著者は何の確認応答がありません。

すべての手順は、国家ラインラント=プファルツ州の医師会の倫理委員会によって承認され、ヘルシンキ宣言に従って行われました。 1.アトマイザー4 <ol><li>パッケージからセットを削除します。損傷がないことを確認するために製品を検査します。 注：デバイスは1回限りの使用を意図しています。 （材料および装置表を参照のこと）保管・供給に関する詳細な情報は、使用のための説明書を参照してください。 </li></ol>患者の2.一般的製造<ol><li>前に2.5 mgの夕方および/または2 - - 4 mgを1 - （禁忌に注意を払って）介入前の2時間前投薬、 例えばロラゼパム1を管理します。 </li><li>このようなパルス酸素濃度計度（SpO 2）、心電図（ECG）、および非侵襲性血圧（NIBP）などのパラメータを監視する確立します。 注：このようなラムゼイ鎮静スケールとBispectなどの標準を使用して患者の鎮静を監視RALインデックス監視。鎮静のレベルの綿密なモニタリングは、呼吸抑制などの潜在的な合併症を防ぐことができます。 </li><li>末梢静脈アクセスを保護します。 </li></ol>上気道の3表面麻酔<ol><li>各鼻孔にフェニレフリンで0.25％をリドカイン2％1mLの混合物を適用します。 </li><li>舌の裏に先端から噴霧、中咽頭の粘膜に二回直接リドカイン10％のスプレーを適用します。できるだけ長く口の中にリドカインをうがいするために患者を確認して下さい。 注：声門上気道の麻酔を吸引し、局所麻酔薬を噴霧、パッ綿棒または鼻咽頭気道、ドロップ、ゲルを、使用してうがい交互に行うことができます。 </li></ol> 4. Analgo、鎮静<ol><li>静脈薬を使用analgo-鎮静を開始し、 例えば初期のスフェンタニルボーラス（&lt;60キロ：5μgの;&gt; 60キロ：10μgの;&gt; 100キロ：15μgの）。 注：無呼吸や気道狭窄を防ぐために可能な最低レベルの線量薬物誘発性鎮静。 </li><li> 2（静かな、指向、協同組合）のラムゼイ鎮静スコアが達成されるまで、「レスキュー」治療として余分なスフェンタニル静脈内ボーラス、 例えば、5μgのを、与えます。 </li></ol> 5.機器の準備<ol><li>組み立てや制度の基準に応じて柔軟な挿管内視鏡を確認してください。 </li><li>直接酸素流量計に噴霧器の酸素チューブを接続します。 あぶない！加湿器のボトルと酸素流量計を使用することはできません。 </li><li>内視鏡のワーキングチャンネルにルアーに接続するチューブを取り付けます。取扱説明書で推奨されているように、10 L / minに酸素流量を設定します。 </li><li> 3ウェイサイドアームフィッティングにリドカイン2％溶液を含む1 mLシリンジを接続します。 注：その良好な有効性プロファイルを有するリドカイン2％が適してANです美的。 </li></ol> 6.アトマイザーテクニック<ol><li>指を使ってフロー制御開口部を閉じます。急速に薬剤を注入します。すぐにフロー制御開口部を解放します。 注：注射器は、作業チャネルを通じて連続低酸素流量を得るための3ウェイサイドアームフィッティングに接続する必要があります。 </li><li>気道内の軟性内視鏡を進めながら、以下のサイトで噴霧器を用いて局所麻酔薬を注入：鼻孔の内側、後方鼻孔に。喉頭蓋;声門;そして声帯。 </li><li> （「スプレーとして-ユー・ゴー」）内視鏡を進めながら、できるだけ頻繁に必要に応じてこれらの手順を繰り返します。声帯を通過する前に、サイトで十分な薬効を可能にするために2分間待ちます。 注：必要に応じて、（ 例えばスフェンタニル5μgの）静脈薬を用いて患者とトップアップ鎮静の鎮静レベルを監視します。 </li></ol> 7.柔軟な内視鏡挿管<ol><li> endoscを進めますOPE慎重に気管や位置だけ竜骨上記内視鏡の先端に声門を通して。回転下での気管内に内視鏡の上、適切なサイズ、手錠と潤滑柔軟な気管内チューブを鉄道。 注：主気管支に内視鏡の先端部の偶発的な進歩を避けてください。 </li><li>ただ、内視鏡を介した視覚制御によって竜骨上記気管内に気管内チューブの配置を確認してください。代わりに、気管内チューブを残して、内視鏡を取り外します。 </li><li>自発呼吸患者でカプノグラフィーを使用して、呼気終末CO 2を測定することにより、チューブの気管内位置を確認してください。 </li><li>全身麻酔、 例えば、静脈内プロポフォールを2mg / kg /体重を誘導します。現在の基準に従って患者を換気起動します。 </li></ol>注：ENKアトマイザーセットは、クックメディカルから現在使用できません。

