Preventive tracheal intubation in the emergency treatment of an important role in gelsemism
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Objective To investigate the first-aid methods for patients with gelsemism.Methods The application of preventive tracheal intubation were given in the emergency rescue in 20 cases patients with gelsemism.Then gived the mechanical ventilation with the SIMV mode.the breathing rate were 16-18 times/min,and the tidal volume was 6-8ml/kg.3 cases of pulmonary edema were added PEEP 5-10cm H20. On the basis of stable respiratory cycle, 14 cases were given gastric lavaged with water and catharsised by giving 20% mannitol,6 cases were catharsised by giving 20% mannitol only.Results 18 cases were cured (18/20) and 2 cases were dead(2/20) after the treatment for 1-3 weeks.The cured one were all smoothly off-line,and the mechanical ventilation time were for 1.5-8.3(4.6 ± 2.2)d.And the direct cause of death were respiratory failure. Conclusions Preventive tracheal intubation is the primary rescue measures for the gelsemism.
Key words:
Gelsemism; Tracheal intubationObjective:To explore the value of laryngeal mask in the pre-hospital first aid rescue breathing cardiac arrest patients.Methods:Randomly divided 53 cases of patients with cardiac arrest into the observation group(27 cases) and the control group(26 cases),there respectively applied laryngeal mask and tracheal intubation for ventilation.Compared between two groups in terms of the success rate of trachea intubation in one time、the operating time and success rate of recovery.Results:The success rate of trachea intubation in one time and recovery of observation group in the first aid process was significantly higher the control group,the operating time was significantly shorter than the control group,the differences were statistically significant(P0.05).Conclusion:In pre-hospital emergency,compared with endotracheal intubation,using of laryngeal mask airway is safer and more effective,with the advantages of easy operation,rapid,high success rate,etc.
Endotracheal intubation
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Objective To observe the feasibility of application of dexmedetomidine combined with sufentanyl in difficult airway patients bronchoscopy in tracheal intubation. Methods Totally 60 patients with difficult airway required tracheal intubation in burn and plastic surgeries were obtained in this study,and they were randomly divided into observation group( Group Ⅰ,30 cases) and control group( Group Ⅱ,30 cases). Group Ⅰ: 10 minutes before tracheal intubation,infusion of dexmedetomidine for 1. 0 μg / kg,sufentanil for 0. 1 μg / kg was administrated. Group Ⅱ: before intubation,lidocaine surface anesthesia was performed,and then cricothyrotomy endotracheal injection with 1% dicaine for 3 ml. Different time before intubation stress response and hemodynamics was observed. Results Compared to Group Ⅱ,sedation score of tracheal intubation was higher,tracheal intubation condition was better and well tolerated in a short time,success rate of tracheal intubation was higher with better postoperative satisfaction in patients of Group Ⅰ( P 0. 05). Conclusion Dexmedetomidine combined with sufentanyl can be used safely in patients with difficult airways bronchoscopy tracheal intubation.
Dexmedetomidine
Cricothyrotomy
Sufentanil
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Objective:To assess the feasibility of sedation via awake blind nasal tracheal intubation by partial pressure of end-tidal carbon dioxide(PETCO2) monitoring for patients with ankylosing spondylitis that leads to difficult airway intubation.Methods:Thirty ASA Ⅱ patients of ankylosing spondylitis(20 males,10 females;aged 40~80 years;weighing 55~70 kg)undergoing general anesthesia were randomized into groups of blind nasal intubation(group B,n=15) and fiberoptic bronchoscope guidance(FOB,n=15).All patients,who fell into grade Ⅲ~Ⅳ as the classification of difficulty in intubation defined by Cormack and Lehane,with mouth opening less than 2 cm,were undergone awake nasal tracheal intubation,and the two groups of patient were kept concerning the respective changes of mean arterial blood pressure(MAP),heart rate(HR) and SpO2 right after the intubation(T0),at 1 min(T1),5 min(T2),10 min(T3) and the moment of extubation(T4) besides duration of intubation,successful rate and complications.Results:Intubation was performed successfully in the total 30 patients.Nevertheless,group B consumed longer time in intubation than did of group FOB(P0.05),and significant differences of the two groups was found regarding the variation of MAP and HR at T1,T2,T3,T4 as compared with T0(P0.05).There was no significant difference concerning the rate of successful intubation and complications.Conclusion:Sedation via awake blind nasal tracheal intubation by partial pressure of end-tidal carbon dioxide(PETCO2) monitoring is safe and reliable for patients with difficult airway intubation due to ankylosing spondylitis.
Respiratory Rate
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Objective To observe the ventilation function of laryngeal mask airway(LMA) in general anesthesia.Methods One hundred ASA Ⅰ-Ⅱ patients were randomly divided into two groups:LMA group(n=50) and tracheal intubation group(n=50).After induction of general anesthesia,laryngeal mask airway and tracheal intubation were used in LMA group and tracheal intubation group,respectively.Simultaneously,anaesthetic apparatus was used for controlling the breath.Anesthesia was maintained with intravenous infusion of propofol,and vital signs were observed with the medical monitoring equipment before induction of general anesthesia,1,5 and 10 min after intubation,before extubation,and 1,5 and 10 min after extubation.Blood gas values were measured 30 min after intubation.Results In tracheal intubation group,SBP increased 1,5 and 10 min after intubation(P0.01 or P0.05),DBP increased 1 and 5 min after intubation,and HR increased 1 min after intubation(P0.01 or P0.05).There were no significant differences in vital signs and blood gas values between the two groups 30 min after intubation.Conclusion LMA can effectively maintain ventilation.With a monitor,the application of LMA is safe in general anesthesia.
Laryngeal Masks
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Objective:To investigate the effect of the fiberoptic bronchoscope guided nasotracheal intubation in rescuing patients with respiratory failure in the COPD.Methods:50 cases of COPD patients with severe respiratory failure in the fiber bronchoscope after nasotracheal intubation mechanical ventilation treatment,the success rate,clinical symptoms,blood gas analysis were observed.Results:The success rate of 50 patients guided by fiberbronchoscope through nasal tracheal intubation was 100%,50 patients had fewer complications,short operating time (0.5～2 min),blood gas analysis of pH,PaO2 and PaCO2 significantly improved (P0.01),SaO2 rose.Conclusion:Guided by fiberbronchoscope through nasal tracheal intubation in treatment of severe respiratory failure patient is safety,rapid,the intubation success rate is high,can effectively correct the respiratory failure,improve ventilation,improve the success rate of emergency patients.
Nasotracheal intubation
Respiratory Rate
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Objective:To observe the safety and effectiveness after the management of pre-anaesthetic,basal anaesthetic methods and intubation technique by fiberbronchoscope for difficult airway in children. Methods:Twenty-three children with difficult airway were sedated before operation and randomly separated into ketamine group(group A,10 cases) and sevoflurane group(group B,13 cases).Based anesthesia,nasal mucosa convergence,surface anesthesia and nasal fiberoptic guided intubation were applied to these children.The ratio of success and the complications during this period were recorded. Results:Twenty-three cases were successfully intubated.The average time of tracheal intubation was(11.8±2.4) min.The times of intubation(including changing hands) were 1-3.Fifteen cases could be extubated just when operation finished and eight cases could be extubated after operation in PACU.Three patients appeared apnea,upper airway obstruction and oxygen saturation decreased rapidly during intubation.Immediately stopping operation and intubated again when oxygen masks were given.Two cases appeared mild hoarseness after surgery and no after-effects by inhalation.There were SaO2 lower,heart rate and mean artery pressure increased in two groups during intubation,especially in group A(P0.05 to P0.01). Conclusions:Well-prepared before intubation and sevoflurane based anesthesia treatment of nasal fiberoptic guided intubation in children with difficult airway,the success rate of intubation is high with little damage and few complications.
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Objective
To observe whether the high-flow nasal cannulae (HFNC) can reduce the rate of re intubation after extubation in patients with tracheal intubation in the intensive care unit (ICU).
Methods
134 patients with mechanical ventilation in ICU were divided into 2 groups according to the order of ICU. The control group and the observation group were divided into 67 groups. Patients in control group were used routine oxygen inhalation (nasal duct and mask) after weaning, while the observation group was HFNC. All the other patients with the same treatment and care. The rate of re intubation was compared between the 2 groups.
Results
In the observation group, the rate of reintubation was 4.48% (3/67) of all. The control group was 14.92% (10/67), two groups of patients with reintubation rate difference was statistically significant (χ2= 4.17, P < 0.05).
Conclusions
HFNC can decrease the rate of re intubation after extubation in patients with tracheal intubation.
Key words:
High-flow nasal cannulae; Endotracheal intubation; Reintubation rate; Mechanical ventilation
Endotracheal intubation
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Objective To discuss the effect of improved gastric intubation in patients with mechanical ventilation.Methods 120 patients with mechanical ventilation required gastric intubation were randomly divided into control group(n=60) and experiment group(n=60).Routine method of gastric intubation was utilized in control group while improved gastric intubation with left-lateral position by way of right nostril was applied in experiment group.The success rates of intubation at first time,the time of successful intubation and the complication of intubation such as vomiting and coughing were observed.Results There were significant differences of success rates of intubation at first time,incidence of vomiting and coughing and time of successful intubation in two groups(P0.01).Conclusion Improved gastric intubation can enhance the success rate of intubation of patients with mechanical ventilation.
Nostril
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Objective To evaluate timing of tracheal intubation impact on the therapeutic effect of acute severe organophosphate poisoning( ASOPP) patients. Methods Retrospectively analyze 82 ASOPP patients with respiratory failure ( RF). The patients were divided into timely tracheal intubation group(n = 42) and delay tracheal intubation group (n =40) ,and compare the therapeutic effect of these two groups. Results Compared with timely tracheal intubation patients and delay tracheal intubation patients,total time of mechanical ventilation,hospital day decreased significantly (P 0.05). Conclusion It was exact that the therapeutic effect of timely tracheal intubation on rescuing the ASOPP patients, and the best time to tracheal intubation was in RF early period.
Key words:
Poisoning; Insecticide, orgnaophosphorus; Ventilators, mechanical; Intubation, intratracheal
Therapeutic effect
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Objective To discuss the feasibility and safety of the thyrocricocentesis in awake tracheal intubation in the emergency patients with stomach fully filled.Methods The tracheal intubation was induced slowly with droperidol-fentanyl injected by intravenous,tetracaine sprayed around the throat and lidocaine injected by thyrocricocentesis in 37 emergency patients with stomach fully filled.Results During the intubation process,the discomfort reaction of 3 cases was slightly obvious and the others were well tolerated without airway spasm or cough.In all the 37 patients,the electrocardiogram and blood pressure changes were in the expected range,SpO2 was not decreased during the tracheal intubation procedure.And no appearance of reflux and aspiration happened.Conclusion The use of surface anesthesia in awake tracheal intubation after the thyrocricocentesis is feasible.Furthermore,it can significantly improve the patients' safety as well.
Droperidol
Tetracaine
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