Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an ar...Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.展开更多
BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practi...BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.展开更多
Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,thr...Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,throat,and trachea and other diseases or other conditions,if the exposure of the glottic area is not ideal,there are difficult airways.For difficult airways,this visual intubation tool has great limitations.Studying the new guidance method of endotracheal intubation and providing a reference or solution for difficult airway intubation is a crucial problem in the biomedical clinical field.In this paper,an endotracheal intubation method is proposed based on end-tidal carbon dioxide(ETCO_(2))perception.The simulation model verifies the feasibility of this method for endotracheal intubation guidance.Then,four micro-cavity tubes are used as a gas collection tube,and a set of endotracheal tube guidance systems based on ETCO_(2) perception is designed and developed to collect and process the CO_(2) concentration information in the pharyngeal cavity.The experimental results show that this guidance system can be used for intubation guidance in the simulated pharyngeal cavity without vision.展开更多
Cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and r...Cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and respiratory issues.[2]Recommendations emphasize the expertise of responders in airway management.[3]Various options exist,such as chest compression-only cardiopulmonary resuscitation(CPR),bag-mask ventilation(BMV),and advanced airways.The BMV and advanced airways are not deemed equivalent or superior based on previous evidence.[4]Achieving consistency in choosing and timing the optimal airway approach during IHCA is crucial.The current American Heart Association guidelines suggest an advanced airway strategy when endotracheal intubation(ETI)success rates are high,but the optimal time for advanced airway management remains unclear.[5]Wong et al[6]revealed that survival improved by less than 5 min with advanced airway management.According to a subgroup analysis of IHCA patients in emergency departments(EDs),early intubation was associated with a 1.5-fold greater rate of return of spontaneous circulation(ROSC)than in other locations.[7]ED patients’constant monitoring and immediate management,with readily available intubation equipment,enhance early intubation and survival rates.[6]Nonetheless,IHCA patients intubated within the first 15 min had a lower ROSC rate.展开更多
AIM:To demonstrate the outcomes of translacrimal canalicular drainage using a lacrimal probe and intranasal drainage by D-silicone intubation for acute dacryocystitis(AD).METHODS:This retrospective study included 23 p...AIM:To demonstrate the outcomes of translacrimal canalicular drainage using a lacrimal probe and intranasal drainage by D-silicone intubation for acute dacryocystitis(AD).METHODS:This retrospective study included 23 patients with AD and had undergone abscess decompression with the use of lacrimal probe and intranasal drainage by D-silicone intubation between January 2019 and December 2022.Patients received abscess decompression and systemic antibiotic-corticosteroid from the time of diagnosis.D-silicone tube was inserted within 10d after diagnosis and removed 3-6mo after intubation.The procedure and outcomes of this method were evaluated.RESULTS:All patients showed improvement of signs and symptoms of AD within 72h.No intraoperative and postoperative complications were observed.No recurrence of lacrimal sac abscesses occurred after D-silicone tube removed.CONCLUSION:Lacrimal probe and D-silicone intubation appear to be a feasible,minimally invasive,safe,and effective method,which could be a reasonable choice in the treatment of AD.展开更多
In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications ...In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications for emergency airway management,level of education,the intubating department,the intubation method,and other factors that can serve as a basis for quality improvement changes.展开更多
Dear Editor,We read with interest the article by Han et al[1]in which they retrospectively assessed the effect of bicanalicular intubation for functional epiphora after a failed endoscopic dacryocystorhinostomy(DCR).T...Dear Editor,We read with interest the article by Han et al[1]in which they retrospectively assessed the effect of bicanalicular intubation for functional epiphora after a failed endoscopic dacryocystorhinostomy(DCR).They confirmed the post-DCR“functional obstruction”based on fluorescein dye disappearance(FDDT)and irrigation test[1].展开更多
BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distres...BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.展开更多
Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eight...Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.展开更多
The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal wa...The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal was reported. The diagnosis of all 11 cases was confirmed by bariummeal roentgenography. After intubation, all the patients could take liquid or soft diet by mouth.There was no operative mortality and the patients survived 2 to 14 months (mean5.7 months). All of them could take food by mouth before death. The clinical application proved that the intubation has been a safe and suitable management.展开更多
The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for diffi...The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.展开更多
AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patie...AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.展开更多
Tracheal intubation with Macintosh laryngoscope（MAC） might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of ...Tracheal intubation with Macintosh laryngoscope（MAC） might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output（COP） and hemodynamic responses in normal blood pressure（n=60） and hypertensive patients（n=60） among 3 intubation devices： the MAC, the UE videolaryngoscopy ？（UE）, and the UE video intubation stylet ？（VS）. Cardiac index（CI）, stroke volume index（SVI）, heart rate（HR）, systolic blood pressure（SBP） and diastolic blood pressure（DBP） were recorded using Lidco Rapid V2？ preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups（P〈0.001） only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher（P〈0.05 or 〈0.01） than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.展开更多
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 revi...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.展开更多
AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomi...AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.展开更多
