この作品は、ミシガン州の小児病院で麻酔の部門によって資金を供給されます。

1。機器の準備<ol><li>プロポフォール注入のためのメッド融合ポンプ</li><li>加熱マットレスの下に経鼻チュー​​ブをセット</li><li>スコープにカメラを接続し、向きを確認してください</li><li> 3楽章は、スコープを介して、ビューに影響を与えます。 <ol><li>内と外。 </li><li>両手操作を使用して回転。 </li><li>スコープの先端の屈曲伸展。 </li></ol></li></ol> 2。追加の機器<ol><li>フェンタニル0.5から1.0マイクログラム/ kgの</li><li> 12F赤いゴム吸引カテーテル</li><li> 0.1から0.2 mgのグリコ</li><li>金属の腹フック</li><li>アフリン鼻スプレー</li><li>潤滑油</li><li>鼻孔を噴霧するため2％または4％リドカイン</li></ol> 3。患者の準備<ol><li>自然換気を維持するマスクの誘導を行います。 </li><li> IVを起動し、フェンタニルとグリコIVを与える。 </li><li>プロポフォールボーラスに1 mg / kgを与えると始めるプロポフォール注入200 mcgか/ kg /分。 </li><li>生徒の膨張を避けるために、アフリンを噴霧する前に、テープの目。 </li><li>両方の鼻孔にスプレーアフリンとリドカイン。 </li><li>遠位アフリンとリドカインを配布するために患者の換気をマスクする。 </li><li>開存性を確認するには、両方の鼻孔に赤いゴム製のカテーテルを渡します。 </li><li>光ファイバースコープに対して複数の特許の鼻孔を選択してください。 </li><li> O 2の下咽頭の先端と他の鼻孔の赤色のゴムをしてください。 </li><li>回路に赤ゴムを接続し、O 2（下咽頭に高いフローを吹き込むしない）の2 L /分を管理するために腹フックを使用してください。 </li></ol> 4。実際のファイバースコープ挿管<ol><li>経鼻気管チューブからコネクタをとる。 </li><li>潤滑光ファイバースコープアップアドバンスチューブはすべての方法。 </li><li>アルコールとの光ファイバ先端を清掃</li><li>鼻の床に従うように、スコープの終わりにわずかなカーブを置く。 </li><li>盲目的に喉頭に光ファイバーを通します。 </li><li>認識可能な解剖学的構造を探します。 FREEZE！ </li><li>フィールドの中心に解剖学的構造を持って、そこに保管してください。 </li><li>声帯に近づくとき、プロポフォール1 mg / kgのIVのボーラスを与える。 </li><li>一度コードを介して、気管内に下向きに曲がる。 </li><li>気管分岐部のレベルに気管リングに従ってください。 </li><li>あなたは、1 mg / kgのIVの追加のプロポフォールボーラスが必要な場合があります。 </li><li>光ファイバースコープ先端が中立位置にあることを確認してください。 </li><li> ETTを通します。 ETTは喉頭でハングアップされた場合、気管にそれを回転させるチューブを360 °回転を与える。 </li></ol> 5。代表的な結果このビデオでは、簡単に住民や仲間に教えやすいと再現性のある小児患者の選択科目ファイバー挿管のための効率的な手法を示しています。主キーは常に自発的な換気を維持することです。手の前に良い設備の準備も重要です。

<ol>
	<li>Kinouchi, K. <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+difficult+pediatric+airway.">Management of difficult pediatric airway.</a> Masui. 55, 24-32 (2006).</li><li>Chen, Y. L., Wu, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+management+of+patients+with+craniofacial+abnormalities:+10-year+experience+at+a+teaching+hospital+in+Taiwan.">Airway management of patients with craniofacial abnormalities: 10-year experience at a teaching hospital in Taiwan.</a> J Chin Med Assoc. 72, 468-470 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+for+management+of+the+difficult+airway:+an+updated+report+by+the+American+Society+of+Anesthesiologists+Task+Force+on+Management+of+the+Difficult+Airway.">Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.</a> Anesthesiology. 98, 1269-1277 (2003).</li><li>Fiadjoe, J., Stricker, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+difficult+airway+management:+current+devices+and+techniques.">Pediatric difficult airway management: current devices and techniques.</a> Anesthesiol Clin. 27, 185-195 (2009).</li><li>Wheeler, M., Roth, A. G., Dsida, R. M., Rae, B., Seshadri, R., Sullivan, C. L., Heffner, C. L., Cote, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+residents+pediatric+fiberoptic+intubation+of+the+trachea:+traditional+fiberscope+with+an+eyepiece+versus+a+video-assisted+technique+using+a+fiberscope+with+an+integrated+camera.">Teaching residents pediatric fiberoptic intubation of the trachea: traditional fiberscope with an eyepiece versus a video-assisted technique using a fiberscope with an integrated camera.</a> Anesthesiology. 101, 842-846 (2004).</li><li>Roth, A. G., Wheeler, M., Stevenson, G. W., Hall, S. 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+a+rigid+laryngoscope+with+the+ultrathin+fibreoptic+laryngoscope+for+tracheal+intubation+in+infants.">Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.</a> Can J Anaesth. 41, 1069-1073 (1994).</li><li>Ovassapian, A., Dykes, M. H., Golmon, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+training+programme+for+fibreoptic+nasotracheal+intubation.+Use+of+model+and+live+patients.">A training programme for fibreoptic nasotracheal intubation. Use of model and live patients.</a> Anaesthesia. 38, 795-798 (1983).</li><li>Stevenson, G. W., Roth, A. G., Wheeler, M., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+Olympus+LF-P+fibreoptic+laryngoscope+by+trainees+in+paediatric+anaesthesia.">Use of the Olympus LF-P fibreoptic laryngoscope by trainees in paediatric anaesthesia.</a> Anaesthesia. 51, (1996).</li><li>Taguchi, S., Kusunoki, S., Fukuda, H., Hamada, H., Kawamoto, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+tracheal+intubation+using+airway+scope+in+a+pediatric+patient+with+Hunter+syndrome.">Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome.</a> Masui. 58, 1278-1281 (2009).</li></ol>

