Name: topical airway anesthesia for awake-endoscopic intubation using the spray-as-you-go technique with high oxygen flow
Uploaded: 2017-01-13T14:00:00.000+00:00
Duration: 5 min 43 s
Description: Watch this Scientific Journal Video about Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow at JoVE.com

作者没有确认。

所有的程序是由国家莱茵兰 - 普法尔茨州的医学会伦理委员会的批准，并按照赫尔辛基宣言进行。 1.雾化器4 <ol><li>卸下包集。检查产物，以确保没有损坏。 注:该设备适用于一次性使用。请参考使用了约储存和供应的进一步信息的说明（参阅材料和设备表）。 </li></ol> 2.病人的一般制备<ol><li>辖术前用药， 如劳拉西泮1 - 2.5毫克晚上之前和/或2 - 4毫克1 -干预（同时注意禁忌）前2小时。 </li><li>建立监测参数，如脉搏血氧饱和度（SPO 2），心电图（ECG）和无创血压（血压）。 注:使用监测病人的镇静标准，如拉姆齐镇静评分和Bispect拉尔指数监测。镇静的水平，密切监测可以帮助防止潜在的并发症，如呼吸抑制。 </li><li>安全外围静脉通路。 </li></ol> 3.上气道表面麻醉<ol><li>适用的2％利多卡因1毫升混合物用去氧肾上腺素0.25％至每个鼻孔。 </li><li>直接两次应用利多卡因10％喷洒到口咽粘膜，从尖端喷射到所述舌的后部。让病人漱口在口中的利多卡因尽可能长的时间。 可以使用交替棉拭子或鼻咽气道，滴，露，沙沙和漱口，抽吸和喷涂局部麻醉下进行的声门上气道的麻醉:注意。 </li></ol> 4. Analgo镇静<ol><li> 60公斤;:使用IV药物， 如舒芬太尼初始丸（&lt;5微克60公斤&gt;:启动analgo镇静10微克;"100。KG:15微克）。 注:在为了防止窒息或气道收缩的最低水平可能剂量药物引起的镇静作用。 </li><li>举一个额外的舒芬太尼静脉推注， 例如 5微克，为"救市"的治疗，直到2拉姆齐镇静评分（合作，面向，宁静）的实现。 </li></ol> 5.设备准备<ol><li>组装和检查根据的制度规范灵活的气管插管内窥镜。 </li><li>连接雾化器直接在氧气流量计的氧气管。 警告！用湿化瓶氧气流量计不能使用。 </li><li>附加连接管以在Luer在内窥镜的工作通道。氧流量设定为10L /分钟，如在说明书推荐的。 </li><li>连接含有2％利多卡因溶液到三路侧臂接头1毫升注射器。 注:具有其良好的功效轮廓2％利多卡因是合适的美观。 </li></ol> 6.雾化技术<ol><li>关闭用手指流控开启。迅速注入药物。立即释放流量控制开启。 注:注射器必须连接到三路侧臂嵌合获得通过工作通道的连续低氧气流量。 </li><li>而在气道推进柔性内窥镜，使用喷雾器在以下站点注入局麻药:内鼻孔，在鼻孔后;会厌;声门;和声带。 </li><li>经常同时推进内窥镜（"喷雾为你去"），根据需要重复这些步骤。通过声带之前，等待2分钟，以允许在现场足够药物的效果。 注:监测患者加满油使用IV药物镇静镇静水平（ 如舒芬太尼5微克），根据需要。 </li></ol> 7.灵活的内镜插管<ol><li>推进endoscOPE仔细通过声门进入气管和位置内窥镜只是隆突上方的一角。铁路合适的大小，手铐和润滑灵活的气管在内窥镜管进入下旋转气管。 注:避免内窥镜末端的意外发展到一个主干支气管。 </li><li>确认气管内导管放置在气管刚好通过经由内窥镜视觉控制隆突以上。取出内窥镜，而使气管导管就位。 </li><li>确认通过在自主呼吸的病人使用二氧化碳监测测量呼气末CO 2的该管的气管内的位置。 </li><li>诱导全身麻醉， 如静脉内异丙酚2毫克/千克/体重。开始根据当前的标准通风患者。 </li></ol>注:脑啡肽雾化组目前不提供从库克医疗公司。

