BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia,which can lead to potentially dangerous complications.In this meta-analysis,we evaluated the efficacy and safe...BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia,which can lead to potentially dangerous complications.In this meta-analysis,we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.METHODS PubMed,Embase,Cochrane,and Web of Science were searched for randomized controlled trials(RCTs)that compared intracuff alkalinized lidocaine to placebo.We used risk-of-bias assessment to assess the RCTs,and the quality of evidence was assessed using the grading of recommendations,assessment,development,and evaluations.RESULTS Twelve randomized trials(1175 patients)were analyzed.Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo[risk ratio(RR):0.38;95%confidence interval(CI):0.23-0.63].Similarly,intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h(RR:0.19;95%CI:0.09-0.41)and postoperative hoarseness(RR:0.38;95%CI:0.21-0.69).CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications,such as coughing,hoarseness,and sore throat.展开更多
目的 探讨喉罩（LMA）合理的套囊充气容量.方法 择期手术30例置入4号一次性喉罩,测量套囊充气容量范围为0～30 ml（每5 ml递增）的套囊内压（ICP）和口咽漏气压（OLP）;并测量ICP为60 cm H2O时的OLP和套囊充气容量;记录ICP为60 cm H2O...目的 探讨喉罩（LMA）合理的套囊充气容量.方法 择期手术30例置入4号一次性喉罩,测量套囊充气容量范围为0～30 ml（每5 ml递增）的套囊内压（ICP）和口咽漏气压（OLP）;并测量ICP为60 cm H2O时的OLP和套囊充气容量;记录ICP为60 cm H2O时正压通气苏醒后的咽痛发生率.结果 5～15 ml的套囊充气容量可满足正压通气需要.充气超过15 ml时,ICP明显增加,而OLP改变不明显.ICP为60 cm H2O时OLP为（25.3±3.1）cm H2O、套囊充气容量为（10.7±2.2）ml,术后咽痛发生率为13.3%.结论 4号喉罩合理的套囊充气容量为5～15 ml.展开更多
目的评价不同头颈位对LMA-SupremeTM(SLMA)间歇正压通气时口咽漏气压(OLP)的影响。方法妇科全麻手术患者60例,麻醉诱导后插入SLMA行间歇正压通气,设定喉罩气囊压(ICP)为60 cm H2O。喉罩插入即刻,机械通气后60 min分别测量正中位、前屈...目的评价不同头颈位对LMA-SupremeTM(SLMA)间歇正压通气时口咽漏气压(OLP)的影响。方法妇科全麻手术患者60例,麻醉诱导后插入SLMA行间歇正压通气,设定喉罩气囊压(ICP)为60 cm H2O。喉罩插入即刻,机械通气后60 min分别测量正中位、前屈位、旋转位、后仰位四个头颈位时的OLP和ICP。统计各头颈位正压通气时漏气率。分别在四个头颈位通过引流管插入润滑后的胃管,记录胃管插入成功率并经通气导管插入纤维支气管镜(FOB),采用FOB分级法评价喉罩解剖位置。结果喉罩置入即刻和机械通气后60 min的OLP,前屈位>正中位>后仰位,旋转位与正中位比较无明显差异(P<0.05)。ICP在前屈位大于正中位,后仰位小于正中位,旋转位与正中位比较无明显差异。各种头颈位下患者喉罩解剖位置FOB分级无差异;前屈位时胃管插入成功率低于其他头颈位。结论头前屈位可改善SLMA气道密闭性,适度前屈患者头部是改善SLMA正压通气效果的有效方法。相对于正中位,旋转位不影响SLMA通气效果,而后仰位降低SLMA气道密闭性。展开更多
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 t...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.展开更多
Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow stat...Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow states is still controversy. The aim of this study is to test the possibility of using LMA in pediatric closed circuit controlled ventilation, and to find out the optimum cuff volume to perform closed system ventilation. Methods： Twenty children scheduled for elective surgeries were enrolled in a crossover study. Laryngeal mask airway was used. In stage I, the cuff was inflated with the maximum volume of air as rec- ommended by the manufacturers. Adjustment of volume of air inflated into the LMA cuff to the minimum volume to obtain the effective seal was done at stage II. The leak pressure, intracuff pressure and the leak volume were measured in both stages. Results： The cuff filling volume was significantly lower compared to the maximum cuff inflation volume in stage I. Leakage values showed significantly less values in stage II of the study with smaller cuff inflation volumes. The airway leakage pressure was significantly lower in stage fl in comparison to stage I. Cuff inflation pressure in stage I showed marked elevation which dropped significantly after adjustment of cuff volume in stage I1. Conclusion： Laryngeal mask airway is an effective tool to provide closed circuit controlled ventilation in pediatrics. Inflation of the cuff by the minimum volume of air needed to reach the just sealing pressure is suggested to minimize the leakage volume.展开更多
