Tracheal Intubation Group Research Articles

Efficacy of penehyelidine hydrochloride for prevention of postoperative pulmonary complications in patients undergoing off-pump coronary artery bypass grafting

Objective To evaluate the efficacy of penehyelidine hydrochloride for prevention of postoperative pulmonary complications (PPCs) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred and forty ASAⅡ or Ⅲ patients of both sexes,aged 35-80 yr,weighing 55-80 kg,undergoing OPCABG,were randomly divided into 2 groups (n =70 each):control group (group C) and penehyelidine hydrochloride group (group P).Anesthesia was induced with iv injection of midazolam,etomidate,sufentanil and rocuronium.The patients were mechanically ventilated after tracheal intubation.PET CO2 was maintained at 35-40 mm Hg.Penehyelidine hydrochloride 20μg/kg (5 ml) was injected intravenously and slowly immediately after tracheal intubation in group P.While the equal volume of normal saline was administered instead in group C.Anesthesia was maintained with iv infusion of propofol,intermittent iv boluses of sufentanil and pipecuronium,and inhalation of sevoflurane.BIS value was maintained at 40-50.The occurrence of PPCs was recorded within 72 h after operation.Results The incidences of PPCs were 33％ and 16％ in groups P and C,respectively.The incidence of PPCs was significantly lower in group P than in group C (P ＜ 0.05).Conclusion Intravenous injection of penehyelidine hydrochloride 20μg/kg before operation can prevent the occurrence of PPCs in patients undergoing OPCABG. Key words: Cholinergic antagonists; Coronary artery bypass, off-pump; Postoperative complications

Differential effects of propofol and sevoflurane on QT interval during anesthetic induction

There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.

The Use of Disposable Laryngeal Mask Airway for Adenotonsillectomies

Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT). We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n=100) or the laryngeal mask airway group (LMA, n=104). It was measured the level of oxygen saturation by pulse oximetry (SpO(2)) after the induction of anesthesia (SpO(2)-1), after establishing the operative field (SpO(2)-2), at the end of the surgical procedure (SpO(2)-3), three minutes after the removal of the contained breathing apparatus (SpO(2)-4) and upon admission to the post-anesthesia care unit (SpO(2)-5). All respiratory complications were recorded. The mean SpO(2) values and standard deviations for the TT and LMA groups were as follows: SpO(2)-1: 98.9±1.0 and 98.7±0.8 (p>0.25), SpO(2)-2: 97.4±1.0 and 94.9±4.3 (p<0.001), SpO(2)-3: 96.9±1.1 and 97.2±1.1 (p=0.037), SpO(2)-4: 91.7±9.0 and 95.2±2.2 (p<0.001) and SpO(2)-5: 94.0±2.1 and 95.8±2.6 (p<0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a TT. Respiratory complications were similar between groups. Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO(2), compared to using a TT. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a TT is preferred for safety.

The clinical application of video-laryngoscope in spontaneous respiration tracheal intubation

Objective To assess the safety and clinical values of video-laryngoscope in spontaneous respiration tracheal intubation for emergency patients. Methods Seventy-nine patients,who needed the endotracheal intubation,were recruited in our department between January 2010 and December 2010,and were randomly ( random number) divided into two groups according to consultative sequence.Forty patients (group A ) were operated with traditional laryngoscope and thirty-nine patients (group B ) with videolaryngoscope.The operative time and success rate of tracheal intubation,Cormack-Lehane classification,as well as adverse events,were recorded.The heart rate ( HR ),mean arterial blood pressure ( MAP),respiratory rate ( RR ),and saturation of pulse oxygen ( SpO2 ) were observed pre-operation,during operation and 2 min post-operation.Results ( 1 ) The Cormack-Lehane classification in group A were significantly lower than in group B. (2) The operative time of tracheal intubation in group B was significantly less than that in group A [(35.6+12.7) svs. (58.3 ± 13.5) s; P＜0.05] ; and one-time success rate of tracheal intubation in group B was higher than that in group A ( 84.6％ vs.52.5％ ; P ＜0.05).(3) Compared to group B,the HR and MAP in Group A were significantly increased at t2 and t3 ( P ＜ 0.05 ). ( 4 ) The adverse events,including restlessness,bucking and injury,were significantly decreased in group B than those in group A ( P ＜ 0.05 ).Conclusions The video-laryngoscope used in spontaneous respiration tracheal intubation,could improve Cormack-Lehane classification,short operative time,enhance one-time success rate and reduce adverse evevnts. Key words: Video-laryngoscope; Emergency ; Tracheal intubation; Cormack-lehane classification ; Complication