<ol>
	<li>Simmons, S. T., Schleich, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+regional+anaesthesia+for+awake+fibreoptic+intubation.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+the+difficult+adult+airway.+With+special+emphasis+on+awake+tracheal+intubation.">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., G&#246;bler, S. M., Maybaur, M. O., Werner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+two+different+techniques+of+fiberoptic+intubation.">Comparison of two different techniques of fiberoptic intubation.</a> Eur J Anaesthesiol. 26, 328-332 (2009).</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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+the+atomizer+with+boluses+of+topical+anaesthesia+for+awake+fibreoptic+intubation.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&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:+a+randomised+controlled+trial.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+nebulization+and+spray-as-you-go+topical+anaesthesia+of+the+airway.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+of+administering+topical+anaesthesia+for+flexible+airway+endoscopy.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=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.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spray-as-you-go+airway+topical+anesthesia+in+patients+with+a+difficult+airway:+a+randomized,+double-blind+comparison+of+2%+and+4%+lidocaine.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+distension+and+rupture+from+oxygen+insufflation+during+fiberoptic+intubation.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+rupture+after+awake+fiberoptic+intubation+in+a+patient+with+laryngeal+carcinoma.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastric+rupture+and+pneumoperitoneum+caused+by+oxygen+insufflation+via+a+fibreoptic+bronchoscope.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oxygen+insufflation+through+the+fiberscope+to+assist+intubation+is+not+recommended.">Oxygen insufflation through the fiberscope to assist intubation is not recommended.</a> Anesthesiology. 87, 183 (1997).</li></ol>

著者らは、開示することは何もありません。 ENK-アトマイザーセットは、クックメディカルから現在使用できません。発明者（私信）によると同等のデバイスは、将来的に利用できるようになります。

ここでは、目を覚まし、内視鏡挿管用高酸素流量で噴霧器を使用して局所麻酔を実証します。アトマイザーの技術を評価した最初の研究では、柔軟な挿管内視鏡5のワーキングチャネルを介して局所麻酔の古典ボーラスとそれを比較しました。噴霧器群の患者は、対照群のものよりも優れたとして、快適性のレベルを評価し、少ない咳や個別の咳の発作を経験しました。また、噴霧器?...

目を覚まし挿管のための気道の局所麻酔は、一般的手順を成功させるのに役立ちます患者の快適さを改善することをお勧めします。高酸素流れにスプレーとして-ユー・ゴー技術は患者の間で受け入れの高いレベルを見つけることですシンプルかつ安全な概念です。咳や咽頭反射の少ない刺激で10リットル/分の結果の流量で酸素による局所麻酔薬の微粒化。 数人の患者からの負のフィードバックに直面し、我々は標準ユー・ゴースプレーとして、制度的な技術を改良することを決めました。局所麻酔薬のこの古典的なボーラスアプリケーションが気管内に、2分間の待ち時間の後、最初の声帯に、2回の注射、5 mLのリドカイン2％プラス10 mLシリンジで5 mLの空気のそれぞれから成っています。患者は、気道粘膜に当たるボーラスのしぶきによって溺死さの感覚不満。 スプレーとして-ユー・ゴー技術一般的に1世界中で使用されています。 patient&#39;s気管に挿管することを目標に、上部および下部気道を通じて先端を進めながら、この技術は、柔軟な挿管内視鏡の作業チャネルを介して局所麻酔薬を適用することを含みます。実際には複数のアプローチと文献中に記載された方法のいくつかの説明があります。スプレーとして-あなたゴー技術ワーキングチャネルを通じて一定の酸素流量のアプリケーションとの組み合わせで用いた初期の経験は、1990年代2に掲載されました。ここでの焦点は、離れてレンズからの粘液分泌と血液を分散させ、吸気酸素供給を高めることによって、レンズをクリーニングのような酸素流の影響でした。局所麻酔薬の微粒化を支援における酸素流の利点がPiephoと同僚3によって以前に示されました。これらは、3リットル/分の酸素の供給は、患者が少ない咳を生じた気化技術を記載しました。仮定して10 L / minの流れは、我々が正常にこの高い花の速度で噴霧器をテストし、さらに少ない咳呼び起こすだろう細かい粒子にローカルエージェントを霧化だろう。噴霧器は小容量、キンク性、柔軟性のある、圧力認定酸素管と接続管から構成されています。これらは、小流量制御開口部と嵌合三方サイドアームに接続されています。 噴霧技術は、すべての気道の状況のた​​めに使用することができます。しかし、デバイスは、このような腫瘍塊などの条件によって引き起こされるグレードの高い気道狭窄から慎重に遠位使用する必要があります。酸素の逆流がないことは、増加した気道圧力を引き起こし、気圧障害のリスクを増大させる可能性があります。また、噴霧器は、緊急時の設定に有用なツールです。セットの製造は、分未満を必要とし、ユーザーは特別なトレーニングを必要としません。以下では、個別の例を示す、高い酸素流量とスプレーとして-ユー・ゴー技術の詳細な取扱説明書を提示します作業工程。

