Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

Due to the development of newer generation of lithotriptor, the anesthesia for extracorporeal shock wave lithotripsy (ESWL) was variable recently. To compare opioid analgesia with epidural lidocaine for their efficacy in pain control, hemodynamic changes, side effects and patient acceptance during ESWL, sixty unpremedicated patients undergoing elective ESWL for upper urinary calculi with second generation Dornier MFL 5000 nonimmersion lithotriptor were randomly assigned equally into one of the following managements: Group E: 1% epidural lidocaine with 1:200000 epinephrine; Group A: 15 micrograms/kg alfentanil initially and 7 micrograms/kg on demand intravenously; Group F: 4 micrograms/kg fentanyl initially and 2 micrograms/kg on demand intravenously. Significant hypotension and bradycardia occurred in Gp.E as compared to baseline value (p < 0.05). Early respiratory depression was observed in both Gp. A and Gp. F, but Gp. A showed significantly shorter period (2 to 5 minutes) as compared to Gp.F (2 to 15 minutes). Under the insufflation of oxygen by nasal cannula, mean PaCO2 increased maximally to 50 mmHg, but no arterial oxygen desaturation (< 90%) was noted in Gp.A and Gp.F. The incidence of post-ESWL nausea was higher in Gp.F (p < 0.05), shivering and delayed recovery time were the main disturbing problems in Gp.E (p < 0.01). Although five-point verbal pain scale was significantly higher in Gp.A and Gp.F (at 30 to 45 minutes during ESWL) as compared to Gp.E, acceptance among patients was high throughout the course. We conclude that different anesthetic plans should be determined on different lithotriptors settings and patient's physical condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Even though high frequency ventilation is the most important anesthetic ventilation technique for patients who have tracheal T-tube, other method is still in use, especially the Montgomery's method. In our daily practice, we found that there are some practical problems in the application of the Montgomery's method. Firstly, air leakage is present due to the presence of the Fogarty catheter at the connection of T-tube and endotracheal tube. Secondly, the internal diameter of the extraluminal limb of T-tube is smaller than the internal diameter of the intraluminal limbs, and the internal diameter of the endotracheal tube is smaller than the internal diameter of the extraluminal limb. This causes an increase in airway pressure in some patients. Thirdly, the endotracheal tube may kink and reduce the effective size of the lumen. Fourthly, the operation field may be interfered by the tube. We have designed a modification to solve these problems. A non-kinking endotracheal tube was used and the distal end of the non-kinking endotracheal tube was pushed to fit into the extraluminal limb of a T-tube. The other proximal end was connected to a mask elbow which was equipped with a sampling port. A Fogarty catheter was passed through the sampling port of the mask elbow and the trio attachment (mask elbow, non-kinking endotracheal tube, and T-tube) into the upper intraluminal limb of the T-tube. The balloon of the Fogarty catheter was inflated to occlude the opening of the upper intraluminal limb. Ventilation was performed by connecting the free end of the mask elbow to the anesthesia ventilator.(ABSTRACT TRUNCATED AT 250 WORDS)

The Department of Anesthesiology, College of Medicine, National Taiwan University (NTU) was founded in 1953 with the first chairman Doctor Kwang-yi Lee. Since its establishment 40 years ago, the department has made many contributions and caused great influence to the development of anesthesiology and clinical anesthesia in Taiwan. Among these, the establishment of the Society of Anesthesiologists of ROC (Taipei, Taiwan) in 1956, the publication of the society journal, Acta Anesthesiologica Sinica in 1961, the establishment of the Board of Anesthesiologists (1971), and the participation of the important international anesthesia-related societies such as The World Federation of Societies of Anesthesiologists (1964), The Asian and Australasian Regional Section of the World Federation of Societies of Anesthesiologists (1967), the International College of Surgeons (1969). During the past 40 years, the department has been experiencing dramatic changes both in the hardware (the operating room facilities and anesthetic equipment) and the software (the staff member, the training of clinical anesthesiologists and researchers, the quantity and quality of anesthetic and pain service). The full-blown modernization took place with the opening of the new operating room in the new medical center one more year ago (October 29, 1991). New anesthetic machines and monitoring systems together with other modern facilities and equipment annodated the new era for the department. The annual service has reached more than 16,000 cases. As a national university hospital, with the mission of teaching, research and service, we are the pioneer for anesthesia in open-heart surgery and organ transplantation as well as in pain and immunological-related anesthesia research.