The curative effect of double-tube laryngeal mask on fast-track surgery in pediatric patients

Objective To explore the value of double-tube laryngeal mask in fast-track surgery in pediatric patients.Methods 60 pediatric patients scheduled for fast-track surgery were randomly divided into group of double-tube laryngeal mask (group A) and group of tracheal intubation (group B).At the same time points,mean arterial pressure (MAP),heart rate (HR),oxyhemoglobin saturation (SpO2),surgical duaration,awakening time,success rate of one-off tube placement and agitation after awakening were recorded in both groups before and after induction of anesthesia,1,3,and 5 min after placement of laryngeal mask or tracheal tube,and 5 min before and after removal of laryngeal mask or tracheal tube were recorded.A statistical analysis was conducted.Results No statistical difference was observed between the two groups in general conditions,MAP,HR and SpO2before and after induction of anesthesia,surgical duration,and success rate of one-off tube placement (P＞0.05).MAP and HR were significantly lower in group B than in group A after placement or removal of tube (P ＜ 0.05 or P ＜ 0.01).Conclusions Double-tube laryngeal mask is easy to apply and less invasive.It can be an ideal choice for anesthesia in fast-track surgery in pediatric patients if intraoperative ventilation monitoring is strengthened. Key words: Double-tube laryngeal mask; Pediatric patients; Fast-track surgery; Anesthesia

Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation

BackgroundThis study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation.MethodsA total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation.ResultsThe percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05).ConclusionsIn healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.

Comparison between the Hemodynamic Parameters of Rigid Laryngoscopy and Lighted Stylet in Patients with Coronariopathies

Anesthesiologists are responsible for airway management whenever they assume the anesthesia of a patient. In this study, we compare the hemodynamic parameters of rigid laryngoscopy and lighted stylet in patients with coronariopathies. This randomized clinical trial included 40 patients undergoing myocardial revascularization assigned into two groups: lighted stylet and rigid laryngoscope. Besides time of tracheal intubation in each group, heart rate, mean arterial pressure, changes in ST segment, and central venous pressure were evaluated during patient preparation, 1 minute and 5 minutes after anesthetic induction, and 1 minute after tracheal intubation. Both groups were homogenous regarding demographic data. Time of tracheal intubation in the rigid laryngoscope group (24 ± 5 sec) was lower than that of the lighted stylet group (28 ± 7 sec), but without significance. Heart rate showed a reduction in both groups during anesthetic induction (p < 0.05), but 1 minute after tracheal intubation the heart rate increased to levels close to baseline levels in both groups (p > 0.05). In the rigid laryngoscope group mean arterial pressure increased after tracheal intubation to levels close to those observed during patient preparation (p > 0.05), while in the lighted stylet group mean arterial pressure remained below baseline levels (p < 0.05). Central venous pressure increased on both groups at all times (p < 0.05). It was possible to observe that both techniques are safe for tracheal intubation in patients with coronariopathies. However, lighted stylet has fewer repercussions on mean arterial pressure.

A simulated severe difficult airway does not alter the intubation performance with the SensaScope: a prospective randomised manikin study

