尼卡地平对围拔管期心血管反应的影响

我们在术毕拔管前试用尼卡地平,观察拔管前后心血管反应,兹报告如下。资料与方法胸腹部择期手术患者40例(21～66岁),ＡＳＡⅠ～Ⅱ级。均采用静脉快速诱导气管内插管静吸复合麻醉。术终拔管指征:吞咽反射恢复,能睁眼,抬头试验时间>5秒。吸空气时ＳｐＯ2>94%、ＰＥＴＣＯ2<6ｋＰａ持续5分钟以上。将40例随机分为两组:Ａ组静注生理盐水5ｍｌ;Ｂ组静注尼卡地平20μｇ/ｋｇ(生理盐水稀释至5ｍｌ)。均于拔管前10分钟注入。记录注药前5分钟、注药后5分钟、注药后10分钟(即拔管时)、拔管后5分钟的ＳＢＰ、ＨＲ。所有数据计算平均值和标准差(ｘ±ｓ),…     

不同药物预防拔管时心血管反应效果比较

资料与方法比较利多卡因、艾司洛尔及利多卡因 艾司洛尔混合液对预防气管拔管时心血管反应的效果。 80例静吸全麻病人随机分为四组。术毕具备拔管指征时 ,于气管吸痰及拔管前2分钟分别注射 :Ａ组 (对照组 ) ,生理盐水 5ｍｌ;Ｂ组 (利多卡因组 ) ,2 %利多卡因 1 5ｍｇ/ｋｇ ;Ｃ组 (艾司洛尔组 ) ,艾司洛尔 2ｍｇ/ｋｇ加水至 10ｍｌ;Ｄ组 (混合组 ) ,利多卡因 0 75ｍｇ/ｋｇ+艾司洛尔 1ｍｇ/ｋｇ。监测ＥＣＧ、ＳｐＯ2 、ＳＢＰ、ＤＢＰ ,记录给药前、拔管时、拔管后 1、3、5、10分钟时的ＨＲ、ＢＰ变化。结果Ａ组在吸痰拔管时至拔管后 5分…     

胰十二指肠切除术后腹腔引流管的拔管指征探讨

目的探讨胰十二指肠切除术后腹腔引流管的拔管指征。方法回顾性收集2014年1月至2016年6月期间在四川省人民医院行胰十二指肠切除术、术后按定义的拔管指征拔除腹腔引流管的76例患者为加速康复外科(ERAS)组,回顾性收集同期在四川省人民医院行胰十二指肠切除术、术后根据医生经验拔除腹腔引流管的80例患者为对照组,比较ERAS组和对照组患者的拔管时间、术后并发症发生情况(包括胰瘘、胃排空障碍及腹腔感染)、住院时间及术后30 d内再入院情况。结果与对照组比较,ERAS组患者的拔管时间[(6.2±2.5)d比(10.8±2.2)d,P0.001]和术后住院时间[(11.8±3.4)d比(15.7±3.6)d,P0.001]均较短,腹腔感染率较低[1.3%(1/76)比10.0%(8/80),P=0.020],但2组患者的胰瘘发生率[18.4%(14/76)比21.3%(17/80)]、胃排空障碍发生率[1.4%(1/76)比7.5%(6/80)]和术后30 d内再入院率[5.3%(4/76)比3.8%(3/80)]比较差异均无统计学意义(P0.05)。结论以本组定义的拔管指征指导胰十二指肠切除术后腹腔引流管的拔管是安全的。     