利害の衝突は宣言されません。

気道確保困難の小児患者における光ファイバー挿管は困難な作業の1,2である可能性があり、頭蓋顔面dysmorphismsの存在は、気管挿管3に新たな課題を提示。それはfirberopticスコープの先端のどんな小さな動きでの粘膜に触れるのリスクを実行しているので、光ファイバの操作をより困難に小児患者の主な理由は、小さい気道の成人よりも小児の患者でこの手順を実行することはよ...

<ul><li>プロポフォール注入のためのメッド融合ポンプ</li><li>フェンタニル0.5から1.0マイクログラム/ kgの</li><li> 12F赤いゴム吸引カテーテル</li><li> 0.1から0.2 mgのグリコ</li><li>金属の腹フック</li><li>アフリン鼻スプレー</li><li>潤滑油</li><li>鼻孔を噴霧するため2％または4％リドカイン</li></ul>

guidelines for elective pediatric fiberoptic intubation

小児患者における光ファイバー挿管は、多くの場合、特に症候性の患者、すなわちピエールロバン症候群の困難気道が必要です。換気が高い代謝率に主に中断された場合、小さな赤ちゃんは非常に迅速に彩度になります。我々は、プロシージャ全体で自発呼吸を維持しながら安全な光ファイバー挿管を行うためのガイドラインを説明します。プロポフォールポンプ、フェンタニル、グリコ、赤ゴムのカテーテル、金属insuflationフック、アフリン、潤滑剤とリドカインスプレーの使用を必要とする手順が示されている。

Watch this Scientific Journal Video about Guidelines for Elective Pediatric Fiberoptic Intubation at JoVE.com

Guidelines for Elective Pediatric Fiberoptic Intubation

我々は、自然換気を維持しながら、小児患者に安全かつ効率的な選択科目ファイバー挿管を行うためのガイドラインを説明します。

選択科目小児光ファイバー挿管のためのガイドライン

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

guidelines-for-elective-pediatric-fiberoptic-intubation

Research

JoVE Journal

Medicine

17.3K ビュー.  St. Jude Children's Research Hospital. 我々は、自然換気を維持しながら、小児患者に安全かつ効率的な選択科目ファイバー挿管を行うためのガイドラインを説明します。

ビデオ: Guidelines for Elective Pediatric Fiberoptic Intubation

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.

難しい挿管と困難な換気のための新規のレスキューテクニック

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

医学

A Simple Method of Mouse Lung Intubation

A simple procedure to intubate mice for pulmonary function measurements would have several advantages in longitudinal studies with limited numbers or expensive animal. One of the reasons that this is not done more routinely is that it is relatively difficult, despite there being several published studies that describe ways to achieve it. In this paper we demonstrate a procedure that eliminates one of the major hurdles associated with this intubation, that of visualizing the trachea during the entire time of intubation. The approach uses a 0.5 mm fiberoptic light source that serves as an introducer to direct the intubation cannula into the mouse trachea. We show that it is possible to use this procedure to measure lung mechanics in individual mice over a time course of at least several weeks. The technique can be set up with relatively little expense and expertise, and it can be routinely accomplished with relatively little training. This should make it possible for any laboratory to routinely carry out this intubation, thereby allowing longitudinal studies in individual mice, thereby minimizing the number of mice needed and increasing the statistical power by using each mouse as its own control.

This paper describes a striaghforward and efficient method of intubating mice for pulmonary function measurements or pulmonary instillation, that allows the mice to recover and be studied at later times. The procedure involves an inexpensive fiberoptic light source that directly illuminates the trachea.