Prospective randomised controlled study. Operation unit in a tertiary academic university hospital in a central European city. Period of the study was springtime and summer 2010. Twenty-four anaesthesiologists with various levels of professional experience were allocated to intubate an airway manikin either with the SensaScope (group S) or with the conventional Macintosh 3 laryngoscope (group L). Each participant performed three consecutive intubations with normal anatomy followed by three intubations with difficult anatomy. The airway difficulty was simulated by inflation of the manikin's tongue base with 40 ml of air. The times taken to view the larynx and to insert the tracheal tube were noted. The resulting tube position and the occurrence of dental damage were recorded. Those planned in the protocol. In normal anatomy, the laryngeal view (group L 5.9 ± 4.2 s vs. group S 9.2 ± 3.5 s) and intubation (group L 13.4 ± 7.6 s vs. group S 23.3 ± 8.6 s) was more rapidly obtained with conventional laryngoscopy (values presented as mean ± SD). In difficult anatomy, only the SensaScope permitted successful laryngeal view (group L impossible vs. group S 9.9 ± 4.8 s) and tracheal intubation (group L impossible vs. group S 23.4 ± 8.8 s). The latter always enabled correct tracheal tube position, whereas with laryngoscopy alone either oesophageal intubation or aborted attempts resulted. In the difficult airway setting, the frequency of simulated tooth damage was also significantly higher with conventional laryngoscopy (group L 26 of 36 vs. group S 6 of 36). The SensaScope performed fairly well in normal intubation anatomy, although its use was more complex than with conventional laryngoscopy and it required a slightly longer time. In the difficult airway setting, the SensaScope performed as well as in normal anatomy, whereas intubation by direct laryngoscopy proved to be impossible. The SensaScope enables the user to overcome severe airway difficulties caused by large tissue masses at the level of the tongue base or mouth floor.

Use of laryngeal mask airway ProSeal for airway management during open heart surgery performed under CPB in children

Objective To investigate the use of laryngeal mask airway （LMA） ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups （ n = 38 each）： tracheal intubation group （group T） and ProSeal LMA group （group P1）. Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups （P〉 0.05）. The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T （ P 〈 0.05）. Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children. Key words: Laryngeal mask; Respiration,artificial; Cardiopulmonary bypass; Cardiac surgical procedures; Child

Timing of tracheal intubation impact on the therapeutic effect of acute severe organophosphate poisoning patients

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

Modified double-lumen endobronchial tubes with EtCO2 oscillogram in anesthetic intubation of Patients with cervical spine fractures

Objective To investigate the feasibility of solving incubation difficulty in patients with cervical spine fractures using blind tracheal incubation instrument transformed from double-lumen endobron-chial tubes with EtCO2 （end-tidal carbon dioxide） oscillogram monitoring. Methods Patients with cervical spine fractures suffered incubation difficulty were randomly divided into two groups： blind tracheal intubation group （group A, n = 25） and the group of modified double-lumen endobronchial tubes with EtCO2 monitoring （group B, n = 25）. Blind tracheal incubation was conducted in the two groups. The number of intubation, intubation duration （from the beginning to successful intubation proved by auscultation）, additional uses of anesthetics throughout the intubation period, blood pressure （BP）, heart rate （HR）, changes of oxygen saturation （SpO2）, and intubation complications were recorded, Results There was no significant difference between the two groups in assessment of intubation difficulty （P〉0.05）, the success rate of incubation for 1 to 2 times was significantly higher in group B than in group A （P〈0.05）, changes of BP and of HR were significantly smaller than in group A （P〈0.05）. No hypoxemia （SPO2 〈92%）, bucking, bronchial spasm, and other complications occurred. Conclusions Modified double-lumen ndobronchial tubes with EtCO2 oscillogram monitoring for patients with intubation difficulty, especially for those with cervical fractures, is a simple, safe, and effective procedure of endotracheal intubation, and is worth popularizing. Key words: Cervical spine fracture; Tracheal intubation; Modified double-lumen endobronchial tubes; EtCO2 oscillogram

Compare with application of SLIPA larygneal mask and tracheal intubation to laparoscopic cholecystectomy