<ol>
	<li>Simmons, S. T., Schleich, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+regional+anaesthesia+for+awake+fibreoptic+intubation.">Airway regional anaesthesia for awake fibreoptic intubation.</a> Reg Anesth Pain Med. 27, 180-192 (2002).</li><li>Benumof, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+the+difficult+adult+airway.+With+special+emphasis+on+awake+tracheal+intubation.">Management of the difficult adult airway. With special emphasis on awake tracheal intubation.</a> Anesthesiology. 75, 1087-1110 (1991).</li><li>Piepho, T., Thierbach, A. R., G&#246;bler, S. M., Maybaur, M. O., Werner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+two+different+techniques+of+fiberoptic+intubation.">Comparison of two different techniques of fiberoptic intubation.</a> Eur J Anaesthesiol. 26, 328-332 (2009).</li><li>Pirlich, N., Lohse, J. A., Schmidtmann, I., Didion, N., Piepho, T., Noppens, R. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+the+atomizer+with+boluses+of+topical+anaesthesia+for+awake+fibreoptic+intubation.">A comparison of the atomizer with boluses of topical anaesthesia for awake fibreoptic intubation.</a> Anaesthesia. 71, 814-822 (2016).</li><li>Malcharek, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+Enk+Fibreoptic+Atomizer+with+translaryngeal+injection+for+topical+anaesthesia+for+awake+fibreoptic+intubation+in+patients+at+risk+of+secondary+cervical+injury:+a+randomised+controlled+trial.">Comparison of the Enk Fibreoptic Atomizer with translaryngeal injection for topical anaesthesia for awake fibreoptic intubation in patients at risk of secondary cervical injury: a randomised controlled trial.</a> Eur J Anaesthesiol. 32, 615-623 (2015).</li><li>Williams, K. A., Barker, G. L., Harwood, R. J., Woodall, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+nebulization+and+spray-as-you-go+topical+anaesthesia+of+the+airway.">Combined nebulization and spray-as-you-go topical anaesthesia of the airway.</a> Br J Anaesth. 95, 549-553 (2005).</li><li>O'Hare, D. O., Harwood, R., Woodall, N., Barker, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+of+administering+topical+anaesthesia+for+flexible+airway+endoscopy.">A method of administering topical anaesthesia for flexible airway endoscopy.</a> Anaesthesia. 55, 616 (2000).</li><li>Long, T. R., Wass, C. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+alternative+to+transtracheal+injection+for+fiberoptic+intubation+in+awake+patients:+A+novel+noninvasive+technique+using+a+standard+multiorifice+epidural+catheter+through+the+bronchoscope+suction+port.">An alternative to transtracheal injection for fiberoptic intubation in awake patients: A novel noninvasive technique using a standard multiorifice epidural catheter through the bronchoscope suction port.</a> Anaesthesiology. 101, 1253 (2004).</li><li>Xue, F. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spray-as-you-go+airway+topical+anesthesia+in+patients+with+a+difficult+airway:+a+randomized,+double-blind+comparison+of+2%+and+4%+lidocaine.">Spray-as-you-go airway topical anesthesia in patients with a difficult airway: a randomized, double-blind comparison of 2% and 4% lidocaine.</a> Anesth Analg. 108, 536-543 (2009).</li><li>Hershey, M. D., Hannenberg, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+distension+and+rupture+from+oxygen+insufflation+during+fiberoptic+intubation.">Gastric distension and rupture from oxygen insufflation during fiberoptic intubation.</a> Anesthesiology. 85, 1479-1480 (1996).</li><li>Ho, C. M., Yin, I. W., Tsou, K. F., Chow, L. H., Tsai, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+rupture+after+awake+fiberoptic+intubation+in+a+patient+with+laryngeal+carcinoma.">Gastric rupture after awake fiberoptic intubation in a patient with laryngeal carcinoma.</a> Br J Anaesth. 94, 856-858 (2005).</li><li>Chapman, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+rupture+and+pneumoperitoneum+caused+by+oxygen+insufflation+via+a+fibreoptic+bronchoscope.">Gastric rupture and pneumoperitoneum caused by oxygen insufflation via a fibreoptic bronchoscope.</a> Anesth Analg. 106, 1592 (2008).</li><li>Ovassapian, A., Mesnick, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oxygen+insufflation+through+the+fiberscope+to+assist+intubation+is+not+recommended.">Oxygen insufflation through the fiberscope to assist intubation is not recommended.</a> Anesthesiology. 87, 183 (1997).</li></ol>

