Name: topical airway anesthesia for awake-endoscopic intubation using the spray-as-you-go technique with high oxygen flow
Uploaded: 2017-01-13T14:00:00.000+00:00
Duration: 5 min 43 s
Description: 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

Yazarlar hiçbir onayları var.

Tüm işlemler Devlet Rheinland-Pfalz tıbbi dernek etik kurulu tarafından onaylandı ve Helsinki Bildirgesi uyarınca yapıldı. 1. Atomizer 4 <ol><li> paketinden setini çıkarın. herhangi bir hasar olmadığından emin olmak için ürün kontrol edin. NOT: Cihaz bir defalık kullanım için tasarlanmıştır. depolama ve arz hakkında daha fazla bilgi için kullanım talimatlarına (Materyalleri ve Ekipmanları Tabloya bakınız) bakınız. </li></ol> Hastanın 2. Genel Hazırlık <ol><li> Daha önce 2.5 mg akşam ve / veya - 2 - 4 mg 1 - (kontrendikasyonlar dikkat) müdahale öncesinde 2 saat premedikasyon, örneğin lorazepam 1 yönetin. </li><li> Böyle pulse oksimetre (SpO 2), elektrokardiyografi (EKG) ve non-invaziv kan basıncı (NIBP) gibi parametreleri izleme kurar. NOT: Ramsay sedasyon skalası ve Bispect olarak Monitör hasta sedasyon kullanarak standartlarıral Endeksi izlenmesi. sedasyon düzeyine yakından izlenmesi, solunum depresyonu gibi potansiyel komplikasyonları önlemeye yardımcı olabilir. </li><li> periferik damar yolu sabitleyin. </li></ol> Üst Solunum Yolu 3. Topikal Anestezi <ol><li> Her bir burun deliğine fenilefrin ile% 0.25 lidokain% 2 1 mL karışımı uygulanır. </li><li> Dilin arka ucundan püskürtme, orofarinksin mukoza üzerine iki kez doğrudan lidokain% 10 sprey uygulayın. mümkün olduğunca uzun süre için ağızda lidokain gargara için hasta isteyin. NOT: supraglottik havayolu Anestezi aspire ve lokal anestezikler püskürtme, homoseksüel pamuk uçlu çubuk veya nazofarengeal hava yolları, damla, jel kullanarak ve gargara alternatif yapılabilir. </li></ol> 4. Analgo-sedasyon <ol><li> 60 kg; iv ilaç, örneğin ilk sufentanil bolus (&lt;5 mg 60 kg&gt;: kullanarak analgo-sedasyon başlatın 10 ug;&gt; 100 kg: 15 mikrogram). Not: apne ya da solunum yolu daralma önlemek için mümkün olan en düşük seviyede doz ilaç kaynaklı sedasyon. </li><li> 2 Bir Ramsay Sedasyon Skoru kadar &#39;kurtarma&#39; tedavi olarak ekstra bir sufentanil iv bolus, örneğin 5 ug, Give (kooperatif, odaklı, sakin) elde edilir. </li></ol> 5. Ekipman Hazırlık <ol><li> Birleştirin ve kurumsal standartlara göre esnek entübasyon endoskop kontrol edin. </li><li> doğrudan oksijen akış ölçere atomizer oksijen tüpünü bağlayın. Dikkat! Nemlendirici şişeleri ile oksijen akış metre kullanılmamalıdır. </li><li> endoskopun çalışma kanalı üzerinde Luer bağlanırken tüp takın. kullanım kılavuzunda önerilen, 10 L / dk oksijen akış hızını ayarlayın. </li><li> Üç yollu yan kol bağlantı parçasına lidokain% 2 solüsyon ihtiva eden bir 1 ml şırınga bağlayın. NOT: onun olumlu etkinlik profili ile Lidokain% 2, uygun bir bir olduğunuestetik. </li></ol> 6. Atomizer Tekniği <ol><li> Bir parmağınızı kullanarak akış kontrol ağzını kapatınız. Hızla ilaç enjekte edilir. Hemen akış kontrol açılış bırakın. NOT: Bir şırınga çalışma kanalından sürekli düşük oksijen akışı elde etmek üç yollu yan kol uydurma bağlı olmalıdır. </li><li> havayolu esnek endoskop ilerleyen, aşağıdaki sitelerde püskürtücü kullanılarak lokal anestezik enjekte: burun deliğine içinde arka burun üzerinde; epiglot; glotis; ve ses tellerinin. </li><li> sık sık endoskop ( &quot;sprey-as-you-go&quot;) ilerleyen süre gerektiği gibi bu adımları yineleyin. ses tellerinin geçmeden önce, yerinde yeterli ilaç etkisi sağlamak için 2 dakika bekleyin. NOT: Gerektiğinde, hasta ve kontör iv ilaç kullanarak sedasyon sedasyon düzeyini (örn sufentanil 5 ug) izleyin. </li></ol> 7. Esnek Endoskopik Entübasyon <ol><li> Endosc Advanceope dikkatlice trakea ve pozisyon sadece karinanın üstünde endoskop ucu içine glottisin yoluyla. dönme altında trakea içine endoskop üzerinde uygun bir büyüklükte, kelepçeli ve yağlanmış esnek endotrakeal tüp sıkıştırıyor. NOT: Bir ana bronş içine endoskop ucu kazara ilerlemesini kaçının. </li><li> sadece endoskop aracılığıyla görsel kontrol ile karina üzerinde trakea endotrakeal tüpün yerleştirilmesini onaylayın. yerinde endotrakeal tüpü bırakarak, endoskop çıkarın. </li><li> Spontan soluyan hastada kapnografi kullanarak end tidal CO 2 ölçerek tüp endotrakeal konumunu onaylayın. </li><li> Genel anestezi, örneğin intravenöz Propofol 2 mg / kg / vücut ağırlığını neden olur. mevcut standartlara göre hastalarda ventilasyon başlayın. </li></ol> NOT: Enk Atomizer seti şu anda Cook Medical ulaşılabilir değil.

