and it deserves clinical attention and promotion.
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Objective To explore the efficacy of self-made adjustable tracheal cannula in obese patients with tracheotomy. Methods A corresponding model of tracheal cannula was taken and cut with a length of 16 cm. It is noted that the inflation catheter of the airbag should not be broken. A further trim was done along the longitudinal side of the inflation catheter. The inflation catheter was retained. A rubber cork from a nutrient solution bottle was chosen, and a hole was trimmed with the same length of the diameter of the tracheal cannula, through which the tracheal cannula was put. A disposal oxygen mask was trimmed into two wings like a butterfly, the middle of which was made into a hole with the same length of the diameter of the tracheal cannula. Two rectangular holes were made on the two wings in order to fit the rubber cork. The fixed wings of and rubber cork were put together through sutures. The other end of the tracheal cannula was cut and put on a connector and sterilized with ethylene oxide in the supply room. The intraoperative method was the same as the conventional tracheotomy. After the cannula was inserted, the length of the cannula was adjusted by moving the rubber cork up and down according to the obesity of the patient′s neck. Results Compared with regular tracheal cannula, the self-made adjustable tracheal cannula could be easily inserted into the trachea of patients no matter how obese their necks were. It could be connected to ventilator, keep patient′s airway clear and effectively drain phlegm. No slippage was observed in our practice. It was simple, accessible and lower in cost. Conclusions The application of self-made adjustable tracheal cannula in obese patients with tracheotomy can meet the clinical therapeutic needs, and it also proves to be affordable for patients.
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Objective To explore the value of afterdischarges monitoring for intraoperative electrical stimulation for brain mapping. Methods 34 patients received cerebral cortex electrical stimulation for brain mapping during operation of brain function area , afterdischarges were monitored simultaneously to determine the upper limit of stimulus intensity. Results 34 cases underwent electrical stimulation successfully , and received surgery without neurologic decline except 2 cases of hypokinesia. Conclusion After discharges monitoring improve the accuracy, reduce the risk of intraoperative cerebral cortex electrical stimulation.
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Objective To investigate the minimal and optimal concentration of ropivacain for epidural anesthesia in patients with breast cancer.Methods 103 patients with breast cancer ASA Ⅰ-Ⅱ undergoing elective radical mastectomy were conducted with epidural anesthesia.T2-3 were selected as a puncture site.A catheter was inserted into the epidural space in a cephalic direction for 3.5-4.0 cm.The concentration of ropivacain was produced by the test of up-down sequential allocation technique.20-25 ml of 0.20 ％ ropivacaine was given after a test of 0.20 ％ 5 ml ropivacaine.If the anesthesia was effective (VAS≤3),the next concentration was down 0.01％,while the VAS was more than 5,the next concentration was up 0.01％.The anesthesia effect and segments of block were measured with acupuncture.Blood pressure (NIBP),heart rates(HR),blood oxygen saturation (SPO2),blood gas and VAS were monitored during operation.Nasal catheter oxygen inhalation was used in routine method.Results The median effective concentration (EC50) of ropivacaine was 0.10 ％ determined by the formula of dixon and massey.The 95 ％ confidence intervals was 0.1022 ％-0.1065 ％.The least and the best analgesic concentration of ropivacaine for the upper thoracic epidural block was 0.14 ％ and 0.17 ％-0.18 ％ respectively.Conclusion The minimal and the optimal analgesic concentration of ropivacaine for the upper thoracic epidural block are 0.14 ％ and 0.17 ％-0.18 ％respectively,and which provides a safe and rational use of ropivacaine for the clinic.
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Three ASA Ⅱ male patients aged 22-46 yr weighing 50-75 kg underwent operation on language areas from June to September 2009 in our hospital. Anesthesia was induced with propofol 2-2.5 mg/kg, fentanyl 4-5 μg/kg and atracurimm 0.6 mg/kg. The esophago-pharyngeal tube was inserted into esophagus and oropharynx under direct vision. The esophageal balloon was inflated with 10-15 ml of air and the pharyngeal balloon with 40-60 ml of air. After the correct position of the tube was confirmed, the patients were mechanically ventilated.Anesthesia was maintained with propofol 50-70 μg · kg- 1 · min- 1 , remifentanil 0.15-0.25 μg· kg- 1 · min- 1 and atracurium 0.3-0.4 μg·kg-1·h-1. The pharyngeal balloon was deflated during wake-up test. The patients were asked to count continuously and answer question as instructed to locate the language areas. After the language areas had been located, the pharyngeal balloon was inflated again. The tidal volume was set at 500-510 ml and measured 500-512 ml. The airway pressure measured 16-18 cm H2O. The hemodynamics was stable and blood gas indexes were within the normal range. The language in response to questions was clear in one patient, not very clear in the second patient and vague in the third patient. Hypoxemia hypercapnea and intracranial hypertension were not observed during operation and wake-up test. After the patients became conscious, the balloons were deflated and the vital signs were stable. The patients were transferred to ICU after removal of esophago-pharyngeal tube. No postoperative complications occurred.
