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difficult airway management in children and young adults with arthrogryposis

World Journal of Otorhinolaryngology-Head and Neck Surgery 2018年第2期4卷 122-125页

作者： Glenn Isaacson Elizabeth T.Drum Department of Otolaryngology—Head&Neck Surgery Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPAUSA Department of Anesthesiology and Critical Care Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA Department of Pediatrics Lewis Katz School of Medicine at Temple UniversityPhiladelphiaPAUSA

Objective: To review current evidence and experience with anesthesia and airway management issues in children and young adults with arthrogryposis. Data sources: Review of existing world literature and description of personal experience at a center for children's orthopedic surgery and rehabilitation over 2 decades. Methods: Description of common problems and their solutions in this unusual and diverse group of patients. Results: Arthrogryposis multiplex congenital includes more than 400 conditions that lead to congenital joint contractures affecting more than one body area. Among the many causes of arthrogryposis, 50％—65％ fall into two large categories — amyoplasia and distal arthrogryposis. There is general agreement that best function in children with arthrogryposis is achieved through early mobilization of joint contractures. Children with arthrogryposis average >5 operative procedures during childhood. Anesthesia for these procedures may be complicated by limited jaw mobility and mouth opening, restricted lung development, positioning diffi-culties, difficult venous access and concerns about increased risk for malignant hyperthermia. 75％ of arthrogryposis patients do not have a difficult airway. For those with a history of airway problems or those meeting criteria for a difficult airway, careful advanced planning helps to assure safe and successful surgery. We describe several specialized techniques for endotra-cheal intubation of children with arthrogryposis.Conclusions: Children and young adults with arthrogryposis are a diverse group. Many pose un-ique challenges for airway and surgical management. Review of individual anesthesia records and careful advanced planning by a coordinated, experienced airway team can lead to best outcomes from arthrogryposis surgery.

关键词： Arthrogryposis Endotracheal intubation difficult airway Malignant hyperthermia

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Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 73-78页

作者： Jun Wen Tao Li Yi Lu Li-Ke Bie Biao Gong Digestive Endoscopy Center Department of Gastroenterology Ruijin Hospital Shanghai Jiaotong University School of Medicine Digestive Endoscopy Center The Sixth Affiliated Hospital of Sun Yat-sen University

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

关键词： difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife fistulotomy Precut techniques Transpancreatic septotomy

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difficult Intubation in a Patient with Dysphagia after Posterior Occipitocervical Fusion: A Case Report

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Open Journal of Anesthesiology 2017年第5期7卷 121-129页

作者： Junichi Nishiyama Aki Ando Tomohiko Murata Mariko Watanabe Hajime Yamazaki Satoru Saito Toshiyasu Suzuki Department of Anesthesiology Tokai University School of Medicine Isehara Japan

The authors encountered a case involving difficult intubation during anesthesia for revision of cervical fixation angle in a 62-year-old woman, with a history of chronic rheumatoid arthritis, who experienced dysphagia after initial posterior occipitocervical fusion to correct atlantoaxial subluxation. Two days after initial surgery, she developed trismus with neck flexion and dysphagia, and underwent revision surgery. General anesthesia was planned;however, tracheal intubation using the McGrath laryngoscope and bronchofiberscope was difficult, which prolonged anesthesia induction. Narrowing of the oral and pharyngeal cavities associated with overcorrection of the cervical spine was believed to be the reason for difficulty in manipulating the tracheal intubation devices. In posterior occipitocervical fusion, intraoperative evaluation of the occipito-second cervical vertebra (O-C2) angle is reported to be useful in preventing postoperative dyspnea and/or dysphagia, and avoids the need for revision of fixation angle. However, when revision surgery is needed, selection of airway management methods and tracheal intubation devices are important considerations because patients are likely to have restricted mobility in the cervical spine and narrowing of the oral and pharyngeal cavities.

关键词： Occipitocervical Fusion Postoperative Dysphagia difficult Intubation O-C2 Angle

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Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial

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World Journal of Gastroenterology 2013年第29期19卷 4732-4736页

作者： Atsuo Yamada Hirotsugu Watabe Noriyuki Takano Goichi Togo Yutaka Yamaji Haruhiko Yoshida Takao Kawabe Masao Omata Kazuhiko Koike Department of Gastroenterology University of Tokyo Tokyo 113-8655 Japan

AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies. METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The study outcomes were the cecal intubation rate and time, endoscopic findings, complications, and pain score. RESULTS: The SBC and DBC groups included 11 and 10 patients, respectively. All but one SBC patient achieved total colonoscopy successfully. The cecal intubation times were 18 min (range: 10-85 min) and 12.8 min (range: 9.5-42 min) in the SBC and DBC groups, respectively (P= 0.17). No difference was observed in the prevalence of colon polyps between the SBC and DBC groups (45% vs 30%, P = 0.66). SBC showed advanced colon cancer in the ascending colon, which was inaccessible using conventional colonoscopy. The respective pain scores were 5 (1-10) [median (range)] and 5 (1-6) in the SBC and DBC groups (P = 0.64). No complications were noted in any patient. CONCLUSION: The utility of singleand double-balloon endoscopy for colonoscopy seems comparable in patients with incomplete colonoscopy using a conventional colonoscope.