Coronavirus Disease 2019(COVID-19),caused by a novel coronavirus(SARS-Co V-2),is a highly contagious disease.It firstly appeared in Wuhan,Hubei province of China in December 2019.During the next two months,it moved ra...Coronavirus Disease 2019(COVID-19),caused by a novel coronavirus(SARS-Co V-2),is a highly contagious disease.It firstly appeared in Wuhan,Hubei province of China in December 2019.During the next two months,it moved rapidly throughout China.Most of the infected patients have mild symptoms including fever,fatigue and cough,but in severe cases,patients can progress rapidly and develop into acute respiratory distress syndrome,septic shock,metabolic acidosis and coagulopathy.The new coronavirus was reported to spread via droplets,contact and natural aerosols from human to human.Therefore,aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections.In fact,SARSCo V-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan.The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation,by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians.During the airway management,enhanced droplet/airborne personal protective equitment(PPE)should be applied to the health care providers.A good airway assessment before airway intervention is of vital importance.For patients with normal airway,awake intubation should be avoided,and modified rapid sequence induction is strongly recommended.Sufficient muscle relaxant should be assured before intubation.For patients with difficult airway,good preparation of airway devices and detailed intubation plans should be made.展开更多
AIM:To investigate the efficacy of cap-fitted colonoscopy(CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University Col...AIM:To investigate the efficacy of cap-fitted colonoscopy(CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010.Colonoscopies were conducted by a single endoscopist.Patient characteristics including age,sex,body mass index,history of abdominal surgery,quality of preparation,and the presence of diverticulosis were recorded.RESULTS:One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC(NCF) group.Cecal intubations were achieved in all patients.Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions:age ≥ 60 years,prior abdominal surgery,and poor bowel preparation.The number of detected adenomas was higher in the CFC group than in the NCF group(P = 0.040).CONCLUSION:CFC facilitated shortening of the cecal intubation time in difficult cases,and was more sensitive for detecting adenomas than was NCF.展开更多
Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face an...Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.展开更多
BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses...BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for diffi cult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41(26.8%), 50(32.7%), 51(33.3%), 38(24.8%) and 25(16.3%) patients respectively. Cricoid pressure was not applied at all for 17(11.1%) patients and 53(34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55(35.9%) patients desaturated during RSII(SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6(3.9%), 7(4.6%), 5(3.3%), 10(6.5%), 13(8.5%) and 14(9.2%) patients respectively.CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.展开更多
AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital naso...AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS： Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation（P =0.00）.In addition,Monoka intubation had better outcomes compared to Masterka technique（P =0.046）.No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION： Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.展开更多
基金supported by the National Natural Science Foundation of China(Nos.52203046 and 82171219)Sichuan Science and Technology Program(No.2023NSFSC1944)+3 种基金West China Nursing Discipline Development Special Fund ProjectSichuan University(No.HXHL21007)the China Postdoctoral Science Foundation(No.2023M742483)the National Natural Science Foundation of Guangdong(No.2024A1515012881)。
文摘Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.
基金National Natural Science Foundation of China(U24A20714 to XMF and 82102238 to PC)。
文摘BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.
基金the Science and Technology Commission of Shanghai Municipality(No.18441904600)the Cross Research Fund for Translational Medicine of Shanghai Jiao Tong University(No.ZH2018ZDA14)。
文摘Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,throat,and trachea and other diseases or other conditions,if the exposure of the glottic area is not ideal,there are difficult airways.For difficult airways,this visual intubation tool has great limitations.Studying the new guidance method of endotracheal intubation and providing a reference or solution for difficult airway intubation is a crucial problem in the biomedical clinical field.In this paper,an endotracheal intubation method is proposed based on end-tidal carbon dioxide(ETCO_(2))perception.The simulation model verifies the feasibility of this method for endotracheal intubation guidance.Then,four micro-cavity tubes are used as a gas collection tube,and a set of endotracheal tube guidance systems based on ETCO_(2) perception is designed and developed to collect and process the CO_(2) concentration information in the pharyngeal cavity.The experimental results show that this guidance system can be used for intubation guidance in the simulated pharyngeal cavity without vision.
基金granted by the Faculty of Medicine,Chiang Mai University(Grant No.MC017-65)supported by the National Center for Advancing Translational Sciences,National Institutes of Health,through grant number UL1 TR001860(to WW).
文摘Cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and respiratory issues.[2]Recommendations emphasize the expertise of responders in airway management.[3]Various options exist,such as chest compression-only cardiopulmonary resuscitation(CPR),bag-mask ventilation(BMV),and advanced airways.The BMV and advanced airways are not deemed equivalent or superior based on previous evidence.[4]Achieving consistency in choosing and timing the optimal airway approach during IHCA is crucial.The current American Heart Association guidelines suggest an advanced airway strategy when endotracheal intubation(ETI)success rates are high,but the optimal time for advanced airway management remains unclear.[5]Wong et al[6]revealed that survival improved by less than 5 min with advanced airway management.According to a subgroup analysis of IHCA patients in emergency departments(EDs),early intubation was associated with a 1.5-fold greater rate of return of spontaneous circulation(ROSC)than in other locations.[7]ED patients’constant monitoring and immediate management,with readily available intubation equipment,enhance early intubation and survival rates.[6]Nonetheless,IHCA patients intubated within the first 15 min had a lower ROSC rate.