文摘BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia,which can lead to potentially dangerous complications.In this meta-analysis,we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.METHODS PubMed,Embase,Cochrane,and Web of Science were searched for randomized controlled trials(RCTs)that compared intracuff alkalinized lidocaine to placebo.We used risk-of-bias assessment to assess the RCTs,and the quality of evidence was assessed using the grading of recommendations,assessment,development,and evaluations.RESULTS Twelve randomized trials(1175 patients)were analyzed.Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo[risk ratio(RR):0.38;95%confidence interval(CI):0.23-0.63].Similarly,intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h(RR:0.19;95%CI:0.09-0.41)and postoperative hoarseness(RR:0.38;95%CI:0.21-0.69).CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications,such as coughing,hoarseness,and sore throat.
文摘目的评价不同头颈位对LMA-SupremeTM(SLMA)间歇正压通气时口咽漏气压(OLP)的影响。方法妇科全麻手术患者60例,麻醉诱导后插入SLMA行间歇正压通气,设定喉罩气囊压(ICP)为60 cm H2O。喉罩插入即刻,机械通气后60 min分别测量正中位、前屈位、旋转位、后仰位四个头颈位时的OLP和ICP。统计各头颈位正压通气时漏气率。分别在四个头颈位通过引流管插入润滑后的胃管,记录胃管插入成功率并经通气导管插入纤维支气管镜(FOB),采用FOB分级法评价喉罩解剖位置。结果喉罩置入即刻和机械通气后60 min的OLP,前屈位>正中位>后仰位,旋转位与正中位比较无明显差异(P<0.05)。ICP在前屈位大于正中位,后仰位小于正中位,旋转位与正中位比较无明显差异。各种头颈位下患者喉罩解剖位置FOB分级无差异;前屈位时胃管插入成功率低于其他头颈位。结论头前屈位可改善SLMA气道密闭性,适度前屈患者头部是改善SLMA正压通气效果的有效方法。相对于正中位,旋转位不影响SLMA通气效果,而后仰位降低SLMA气道密闭性。
文摘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.
文摘Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow states is still controversy. The aim of this study is to test the possibility of using LMA in pediatric closed circuit controlled ventilation, and to find out the optimum cuff volume to perform closed system ventilation. Methods： Twenty children scheduled for elective surgeries were enrolled in a crossover study. Laryngeal mask airway was used. In stage I, the cuff was inflated with the maximum volume of air as rec- ommended by the manufacturers. Adjustment of volume of air inflated into the LMA cuff to the minimum volume to obtain the effective seal was done at stage II. The leak pressure, intracuff pressure and the leak volume were measured in both stages. Results： The cuff filling volume was significantly lower compared to the maximum cuff inflation volume in stage I. Leakage values showed significantly less values in stage II of the study with smaller cuff inflation volumes. The airway leakage pressure was significantly lower in stage fl in comparison to stage I. Cuff inflation pressure in stage I showed marked elevation which dropped significantly after adjustment of cuff volume in stage I1. Conclusion： Laryngeal mask airway is an effective tool to provide closed circuit controlled ventilation in pediatrics. Inflation of the cuff by the minimum volume of air needed to reach the just sealing pressure is suggested to minimize the leakage volume.