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of a new method (The hand mask technique) for airway maintenance during nasotracheal intubation was evaluated in our randomized crossover study. Sixty, age less than 50, ASA physical status class I-II patients undergoing surgery for the extremities with informed consent were randomly chosen for the study. Pulse oximeter, capnometer, EKG, blood pressure monitor and a peripheral nerve stimulator were attached to the patients before induction for continuous monitoring. An arterial cannula was inserted for intermittent blood gas sampling. After baseline room air blood gas data had been obtained from the spontaneously breathing patients, a flow rate of 6L/min pure oxygen was applied through a loosely fitted face mask and a semi-closed anesthesia breathing circuit for a period of 5 minutes. An arterial blood sample was drawn and the patients were put under general anesthesia with full muscle relaxation thereafter. Patients were then randomly assigned into two groups according to the ventilation technique used. Group A patients (n = 30) were manually ventilated first through a face mask for ten minutes and then the hand mask technique for another ten minutes. Blood gas data was sampled and heart rate, blood pressure, peak inspiratory airway pressure and end tidal CO2 were recorded immediately after each ventilation technique. For patients in Group B (n = 30), the sequence of the two ventilation technique were reversed. The results showed significant increases in PaO2 after artificial ventilation in both groups (No significant difference in results between the two groups) and less incidence of nasal bleeding in Group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Tracheal intubation by direct laryngoscopy is an essential skill for physicians working in the operating room, emergency room or intensive care unit settings. While tracheal intubation can usually be accomplished with ease by direct laryngoscopy, it is sometimes difficult or impossible because of coexisting disease or abnormal physical features. When recognized before attempts at tracheal intubation, virtually all difficult airways can be secured by the selected use of specialized tracheal intubation techniques, although many of these methods require special training, experience, assistance and equipment. When a difficult airway is unrecognized before attempts at intubation the results can be catastrophic because the personnel and equipment necessary for utilizing the specialized tracheal intubation techniques may not be immediately available and the patient's spontaneous respiratory efforts may have been eliminated by anesthetics or muscle relaxants. Thus, identifying patients who are likely to harbor an airway that cannot reliably be secured by simple direct laryngoscopy is an important skill for all acute or critical care physicians. There is an extensive research data base describing historical information, physical examination findings and radiographic features that are associated with the difficult airway. Reviewed collectively, one of the most important underlying concepts suggested by this body of research literature is that the difficult airway is a product of many anatomic and pathologic variables. A surprisingly wide variety of historical, physical examination and radiographic features associated with difficult direct laryngoscopy have been described. A rational approach to airway assessment, therefore, naturally includes a detailed history, a careful physical examination and inspection of relevant x-rays whenever time permits. As outlined in Table 5, there are specific questions to address that may warn the physician about possible airway difficulty. A number of airway assessment schemes based on physical examination findings have been proposed and tested. These schemes vary in their complexity and their clinical convenience. The simpler schemes fail to address the multifactorial nature of the problem, while the more complex systems are clinically impractical. Schemes combining the distance of the thyromental space and the visibility of the oropharyngeal structures, such as that proposed by Frerk, are perhaps the most practical and reliable of the methods proposed to date. Clearly, no one scheme is ideal. At present, preintubation airway evaluation remains a poorly quantified gestalt estimate of the chances for difficulty based on a complex juxtaposition of historical information and physical findings.(ABSTRACT TRUNCATED AT 400 WORDS)

