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Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways

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Chinese Medical Journal 2009年第4期122卷 408-415页

作者： XUE Fu-shan HE Nong LIAO Xu XU Xiu-Zheng XU Ya-chao YANG Quan-yong LUO Mao-ping ZHANG Yan-ming Department of anesthesiology Plastic Surgery Hospital ChineseAcademy of Medical Sciences and Peking Union Medical CollegeBeijing 100144 China Department of anesthesiology Peking University ShougangHospital Beijing 100144 China

Background There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation （ETI）, therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways. Methods Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic （two doses） and laryngotracheal areas （one dose） using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores （VAS）, and objective assessments by an independent investigator using patients＇ tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters. Results Of 210 airway sprays, 197 （93.8%） were successfully completed on the first attempt. The total time for airway spray was （14.6±1.5） minutes. During airway topical anesthesia, the average patients＇ tolerance scores were 1.7-2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients＇ reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were le

关键词： difficult airways airway topical anesthesia awake endotracheal intubation lightwand technique

Remote ischemia conditioning-an endogenous cardioprotective strategy from outside the heart

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Chinese Medical Journal 2011年第14期124卷 2209-2215页

作者： XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang LIU Jian-hua Department of anesthesiology Plastic Surgery Hospital ChineseAcademy of Medical Sciences and Peking Union Medical CollegeBeijing 100144 China

Objective A general review was made of studies involving：（1） The experimental evidence of remote ischemic preconditioning （RIPC） and relative clinical studies, （2） The experimental and clinical evidences of remote ischemic postconditioning （RIPOC）, （3） The potential mechanistic pathways underlying their protective *** sources The data used in this review were mainly from manuscripts listed in PubMed that were published in English from 1986 to 2010. The search terms were ＂myocardial ischemia reperfusion injury＂, ＂ischemia preconditioning＂,＂ischemia postconditioning＂, ＂remote preconditioning＂ and ＂remote postconditioning＂.Study selection （1） Clinical and experimental evidence that both RIPC and RIPOC produce preservation of ischemia reperfusion injury （IRI） of myocardium and other organs, （2） Studies related to the potential mechanisms, by which remote ischemic conditioning protects myocardium against *** Both RIPC and RIOPC have been shown to attenuate myocardial IRI in laboratory animals. Also, their cardioprotective effects have appeared in some clinical studies. Except the external, the detailed internal mechanisms of remote ischemic conditioning have been generally described. Through these descriptions better protocols can be developed to provide improved cardioprotective *** Remote ischemic conditioning is an endogenous cardioprotective mechanism from outside the heart that protects against myocardial IRI and represents a general form of inter-organ protection. Remote ischemic conditioning may have an immense impact on clinical practice in the near future.

关键词： myocardial ischemic reperfusion injury ischemia preconditioning ischemia postconditioning remote preconditioning remote postconditioning

Effect of Autophagy Inhibition on the Protection of Ischemia Preconditioning against Myocardial Ischemia/Reperfusion Injury in Diabetic Rats

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Chinese Medical Journal 2018年第14期131卷 1702-1709页

作者： Ya-Yang Liu Chao Sun Fu-Shan Xue Gui-Zhen Yang Hui-Xian Li Qing Liu Xu Liao Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100041 China

