저자는 어떤 승인이 없습니다.

모든 절차는 국가 라인란 트 - 팔츠의 의료 협회의 윤리위원회의 승인과 헬싱키 선언에 따라 수행 하였다. 1. 분무기 4 <ol><li> 패키지 세트를 제거합니다. 손상이 없는지 확인하기 위해 제품을 검사합니다. 주 : 디바이스가 한 번만 사용하도록한다. 저장 및 공급에 대한 자세한 내용은 사용에 대한 지침 (재료 및 장비 표 참조)를 참조하십시오. </li></ol> 2. 환자의 일반적인 제조 <ol><li> 전에 2.5 mg의 저녁 및 / 또는 - 2 - 4 mg을 1 - (금기에 대한 관심에) 개입하기 전에 2 시간 전 처치, 예를 들어, 로라 제 팜은 1을 관리 할 수 있습니다. </li><li> 이러한 맥박 산소 측정기 (SPO 2), 심전도 (ECG) 및 비 침습 혈압 (NIBP) 등의 파라미터를 모니터링 설정합니다. 참고 : 이러한 램지 진정 규모와 Bispect으로 모니터 환자의 진정 작용 사용 기준RAL 인덱스 모니터링. 진정 작용의 수준에 근접 모니터링은 호흡 저하 등의 합병증을 방지 할 수 있습니다. </li><li> 주변 정맥 접근을 고정합니다. </li></ol> 어퍼의기도 3. 국소 마취 <ol><li> 각 콧 구멍에 페닐와 0.25 %를 리도카인 2 %의 1 mL의 혼합물을 적용합니다. </li><li> 혀의 뒤쪽 끝에서 분사, 구강 인두의 점막에 두 번 직접 리도카인 10 % 스프레이를 적용합니다. 가능한 한 오랫동안 입에 리도카인을 양치질하는 환자에게 문의하십시오. 참고 : 성문 상부기도의 마취는 흡입 및 국소 마취제를 분사, 휙 면봉 면봉 또는 비 인두기도, 상품, 젤을 사용하여 양치질 선택적으로 수행 할 수 있습니다. </li></ol> 4. Analgo - 진정 <ol><li> 60kg; 정맥 약물, 예를 들어 초기 펜타닐 러스 (&lt;5 μg의 60kg&gt; : 사용 analgo - 진정 시작 10 μg의를;&gt; 100kg : 15 μg의를). 참고 무호흡 또는기도 협착을 방지하기 위해 가능한 가장 낮은 수준의 투여 량 약물 유발 진정. </li><li> (2)의 램지 진정 점수까지 &#39;구조&#39;치료로 추가 펜타닐 정맥 루스, 예를 들어, 5 μg의를 제공합니다 (협동 조합, 중심, 조용한) 달성된다. </li></ol> 5. 장비 준비 <ol><li> 조립 및 제도적 기준에 따라 유연한 삽관 내시경을 확인합니다. </li><li> 직접 산소 유량계에 분무기의 산소 튜브를 연결합니다. 주의! 가습기 병 산소 유량계는 사용할 수 없습니다. </li><li> 내시경의 작업 채널의 루어로 연결 튜브를 연결합니다. 사용 설명서에서 권장하는 10 L / 분 산소 유량을 설정합니다. </li><li> 삼방 권총 피팅에 리도카인 2 % 용액을 함유하는 1 ml 주사기를 연결한다. 참고 : 유리한 효능 프로파일 리도카인 2 %는 적합한입니다심미적. </li></ol> 6. 분무기 기법 <ol><li> 손가락을 이용하여 유량 제어 개구부를 닫는다. 급속 약물을 주입. 즉시 흐름 제어 개방을 놓습니다. 주 : 주사기의 워킹 채널을 통해 지속적으로 낮은 산소 흐름을 얻기 위해 삼방 권총 피팅에 연결되어야한다. </li><li> 기도의 유연한 내시경을 진행하는 동안, 다음 사이트에서 분무기를 사용하여 국소 마취제를 주입 : 콧 구멍 안쪽, 뒤쪽 콧 구멍에; 후두개; 성문; 그리고 성대. </li><li> 자주 내시경을 ( &quot;스프레이로 - 당신 - 이동&quot;) 진행하는 동안 필요에 따라이 단계를 반복합니다. 성대를 통과하기 전에 사이트에 충분한 약물 효과를 할 수 있도록 2 분 동안 기다립니다. 참고 : 필요에 따라, 환자와 정상까지 정맥 약물을 사용하여 진정 작용의 진정 작용 수준 (예 : 펜타닐 5 μg의)를 모니터링합니다. </li></ol> 7. 유연한 내시경 삽관 <ol><li> endosc을 사전OPE 신중 기관 위치 바로 카리나 상기 내시경의 선단에 성문 내지. 회전 아래 기관에 내시경을 통해 적당한 크기의 커프 및 윤활 유연한 기관 내 튜브를 철도. 주 : 주요 줄기 기관지에 내시경 팁의 실수로 발전을 피하십시오. </li><li> 다만 내시경을 통해 시각적 인 제어에 의해 카리나 위의 기관에서 기관 내 튜브의 위치를 ​​확인합니다. 대신에 기관 내 튜브를 떠나, 내시경을 제거합니다. </li><li> 자발 호흡 환자에서 호 기말 이산화탄소 분압을 사용하여 최종 갯벌 CO 2를 측정하여 튜브의 기관 내 위치를 확인합니다. </li><li> 전신 마취, 예를 들어 정맥 포폴 2 ㎎ / ㎏ / 체중을 유도한다. 현재 표준에 따라 환자 환기 시작. </li></ol> 주 : ENK 분무기 세트가 현재 쿡 의료 사용할 수 없습니다.