不同吸氧流量对高海拔高原地区病人术后血氧饱和度的影响

目的 :探讨高海拔高原(海拔4 000 m)地区全身麻醉手术病人,不同吸氧流量对于术后血氧饱和度(saturation of peripheral oxygen, SpO_2)的影响。方法:选取西藏阿里地区人民医院2017年8月至2018年4月在气管插管全身麻醉下手术的80例病人。采用随机数字表法,分为4组:拔管后2 L/min吸氧为L1组,4L/min吸氧为L2组,6L/min吸氧为L3组,8L/min吸氧为L4组,每组各20例。分别记录进入手术室后未吸氧时(T0)的SpO_2,以及苏醒拔管后,给予口鼻面罩吸氧30min、1h、2h、4h、24h时的SpO_2。结果:本研究男47例,女33例,年龄19～58岁,体重48～72 kg,术前评估病人为美国麻醉医师学会Ⅰ、Ⅱ级。所有病人术后拔管给予面罩吸氧,SpO_2较术前均有升高(P0.05)。吸氧流量为2L/min时,SpO_2处于较低水平。吸氧流量为4L/min时,SpO_2已接近低海拔地区健康人群正常值。吸氧流量≥6 L/min时,SpO_2不再随吸氧流量的增加而升高。吸氧4h后,L_3、L_4组与L_2组比较,SpO_2差异无统计学意义(P0.05),吸氧流量可降低至4L/min。继续吸氧至术后24h,L1组SpO_2为94.86%,接近富氧环境的95%。因此,吸氧流量24h后可降为2L/min。结论:高海拔高原地区全身麻醉病人术后早期吸氧流量建议≥6L/min。此后可以降至4L/min和2L/min,避免高流量氧的浪费和氧中毒风险。     

深麻醉下拔管对小儿OSAS术后躁动的作用研究

目的观察并深入分析深麻下拔管对小儿OSAS术后的整体影响及应用价值。方法选取2019年3月至2020年3月本院收治的小儿OSAS共80例,所有患儿均行手术治疗,治疗医师根据麻醉拔管时机不同将患儿平分为两组。其中观察组40例,为深麻醉下拔管;对照组40例,为清醒时拔管。结果在拔管后即刻、拔管后10分钟以及拔管后15分钟时,观察组患儿的MAP及HR值均明显小于对照组患儿(P0.05);在拔管后20分钟、拔管后40分钟时,观察组患儿的SAS评分明显小于对照组患儿(P0.05);在拔管后即刻及拔管后10分钟时,观察组患儿不良反应发生率(10.0%)明显小于对照组患儿(42.5%),差异具有统计学意义(χ~2=9.3413,P0.05)。结论小儿OSAS手术过程中应用深麻醉下拔管方式可以有效减轻患儿躁动情况,且术后出现SpO290%、喉痉挛以及呛咳的出现几率更低,适合临床选择应用。     

不同通气模式对泌尿外科腹腔镜手术患者动脉血气及气道压的影响

目的:观察泌尿腹腔镜手术中呼吸功能变化及增加每分钟通气量的两种方法的临床应用效果。方法:随机选择全麻下泌尿腹腔镜手术患者200例均分为A、B两组,男120例、女80例,年龄78～15岁。两组观察方法略同:气管内插管后,CO2气腹前行动脉血气分析,同时记录PetCO2、Paw。然后增加机械通气频率(A组2次/min、即每分钟通气量增加约16%,B组3次/min、即每分钟通气量增加约25%)。腹腔镜手术基本结束,终止CO2气腹时,再次行动脉血气分析、同时记录PetCO2、Paw。观察并比较两组CO2气腹前后动脉血气、PetCO2、Paw变化及差异。结果:两组患者气腹前pH、PaCO2、PetCO2及Paw比较差异无统计学意义。人工气腹后,两组患者均较气腹前pH降低,PaCO2、PetCO2和Paw升高,A组和B组相比,pH降低、PaCO2、Paw升高,而PetCO2无明显差异。结论:泌尿腹腔镜手术中的呼吸功能监测十分重要,不可忽视。为抵消CO2气腹所导致的PaCO2增加,选择每分钟通气量提高25%进行调节较为合适。     

乌拉地尔对围拔管期心血管反应的影响

目的:观察乌拉地尔对围拔管期心血管反应的影响。方法:40例全麻病人随机分为2组,分别于术毕符合气管拔管指征时静注乌拉地尔0.1mg/kg或生理盐水0.1ml/kg,观察围拔管期血压、心率、心律,并计算心率与动脉收缩压乘积(RPP)。结果:围拔管期发生明显的心血管反应,血压、心率及RPP明显升高(P<0.05),应用乌拉地尔使上述指标趋于平稳。结论:小剂量乌拉地尔能有效地预防全麻病人气管拔管时心血管反应。     