作者什么都没有透露。 该脑啡肽雾化器集目前无法从库克医疗公司。根据本发明人（个人通讯）一个类似设备将在未来使用。

在这里，我们演示使用与清醒，气管插管胃镜高流量氧气雾化表面麻醉。第一项研究评估雾化技术，通过灵活的插管内窥镜5的工作通道的局部麻醉古典推注进行了比较。雾化器组中的患者评价其的舒适水平低于对照组更好的和有经验较少的咳嗽和鲜明咳嗽发作。此外，该雾化器技术是更快并且需要较少的局部麻醉。 当调查相比，雾化器，其使用低氧气流量，以translaryngeal注射清醒插管患者在颈椎损伤的危险，有在舒适性评价6方面的组间无差异。在高氧流量喷雾为你去技术是几个不同的喷雾，为你去高科技的一个变niques。 的所有喷雾作为你去的技术的主要优点是其灵活性，涉及选择性地且重复地麻醉气道，这使得这些技术对于大多数内窥镜插管一个合适的选择。 局部麻醉的经典推应用程序经常唤起患者的不适感。几个已作出努力以减少这种限制。例如，利用切割到柔性插管内窥镜的长度，并插入穿过工作通道硬膜外导管在文献7,8,9反复建议。本变形例的结果还没有得到证实，由于缺乏前瞻性，对照和随机研究。然而，硬膜外导管技术的一个限制是，有经验的操作是需要的成功操纵局部麻醉剂应用。此外，使用硬膜外导管局部麻醉的应用是不到原始泰德是昂贵和耗时的8,10。 喷雾如即付技术的另一个优点是其易于处理。局部麻醉剂的喷雾需要额外的设备（ 例如超声波雾化器）和附加的时间之前内窥镜插管。此外，喷雾为你去技术可以用于几乎每一个病人，而合患者和解剖学的知识和标志性建筑的身份进行气道神经阻滞时是基本要求。 动脉内注射，血肿形成和气管损伤，如皮下气肿都担心，由于执行块的侵袭性并发症，但所造成的喷雾为你去技术的并发症是罕见的。 通过插管内窥镜的工作通道使用恒定的氧流量（3至5升/分钟）的潜在的并发症包括胃胀气一ð脏器破裂11,12,13。气道结构难以可视化，长期的过程或意外食道插管过程中可能出现的并发症。如果插管内窥镜通过变窄声门传递和气管套管的通道，因为窄的气道的延迟肺气压伤在理论上是可能的。由于这些原因，一些作者不推荐通过插管内窥镜14的工作通道中施加氧气。在这两项研究调查雾化器5,6中观察到上述的并发症的无。这可以归因于该雾化器的流量控制孔，2毫米孔放置三通-侧臂嵌合的喷射口相对，这使得流量和压力释放，如果不执行喷射。假定没有连续的高氧气流量和压力在内窥镜的工作通道的远端，因为氧可以通过的F逸出低开的控制。仅在注射时，当它被关闭时，可能会在随后的气道结构是一个高的压力下。 有关于在内窥镜的远侧末端的压力没有数据给予氧气或局部麻醉剂的分布和穿透深度时工作通道，并在中，气道粘膜。这一点，还有机制，以高流量氧气雾化如何麻药，就值得研究。