<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>

Yazarlar ifşa hiçbir şey yok. Enk-Atomizer seti şu anda Cook Medical ulaşılabilir değil. Mucit (kişisel iletişim) verilerine göre karşılaştırılabilir cihaz gelecekte mevcut olacak.

Burada uyanık-endoskopik entübasyon için yüksek oksijen akışı ile bir püskürtücü kullanılarak topikal anestezi göstermektedir. Atomizer tekniğini değerlendirmek için ilk çalışma, esnek Entübasyon endoskopun 5 çalışma kanalıyla topikal anestezi klasik bolus ile karşılaştırdık. atomizör grubundaki hastalar kontrol grubuna göre daha iyi olarak konfor düzeyini değerlendirdi ve daha az öksürük ve belirgin öksürük atakları yaşadı. Buna ek olarak, atomizör tekniği daha hı...

uyanık entübasyon için havayolu topikal anestezi genellikle prosedürü başarıya yardımcı olacak hasta konforunu geliştirmek için tavsiye edilir. yüksek oksijen akışı ile you-go sprey olarak tekniği hastalar arasında kabul yüksek düzeyde bulgudur basit ve güvenli bir kavramdır. Öksürük ve gag refleksinin az uyarılması 10 L / dk sonuçlarının bir akış hızında oksijen tarafından lokal anestetik atomizasyon. birçok hasta negatif geribildirim ile karşı karşıya kalan, biz standart you-go sprey olarak kurumsal tekniğini geliştirmek için karar verdi. lokal anestetik Klasik bir bolus uygulaması trakea içine, bir 2-dakikalık bir bekleme süresinden sonra, daha sonra ilk ses tellerinin içine iki enjeksiyon, 5 ml lidokain% 2 artı 10 ml şırınga içinde 5 ml hava her oluşuyordu ve. Hastalar solunum yolu mukozasını çarpıcı bolus sıçrama ile boğuldu olma duygusu hakkında şikayette bulundu. Sprey-as-you-go tekniğidünya genelinde yaygın olarak 1 kullanılır. , hastanın trakea entübe amacı ile üst ve alt solunum yolundan ucu ilerleyen Bu teknik, esnek Entübasyon endoskopun çalışma kanalından lokal anestezik uygulanmasını içerir. Uygulamada birden yaklaşımlar ve literatürde yöntemlerin çeşitli tanımları vardır. Çalışma kanalı üzerinden sabit oksijen akışı uygulaması ile birlikte you-go sprey-gibi-tekniği ile ilk deneyimleri 1990&#39;lı 2 yayınlandı. Odak burada uzaklıkta lens dan mukus salgıları ve kan dağıtılması ve inspiratuar oksijen sunumunu yükseltilerek lens temizleme gibi oksijen akış etkileri oldu. Lokal anestezik atomizasyon yardım oksijen akışının avantajı Piepho ve arkadaşları 3 ile daha önce gösterilmiştir. Bunlar 3 L / dak oksijeni hastalar tarafından daha öksürük sonuçlanan bir buharlaştırma tekniği