<ol><li>Simmons, S. T., Schleich, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Airway+regional+anaesthesia+for+awake+fibreoptic+intubation%5BTitle%5D)+AND+%22Reg+Anesth+Pain+Med%22%5BJournal%5D)">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/pubmed?term=((Management+of+the+difficult+adult+airway.+With+special+emphasis+on+awake+tracheal+intubation%5BTitle%5D)+AND+%22Anesthesiology%22%5BJournal%5D)">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., Göbler, S. M., Maybaur, M. O., Werner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+two+different+techniques+of+fiberoptic+intubation%5BTitle%5D)+AND+%22Eur+J+Anaesthesiol%22%5BJournal%5D)">Comparison of two different techniques of fiberoptic intubation.</a> Eur J Anaesthesiol. 26, 328-332 (2009).</li>
<li>Cook Incorporated, Atomizer instructions for use. , Available from:
 <a target="_blank" href="www.cookmedical.com/data/IFU_PDF/C-T-EFNS1004.PDF">www.cookmedical.com/data/IFU_PDF/C-T-EFNS1004.PDF</a> (2004).</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/pubmed?term=((A+comparison+of+the+atomizer+with+boluses+of+topical+anaesthesia+for+awake+fibreoptic+intubation%5BTitle%5D)+AND+%22Anaesthesia%22%5BJournal%5D)">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/pubmed?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%3A+a+randomised+controlled+trial%5BTitle%5D)+AND+%22Eur+J+Anaesthesiol%22%5BJournal%5D)">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/pubmed?term=((Combined+nebulization+and+spray-as-you-go+topical+anaesthesia+of+the+airway%5BTitle%5D)+AND+%22Br+J+Anaesth%22%5BJournal%5D)">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/pubmed?term=((A+method+of+administering+topical+anaesthesia+for+flexible+airway+endoscopy%5BTitle%5D)+AND+%22Anaesthesia%22%5BJournal%5D)">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/pubmed?term=((An+alternative+to+transtracheal+injection+for+fiberoptic+intubation+in+awake+patients%3A+A+novel+noninvasive+technique+using+a+standard+multiorifice+epidural+catheter+through+the+bronchoscope+suction+port%5BTitle%5D)+AND+%22Anaesthesiology%22%5BJournal%5D)">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/pubmed?term=((Spray-as-you-go+airway+topical+anesthesia+in+patients+with+a+difficult+airway%3A+a+randomized%2C+double-blind+comparison+of+2%25+and+4%25+lidocaine%5BTitle%5D)+AND+%22Anesth+Analg%22%5BJournal%5D)">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/pubmed?term=((Gastric+distension+and+rupture+from+oxygen+insufflation+during+fiberoptic+intubation%5BTitle%5D)+AND+%22Anesthesiology%22%5BJournal%5D)">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/pubmed?term=((Gastric+rupture+after+awake+fiberoptic+intubation+in+a+patient+with+laryngeal+carcinoma%5BTitle%5D)+AND+%22Br+J+Anaesth%22%5BJournal%5D)">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/pubmed?term=((Gastric+rupture+and+pneumoperitoneum+caused+by+oxygen+insufflation+via+a+fibreoptic+bronchoscope%5BTitle%5D)+AND+%22Anesth+Analg%22%5BJournal%5D)">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/pubmed?term=((Oxygen+insufflation+through+the+fiberscope+to+assist+intubation+is+not+recommended%5BTitle%5D)+AND+%22Anesthesiology%22%5BJournal%5D)">Oxygen insufflation through the fiberscope to assist intubation is not recommended.</a> Anesthesiology. 87, 183(1997).</li>
</ol>