气道的清醒插管的表面麻醉，一般建议，以改善患者的舒适度，这将有助于使该过程是成功的。的具有高的氧流量喷雾作为即付技术是发现患者中高水平接受一种简单和安全的概念。以10升/分钟的结果的流速局部麻醉剂的氧的咳嗽和咽反射的较少刺激雾化。 从几个病人负反馈面前，我们决定细化标准制度喷雾为你去技术。局部麻醉的这个经典的推应用程序由两次注射，每次5毫升2％利多卡因加5毫升空气中10毫升注射器，先入声带，然后，一个2分钟的等待时间后，进气管。患者抱怨由丸惊人的气道粘膜的飞溅被淹没的感觉。 喷雾为你去技术通常1世界范围内使用。该技术包括通过柔性插管内窥镜的工作通道中的局部麻醉应用程序，同时，通过上和下气道与插管的patient&#39;s气管的目标前进前端。有在实践中多种方法和的文献中的方法的几个描述。在与通过工作通道的恒定氧气流的应用组合喷雾作为你去-技术初步经验被刊登在1990年代2。这里的重点是氧气流量效果，如通过分散黏液分泌物和血液远离镜头和提升吸气氧气输送清洁镜头。在辅助的局部麻醉的雾化氧气流的优点是由Piepho和同事3前面所示。他们描述的汽化技术，其中3L /分钟的氧气的供给导致由患者较少咳嗽。在假设一的10升/分钟将雾化本地代理成较细的颗粒，将唤起更少咳嗽流，我们成功地测试了雾化器在这个较高的花率。雾化器包括一小体积，耐扭结的，灵活的，压力认证氧气管和连接管组成。这些被连接到具有小流控制开口三通体侧嵌合。 雾化器技术可以用于所有气道的情形。然而，该设备应该使用从引起诸如肿瘤块条件较高等级的气道狭窄谨慎远端。缺氧回流的可能会导致增加气道压力，并增加气压伤的风险。此外，雾化器是在紧急情况下设置一个有用的工具。该集的编写需要不到一分钟，用户无需特殊培训。在下文中，我们提出详细的操作说明对于高流量氧气喷雾为你去的技术，说明分离工作步骤。

<table><tbody><tr><td>Lidocaine 10% pump spray&amp;nbsp;</td><td>&lt;em&gt;e.g.&lt;/em&gt; AstraZeneca</td><td></td><td></td></tr><tr><td>Opiod for i.v. administration</td><td></td><td></td><td>Any opiod can be used. We prefer either Sufentanil or Fentanyl</td></tr><tr><td>Enk Fiberoptic Atomizer Set&amp;nbsp;</td><td>Cook Medical</td><td>C-EFNS-100</td><td>The Enk Atomizer set is currently not available from Cook Medical</td></tr><tr><td>Lidocaine 2%&amp;nbsp;</td><td>&lt;em&gt;e.g.&lt;/em&gt; AstraZeneca</td><td></td><td></td></tr><tr><td>Intubation endoscope</td><td>&lt;em&gt;e.g.&lt;/em&gt; Karl Storz Endoscope</td><td></td><td>We prefer a fibrescope with an outer diamter of 5 mm and a working channel with a diamter of 2 mm&amp;nbsp;</td></tr><tr><td>Endotracheal tube</td><td>&lt;em&gt;e.g.&lt;/em&gt; R&amp;uuml;sch</td><td></td><td>Size of the endotracheal tube needs to be adjusted to the patient. We prefer a ID 6.5 mm for nasal approach and ID 7.0 mm for oral approach</td></tr><tr><td>Anesthetic drug, &lt;em&gt;e.g.&lt;/em&gt; Propofol 1%</td><td>&lt;em&gt;e.g.&lt;/em&gt; AstraZeneca</td><td></td><td></td></tr></tbody></table>

topical airway anesthesia for awake-endoscopic intubation using the spray-as-you-go technique with high oxygen flow

病人的合作意愿是气管成功清醒插管的绝对前提。虽然患者的药物镇静可能危及他们的自主呼吸，气道表面麻醉是一种流行的技术。喷雾为你去技术代表的麻醉气道黏膜最简单的机会之一。局部麻醉剂的通过柔性内窥镜的工作通道中的应用为麻醉师以及肺病一种普遍的做法。有既不需要额外的设备，也没有特殊的训练作为前提来执行该技术。然而，一个已知的临床问题是当液体麻醉撞击气道粘膜和其他敏感结构如声带可能发生的咳嗽和作呕反射。这可以通过使用氧气通过工作通道与灰雾的局部麻醉剂成为更微细颗粒的目的应用来避免。此外，氧气流量提供了更高的氧气供应，并有助于更好的视野，分散粘液分泌物和血液远离镜头。使用具有10L /分钟我们最大化这些好处高氧流量雾化器，造成少咳嗽和有更满意，因此合作的患者。用氧流量，包括胃胀气，脏器破裂或气压伤没有出现的可能，但非常罕见的并发症。我们归因于无并发症使用高氧流量的设定的，它允许流量和压力释放的设计。