艾司洛尔对全麻拔管时心率变异和血液动力学的影响

全麻拔管时可造成血液动力学的剧烈变化 ,增加心脏负担 ,导致心脑血管的严重意外。本组采取监测心率变异性(ＨＲＶ)和血液动力学指标的变化 ,了解全麻拔管前静注艾司洛尔对此的影响和作用。资料与方法选择胸腹部择期全麻手术病人 4 0例 ,年龄 2 3～ 6 5岁 ,ＡＳＡⅠ～Ⅱ级。术毕待有拔管指征 (咳嗽、吞咽反射恢复、意识基本清楚、抬臂 5秒以上、潮气量 >8ｍｌ/ｋｇ、呼吸空气 5分钟后ＳｐＯ2 >95 % )拔管。 4 0例病人随机分为对照组 (Ｃ组 )和艾司洛尔组 (Ｅ组 ) ,每组 2 0例 ,采用双盲对照法 ,记录者与用药者均不知所用药品。Ｃ组静注生理…     

小剂量咪唑安定用于预防气管拔管时心血管反应的比较观察

全麻后气管拔管期间 ,因吸痰、气管导管刺激及伤口疼痛等可继发潜在有害的血液动力学变化。我们采用小剂量咪唑安定用于气管拔管前 ,有效地减轻了气管拔管期间的心血管反应 ,并具有显著的镇静作用。资料与方法一般资料　选择ＡＳＡⅠ～Ⅱ级择期普外科手术患者 2 0例 ,年龄 2 2～ 5 8岁 ,采用气管内麻醉。随机分为Ａ、Ｂ两组 :Ａ组于拔管前 10分钟静注咪唑安定 0 0 7ｍｇ/ｋｇ ,Ｂ组为对照组。拔管指征 :自主呼吸自行恢复 ,各项反射存在 ,不给氧时ＳｐＯ2 ≥ 95 %持续 5分钟以上。监测　拔管期间监测ＳｐＯ2 、ＨＲ、ＭＡＰ。分别记录拔管前…     

小儿手术后清醒或深麻醉时拔管后SpO_2的变化和并发症的发生率

在气管内插管全麻后拔管有两种方法,即清醒拔管和深麻醉下拔除。作者在接受眼斜视纠正术、增殖体和/或扁桃体切除术的小儿比较了清醒和深麻醉下拔管后氧饱和度(SpO_2)的改变和气道并发症的发生率。方法:作者将70例除需外科纠治的疾患外,其它方面均健康(ASAI或Ⅱ)的2至8岁的小儿分成两组进行观察比较。应用笑气/氧气和氟烷或硫成巴比妥5～6 mg/kg作麻醉诱导,用或不用琥珀胆碱完成插管。术中不再追加肌松剂。麻醉维持用笑气/氧气和氟烷,并保持小儿的自主呼吸。诱导后随机地将小儿分至两组中的一组。第一组小儿在术华清醒状态下(自主呼吸和吞咽反射恢复,气管内氟烷浓度<0.15%)拔管。第二组小儿在全麻外科手术期(深麻醉,气管内氟烷浓度≥0.8%)拔管,所有的小儿都给纯氧吸入至少五分钟(第一组在拔管前,第二组在拔管后离开手术室前)。测     