Background： Ischemia preconditioning （IPC） remains the most powerful intervention of protection against myocardial ischemiaJreperfusion injury （IRI）, but diabetes can weaken or eliminate its cardioprotective effect and detailed mechanisms remain unclear. In this study, we aimed to explore whether changes of autophagy in the diabetic condition are attributable to the decreased cardioprotective effect of I PC. Methods： Sixty diabetic male Sprague-Dawley rats were randomly divided into the control （C）, IRI, rapamycin （R）, wortmannin （W）, rapamycin ＋ IPC （R ＋ IPC）, and wortmannin ＋ IPC （W ＋ IPC） groups. The in vivo rat model of myocardial IRI was established by ligaturing and opening the left anterior descending coronary artery via the left thoracotomy. Durations of ischemia and reperfusion are 30 min and 120 min, respectively. Blood samples were taken at 120 min of reperfusion for measuring serum concentrations of troponin I （TnI） and creatine kinase isoenzyme MB （CK-MB） using the enzyme-linked immunosorbent assay. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. The expressions ofLC3-11, beclin- 1, phosphoinositide 3-kinase （PI3K）, naammalian target of rapamycin （mTOR）, and P-Akt/Akt ratio in the ischemic myocardium were assessed by Western blotting. Results： Compared to the IRI group, infarct size （56.1% ± 6.1% vs. 75.4 ± 7.1%, P 〈 0.05）, serum cTnl （0.61 ± 0.21 vs. 0.95 ±0.26 ng/ml, P 〈 0.05）, and CK-MB levels （6.70 ± 1.25 vs. 11.51 ±2.35 ng/ml, P 〈 0.05） obviously decreased in the W ＋ IPC group. Compared with the C group, myocardial expressions of LC3-11 （0.46 ± 0.04 and 0.56 ± 0.04 vs. 0.36 ± 0.04, P 〈 0.05） and beclin- 1 （0.34 ± 0.08 and 0.38 ± 0.07 vs. 0.24 ±0.03, P 〈 0.05） evidently increased, and myocardial expressions of mTOR （0.26 ± 0.08 and 0.25 ± 0.07 vs. 0.38 ± 0.06, P 〈 0.05）, PI3K （0.29 ± 0.04 and 0.30 ±0.03 vs. 0.38 ± 0.02, P 〈 0.05）, and P-Akt/Akt ratio （0.49 ± 0.10 and 0.48 ± 0.06 vs. 0.72 ± 0.07, P 〈 0.05） mark

关键词： Autophagy Diabetes Ischemia Preconditioning Ischemia-Reperfusion Injury

How to Initiate and Perform Simulation-based Airway Management Training More Effectively and Efficiently in China？

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Chinese Medical Journal 2016年第4期129卷 472-477页

作者： Dong Yang Xiao-Ming Deng Fu-Shan Xue Juan Zhi Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100144 China

INTRODUCTION While airway management is a fundamental skill set for many healthcare professionals, the difficult airway management has long been recognized as one of the most challenging tasks facing healthcare *** yet, failure to properly manage airway conditions remains a significant source of patients＆#39; morbidity and mortality.[1] To avoid or reduce medical errors and improve patient safety and outcomes, training for healthcare providers for airway management skills is essential.

关键词： Airway Management Training China Simulation

Cholinergic anti-inflammatory pathway： a possible approach to protect against myocardial ischemia reperfusion injury

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Chinese Medical Journal 2010年第19期123卷 2720-2726页

作者： XIONG Jun XUE Fu-shan YUAN Yu-jing WANG Qiang LIAO Xu WANG Wei-li Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China

Objective A general review was made of studies involving：（1） the concept and mechanism of the cholinergic anti-inflammatory pathway （CAP）, （2） the important role of inflammatory response in myocardial ischemia reperfusion （I/R） injury and （3） the evidence and mechanisms by which CAP may provide protection against myocardial I/R injury. Data sources The data used in this review were mainly from manuscripts listed in PubMed that were published in English from 1987 to 2009. The search terms were ＂vagal nerve stimulation＂, ＂myocardial ischemia reperfusion injury＂, ＂nicotine acetylcholine receptor＂ and ＂inflammation＂. Study selection （1） Clinical and experimental evidence that the inflammatory response induced by reperfusion enhances myocardial I/R injury. （2） Clinical and laboratory evidence that the CAP inhibits the inflammation and provides protection against myocardial I/R injury. Results The myocardial I/R injury is really an inflammatory process characterized by recruitment of neutrophils into the ischemic myocardium and excessive production of pro-inflammatory cytokines. Because the CAP can modulate the inflammatory response by decreasing the production and release of pro-inflammatory cytokines, it can provide protection against myocardial I/R injury. Conclusions The CAP can inhibit the inflammatory response induced by reperfusion and protect against myocardial I/R injury. It represents an exciting opportunity to develop new and novel therapeutics to attenuate the myocardial I/R injury.

关键词： vagal nerve stimulation myocardial ischemia reperfusion injury nicotine acetylcholine receptor cytokines inflammation

Feasibility Analysis of Oxygen-Glucose Deprivation-Nutrition Resumption on H9c2 Cells In vitro Models of Myocardial Ischemia-Reperfusion Injury

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Chinese Medical Journal 2018年第19期131卷 2277-2286页

作者： Gui-Zhen Yang Fu-Shan Xue Ya-Yang Liu Hui-Xian Li Qing Liu Xu Liao Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China

Background： Oxygen-glucose deprivation-nutrition resumption （OGD-NR） models on H9c2 cells are commonly used in vitro models of simulated myocardial ischemia-reperfusion injury （M1RI）, but no study has assessed whether these methods for establishing in vitro models can effectively imitate the characteristics of MIRI in vivo. This experiment was designed to analyze the feasibility of six OGD-NR models of MIRI. Methods： By searching the PubMed database using the keywords ＂myocardial reperfusion injury H9c2 cells,＂ we obtained six commonly used OGD-NR in vitro models of MIRI performed on H9c2 cells from more than 400 published papers before January 30, 2017. For each model, control （C）, simulated ischemia （SI）, and simulated ischemia-reperfusion （SIR） groups were assigned, and cell morphology, lactate dehydrogenase （LDH） release, adenosine triphosphate （ATP） levels, reactive oxygen species （ROS）, mitochondrial membrane potential （MMP）, and inflammatory cytokines were examined to evaluate the characteristics of cell injury. Subsequently, a coculture system of cardiomyocyte-endothelial-macrophage was constructed. The coeulture system was dealt with SI and SIR treatments to test the effect on cardiomyocytes survival. Results： For models l, 2, 3, 4, 5, and 6, SI treatment caused morphological damage to cells, and subsequent SIR treatment did not cause further morphological damage. In the models 1, 2, 3, 4, 5 and 6, LDH release was significantly higher in the SI groups than that in the C group （P 〈 0.05）, and was significantly lower in the SIR groups than that in the SI groups （P 〈 0.05）, except tbr no significant differences in the LDH release between C, SI and SIR groups in model 6 receiving a 3-h SI treatment. In models 1, 2, 3, 4, 5, and 6, compared with the C group, ATP levels of the S1 groups significantly decreased （P 〈 0.05）, ROS levels increased （P 〈 0.05）, and MMP levels decreased （P 〈 0.05）. Compared with the SI group, ATP level of the SIR groups was significantly

关键词： Feasibility In vitro Models Myocardial Ischemia-Reperfusion Injury

Comparative study of hemodynamic responses to orotra- cheal intubation with intubating laryngeal mask airway and direct laryngoscope

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Chinese Medical Journal 2006年第11期119卷 899-904页

作者： ZHANG Guo-hua XUE Fu-shan SUN Hai-yan LI Cheng-wen SUN Hai-tao LI Ping LIU Kun-peng Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100041 China

Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.

关键词： intubating laryngeal mask airway general anesthesia orotracheal intubation hemodynamic responses

Median effective dose of remifentanil for awake laryngoscopy and intubation

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Chinese Medical Journal 2009年第13期122卷 1507-1512页

作者： XU Ya-chao XUE Fu-shan LUO Mao-ping YANG Quan-yong LIAO Xu LIU Yi ZHANG Yan-ming Department of anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China

Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose （ED50） of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon＇s up-and-down method. Patient＇s reaction score at laryngoscopy and an Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED50 of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon＇s up-and-down method. In the patients who were scored as ＂accept＂, patient＇s OAA/S and reactJon scores at dJfferent observed points, JntubatJng conditJon score and patient＇s tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon＇s up-and-down method was （0.62±0.02） μg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg （95% CI, 0.54-0.70） and 0.83 μg/kg （95% CI, 0.73-2.59）, respectively. Nineteen patients who were scored as ＂accept＂ had an OAA/S of 〉15 and tolerated well laryngoscopy without significant di

关键词： laryngoscopy awake intubation remifentanil median effective dose sedation and analgesia

Delayed endotracheal tube obstruction by mucus plug in a child

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Chinese Medical Journal 2009年第7期122卷 870-872页

作者： XUE Fu-shan LUO Mao-ping LIAO Xu LIU Jian-hua ZHANG Yan-ming Department of anesthesiology Plastic Surgery Hospital ChineseAcademy of Medical Sciences & Peking Union Medical CollegeBeijing 100144 China

Endotracheai intubation is a common technique of airway control for surgical procedures requiring general anesthesia. Untortunately, hawng an endotracheal tube （ETT） in place does not guarantee a patent airway and the ETT itself may become a source of airway obstruction. We reported a pediatric case of delayed ETT obstruction due to mucus plug.

关键词： airway management endotracheal tube obstruction mucoid impaction general anesthesia children