<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

協力する患者の意欲は気管の成功アウェイク挿管のための絶対的な前提条件です。患者の薬物鎮静が彼らの自発呼吸を危険にさらすことができますしながら、気道の局所麻酔は、人気の手法です。スプレーとして-ユー・ゴー技術は、気道粘膜を麻酔するための最も簡単な機会の1を表します。軟性内視鏡のワーキングチャンネルを通じて局所麻酔剤の適用は麻酔科医だけでなく、呼吸器のために広く行わです。追加のデバイスも、この技術を実行するための前提条件として、特別なトレーニングのためのどちらが必要です。しかし、既知の臨床上の問題は、液体麻酔薬は、気道粘膜と声帯のような他の敏感な構造物に衝突する際に発生する可能性がある咳や吐き気反射です。これは、より微細な粒子に局所麻酔薬をかぶりを目的とワーキングチャネルを通して印加酸素を使用することによって回避することができます。さらに酸素流量は、より高い酸素の供給を提供し、よりよい表示に寄与し、離れてレンズからの粘液分泌物と血液を分散させます。我々はこれらの利点を最大に10リットル/分の高酸素流量と噴霧器を用いて、少ない咳引き起こされ、したがって、より満足し、協力的な患者を持っていました。胃送気、臓器破裂や気圧外傷を含む酸素流を使用しての可能性が、非常にまれな合併症は発生しませんでした。私たちは、流量と圧力の放出を可能にするセットの設計に高い酸素流の合併症のない使用を属性。

<html>私たちは、48人の患者に提示局所麻酔技術を使用して目を覚まし可撓性内視鏡挿管を行いました。我々は、それが不可能なチューブを前進させるために作られた咽頭のstenosing腫瘍、苦しん1を除くすべての患者に挿管することに成功しました。 目を覚まし挿管快適の品質は耐え難い10 = 0 =不快ではないから11点視覚的ア?...

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.

高酸素流量でスプレーとして-ユー・ゴー技術を使用して目を覚まし、内視鏡挿管のための局所麻酔気道

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

16.5K ビュー.  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.

ビデオ: 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.

難しい挿管と困難な換気のための新規のレスキューテクニック

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

医学

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.

選択科目小児光ファイバー挿管のためのガイドライン

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.

マウスの気管内挿管<em&gt;経由</emオトスコープの使用&gt;直接喉頭鏡検査

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.

マウスの気管の迅速な挿管のための改善された方法

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.

閉塞性睡眠時無呼吸における目標制御注入（TCI）とバイスペクトル解析による薬剤誘発性睡眠内視鏡検査（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.

集中治療室型装置による急性呼吸窮迫症候群の豚モデルにおけるハロゲン化剤の送達

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.

ブタの安全な気道管理のための標準化モデルとしての柔軟な挿管内内視鏡を使用した気管内挿管

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.

緊急気道管理のためのポータブル超音波検査を用いた画像取得

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

自律呼吸を維持したビデオ支援胸腔鏡手術のための非挿管プロトコル

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.

著者スポットライト:マルチモーダル鎮痛およびセボフルラン吸入麻酔による挿管されていないビデオ支援胸腔鏡手術 

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

挿管されていないビデオ支援胸腔鏡手術

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

高酸素流量でスプレーとして-ユー・ゴー技術を使用して目を覚まし、内視鏡挿管のための局所麻酔気道

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難しい挿管と困難な換気のための新規のレスキューテクニック

選択科目小児光ファイバー挿管のためのガイドライン

マウスの気管内挿管

マウスの気管の迅速な挿管のための改善された方法

閉塞性睡眠時無呼吸における目標制御注入（TCI）とバイスペクトル解析による薬剤誘発性睡眠内視鏡検査（DISE）

集中治療室型装置による急性呼吸窮迫症候群の豚モデルにおけるハロゲン化剤の送達

ブタの安全な気道管理のための標準化モデルとしての柔軟な挿管内内視鏡を使用した気管内挿管

緊急気道管理のためのポータブル超音波検査を用いた画像取得

挿管されていないビデオ支援胸腔鏡手術

挿管されていないビデオ支援胸腔鏡手術