前列腺增生剜除术主动保留尽可能全部的前列腺前括约肌功能对术后尿控水平及生活质量的影响

目的探讨前列腺增生剜除术主动保留尽可能全部的前列腺前括约肌功能对术后尿控水平及生活质量的影响。方法选取2017年2月至2018年9月某院泌尿外科经前列腺增生剜除术治疗的78例患者作为研究对象,按照有无保留尽可能全部的前列腺括约肌功能分为未保留组(38例)与保留组(40例),观察两组术后拔管24 d、1周、2周、1个月、3个月尿控情况与术前、术后3个月最大尿流率变化情况,术前、术后3个月国际前列腺评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)及并发症(感染、尿外渗、性功能障碍)。结果保留组与未保留组拔尿管后24 h尿失禁率为12.5%(5/40)、31.6%(12/38)、拔尿管后1周为7.5%(3/40)、21.1%(8/38)、拔管后2周为5.0%(2/40)、18.4%(7/38),差异具有统计学意义(P<0.05);拔尿管后1个月尿失禁率为2.5%(2/40)、7.9%(3/38)、拔管后3个月为0.0%(0/40)、5.2%(2/38),差异无统计学意义(P>0.05),两组术后均未发生永久性尿失禁;术后保留组其IPSS、QOL、PVR优于未保留组,组间差异无统计学意义(P>0.05);术后保留组前列腺体积、前列腺特异性抗原明显低于未保留组,且保留组ICI-Q-SF评分显著优于未保留组,差异具有统计学意义(P<0.05);保留组并发症显著低于未保留组,差异具有统计学意义(P<0.05)。结论前列腺增生剜除术主动保留部分前列腺括约肌功能可有效改善患者术后尿控水平,减少术后并发症。     

鼻咽通气道用于肥胖患者麻醉恢复期气道管理的效果

目的 评价鼻咽通气道用于肥胖患者麻醉恢复期气道管理的效果.方法 全麻术毕患者80例,年龄48～72岁,ASA Ⅰ～Ⅲ级,体重指数>30 kg/m~2,随机分为2组(n=40):鼻咽通气道组(Ⅰ组)和口咽通气道组(Ⅱ组).待患者呼吸恢复(呼吸频率≥10次/min,潮气量≥5 ml/kg)后,拔除气管导管,Ⅰ组即刻经鼻腔置入鼻咽通气道,Ⅱ组经口腔置入口咽通气道,置入通气道后均以面罩给氧(氧流量3 L/min)至苏醒,脉搏血氧饱和度<90%时采取补救措施.于置入通气道后1 min(T_1)、5 min(T_2)、10 min(T_3)和20 min(T_4)时记录呼吸频率、脉搏血氧饱和度、心率、收缩压和舒张压,并记录置入通气道后20 min内并发症的发生情况.结果 置入通气道后,两组患者吸频率、脉搏血氧饱和度、心率、收缩压和舒张压均维持在正常范围.与Ⅱ组比较,Ⅰ组各时点脉搏血氧饱和度差异无统计学意义(P>0.05),T_(3.4)时呼吸频率、心率、收缩压和舒张压降低,躁动、恶心呕吐和喉痉挛的发生率降低(P<0.05).结论 与口咽通气道相比,鼻咽通气道维持肥胖患者全麻恢复期上呼吸道通畅的效果相同,但诱发的应激反应较低、并发症发生较少.     

麻醉状态下拔除气管导管-置入鼻咽通气道预防高血压患者拔管反应的效果

目的 评价麻醉状态下拔除气管导管-置入鼻咽通气道预防高血压患者拔管反应的效果.方法 择期全麻下行腹腔镜胆囊切除术的高血压患者80例,随机分为气管导管组(Ⅰ组)和气管导管-鼻咽通气道组(Ⅱ组),每组40例.两组麻醉诱导气管插管后行机械通气,术中靶控输注异丙酚(血浆靶浓度3～4 μg/L)和舒芬太尼(血浆靶浓度0.2～0.4 ng/L)维持麻醉,维持脑电双频指数40～50.术毕调整异丙酚血浆靶浓度至1 μg/L、舒芬太尼靶浓度至0.1 ng/L,待呼吸恢复后停止输注,Ⅱ组拔除气管导管,置入鼻咽通气道辅以面罩给氧,待患者完全苏醒后拔除;Ⅰ组待患者完全苏醒后拔除气管导管;于麻醉诱导前即刻(T_0)、置入鼻咽通气道后即刻(T_1)、2 min(T_2)、拔除后即刻(T_3)、2 min(T_4)时记录收缩压(SP)、舒张压(DP)、心率(HR)、脉搏血氧饱和度(SpO_2),记录拔管过程中血液动力学指标的最大值(SP_(max)、DP_(max)及HR_(max)),计算拔管前后的差值(△SP、△DP及△HR),并测定血浆肾上腺素(AD)、去甲肾上腺素(NE)浓度,观察呛咳、躁动的发生情况.结果 与T_0时比较,Ⅰ组T_(3,4)时SP、DP、HR、血浆AD及NE浓度升高,Ⅱ组T_(1,3,4)时SP和DP,T_(2,3)时HR降低(P<0.05);与Ⅰ组比较,Ⅱ组T_(2～4)时SP、DP、HR、血浆AD及NE浓度降低,SP_(max)、DP_(max)、HR_(max)及△SP、△DP、△HR降低.拔管反应发生率降低(P<0.05).结论 麻醉状态下拔除气管导管-置入鼻咽通气道可有效预防高血压患者全麻恢复期的拔管反应.     