Endotracheal intubation is a common procedure in anesthesia which can usually be accomplished easily. However if the attempt is unexpectedly difficult the patient may be seriously at risk. If all difficult airways can be predicted confidently in the pre-operative period, anesthesiologists can plan the safest and most effective way of managing tracheal intubation. The purpose of this study was to analyze not only the incidence, anatomic factors, immediate complications and management of difficult intubation cases but also the view obtained at laryngoscope which was graded according to the Cormack's and Lehane's description. Patients who received general anesthesia with endotracheal tube within 1 year's period from November 1, 1991 to October 31, 1992 in Show Chwan Memorial Hospital were collected. All difficult intubations were performed by senior anesthesiologists. 3925 patients were intubated, 92 cases were noted to have difficult intubations and their overall incidence were 2.3%. Among the 92 patients, those with 2 anatomic factors (41 patients, 44.6%) represented the majority for patients with difficult intubations. On the other hand, the four most common anatomic factors and their incidences in order of frequency included short neck (48.9%), protruding teeth (38.0%), receding mandible (27.2%) and limited opening mouth (26.1%). According to Cormack's and Lehane's laryngoscopic grading, the results were shown respectively as follow: 4 cases (4.4%) for grade 1;2 cases (2.2%) for grade 2;82 case (89%) for grade 3 and 4 cases (4.4%) for grade 4. We also found that tachycardia/hypertension (70.7%), bleeding (37.0%) and esophageal intubation (33.7%) were the three most frequent immediate complications during difficult intubations.(ABSTRACT TRUNCATED AT 250 WORDS)

30 cases receiving epidural anesthesia for lower extremities and abdominal surgery were selected in this study. Their physical status and average age were ASA I or II and 41 +/- 10.0 years old. Premedication included intramuscular injection of pethidine, atropine and promethazine. Epidural anesthesia was accomplished with 15 ml 2% lidocaine with epinephrine (1:80,000). After the stabilization of vital signs, the patients were put asleep by 0.1 mg/kg of midazolam intravenously. They were then evaluated by the sedative, cardiovascular, respiratory and recovery effects of intravenous midazolam in epidural anesthesia. The results were as follows: The patients receiving IV midazolam averagely fell asleep in 61.6 +/- 20.5 seconds and maintained asleep for 55.4 +/- 12.7 minutes. Pain on injection was not noted in these cases. Cardiovascular parameters revealed midazolam with general depression on systolic pressure (17.4 +/- 7.3%), diastolic pressure (13.4 +/- 8.4%), mean arterial pressure (12.7 +/- 7.0%), heart rate (10.9 +/- 7.2%), stroke volume (13.7 +/- 8.9%) and cardiac output (18.4 +/- 7.0%) respectively. The peak depression reached around 10 minutes after drug administration. Respiratory parameters dropped with SaO2 (1.1 +/- 1.6%) and respiratory rate (9.7 +/- 5.7%) and fell into trough after 5 minutes of drug administration. Although all the above parameters measured were statistically significant, they were of no clinical importance that required further management. No case had delirium, anxiety and vomiting in the recovery period. Conclusively, patients receiving epidural anesthesia with supplement of intravenous midazolam provides a good sedative effect. Clinically, there was less severe untowards reaction either in cardiovascular or respiratory systems. Smooth and stable recovery was also noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Three cases of thoracotomy with unsuccessful double-lumen endobronchial intubation were reported. Two were first intubated with an endotracheal tube. In the first patient a Fogarty catheter was inserted alongside the endotracheal tube into the right main bronchus to act as a bronchial blocker. The second patient employed a tracheal tube exchanger to change the endotracheal tube into an Univent tube for one lung ventilation. Nasal fiberoptic intubation was performed in the third case and a Fogarty catheter was passed through the lumen of the endotracheal tube into the left main bronchus as the bronchial blocker. All reported cases were operated with one lung ventilation successfully without the use of a double-lumen endobronchial tube.