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Evaluation of Risk Factors for Arytenoid Dislocation after endotracheal Intubation: a Retrospective Case-control Study

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Chinese Medical Sciences Journal 2014年第4期29卷 221-224页

作者： Le Shen Wu-tao Wang Xue-rong Yu Xiu-hua Zhang Yu-guang Huang Department of Anesthesiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Anesthesiology Affiliated Hospital of Xi'an Medical University

Objective To investigate the risk factors for postoperative arytenoid dislocation. Methods From September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in terms of date and type of procedures were chosen as the controls(n=16). Recorded data for all patients were demographics, smoking status, alcoholic status, preoperative physical status, airway evaluation, intubation procedures, preoperative laboratory test results, anesthetic consumption and intensive care unit stay. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocation, and the outcomes of surgical repair and conservative treatment. Categorical variables were presented as frequencies and percentages, and were compared using the chi-squared test. Continuous variables were expressed as means±SD and compared using the Student's unpaired t-test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis. Results Sixteen patients with postoperative arytenoid dislocation were enrolled, with a median age of 52 years. Most postoperative arytenoid dislocation patients(15/16, 93.75%) received surgical repair, except one patient who recovered after conservative treatment. None of the postoperative arytenoid dislocation patients were smokers. Red blood cell(P=0.044) and hemoglobin(P=0.031) levels were significantly lower among arytenoid dislocation cases compared with the controls. Conclusions Non-smoking and anemic patients may be susceptible to postoperative arytenoid dislocation. However, neither of them was independent risk factor for postoperative arytenoid dislocation.

关键词： arytenoid dislocation complication endotracheal intubation

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Nitinol　alloy　endotracheal　stent　for　treatment　of　tracheal　stenosis

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Chinese Medical Journal 1997年第7期 44-46页

作者：刘阳孙玉鹗周乃康黄孝迈

Objective To treat inoperable tracheal stenosis by using nitinol endotracheal stent and to solve some problems facing endotracheal stenting with other kinds of stents. Methods The stent was made of nitinol wire. It can be deformed to smaller size in iced water. With a self made introducer, the stent was placed in the location of stenosis. After hot water was injected into the introducer, the stent resumed its original form and anchored there itself. Results Altogether, 5 patients with severe tracheal stenosis received this treatment. Dyspnea was relieved immediately after implantation of stents in all patients. Long term follow up also showed satisfactory results. Conclusions Nitinol stent has some remarkable advantages as compared with other tracheal stents. It can be used as a new endoprosthesis in treating narrowed trachea.

关键词：孙玉鹗 endotracheal stent Nitinol alloy treatment 刘阳黄孝迈

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endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital

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Open Journal of Anesthesiology 2013年第10期3卷 427-432页

作者： Akwasi Antwi-Kusi Gabriel Boakye Wilfred Sam Awortwi Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana

Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse a

关键词： endotracheal Cuff Pressure Aneroid Manometer Intubation Tracheal Stenosis

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Evaluation and Management of Massive endotracheal Hemorrhage in Pediatric Patients: A Case Report and Review of Literature

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International Journal of Otolaryngology and Head & Neck Surgery 2013年第6期2卷 236-239页

作者： Cory Vaughn Mona Shete Rose Mary Stocks Jerome Thompson University of Tennessee Health Science Center Memphis USA

Massive hemoptysis is a frightening and life-threatening event in children. Prompt, aggressive evaluation and management are necessary. The most common cause of hemoptysis in a pediatric patient is infectious, but other various etiologies including tracheotomy related problems, cystic fibrosis, bronchiectasis, congenital anomalies of the cardiopulmonary vasculature and suction trauma must be considered as well. Presented is a report of a case of acute, massive endotracheal hemorrhage with multiple methods of management including balloon tamponade, highly selective embolization, and mainstem occlusion. This case is an addition to our previously reported case series of nine pediatric patients with massive pulmonary hemorrhage. Various diagnostic and management techniques of hemoptyis in pediatric patients are discussed with an extensive review of the literature.