Objective To compare the changes of circulation and respiration parameters and the complications of the patients undergoing laparoscopic cholecystectomy with SLIPA larygneal mask and tracheal intubation, and explore appropriate methods of nursing care for it. Methods A total of 60 patients undergoing laparoscopic cholecystectomy were randomly allocated into two groups: SLIPA group(n = 30) and tracheal intubation group ( n = 30). Two groups of patients with intubation were recorded before and after intubation in terms of HR, SBP, DSP, and the minute ventilation, tidal volume, peak airway pressure (Ppeak), PETCO2. The incidence of complications such as reflux and aspiration in the operation, bucking when the operation finished,sore throat, hoarseness, nausea, vomiting, lung infection after operation and were observed. Results The minute ventilation (MV), tidal volume (TV), peak airway pressure (Ppeak), and PETCO2 at 15 minute after positive pressure ventilation and pneumoperitoneum were significantly different between the two groups. The incidence of postoperative complications of SLIPA (group L) was significantly lower than that of tracheal intubation group.Conclusions SLIPA laryngeal mask airway for laparoscopic cholecystectomy is superior to tracheal intubation. It can maintain hemodynamic stable and low complications. Nursing care on patients used laryngeal mask anesthesia and tracheal intubation have different emphases, the former focused on the preoperative nursing assessment and prevention of intraoperative displacement, and the latter focused on tracheal nursing care and prevention of infection and other complications. Key words: SLIPA larygneal mask; Tracheal intubation; Laparoscopic cholecystectomy; Nursing

Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation

Study Objective To evaluate the effect of dexmedetomidine combined with fentanyl on hemodynamics. Design Prospective, double-blinded, randomized study. Setting Operating room of a university hospital. Patients 30 ASA physical status II and III patients with mild-to-moderate cardiovascular disease. Interventions Patients were assigned to one of three groups: Group D-F2 [dexmedetomidine, effect-site concentration (ESC) of fentanyl = two ng/mL]; Group F2 (placebo, ESC of fentanyl = two ng/mL), or Group F4 (placebo, ESC of fentanyl = 4 ng/mL). Measurements Dexmedetomidine (an initial dose of 1.0 μg/kg for 10 min, followed by a continuous infusion of 0.7 μg·kg –1·hr –1) or placebo saline was administered 15 minutes before anesthetic induction. Anesthesia was induced with propofol and fentanyl using a target-controlled infusion system. Hemodynamic parameters: systolic (SBP) and diastolic blood pressures (DBP), and heart rate (HR) during anesthetic induction were measured and the percent changes were calculated for both induction and intubation. Main Results After inducing anesthesia, SBP was significantly higher in Group D-F2 (127 ± 24 mmHg) than Group F2 (90 ± 20 mmHg) or Group F4 (77 ± 21 mmHg). The SBP in Groups F2 and F4 reached 160 ± 31 mmHg and 123 ± 36 mmHg, respectively, after intubation, but no significant change in SBP was noted in Group D-F2. The percent increase in SBP due to tracheal intubation in Group D-F2 was 3% ± 4% and was significantly lower than that of Group F2 (70% ± 34%) or Group F4 (45% ± 36%). Conclusion Dexmedetomidine combined with fentanyl during anesthetic induction suppresses the decrease in blood pressure due to anesthetic induction and also blunts the cardiovascular response to tracheal intubation.

Effect of landiolol on bispectral index and spectral entropy responses to tracheal intubation during propofol anaesthesia

Backgroundβ1-Adrenoceptor antagonists suppress the haemodynamic and arousal responses to tracheal intubation. The Entropy™ Module shows two spectral entropy-based indices, response entropy (RE) and state entropy (SE). The difference between RE and SE (RE−SE) may reflect nociception during general anaesthesia. In the present study, we investigated the effect of landiolol on entropy indices in response to tracheal intubation. MethodsA total of 60 patients were randomly assigned to receive saline (Group S), remifentanil (Group R), or landiolol (Group L). Anaesthesia was induced by propofol target-controlled infusion. Two minutes after the induction of anaesthesia, infusion with vecuronium bromide and remifentanil, landiolol, or saline was initiated. Tracheal intubation was performed 7 min after anaesthesia induction. Arterial pressure, heart rate (HR), bispectral index (BIS), and entropy indices were recorded. ResultsIn Group S, RE increased significantly after tracheal intubation, but there was no significant increase in BIS or SE. These increases in RE were abolished in Groups R and L. RE−SE increased significantly after tracheal intubation in Group S, whereas no increase in RE−SE was observed in Groups R and L. Increases in mean arterial pressure and HR after tracheal intubation were suppressed in Groups R and L compared with Group S. ConclusionsRE increased in response to tracheal intubation, whereas BIS and SE did not. Landiolol and remifentanil suppressed the increase in RE after tracheal intubation with significant inhibition of RE−SE difference.