关键词： difficult colonoscopy Double-balloon endoscopy Single-balloon endoscopy Double-balloon colonoscopy Single-balloon colonoscopy

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Endoscopic management of difficult common bile duct stones

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World Journal of Gastroenterology 2013年第2期19卷 165-173页

作者： Guru Trikudanathan Udayakumar Navaneethan Mansour A Parsi Department of Internal Medicine University of Connecticut Medical CenterFarmingtonCT 06269United States Digestive Disease Institute Cleveland ClinicClevelandOH 44195United States

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones.In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones.Most biliary stones can be removed with an extraction balloon,extraction basket or mechanical lithotripsy after endoscopic sphincterotomy.Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients.Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed.Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

关键词： Choledocholithiasis Mechanical lithotripsy Laser lithotripsy Electrohydra-ulic lithotripsy difficult to remove biliary stones Endoscopic large balloon papillary dilation Peroral cholangioscopy

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Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

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Open Journal of Gastroenterology 2013年第2期3卷 142-147页

作者： Duk Joo Choi Yeon Suk Kim Jung Ho Kim Yang Suh Ku Min Su Ha Ju Hyeon Kim Department of Internal Medicine Gachon University Gil Medical Center Incheon South Korea

Background/Aims: Recently, endoscopic papillary large balloon dilation (EPLBD) using a large balloon (12 - 20 mm) for extraction of difficult common bile duct (CBD) stones has been widely accepted with favorable outcomes. However, there is no consensus with regard to the ballooning time. The aim of our study was to evaluate the efficacy and safety of immediate balloon deflation in EPLBD for the treatment of difficult bile duct stone. Methods: This was a retrospective study of 80 consecutive patients with bile duct stones who were treated with an immediate balloon deflation method in EPLBD combined with endoscopic sphincterotomy (EST) between January 2010 and December 2012. Overall success rate, success rate at first ERCP, and the frequency of mechanical lithotripsy for complete stone removal were assessed for efficacy and safety was evaluated by assessing major complications. Results: Overall success rate for complete stone removal was high (78/80, 97.5%) and success rate for complete stone removal at first ERCP was 86.3% (69/80). The use of mechanical lithotripsy was 0% (0/80). The overall complication rate was favorable (5/80, 6.3%). PostERCP pancreatitis was observed in 3 patients (two: mild, one: moderate). In subgroup analysis, the presence of periampullary diverticulum was the only factor affecting the success rate at first ERCP. Conclusion: This study demonstrated the favorable outcome of immediate balloon deflation for treatment of difficult CBD stones and can be considered for clinical application.

关键词： Endoscopic Papillary Large Balloon Dilation Ballooning Time Immediate Balloon Deflation difficult Bile Duct Stone

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Establishing a Rule-based International Order is a difficult and Long Process

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Peace 2019年第3期 75-78页

作者： Yu Hongjun the CPAPD IDCPC

In recent years,the complex and changeable world situation has become particularly prominent,and the trend of international relations,especially the major country relations is uncertain,which is of great concern.The establishment of a new international order based on new rules is becoming the focus and gravity of study of international relations.

关键词： Establishing a Rule-based International Order a difficult and Long Process

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The GlideScope<sup>®</sup>Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

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Open Journal of Anesthesiology 2012年第2期2卷 23-28页

作者： Wiebke Ackermann Leonardus M. Pott Sonia J. Vaida Arne O. Budde Milton S. Hershey Medical Center—Department of Anesthesiology Penn State University Columbus USA. Milton S. Hershey Medical Center—Department of Anesthesiology Penn State University Hershey USA

Background: This study assesses the effectiveness of the GlideScope? Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation att

关键词： GlideScope difficult Airway

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Relevance of Predictors in difficult Intubation for Patients Undergoing Maxillofacial Surgery

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International Journal of Clinical Medicine 2014年第21期5卷 1365-1373页

作者： Shalender Sharma Kaberi Majumder Krishna Kishor Ripan Das Shiv Kishor Sunil Gulia Department of Oral and Maxillofacial Surgery SGT Dental College Gurgaon India Department of Orthodontics SGT Dental College Gurgaon India Department of General Surgery SPS Apollo Hospitals Ludhiana India

Objective: To determine a clinically useful variable for predicting difficult tracheal intubation in patients with seemingly normal airways. Material and Methods: In our study we had included 68 patients from September 2011 to September 2013 who needed tracheal intubation for elective maxillofacial surgery. An airway assessment test was conducted on each patient prior to general anaesthesia, with respect to mouth opening, sternomental distance, thyromental distance, oropharyngeal (Mallampati) classification and ability to protrude the mandible. After induction of anaesthesia, the laryngeal view during laryngoscopy was graded and then the ability to intubate was assessed. Results: Incidence of difficult intubation occurred in 8 (11.76%) cases out of 68 patients. Airway test that was significant for predicting difficult tracheal intubation was SMD of less than 12.5 cm, TMD of less than 6 cm, a score according to Mallampati et al. of greater than III, protrusion of mandible position B and position C and IIG less than 3 cm with sensitivity of 87.5%, 62.5%, 62.5%, 25% and 50%, respectively. Conclusion: Our study concluded that sternomental distance had the highest sensitivity of 87.5% which was statistically significant

关键词： difficult Intubation Sternomental Distance Airway Mallampatti Score Oral Surgery

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difficult WORDS IN THE MAGAZINE

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英语角 2019年第15期 23-23,45页

作者：郑辛遥不详

小朋友,这里有几个句子需要你来帮忙补全哦。缺失的单词已用下划线在本期杂志第5页到第15也中注明,一起来找找看吧!

关键词： difficult WORDS IN THE MAGAZINE 小朋友

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