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Objective To find out an optimal anesthesia and the d osage used in painless gastroscopy, and to evaluate its efficiency. Meth ods 200 patients undergoing painless gastroscopy were divided into 4 gr oups randomly. 2?g/kg iv of propofol was used in group Ⅰ, fentani 1?g/kg + pr opofol 2?g/kg in group Ⅱ, rimifentani 0.5?g/kg + propofol 1.5?g/kg in grou p Ⅲ, and rimifentani 0.75?g/kg + propofol 0.75?g/kg in group Ⅳ. Observed o bjects induced starting time and depth of anaesthesia, HR, R and SpO2 during o peration, side effects such as cough reflex and larynx spasm, time of regaining consciousness, postoperative side effects such as nausea and vomiting. R esult Significant differences (P≤0.01) were found between group Ⅳand the other 3 groups in starting time and depth of anaesthesia, side effects , time of regaining consciousness and suppression of respiration during operatio n. Conclusion Combined rimifentani 0.75?g/kg + propofol 0.75 ?g/kg are optimal anestheties in painless gastroscopy if side effects are preve nted.
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Objective:To study the time-course effect and postoperative residual curarization of rocuronium(ROC) in patients with obstructive jaundice.Methods: Forty patients(with normal renal function and without muscle or nerves diseases) receiving elective surgery under general anesthesia were divided into 2 groups: trial group(group Ⅰ) included 20 ASA(American Society of Anesthesiologists) Ⅲ patients with obstructive jaundice and control group(groupⅡ) included 20 ASA Ⅰ-Ⅱpatients without obstructive jaundice.All patients received total intravenous anesthesia with pentothal sodium,fentainyl and propofol.Neuromuscular blockade was evaluated with train-of-four(TOF) stimuli of the ulnsar nerve during operation.The 3?ED_(95)((0.9 mg/kg)) of ROC was given during anesthesia induction.As TOF rate(TOFR) reached 25%,1?ED_(95)(0.3 mg/kg)of ROC was added.Postoperation neuromuscular blockade was continuously evaluated until TOFR reached 90%.Tracheal extubation trigger was defined as that patient was able to open his/her eyes and to raise his/her arm or head for 5 s.The onset time,effect time of ROC,the time of TOFR from 0 to 70% and from 70% to 90%,and the TOFR at the time of tracheal extubation were observed.The blood gas analysis was done at the same time.Results: The effect duration in groupⅠwas longer than that in group Ⅱ(P
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Objective To evalue the effects of elevation epidural block with 0.2% ropivacaine on lung function. Methods fifty ASA Ⅰ-Ⅱ patients undergoing elective radical mastectomy were anesthetized with method of epidural block .T 2-3 or T 3-4 were selected as puncture site. A catheter was inserted into the epidural space in a cephalad direction for 3-4cm. Nasal catheter oxygen inhalation was used in routine method. A loading dose of 0.2% Ropivacaine 15-20ml was given after a test dose of 1% lidocaine 5ml or 0.2% ropivacaine 5ml. Generally, the first dosage was at 25-30ml. The anesthesia effect, segments of block were measured and heart rates (HR),blood pressure (BP), blood oxygen saturation(SpO 2) were assessed before anesthesia, after anesthesia and at the end of surgery, meanwhile the breathing frequency, minute ventilation and maximal voluntary ventilation(MVV) were monitored. Blood gas, lactic acid and serum glucose were detected from 25 of the total case before and after anesthesia. Levels of sense obstacle and movement of bilateral upper limbs were recorded after operation. Results All 50 patients but one were finely anesthetized by elevation epidural block with 0.2% ropivacaine. Among them 39(78%) patients were blocked at C 5-T 8. No significant difference existed before and after anesthesia on breathing frequency, minute ventilation and maximal voluntary ventilation, and the values of blood gas in all those patients analysed were normal. Over 20% of decline on BP and obvious reduction on HR were found in 8 patients after anesthesia (P