Effect of emergency care simulator combined with problem-based learning in teaching of cardiopulmonary resuscitation

To evaluate the teaching effects of emergency care simulator (ECS) combined with problem-based learning (PBL) in teaching of cardiopulmonary resuscitation (CPR). 42 medical students were randomly divided into 2 equal groups, control group receiving PBL and training of specific operation such as artificial respiration, external cardiac compression, tracheal intubation, and defibrillation, and ECS group receiving ECS training in addition. Then test was given to record the scores in artificial respiration. A questionnaire survey was conducted to collect the feedback. There were no significant differences in the scores of artificial respiration, external cardiac compression, tracheal intubation, and defibrillation between the 2 groups (all P > 0.05). There were significant differences between the Control group and the ECS group (P < 0.05). The percentages of students with enhanced emergency awareness, emergency skill, team spirit and cooperative effort, with improved analytic skill in clinical setting and in amalgamating the theoretic learning with textbook knowledge and clinical practice were all higher in the ECS group than in the control group (all P < 0.05). More than 86% of the students considered that there was significant difference between these two groups. Using ECS combined with PBL in teaching CPR technique directly involves the medical students in "emergency practice", resolving of "all sorts of problems", enhancing emergency awareness, and emergency skill. It can improve teaching quality significantly that is in accordance with the development of modern medicine.

Pharyngo-laryngeal discomfort after breast surgery: Comparison between orotracheal intubation and laryngeal mask

Sore throat and dysphonia are a significant source of postoperative discomfort for patients scheduled for breast surgery who have been intubated for general anaesthesia. The aim of this study was to compare the incidence of postoperative pharyngo-laryngeal pain and dysphonia in the use of the laryngeal mask airway (LMA) or tracheal intubation in these patients. In a prospective, double-blind, randomised clinical trial we studied 53 women undergoing elective breast surgery to test the hypothesis that the use of the LMA could reduce the incidence of pharyngo-laryngeal morbidity compared with tracheal intubation. Postoperative sore throat and hoarseness were assessed at 6 and 24 h by a standardised interview. The incidence of postoperative sore throat was significantly higher in the case of tracheal intubation at 6 h (74% vs. 27%, p = 0.0003) and at 24 h (27% vs. 0%, p = 0.004). The incidence of hoarseness was significantly higher in the tracheal intubation group than in the LMA group at 6 h after surgery (40% vs. 15%, p = 0.04), but not at 24 h. Compared with tracheal intubation, the use of the LMA is associated with a lower incidence of postoperative sore throat and hoarseness and may contribute for improving patient comfort after breast surgery.

Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 +/- 170 mL versus 560 +/- 140 mL) and end-tidal CO(2) lower (33 +/- 4 mm Hg versus 37 +/- 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

Pulmonary Artery Catheter Placement in High-risk Coronary Artery Bypass Grafting : Should it be done Before or After Induction of Anaesthesia?

Pulmonary artery catheter (PAC) is generally inserted after induction of general anaesthesia (GA). However, in high-risk coronary artery disease patients (left main disease / ejection fraction (35%), it may be desirable to insert it before the induction of GA. Thirty patients with left main coronary artery disease and / or left ventricular ejection fraction < 35% undergoing coronary artery bypass grafting (CABG) surgery were prospectively randomized into 2 groups of 15 each. In group A, pulmonary artery catheter was inserted before induction and in group B, after induction of GA. Haemodynamic parameters like heart rate (HR), mean arterial pressure (MAP), cardiac index (CI) and other derived parameters were obtained serially up to 10 min after tracheal intubation in group A and the haemodynamic management was based on these parameters. In group B, the haemodynamic management was based on HR and MAP. The demographic data was similar in both the groups. The time required for insertion of PAC was also similar in the two groups (7.6 +/- 1.8 and 6.2 +/- 1.3 min, p > 0.05). The number of interventions in the form of infusions of volume, nitroglycerin or dopamine were significantly more in group A before tracheal intubation. The patients in group A maintained better haemodynamics at 10 min after tracheal intubation as compared with group B (CI 2.8 +/- 0.67 vs 2.1 +/- 0.49, p < 0.05; stroke volume 54 +/- 18 vs 51 +/- 0.65, p < 0.05; systemic vascular resistance 1431 +/- 409 vs 1724 +/- 430, p < 0.05; pulmonary vascular resistance 109 +/- 34 vs 181 +/- 110, p < 0.05). Insertion of PAC before induction of GA provides informative data and can be utilized to treat haemodynamic alterations in high-risk patients undergoing CABG.