基金Supported by Natural Science Foundation of Zhejiang Province(No.LQ18E020002)Traditional Chinese Medicine of Zhejiang Provincial Scientific Research Foundation(No.2020ZA005).
文摘AIM:To demonstrate the outcomes of translacrimal canalicular drainage using a lacrimal probe and intranasal drainage by D-silicone intubation for acute dacryocystitis(AD).METHODS:This retrospective study included 23 patients with AD and had undergone abscess decompression with the use of lacrimal probe and intranasal drainage by D-silicone intubation between January 2019 and December 2022.Patients received abscess decompression and systemic antibiotic-corticosteroid from the time of diagnosis.D-silicone tube was inserted within 10d after diagnosis and removed 3-6mo after intubation.The procedure and outcomes of this method were evaluated.RESULTS:All patients showed improvement of signs and symptoms of AD within 72h.No intraoperative and postoperative complications were observed.No recurrence of lacrimal sac abscesses occurred after D-silicone tube removed.CONCLUSION:Lacrimal probe and D-silicone intubation appear to be a feasible,minimally invasive,safe,and effective method,which could be a reasonable choice in the treatment of AD.
文摘In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications for emergency airway management,level of education,the intubating department,the intubation method,and other factors that can serve as a basis for quality improvement changes.
文摘Dear Editor,We read with interest the article by Han et al[1]in which they retrospectively assessed the effect of bicanalicular intubation for functional epiphora after a failed endoscopic dacryocystorhinostomy(DCR).They confirmed the post-DCR“functional obstruction”based on fluorescein dye disappearance(FDDT)and irrigation test[1].
文摘BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.
基金Research Project of the Xi’an Municipal Health Commission(No.2023yb40,Project leader:Duan Chunyu)。
文摘Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.
文摘The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal was reported. The diagnosis of all 11 cases was confirmed by bariummeal roentgenography. After intubation, all the patients could take liquid or soft diet by mouth.There was no operative mortality and the patients survived 2 to 14 months (mean5.7 months). All of them could take food by mouth before death. The clinical application proved that the intubation has been a safe and suitable management.
文摘The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.
文摘AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.
文摘Tracheal intubation with Macintosh laryngoscope（MAC） might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output（COP） and hemodynamic responses in normal blood pressure（n=60） and hypertensive patients（n=60） among 3 intubation devices： the MAC, the UE videolaryngoscopy ？（UE）, and the UE video intubation stylet ？（VS）. Cardiac index（CI）, stroke volume index（SVI）, heart rate（HR）, systolic blood pressure（SBP） and diastolic blood pressure（DBP） were recorded using Lidco Rapid V2？ preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups（P〈0.001） only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher（P〈0.05 or 〈0.01） than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.
文摘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.
文摘AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.
文摘Coronavirus Disease 2019(COVID-19),caused by a novel coronavirus(SARS-Co V-2),is a highly contagious disease.It firstly appeared in Wuhan,Hubei province of China in December 2019.During the next two months,it moved rapidly throughout China.Most of the infected patients have mild symptoms including fever,fatigue and cough,but in severe cases,patients can progress rapidly and develop into acute respiratory distress syndrome,septic shock,metabolic acidosis and coagulopathy.The new coronavirus was reported to spread via droplets,contact and natural aerosols from human to human.Therefore,aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections.In fact,SARSCo V-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan.The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation,by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians.During the airway management,enhanced droplet/airborne personal protective equitment(PPE)should be applied to the health care providers.A good airway assessment before airway intervention is of vital importance.For patients with normal airway,awake intubation should be avoided,and modified rapid sequence induction is strongly recommended.Sufficient muscle relaxant should be assured before intubation.For patients with difficult airway,good preparation of airway devices and detailed intubation plans should be made.
文摘AIM:To investigate the efficacy of cap-fitted colonoscopy(CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010.Colonoscopies were conducted by a single endoscopist.Patient characteristics including age,sex,body mass index,history of abdominal surgery,quality of preparation,and the presence of diverticulosis were recorded.RESULTS:One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC(NCF) group.Cecal intubations were achieved in all patients.Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions:age ≥ 60 years,prior abdominal surgery,and poor bowel preparation.The number of detected adenomas was higher in the CFC group than in the NCF group(P = 0.040).CONCLUSION:CFC facilitated shortening of the cecal intubation time in difficult cases,and was more sensitive for detecting adenomas than was NCF.
文摘Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.
文摘BACKGROUND: Rapid sequence induction and intubation(RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for diffi cult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41(26.8%), 50(32.7%), 51(33.3%), 38(24.8%) and 25(16.3%) patients respectively. Cricoid pressure was not applied at all for 17(11.1%) patients and 53(34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55(35.9%) patients desaturated during RSII(SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6(3.9%), 7(4.6%), 5(3.3%), 10(6.5%), 13(8.5%) and 14(9.2%) patients respectively.CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.
文摘AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS： Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation（P =0.00）.In addition,Monoka intubation had better outcomes compared to Masterka technique（P =0.046）.No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION： Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.