tarif. varsayımına birdaha az öksürük uyandırmayacak ince parçacıklar halinde yerel ajan atomize olur 10 L / dk akış, başarıyla bu yüksek çiçek hızında atomizer test etti. Atomizör küçük bir hacme, kink dayanıklı, esnek, basınç sertifikalı oksijen tüpü ve bir bağlantı borusu içermektedir. Bu, küçük bir akış kontrol açıklığı olan bir üç-yollu yan kol bağlantı parçasına bağlanır. Atomizör teknik tüm hava yolu durumlar için kullanılabilir. Bununla birlikte, cihaz, tümör kütleleri olarak koşullarının neden olduğu daha yüksek dereceli hava yolu stenozu dikkatli uzak kullanılmalıdır. oksijen backflow eksikliği havayolu basıncı artmış ve barotravma riskini artırır neden olabilir. Ayrıca, atomizör acil bir ortamda yararlı bir araçtır. setin hazırlanması bir dakikadan az ihtiyacı vardır ve kullanıcı özel eğitim ihtiyacı vardır. Aşağıda biz ayrı gösteren, yüksek oksijen akışına you-go sprey-as-teknik için ayrıntılı kullanım kılavuzunu sunuyoruzçalışma adımlar.

<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

işbirliği Hastanın isteği trakea başarılı uyanık entübasyon için mutlak bir ön koşuldur. Hastaların ilaç-sedasyon onların spontan solunumu tehlikeye sokabilir iken, havayolu topikal anestezi popüler bir tekniktir. Sprey-as-you-go tekniği havayolu mukozasının uyutmak için basit fırsatlardan birini temsil etmektedir. Esnek endoskopun çalışma kanalından lokal anestezik uygulama anestezist yanı sıra göğüs hastalıkları için yaygın bir uygulamadır. ek aygıtlar ne bu tekniği gerçekleştirmek için bir ön koşul olarak özel eğitime ne ihtiyaç vardır. Ancak, bilinen bir klinik problem sıvı anestetik ses tellerinin gibi solunum yolu mukozasını ve diğer hassas yapıların grev oluşabilecek öksürük ve tıkanma reflekstir. Bu ince parçacıklar halinde lokal anestezik sis amacıyla çalışma kanalından uygulanan oksijen kullanımıyla önlenebilir. ayrıcaOksijen akışı uzak mercekten mukus salgıları ve kan dağıtma, daha yüksek bir oksijen kaynağı sağlar ve daha iyi bir görünüme katkıda bulunur. Bu faydalar maksimize 10 L / dakikalık bir yüksek oksijen akışına sahip bir püskürtücü kullanılarak, daha az öksürük neden olmuş ve daha memnun ve bu nedenle ortak hasta vardı. mide insuflasyon, organ yırtılması ya da ortaya çıkmadı barotravmaya dahil oksijen akışını kullanarak Olası, ama çok nadir komplikasyonlar. Biz akış ve basınç salınımını izin seti, tasarımı yüksek oksijen akışının komplikasyon-ücretsiz yararlanma bağlıyor.