关键词： Pediatric Massive Hemoptysis endotracheal Tube Management

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Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and endotracheal Intubation Conditions

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Open Journal of Anesthesiology 2013年第7期3卷 320-325页

作者： Gustavo Henrique S. Wanderley Luciana Cavalcanti Lima Tania Cursino de Menezes Couceiro Waston Vieira Silva Raquel Queiroz G. A. Coelho Andrea Cavalcanti C. Lucena Anne Danielle Santos Soares Agreste Regional Hospital Caruaru Brazil Brazilian Society of Anesthesiology Accredited Teaching and Training Center IMIP Recife Brazil. Instituto de Medicina Integral Professor Fernando Figueira (IMIP) Recife Brazil

Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.

关键词： Preanesthetic Evaluation Respiratory System Airway endotracheal Intubation Measurement Tech-niques Mallampati Wilson Cormack-Lehane

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Novel Formula for Calculation of the Optimal Insertion Depth for Cuffed endotracheal Tubes in Pediatric Major Surgery

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Open Journal of Anesthesiology 2019年第3期9卷 42-50页

作者： Mao Kinoshita Kazuma Hayase Mizuki Bando Naofumi Kawai Masaru Shimizu Masayuki Shibasaki Department of Anesthesiology Kyoto Prefectural University of Medicine Kamigyo Kyoto Japan

Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92);BSA (R = 0.92);weight (R = 0.91);age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.

关键词： Insertion Depth Infants Small Children Cuffed endotracheal Tubes

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Estimation of endotracheal Tube Cuff Pressure in a Large Teaching Hospital in Ghana

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Open Journal of Anesthesiology 2015年第12期5卷 233-241页

作者： Ebenezer Owusu Darkwa Frank Boni Eugenia Lamptey Yaw Adu-Gyamfi Christian Owoo Robert Djagbletey Alfred Edwin Yawson Edmund Ayesu Daniel Akwanfo Yaw Sottie Department of Anaesthesia School of Medicine and Dentistry College of Health Sciences University of Ghana Accra Ghana Department of Community Health School of Public Health College of Health Sciences University of Ghana Accra Ghana Department of Statistics Kumasi Polytechnic Kumasi Ghana Department of Anaesthesia Korle-Bu Teaching Hospital Accra Ghana

Background: Maintenance of optimal endotracheal Tube cuff Pressure (ETTcP) in anaesthetic practice reduces cuff pressure complications. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH). It also evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient’s age, weight and height on this volume. Methods: Eighty-one patients who underwent general anaesthesia were recruited. ETTcP was measured using an aneroid manometer via a three-way tap. After full cuff deflation, the cuff was refilled with air until an ETTcP of 20 cm H2O was obtained. Independent t-test was used to measure the statistical variations in the ETTcP using estimation techniques in relation to recommended levels as well as the significant difference of mean VAR to obtain a cuff pressure of 20 cm H2O. Grouped t-test was used to determine significant differences in ETTcP between anaesthesia providers using estimation techniques. Results: Mean ETTcP obtained from estimation techniques was (61.87, 73.79) cm H2O. The mean ETTcP measured for Physician and Nurse Anaesthetists were 65.36 cm H20 and 69.52 cm H2O respectively. The mean VAR to achieve an ETTcP of 20 cm H2O for endotracheal tube sizes 7.0 mm and 8.0 mm were 3.90 ± 1.13 mls and 4.55 ± 0.95 mls respectively. Age and weight significantly influenced the VAR to achieve a cuff pressure of 20 cm H2O, however, height did not. Conclusions: This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers. However, in the absence of an aneroid manometer, ETTcP of tube sizes 7.0 mm and

关键词： endotracheal Tube Cuff Pressure Physician Anaesthetist Nurse Anaesthetist Korle-Bu Teaching Hospital

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National Survey of Attitudes and Practices of endotracheal Tube Management in Infants and Small Children in Japan

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Open Journal of Anesthesiology 2019年第2期9卷 9-22页

作者： Masayuki Shibasaki Yasuyuki Suzuki Tetsuro Kagawa Yasuhiro Kogure Keiichiro Mizuno Nobuaki Shime Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan Department of Critical Care and Anesthesia National Center for Child Health and Development Tokyo Japan Department of Anesthesia Hyogo Prefectural Kobe Children’s Hospital Kobe Japan Department of Anesthesia Fukuoka Children’s Hospital Fukuoka Japan Department of Emergency and Critical Care Medicine Hiroshima University Hiroshima Japan

Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.