<html>我们使用的呈现表面麻醉技术，48例患者进行清醒灵活内镜插管。我们成功地插管所有患者除一人外，谁从咽的狭窄性肿瘤，这使得它不可能推进管遭遇。 中清醒插管舒适的品质是通过使用11点视觉模拟评分法（VAS），从0 =不难闻到10 =无法忍受的患者，麻醉师和护士评价。雾化器技术会见了广泛的认可和舒适度的评价表现出良好的性能。术后第一天，患者评价他们的舒适度中位（四分范围（IQR））VAS评分1（1 - 3）。麻醉师和护士评为技术作为VAS 2（1 - 4，1 - 3分别）。 55116fig1.jpg"/&gt; 图 1: 在术后第一天接受内镜清醒气管插管病人的舒适感和舒适由麻醉师和护士评价。 VAS 0 =不难闻，VAS 10 =无法忍受。符号，中位数;误差线，IQR。 <a href="http://ecsource.jove.com/files/ftp_upload/55116/55116fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/55116/55116fig2.jpg" /> 图2:中位数在对照组的咳嗽，用2×5毫升2％利多卡因的经典丸药应用几乎两倍。 咳嗽的发生率是清醒的插管的质量的替代量度。一个训练有素的研究护士，谁没有参与病人的治疗在任何时间，在操作过程中只收集到的数据，以避免报告偏倚。我们评估咳嗽当施加表面麻醉（协议包括利多卡因5次注射）。咳嗽期间插管的期间中位数为6（3 - 10）。 用于评估清醒插管的安全进一步标准是插管和局部麻醉剂的相对消耗，神经毒性所需要的时间。清醒插管的平均时间为5（3 - 6）分钟。这期间包括使用喷雾器施用局部麻醉剂所需的时间。雾化喷雾可以给予一个接一个（喷雾，当您去）。根据该雾化利多卡因更深地穿入气道粘膜并为此作用更快，该协议仅包括通过声带前一个2分钟的等待时间的假设。 <img alt="图1" src="/files/ftp_upload/55116/55116table1.jpg" /> 表1:从局部麻醉的气管内管的插入之后立即开始心肺指数的稳定性。数据是在基线和每分钟记录之后。数据显示，中位数和IQR。 <a href="http://ecsource.jove.com/files/ftp_upload/55116/55116table1large.jpg">请点击这里下载此文件。</a>

Watch this Scientific Journal Video about Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow at JoVE.com

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

The topical anesthetic lidocaine was atomized using a high oxygen flow through the working channel of a flexible intubating endoscope to achieve topical airway anesthesia for awake endotracheal intubation. We prefer this modified spray-as-you-go technique for endoscopic intubation to classical bolus application because of higher patient satisfaction and better compliance.

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

topical-airway-anesthesia-for-awake-endoscopic-intubation-using-spray

Nanyang Technological University

Research

JoVE Journal

Medicine

16.5K 次观看.  University Medical Center of the Johannes Gutenberg-University. The topical anesthetic lidocaine was atomized using a high oxygen flow through the working channel of a flexible intubating endoscope to achieve topical airway anesthesia for awake endotracheal intubation. We prefer this modified spray-as-you-go technique for endoscopic intubation to classical bolus application because of higher patient satisfaction and better compliance.

视频: Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

一个新型插管困难和困难通风救援技术

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

科研

医学

Guidelines for Elective Pediatric Fiberoptic Intubation

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small babies will desaturate very quickly if ventilation is interrupted mainly to high metabolic rate. We describe guidelines to perform a safe fiberoptic intubation while maintaining spontaneous breathing throughout the procedure. Steps requiring the use of propofol pump, fentanyl, glycopyrrolate, red rubber catheter, metal insuflation hook, afrin, lubricant and lidocaine spray are shown.

We describe guidelines to perform a safe and efficient elective fiberoptic intubation in pediatric patients while maintaining spontaneous ventilation.

选修儿科光纤插管指南

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are necessary for whole animal experiments that require surgery under deep anesthesia or measurements of lung function. Tracheostomy has been the standard for intubating the airway in these mice to allow mechanical ventilation. Orotracheal intubation has been reported but has not been successfully used in many studies because of the substantial technical difficulty or a requirement for highly specialized and expensive equipment. Here we report a technique of direct laryngoscopy using an otoscope fitted with a 2.0 mm speculum and using a 20 G&#160;intravenous catheter as an endotracheal tube. We have used this technique extensively and reliably to intubate and conduct accurate assessments of lung function in mice. This technique has proven safe, with essentially no animal loss in experienced hands. Moreover, this technique can be used for repeated studies of mice in chronic models.