<html> Biz 48 hastada sunulan topikal anestezi tekniği kullanılarak uyanık esnek endoskopik entübasyon uygulandı. Biz imkansız tüp ilerletmek için yapılan farenks bir stenoz tümörü, muzdarip biri hariç tüm hastaları entübasyon başardı. uyanık entübasyon konfor kalitesi dayanılmaz = 10 tatsız 0 = bir 11 puanlık görsel analog skala (VAS) ile hastalar, anestezist ve hemşireler tarafından değerlendirildi....

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.

Topikal Havayolu Anestezi Kullanımı Awake-endoskopik entübasyon için yüksek oksijen Flow ile Tekniği Sprey-as-you-go

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

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

16.5K Görüntüleme.  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.

Video: 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.

Zor entübasyon ve zor Havalandırma için Roman Kurtarma Tekniği

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

Tıp

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.

Seçmeli Pediatrik Fiberoptik Entübasyon için rehber

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.

Farelerde Endotrakeal Entübasyon<em&gt; Via</emBir Otoskop Kullanma&gt; Doğrudan Larengoskopi

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.

Farelerde Trakea hızlı intübasyon için geliştirilmiş bir yöntem

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.

İlaç Kaynaklı Obstrüktif Uyku Apnesi Hedef Kontrollü İnfüzyon (MKE) ve Bispectral Analizi ile uyku Endoskopi (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.

Akut Solunum Sıkıntısı Sendromunun Porcine Modelinde Yoğun Bakım Ünitesi Tipi Cihazla Halojenli Ajan Doğumu

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.

Domuzlarda Güvenli Hava Yolu Yönetimi için Standartlaştırılmış Bir Model Olarak Esnek Entübasyon Endoskobu Kullanılarak Endotrakeal Entübasyon

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.

Acil Hava Yolu Yönetimi için Portatif Sonografi Kullanarak Görüntü Yakalama

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

Korunmuş Otonomik Solunum ile Video Yardımlı Torakoskopik Cerrahi için Entübasyon Dışı Protokol

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.

Yazar Spotlight: Multimodal Analjezi ve Sevofluran İnhalasyon Anestezisi ile Entübe Edilmemiş Video Yardımlı Torakoskopik Cerrahi 

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

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

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

Topikal Havayolu Anestezi Kullanımı Awake-endoskopik entübasyon için yüksek oksijen Flow ile Tekniği Sprey-as-you-go

Özet

Daha Fazla Video Keşfet

Bu videodaki bölümler

Zor entübasyon ve zor Havalandırma için Roman Kurtarma Tekniği

Seçmeli Pediatrik Fiberoptik Entübasyon için rehber

Farelerde Endotrakeal Entübasyon

Farelerde Trakea hızlı intübasyon için geliştirilmiş bir yöntem

İlaç Kaynaklı Obstrüktif Uyku Apnesi Hedef Kontrollü İnfüzyon (MKE) ve Bispectral Analizi ile uyku Endoskopi (dise)

Akut Solunum Sıkıntısı Sendromunun Porcine Modelinde Yoğun Bakım Ünitesi Tipi Cihazla Halojenli Ajan Doğumu

Domuzlarda Güvenli Hava Yolu Yönetimi için Standartlaştırılmış Bir Model Olarak Esnek Entübasyon Endoskobu Kullanılarak Endotrakeal Entübasyon

Acil Hava Yolu Yönetimi için Portatif Sonografi Kullanarak Görüntü Yakalama

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi