BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not a...BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.展开更多
BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factor...BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw diffi culties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients(92.2%), and appropriate drugs were not used for RSII in 73 patients(52.1%), equipments for diffi cult intubation in 21(15%), suction machines with catheter not connected and turned on in 122(87.1%), ventilation for patients after induction and before intubation in 41(29.3%), cricoid pressure released before cuff inflation in 12(12.1%), and difficult intubation in 8(5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94(67.1%) patients, but cricoid pressure was not used in 46(32.9%) patients.CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.展开更多
BACKGROUND:Atrial fibrilation(AF) is the most common complication following heart surgeries;it often occurs in patients after coronary artery bypass graft(CABG).The purpose of this review is to categorize prophylaxes ...BACKGROUND:Atrial fibrilation(AF) is the most common complication following heart surgeries;it often occurs in patients after coronary artery bypass graft(CABG).The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG.DATA RESOURCES:We searched google scholar,pubmed,and Cochrane Library databases(the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery.A total of 1 561 articles were identified,and 30 articles met the criteria and were enrolled in this review.RESULTS:Most studies supported Amiodarone for prophylaxi purpose in patients who were performed with CABG;few papers supported Amiodaron as a drug for treating CABG.The prophylaxis can decrease the incidence rate of AF in CABG,but if it uses as a treatment,the side effect of Amiodaron will decrease because all of the patients will not get Amiodarone.In the other hand use of Amiodarone as a treatment does not influence the length of hospital stay significantly but these kinds of study are so few.CONCLUSION:No appropriate therapeutic method has been defined for AF.At present,the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.展开更多
文摘BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.
文摘BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw diffi culties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients(92.2%), and appropriate drugs were not used for RSII in 73 patients(52.1%), equipments for diffi cult intubation in 21(15%), suction machines with catheter not connected and turned on in 122(87.1%), ventilation for patients after induction and before intubation in 41(29.3%), cricoid pressure released before cuff inflation in 12(12.1%), and difficult intubation in 8(5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94(67.1%) patients, but cricoid pressure was not used in 46(32.9%) patients.CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.
文摘BACKGROUND:Atrial fibrilation(AF) is the most common complication following heart surgeries;it often occurs in patients after coronary artery bypass graft(CABG).The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG.DATA RESOURCES:We searched google scholar,pubmed,and Cochrane Library databases(the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery.A total of 1 561 articles were identified,and 30 articles met the criteria and were enrolled in this review.RESULTS:Most studies supported Amiodarone for prophylaxi purpose in patients who were performed with CABG;few papers supported Amiodaron as a drug for treating CABG.The prophylaxis can decrease the incidence rate of AF in CABG,but if it uses as a treatment,the side effect of Amiodaron will decrease because all of the patients will not get Amiodarone.In the other hand use of Amiodarone as a treatment does not influence the length of hospital stay significantly but these kinds of study are so few.CONCLUSION:No appropriate therapeutic method has been defined for AF.At present,the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.
