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Survival differences between definitive radiotherapy and surgery followed by adjuvant radiotherapy in supraglottic and hypopharyngeal carcinoma

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Chinese Medical Journal 2019年第22期132卷 2698-2704页

作者： Min Zhang Xian-Shu Gao Yong Qin Yue Sun Ming-Wei Ma Department of Radiation Oncology Peking University First HospitalPeking UniversityBeijing 100034China Department of Otorhinolaryngology-Head and Neck Surgery Peking University First HospitalBeijing 100034China Department of Otorhinolaryngology Peking University Shougang HospitalBeijing 100144China

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 *** retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal ***: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+*** 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 *** the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent *** 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 ***: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 *** 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,*** 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 ***:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.

关键词： supraglottic Hypopharyngeal Definitive radiotherapy Adjuvant radiotherapy Survival

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A feasibility study of jaw thrust as an indicator assessing adequate depth of anesthesia for insertion of supraglottic airway device in morbidly obese patients

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Chinese Medical Journal 2019年第18期132卷 2185-2191页

作者： Lei Wan Liu-Jia-Zi Shao Yang Liu Hai-Xia Wang Fu-Shan Xue Ming Tian Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China Department of General Surgery Beijing Friendship Hospital Capital Medical University Beijing 100050 China

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 *** 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 ***: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 *** adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 *** motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were *** anatomic position of SAD was assessed using a fiberoptic ***:The SAD was successfully inserted at the first attempt in all *** conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),*** 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.

关键词： Obesity Inhalational induction Sevoflurane supraglottic airway device Jaw thrust test

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A left-side channel design improving insertion of gastric tube via the supraglottic airway device

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Chinese Medical Journal 2019年第11期132卷 1365-1367页

作者： Jing-Dong Ke Hai-Jun Hou Min Wang Fu-Shan Xue Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

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.

关键词： supraglottic airway device (SAD) drainage channel Gastric drainage pathway

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Fiberoptic Intubation through Adapter Removable supraglottic Airways;Comparison of the Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM

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Open Journal of Anesthesiology 2014年第5期4卷 111-118页

作者： Alvin Y. Lee Jonathan L. Benumof UCSD Medical Center Department of Anesthesiology San Diego USA

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.

关键词： Fiberoptic Intubation Laryngeal Mask Airway supraglottic Airway

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i-Gel supraglottic Airway for Inexperienced Anesthesia Residents

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Open Journal of Anesthesiology 2013年第2期3卷 64-66页

作者： Mariko Senda Tokujiro Uchida Hiroyuki Kobinata Koichi Nakazawa Koshi Makita Department of Anesthesiology Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan

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.

关键词： supraglottic Airway Device i-Gel Airway Management

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Endoscopic Management of Severe supraglottic and Posterior Glottic Stenosis Due to Chemotherapy and Radiation

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第3期3卷 133-136页

作者： Shaina M. Rubino Michael J. Pitman Department of Otolaryngology New York Eye & Ear Infirmary The Voice & Swallowing Institute New York USA New York Medical College Valhalla USA

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.

关键词： Posterior Glottic Stenosis supraglottic Stenosis Combined Glottic Stenosis Radiation Endoscopic Surgery

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Cross-Over Assessment of the AmbuAuraGain, LMA Supreme New Cuff and Intersurgical I-Gel in Fresh Cadavers

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Open Journal of Anesthesiology 2014年第12期4卷 332-339页

作者： Ana M. Lopez Xavier Sala-Blanch Ricard Valero Alberto Prats Department of Anaesthesiology Hospital Clínic de Barcelona Barcelona Spain Orthopaedic Anaesthesia Section Department of Anaesthesiology Hospital Clínic de Barcelona Barcelona Spain Neuroanaesthesia Section Department of Anaesthesiology Hospital Clínic de Barcelona Barcelona Spain Laboratory of Surgical Neuroanantomy (LSNA) Human Anatomy and Embryology Unit Faculty of Medicine Universitat de Barcelona Barcelona Spain

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.

关键词： supraglottic Airway Device Cadaver Study Fibreoptic Intubation

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Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest

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Open Journal of Emergency Medicine 2014年第1期2卷 12-18页

作者： David Chase Angelo Salvucci Rafael Marino Robin Shedlosky Nancy Merman Katy Hadduck Ventura County Fire Department Camarillo CA USA

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 ass

关键词： Airway Management Out-Of-Hospital Cardiac Arrest Cardiopulmonary Resuscitation Endotracheal Intubation supraglottic Airways Emergency Medical Services

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A Comparison of Blind and Laryngoscopic Insertion of the EasyTube

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Open Journal of Anesthesiology 2015年第8期5卷 192-195页

作者： Julia C. Caldwell David P. De Korte Renee E. Doll Sonia J. Vaida Department of Anesthesiology Penn State Milton S. Hershey Medical Center Hershey PA USA

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.

关键词： Airway Management supraglottic Airway Devices EasyTube

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Ventilatory effect of normal frequency jet ventilation in non-intubated anesthesia in the treatment of the palmar hyperhidrosis

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Journal of Hainan Medical University 2019年第7期25卷 25-29页

作者： Shu-Rong Li Qing-Hua Wu Chun-Lan Lin Yao-Hua Yu Department of Anesthesiology Fisrt Hospital of PutianPutian351100Fujian ProvinceChina

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, *** 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.

关键词： Non-intubation supraglottic Normal-frequency jet ventilation Wei jet nasal airway Thoracic sympathectomy

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