マウス肺挿管の簡単な方法

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences between the murine and human respiratory systems, especially in their upper respiratory tracts (URT). In some models, these differences in the murine nasal cavity can have a significant impact on disease progression and presentation in the lower respiratory tract (LRT) when using intranasal instillation techniques, potentially limiting the usefulness of the mouse model to study these diseases. For these reasons, it would be advantageous to develop a technique to instill bacteria directly into the mouse lungs in order to study LRT disease in the absence of involvement of the URT. We have termed this lung specific delivery technique intubation-mediated intratracheal (IMIT) instillation. This noninvasive technique minimizes the potential for instillation into the bloodstream, which can occur during more invasive traditional surgical intratracheal infection approaches, and limits the possibility of incidental digestive tract delivery. IMIT is a two-step process in which mice are first intubated, with an intermediate step to ensure correct catheter placement into the trachea, followed by insertion of a blunt needle into the catheter to mediate direct delivery of bacteria into the lung. This approach facilitates a &#62;98% efficacy of delivery into the lungs with excellent distribution of reagent throughout the lung. Thus, IMIT represents a novel approach to study LRT disease and therapeutic delivery directly into the lung, improving upon the ability to use mice as surrogates to study human respiratory disease. Furthermore, the accuracy and reproducibility of this delivery system also makes it amenable to Good Laboratory Practice Standards (GLPS), as well as delivery of a wide range of reagents which require high efficiency delivery to the lung.

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated intratracheal (IMIT) instillation of reagents is an excellent, noninvasive method for studying respiratory disease, as well as a method for instilling therapeutic reagents directly into the lung. It is a rapid and highly reproducible method which is suitable for preclinical testing.

挿管媒介気管内（IMIT）点眼：非侵襲的、肺特異的送達システム

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

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.

マウスの気管の迅速な挿管のための改善された方法

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

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

プロトコルおよび国際専門家のコンセンサスに基づいた新生児の肺疾患の診断にポイント ・ オブ ・ ケア肺超音波のためのガイドライン

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Repeated Orotracheal Intubation in Mice

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ventral neck for direct confirmation of cannula placement in the trachea. The relative difficulty or the tissue trauma induced to the subject by such procedures can be an impediment to an investigator&#8217;s ability to perform longitudinal studies. This article illustrates a technique in which physical manipulation of the mouse following the use of a depilatory to remove hair from the ventral neck permits transcutaneous visualization of the trachea for orotracheal intubation regardless of degree of skin pigmentation. This method is innocuous to the subject and easily achieved with a limited understanding of murine anatomy. This refined approach facilitates repeated intubation, which may be necessary for monitoring progression of disease or instillation of treatments. Using this method may result in a reduction of the number of animals and technical skill required to measure lung function in mouse models of respiratory disease.

The goal of this article is to describe a refined method of intubation of the laboratory mouse. The method is noninvasive and, therefore, ideal for studies that require serial monitoring of respiratory function and/or instillation of treatments into the lung.

マウスにおける反復性の耳管挿管

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ...

Blind Endotracheal Intubation in Neonatal Rabbits

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical characteristics, which is further complicated in the case of the newborn. Of the different methods of advanced airway management, endotracheal intubation is less aggressive than tracheostomy, and is more feasible than supraglottic management given the lack of supraglottic devices of such a small size. As direct glottis visualization is very difficult in animals this size, this blind intubation model is presented as an effective alternative, especially for experiments requiring prolonged anesthesia. Using this method, we performed blind intubations with a 90% success rate.

We describe a technique of endotracheal intubation in newborn rabbits after esophageal catheterization with a gastric tube.

新生児ウサギにおける盲目の気管内挿管

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical ...

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.

ブタの安全な気道管理のための標準化モデルとしての柔軟な挿管内内視鏡を使用した気管内挿管

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

心停止後の動物モデルにおける体外心肺蘇生法

Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest

Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive investigation of this disease requires appropriate and validated animal models. Piglets are commonly used for translational research due to their analogous anatomy and physiology. This work aimed to describe and validate a neonatal piglet model of cardiopulmonary bypass (CPB) with circulatory and cardiac arrest (CA) as a tool for studying severe brain damage and other complications of cardiac surgery. In addition to including a list of materials, this work provides a roadmap for other investigators to plan and execute this protocol. After experienced practitioners performed several trials, the representative results of the model demonstrated a 92% success rate, with failures attributed to small piglet size and variant vessel anatomy. Furthermore, the model allowed practitioners to select from a wide variety of experimental conditions, including varying times in CA, temperature alterations, and pharmacologic interventions. In summary, this method uses materials readily available in most hospital settings, is reliable and reproducible, and can be widely employed to enhance translational research in children undergoing heart surgery.

著者スポットライト:新生児子豚モデルを使用した小児心臓手術のシミュレーション

This protocol describes a neonatal porcine model of cardiopulmonary bypass (CPB), with circulatory and cardiac arrest as a tool for studying severe brain damage and other complications secondary to CPB.

長期循環停止後の体外心肺蘇生法の小児動物モデル

Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive ...