Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was...Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients. Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5--67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 （including 1375 patients with the atlanto-occipital extension of 〉20° and the Mallampatti＇s grade I or II） and group 2 （containing 308 patients with the atlanto-occipital extension of 〈20° and the Mallampatti＇s grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia （TIVA） or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope （FOSL）. The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients. Results In group 1, the intubation was accomplished during the first attempt in 1279 cases （93%） and the intubation time was 〈3 minutes in 1304 cases （95%）. In group 2, the intubation was completed by the first attempt in 114 patients （37%） and 123 patients had an intubation time of 〈3 minutes （40%）. Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients r展开更多
Prediction of a difficult airway is very important to anesthesiologist.Usually,the cause of difficult intubation may be divided into two groups: the problems with the intubation technique and the problems related to c...Prediction of a difficult airway is very important to anesthesiologist.Usually,the cause of difficult intubation may be divided into two groups: the problems with the intubation technique and the problems related to changes in airway anatomy.This article is focus on the latter.We often use thyromental distance,mouth opening,Mallampati classification,Wilson risk sum score etc.as predicting variables in clinical practice.But all of them are associated with poor sensitivity,specificity and positive predictive values.So,a predictive clinical multifactor and multivariate analysis should be adopted to meet the needs.However,it’s still a question that which variables should be considered in the multivariate analysis system.展开更多
Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement...Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement of other organ systems to varying degrees. Patients with JBS may require surgical intervention to address the underlying phenotypic abnormalities. The many craniofacial abnormalities found in patients with JBS are a concern for the anesthesiologist. We present the case of an adult patient with JBS who is undergoing implantation of a leadless pacemaker. Considering the many cardiac and craniofacial abnormalities in these patients, the anesthesiologist should order diagnostic tests such as echocardiography to assess cardiac function, as well as be prepared to perform advanced airway techniques for difficult airways. The anesthetic provider should be aware of the varied phenotypic expression of JBS and should individualize the anesthetic plan to each patient. Prior medical literature on the anesthetic management of these patients is scarce and limited to pediatric patients. This is the first case report addressing anesthetic concerns in an adult patient with JBS.展开更多
文摘Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients. Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5--67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 （including 1375 patients with the atlanto-occipital extension of 〉20° and the Mallampatti＇s grade I or II） and group 2 （containing 308 patients with the atlanto-occipital extension of 〈20° and the Mallampatti＇s grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia （TIVA） or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope （FOSL）. The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients. Results In group 1, the intubation was accomplished during the first attempt in 1279 cases （93%） and the intubation time was 〈3 minutes in 1304 cases （95%）. In group 2, the intubation was completed by the first attempt in 114 patients （37%） and 123 patients had an intubation time of 〈3 minutes （40%）. Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients r
文摘Prediction of a difficult airway is very important to anesthesiologist.Usually,the cause of difficult intubation may be divided into two groups: the problems with the intubation technique and the problems related to changes in airway anatomy.This article is focus on the latter.We often use thyromental distance,mouth opening,Mallampati classification,Wilson risk sum score etc.as predicting variables in clinical practice.But all of them are associated with poor sensitivity,specificity and positive predictive values.So,a predictive clinical multifactor and multivariate analysis should be adopted to meet the needs.However,it’s still a question that which variables should be considered in the multivariate analysis system.
文摘目的评价LEMON法预测困难气道的临床效果。方法选择择期行全身麻醉下喉镜暴露气管插管的手术患者1 528例,男680例,女848例,年龄18~83岁,ASAⅠ或Ⅱ级。麻醉前进行LEMON法评分,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)及曲线下面积(area under the curve,AUC)评价LEMON法预测困难气道的临床效果。结果困难气管插管患者37例,发生率为2.4%。困难喉镜暴露患者106例,发生率为6.9%。LEMON法预测困难喉镜暴露及困难气管插管的AUC分别为0.884(95%CI 0.867~0.899)和0.934(95%CI 0.921~0.946)。结论LEMON法在患者困难气道预测中有较好的临床效果。
文摘Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement of other organ systems to varying degrees. Patients with JBS may require surgical intervention to address the underlying phenotypic abnormalities. The many craniofacial abnormalities found in patients with JBS are a concern for the anesthesiologist. We present the case of an adult patient with JBS who is undergoing implantation of a leadless pacemaker. Considering the many cardiac and craniofacial abnormalities in these patients, the anesthesiologist should order diagnostic tests such as echocardiography to assess cardiac function, as well as be prepared to perform advanced airway techniques for difficult airways. The anesthetic provider should be aware of the varied phenotypic expression of JBS and should individualize the anesthetic plan to each patient. Prior medical literature on the anesthetic management of these patients is scarce and limited to pediatric patients. This is the first case report addressing anesthetic concerns in an adult patient with JBS.