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

We have developed a simple, reliable, and relatively inexpensive method for endotracheal intubation in mice via direct laryngoscopy using an otoscope with a 2.0 mm speculum. This technique is atraumatic and can be used for repeated measurements in chronic experiments. We find it superior to tracheostomy or previously reported nonsurgical techniques.

气管插管小鼠<em&gt;通过</em&gt;直接喉镜使用耳镜

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

An Improved Method for Rapid Intubation of the Trachea in Mice

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity is a commonly used model to study both acute lung injury and fibrosis, and multiple methods have been developed for administering bleomycin (and other toxic agents) into the lungs. However, many of these approaches, such as transtracheal instillation, have inherent drawbacks, including the need for strong anesthetics and survival surgery. This paper reports a quick, reproducible method of intratracheal intubation that involves mild inhaled anesthesia, visualization of the trachea, and the use of a surrogate spirometer to confirm exposure. As a proof of concept, 8-12 week old C57BL/6 mice were administered either 2.0 U/kg of bleomycin or an equivalent volume of PBS, and both damage and fibrotic endpoints were measured post-exposure. This procedure allows researchers to treat a large cohort of mice in a relatively short period with little expense and minimal post-procedure care.

This article presents a rapid and simple method for administering bleomycin directly into the mouse trachea via intubation. Key advantages of this method are that it is highly reproducible, easy to master, and does not require specialized equipment or lengthy recovery times.

在小鼠气管插管快速的改进方法

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in obstructive sleep apnea (OSA). Target-controlled infusion (TCI) of the sedative propofol was combined with real-time monitoring of the depth of sedation using bispectral analysis.
In an observational study 57 patients (mean age 44.8 years, &#177; SD 10.5; mean apnea hypopnea Index (AHI) 30.8/hr, &#177; SD 21.6, mean BMI 28.2 kg/m2, &#177; SD 5.3) underwent cardiorespiratory polysomnography followed by DISE with TCI and bispectral analysis. Sleep was induced solely by the intravenous infusion of propofol with a TCI-pump, with an initial target plasma level of 2.0 &#181;g/ml. Under continuous monitoring of the patient&#39;s respiration, state of consciousness and value of the bispectral analysis, the target plasma propofol level was raised in steps of 0.2 &#181;g/ml/2 min until the desired depth of sedation was reached. The mean value of the bispectral analysis at the target depth of sedation was determined and the obstruction patterns during DISE-TCI-bispectral analysis then classified according to the VOTE-system. Subsequently the results were analyzed according to polysomnographic and anthropometric data. The occurrence of multilevel obstruction sites across all degrees of severity of OSA clarifies the need for sleep endoscopy prior to upper airway surgery.
The advantage of this technique is the reproducibility of the protocol even for heterogeneous groups of patients. In addition, the gradual controlled and standardized increase of the plasma level of propofol with real-time control of the bispectral index leads to a precisely controllable depth of sedation. The DISE-TCI-bispectral analysis procedure is a step towards a required reproducible protocol of sleep endoscopy &#8212; capable of standardization. However it is not yet known whether these observed obstruction patterns also correspond to findings in natural sleep.

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

The aim of this study was to establish a standardized protocol for sleep endoscopy to differentiate obstruction patterns in obstructive sleep apnea (OSA). Target-controlled infusion (TCI) of the sedative was combined with real-time monitoring of the depth of sedation using bispectral analysis.

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in ...

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent need to find effective therapies. Preclinical studies have shown that inhaled halogenated agents may have beneficial effects in animal models of ARDS. The development of new devices to administer halogenated agents using modern intensive care unit (ICU) ventilators has significantly simplified the dispensing of halogenated agents to ICU patients. Because previous experimental and clinical research suggested potential benefits of halogenated volatiles, such as sevoflurane or isoflurane, for lung alveolar epithelial injury and inflammation, two pathophysiologic landmarks of diffuse alveolar damage during ARDS, we designed an animal model to understand the mechanisms of the effects of halogenated agents on lung injury and repair. After general anesthesia, tracheal intubation, and the initiation of mechanical ventilation, ARDS was induced in piglets via the intratracheal instillation of hydrochloric acid. Then, the piglets were sedated with inhaled sevoflurane or isoflurane using an ICU-type device, and the animals were ventilated with lung-protective mechanical ventilation during a 4 h period. During the study period, blood and alveolar samples were collected to evaluate arterial oxygenation, the permeability of the alveolar-capillary membrane, alveolar fluid clearance, and lung inflammation. Mechanical ventilation parameters were also collected throughout the experiment. Although this model induced a marked decrease in arterial oxygenation with altered alveolar-capillary permeability, it is reproducible and is characterized by a rapid onset, good stability over time, and no fatal complications.
We have developed a piglet model of acid aspiration that reproduces most of the physiological, biological, and pathological features of clinical ARDS, and it will be helpful to further our understanding of the potential lung-protective effects of halogenated agents delivered through devices used for inhaled ICU sedation.