关键词： Cuffed endotracheal Tube Size Selection Depth Determination Intracuff Pressure Infants Small Children

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A Randomized Comparison of a Parker endotracheal Tube and a Standard Tube Oriented 90°Counterclockwise

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Open Journal of Anesthesiology 2012年第5期2卷 219-223页

作者： Wade A. Weigel Thomas C. Dean Department of Anesthesiology Virginia Mason Medical Center Seattle USA.

Purpose: During oral fiberoptic intubation, advancement of an endotracheal tube (ETT) into the trachea is occasionally impeded by laryngeal structures. The curved flex tip Parker ETT has been shown to improve the likelihood of successful advancement as opposed to a standard ETT that is advanced in neutral orientation. However, a Parker tube has not been compared to a standard ETT oriented 90° counterclockwise from the neutral position. We hypothesize that fiber-optically-guided advancement of an ETT into the trachea will be more successful when using a Parker tube than a 90° counterclockwise-oriented standard ETT. Methods: This unblinded, randomized controlled trial compares the rate of successful advancement of a fiberoptically-guided endotracheal tube into the trachea. Two groups of randomly assigned patients with non-difficult airways are compared: a Parker flex-tip tube (Parker Group;n = 57) versus a standard ETT oriented 90° counterclockwise (Standard Group;n = 58). Our primary outcome is the first pass success rate of advanceing the ETT into the trachea. Results: First pass success occurred in 48 of 57 (84%) patients in the Parker Group vs. 39 of 58 (67%) of patients in the Standard Group (p = 0.0497). Conclusion: When advancing an ETT over an oral fiberoptic scope and into the trachea, a Parker curved flex tip ETT is statistically more likely to be placed successfully on the first pass than is a standard ETT oriented 90° counterclockwise.

关键词： endotracheal Intubation Parker Mallinckrodt Fiberoptic

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Method for Single Intravenous Anesthetic Infusion in a Rodent Model

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Open Journal of Anesthesiology 2015年第5期5卷 96-104页

作者： Shawn K Puri Jing Li Ming Xiong Johan Reyes Pratap R. Nadavaluru Jiang Hong Ye Alex Bekker Department of Anesthesiology New Jersey Medical School Rutgers The State University of New Jersey Newark NJ USA

Venous catheterization, endotracheal intubation, and mechanical ventilation are necessary for performing total intravenous general anesthesia in rats. Intubation and IV cannulation of the rat is challenging because of the animals’ small size and the lack of equipment specifically designed for the restricted anatomical dimensions. Here, we present methods for tail venous catheterization and intubation that are quickly learned by the provider with clinical operating room experience but lack experience in the lab. For tail venous catheterization, each rat (n = 20) was gently restrained in a rat chamber;its tail was placed in warm water for 10 minutes, and a 24 gauge intravenous catheter was inserted into the lateral tail vein. The catheter was fixed in place using tape and attached to a T-connector for drug administration. A bolus of propofol (n = 10), ketamine (n = 7), or etomidate (n = 3) was administered to achieve rapid deep anesthesia. Once anesthetized, rats were intubated with the aid of a modified pediatric laryngoscope. The standard miller blade 0 was cut on each side for approximately 2/3 of the total blade length to remove a total of half the width. After the ventilator was properly set, the rats’ vital signs and metabolic status were monitored. Throughout the one-hour infusion, the rats’ physiologic parameters were maintained within normal range. These results indicate that intravenous general anesthesia can be performed effectively and safely in small animals using the refined catheterization and intubation methods tested in this study. These techniques are easily reproducible and learned as they mimic the tools and strategies commonly used in the OR.

关键词： Refinement Venous Catheterization endotracheal Intubation Intravenous General Anesthesia Rat

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