저자는 공개 아무것도 없어. ENK-분무기 세트는 현재 쿡 의료 사용할 수 없습니다. 발명자 (개인 통신)에 따르면 유사한 장치는 미래에 사용할 수 있습니다.

여기에 우리가 깨어 내시경 삽관에 대한 높은 산소 흐름 분무기를 사용하여 국소 마취를 보여줍니다. 분무기 기법을 평가하는 제 연구가요 삽관 5 내시경의 워킹 채널을 통해 국소 마취 고전 환약과 비교 하였다. 분무기 투여군은 대조군에 비해 더 컴포트들의 수준을 평가하고 적은 기침 별개 기침 에피소드를 경험 하였다. 또한, 무화 기술은 신속하고 적은 국소 마취가 필요 하였다. <p...

깨어 삽관을위한기도의 국소 마취는 일반적 절차에게 성공을하는 데 도움이됩니다 환자의 편안함을 향상하는 것이 좋습니다. 높은 산소 흐름을 가진 사용자가 이동 중에 분무 그대로 기술은 환자에서 합격의 높은 수준을 발견하는 간단하고 안전한 개념이다. 기침과 개그 반사 덜 자극에서 10 L / min의 결과 유속의 산소에 의한 국소 마취제의 분무. 여러 환자의 부정적인 의견에 직면하여, 우리는 표준이-이동 스프레이로-기관 기술을 수정하기로 결정했다. 국소 마취제이 고전 루스 애플리케이션 기관으로, 2 분, 대기 시간이 경과 한 후 제 성대에 두 주사, 5 ㎖의 리도카인 2 % 플러스 10 ㎖ 주사기 5 mL의 공기를 각각 구성하고. 환자는기도 점막 타격 루스의 시작에 의해 익사되는 느낌에 대해 불평했다. 분무로 - 당신 - 이동 기술일반적으로 전 세계적으로 1 사용된다. patient&#39;s 기관을 삽관의 목적으로 상부 및 하부기도를 통해 팁을 전진하면서 이러한 기술은가요 삽관 내시경의 워킹 채널을 통해 국소 마취제 애플리케이션을 포함한다. 실제로 여러 접근 방법과 문헌 방법 중 몇 가지 설명이있다. 작업 채널을 통해 일정한 산소 흐름의 응용 프로그램과 함께 당신은 이동 중에도 스프레이로 --기술로 초기 경험은 1990 년대 2 년에 출판되었다. 초점은 여기에 떨어져 렌즈에서 점액 분비와 혈액을 분산하고, 흡기 산소 전달을 상승하여 렌즈를 청소 같은 산소 흐름 효과에 있었다. 국소 마취제의 분무를 보조의 산소 흐름의 장점은 Piepho 및 동료 (3)에 의해 이전에 나타났다. 이들은 3 L / 분의 산소의 공급이 적은 환자 기침 결과 기화 기술을 설명했다. 가정에있는더 적은 기침을 불러 일으킬 것 미세한 입자로 로컬 에이전트를 분무 할 10 L / 분의 흐름, 우리는 성공적으로 높은 꽃 비율로 분무기를 테스트했다. 분무기는 작은 부피 꼬임 방지 유연 압력 인증 산소 튜브 및 연결 튜브로 구성된다. 이러한 작은 흐름 제어 개구 삼원 사이드 암 끼워 맞춤 접속된다. 분무기 기술은 모든 상황에서의기도 사용할 수있다. 그러나, 장치는 종양 덩어리와 같은 조건에 의한 높은 수준의기도 협착증에서 조심 원위 사용되어야한다. 산소의 역류의 부족은기도 압을 증가시키고 압력 손상의 위험 증가의 원인이됩니다. 또한, 분무기 긴급 설정에 유용한 도구입니다. 세트의 준비는 분 이내에해야하고 사용자는 특별한 교육을 필요로하지 않는다. 다음에 우리는 별도의를 설명, 높은 산소 흐름 당신은 이동 중에도 스프레이로-기술에 대한 세부 운영 지침을 제시작업 단계.