Inhalational induction of anaesthesia with 8% sevoflurane in children: conditions for endotracheal intubation and side-effects

Background and objective: This study was designed to assess the conditions for endotracheal intubation or insertion of a laryngeal mask airway following an inhalational induction using 8% sevoflurane and nitrous oxide without the use of muscle relaxants or opioids. Methods: There were two groups: 30 children had endotracheal intubation and 30 children had a laryngeal mask airway inserted. Induction of anaesthesia was accomplished using an inspiratory concentration of sevoflurane 8% in a nitrous oxide and oxygen mixture. After an end-expiratory concentration of sevoflurane of at least 4% had been reached, when the pupils were miotic and centred, the trachea was intubated or a laryngeal mask inserted. The time to loss of consciousness and successful airway management was recorded. Jaw relaxation, movements, visibility, and position of the vocal cords and vital parameters were monitored. Results: Jaw relaxation was complete in all children. The vocal cords were completely visible in all patients of the tracheal intubation group, whereas vocal cord relaxation was incomplete in five children. Nevertheless, all children had an atraumatic intubation or insertion of the laryngeal mask without the use of a muscle relaxant. Vital signs were stable in both groups. There were no cases of restlessness and/or postoperative shivering. Four patients in the endotracheal group (13.3%) were nauseous and three (10%) vomited, while two children (6.6%) in the laryngeal mask group experienced nausea and vomiting. Conclusions: Induction with sevoflurane in nitrous oxide and oxygen leads to fast loss of consciousness and provides ideal conditions for managing the airway without supplemental opioids or muscle relaxants. Furthermore, sevoflurane using this technique was very well tolerated, indicated by high haemodynamic stability and a reduced rate of postoperative restlessness, shivering, nausea and vomiting.

Effects of combining midazolam and barbiturate on the response to tracheal intubation: changes in autonomic nervous system

Study Objective: To investigate the effects on the autonomic nervous system of anesthesia induction with a combination of midazolam and barbiturate using plasma catecholamine concentration and heart rate (HR) variability in comparison with the induction with barbiturate alone. Design: Prospective study. Setting: Operating room of a university hospital. Patients: 40 ASA physical status I and II patients aged 30 to 70 years, who were scheduled for general anesthesia. Interventions: Anesthesia was induced with 0.1 mg/kg midazolam followed by 3 mg/kg thiopental sodium (Midazolam-Barbiturate group) or thiopental 5 mg/kg (Barbiturate group) with 6 L/min oxygen. Measurements: Arterial blood pressure (BP), HR, HR variability, and plasma concentrations of epinephrine and norepinephrine were measured. Main Results: Blood pressure and HR increased in response to tracheal intubation in both groups, but the increase was significantly larger in the Barbiturate group. In the Barbiturate group, the high-frequency component (HF) in HR variability increased significantly during intubation, whereas in the Midazolam-Barbiturate group, HF decreased continuously. The low-frequency component (LF)/HF ratio increased in both groups, with significantly higher values noted in the Barbiturate group. Plasma epinephrine concentrations decreased before intubation and increased in response to tracheal intubation in the Barbiturate group. Finally, plasma norepinephrine concentrations increased in response to tracheal intubation only in the Barbiturate group. Conclusions: Anesthesia induction with a combination of midazolam-thiopental was effective in reducing hemodynamic and cardiac autonomic nervous system responses to tracheal intubation in comparison with the conventional induction with thiopental alone.