We describe a model of hydrochloric acid-induced acute respiratory distress syndrome (ARDS) in piglets receiving sedation with halogenated agents, isoflurane and sevoflurane, through a device used for inhaled intensive care sedation. This model can be used to investigate the biological mechanisms of halogenated agents on lung injury and repair.

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Image Acquisition using Portable Sonography for Emergency Airway Management

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of patients, but also to address the potential benefits of employing ultrasound in airway management. The benefits of point of care ultrasound (POCUS) include its portability, the speed at which it can be utilized, and its lack of invasiveness or exposure of the patient to radiation of other imaging modalities.
Two primary indications for airway POCUS include confirmation of endotracheal intubation and identification of the cricothyroid membrane in the event a surgical airway is required. In this article, the technique of using ultrasound to confirm endotracheal intubation and the relevant anatomy is described, along with the associated ultrasonographic images. In addition, identification of the anatomy of the cricothyroid membrane and the ultrasonographic acquisition of appropriate images to perform this procedure are reviewed.
Future advances include utilizing airway POCUS to identify patient characteristics that might indicate difficult airway management. Traditional bedside clinical exams have, at best, fair predictive values. The addition of ultrasonographic airway assessment has the potential to improve this predictive accuracy. This article describes the use of POCUS for airway management, and initial evidence suggests that this has improved the diagnostic accuracy of predicting a difficult airway. Given that one of the limitations of airway POCUS is that it requires a skilled sonographer, and image analysis can be operator dependent, this paper will provide recommendations to standardize the technical aspects of airway ultrasonography and promote further research utilizing sonography in airway management. The goal of this protocol is to educate researchers and medical health professionals and to advance the research in the field of airway POCUS.

Point of care ultrasound (POCUS) is increasingly being utilized in airway management. Presented here are some clinical utilities of POCUS, including differentiating endotracheal and esophageal intubation, identification of the cricothyroid membrane in the event a surgical airway is required, and measuring anterior neck soft tissue to predict difficult airway management.

使用便携式超声采集图像进行紧急气道管理

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of ...

保留自主呼吸的视频辅助胸腔镜手术的非插管方案

Non-Intubated Video-Assisted Thoracoscopic Surgery

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the lung, and lobectomy. However, there is a high incidence of pulmonary complications arising from general anesthesia with tracheal intubation. Non-intubation with the preservation of voluntary breathing is an alternative to anesthesia. Non-intubation procedures minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and post-operative nausea and vomiting. However, the steps for non-intubation procedures are not detailed in many studies. Here, we present a concise non-intubated protocol for the performance of video-assisted thoracoscopic surgery with preserved autonomic breathing. This article identifies the conditions necessary to convert from non-intubated to intubated anesthesia and also discusses the advantages and limitations of non-intubated anesthesia. In this work, this intervention was performed on 58 patients. In addition, the results of a retrospective study are presented. Compared with intubated general anesthesia, patients in the non-intubated video-assisted thoracic surgery group had lower rates of post-operative pulmonary complications, shorter operative times, less intraoperative blood loss, shorter PACU stays, a lower number of days to chest drain removal, less post-operative drainage, and shorter hospital stays.

作者聚焦: 一种具有多模式镇痛和七氟烷吸入麻醉的非插管视频辅助胸腔镜手术 

Here, we present a non-intubated protocol for performing video-assisted thoracoscopic surgery with preserved autonomic breathing.

非插管视频辅助胸腔镜手术

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the ...

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

摘要

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此视频中的章节

一个新型插管困难和困难通风救援技术

选修儿科光纤插管指南

气管插管小鼠

在小鼠气管插管快速的改进方法

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

使用便携式超声采集图像进行紧急气道管理

非插管视频辅助胸腔镜手术

非插管视频辅助胸腔镜手术