<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

협력 환자의 의지 기관의 성공적인 깨어 삽관의 절대 전제 조건이다. 환자의 약물 진정 그들의 자발적인 호흡을 위태롭게 할 수 있습니다 동안,기도의 국소 마취는 인기있는 기술이다. 분무로 - 당신 - 이동 기술은기도 점막을 마취하는 가장 간단한 기회 중 하나를 나타냅니다. 유연한 내시경의 작업 채널을 통해 국소 마취제의 적용은 마취뿐만 아니라 폐 질환에 대한 광범위한 방법입니다. 추가 장치도이 기술을 실행하는 전제 조건으로서 특별한 훈련도 필요하다. 그러나, 공지의 임상적인 문제점은 액체 마취제 성대 같이기도 점막 민감한 구조를 타격 할 때 발생할 수있는 기침 구역질 반사된다. 이는 미세 입자에 국소 마취제를 방담 목적으로 작용 채널을 통해인가 산소를 사용함으로써 피할 수있다. 더욱이산소 유량이 렌즈에서 점액 분비 및 혈액을 분산, 높은 산소 공급 장치를 제공하고, 더 나은 관점에 기여한다. 우리는 이러한 이점을 최대화 10 L / min의 높은 산소 흐름을 분무기를 사용하여, 이하 기침을 초래하고 더 만족하므로 협동 환자였다. 위 통기, 장기 파열 또는 발생하지 않았다 압력 손상을 포함하여 산소 흐름을 사용 가능하지만 매우 드문 합병증. 우리는 흐름과 압력 방출을 허용하는 세트의 디자인에 높은 산소 흐름의 합병증없이 사용 때문이다.

<html> 우리는 48 명에 제시된 국소 마취 기법을 사용하여 깨어있는 유연한 내시경 삽관을 시행 하였다. 우리는 불가능 튜브를 진행하게 인두의 stenosing 종양, 고통 하나를 제외한 모든 환자 삽관에 성공했다. 깨어 삽관 편안함의 품질은 견딜 수 = 10 불쾌하지 = 0에서 11 점 시각 아날로그 척도 (VAS)를 이용하여 환자, 마취와 간호사?...

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.

화제기도 마취는 사용 깨어 내시경 삽관에 대한 높은 산소의 흐름과 기술을 스프레이 것과 같이 당신은-이동

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

Research

JoVE Journal

Medicine

16.6K 조회수.  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.

비디오: 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.

어려운 삽관법 어려운 환기를위한 소설 구조 기술

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

연구

의학

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.

선택 소아 Fiberoptic 삽관법에 대한 지침

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.

마우스의 기관 내 삽관<em&gt;를 통해</em이경 사용&gt; 직접 후두경

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.

마우스의기도 신속 삽관 용 개선 된 방법

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.

약물 유발 폐쇄성 수면 무호흡증의 대상 제어 주입 (TCI) 및 이중 분광 분석과 수면 내시경 (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.

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.

돼지의 안전한 기도 관리를 위한 표준화된 모델로 유연한 삽관 내시경을 사용한 기관내 삽관

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.

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

자율 호흡이 보존된 비디오 보조 흉강경 수술을 위한 비삽관 프로토콜

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.

저자 스포트라이트: Multimodal Analgesia and Sevoflurane Inhalation Anesthesia를 이용한 Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia(다중 모드 진통 및

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

삽관되지 않은 비디오 보조 흉강경 수술

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

화제기도 마취는 사용 깨어 내시경 삽관에 대한 높은 산소의 흐름과 기술을 스프레이 것과 같이 당신은-이동

요약

더 많은 비디오 탐색

어려운 삽관법 어려운 환기를위한 소설 구조 기술

선택 소아 Fiberoptic 삽관법에 대한 지침

마우스의 기관 내 삽관

마우스의기도 신속 삽관 용 개선 된 방법

약물 유발 폐쇄성 수면 무호흡증의 대상 제어 주입 (TCI) 및 이중 분광 분석과 수면 내시경 (DISE)

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

돼지의 안전한 기도 관리를 위한 표준화된 모델로 유연한 삽관 내시경을 사용한 기관내 삽관

Image Acquisition using Portable Sonography for Emergency Airway Management

삽관되지 않은 비디오 보조 흉강경 수술

삽관되지 않은 비디오 보조 흉강경 수술