右美托嘧啶对胸腔镜手术全麻患者拔管期间的临床疗效观察

目的观察右美托嘧啶对胸腔镜肺叶切除术患者拔管期间的临床疗效观察。方法选择我院收治需要气管插管全麻行胸腔镜肺叶切除术的患者60例,分为右美托嘧啶组和对照组,各30例。两组分别在手术结束前30 min用静脉微泵注入0.5μg/kg·min的右美托嘧啶和等量的生理盐水,注射时间15 min。记录两组患者麻醉前、手术结束时、吸痰拔管时、拔管后1min、拔管后5 min、拔管后15 min各个时间点的心率、平均动脉压、Sp O2的变化,记录患者手术时间、睁眼时间、拔管时间、定向力恢复时间,记录拔管期间不良反应。结果右美托嘧啶组在吸痰拔管时、拔管后1 min、拔管后5 min的平均动脉压和心率与对照组比较降低明显(P0.05),拔管期间心动过缓的发生率右美托嘧啶组高于对照组(P0.05),寒颤发生率右美托嘧啶组低于对照组(P0.05),两组患者Sp O2、手术时间、睁眼时间、拔管时间、定向力恢复时间无差异。结论行气管插管全身麻醉的胸腔镜肺叶切除术患者在拔管前使用右美托嘧啶微泵注射,能有效抑制患者拔管期间的不良反应,保持循环及呼吸稳定,镇痛充分并不延长术后苏醒时间和拔管时间。     

Effect of single-dose omeprazole on intragastric acidity and volume during obstetric anaesthesia

Various antacid or antisecretory agents are used to reduce the risk to patients of aspiration of gastric contents during general anaesthesia and a trial of the gastric proton pump inhibitor, omeprazole, is reported here. Twenty women admitted for elective Caesarean section under general anaesthesia received a single 80-mg oral omeprazole dose at 2000 hours on the evening before surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. Eighty-five percent of pH measurements at induction and extubation and 80% and 95% of volume measurements at induction and extubation respectively met the defined success criteria (pH greater than or equal to 2.5, volume less than 25 ml). Omeprazole treatment was well tolerated by the women and Apgar scores and subsequent progress of the babies were acceptable. These results indicate that gastric acidity and volume were acceptable in the majority of women after omeprazole treatment, but the interval from drug administration to induction of anaesthesia may have been too long in some cases and resulted in unacceptably low pHs.     

Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough

STUDY OBJECTIVE: To evaluate the effect of low-dose ketamine on fentanyl-induced cough. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Medical center hospital. PATIENTS: 360 ASA physical status I-II patients aged 18 to 65 years, weighing between 40 and 80 kg, and scheduled for elective surgery during general anesthesia. INTERVENTIONS AND MEASUREMENTS: Patients were randomly assigned to receive either ketamine 0.15 mg/kg or placebo (equal volume of 0.9% saline) given intravenously over 10 seconds, one minute before administration of fentanyl (1.5 microg/kg IV, injected within 5 seconds), during induction of general anesthesia. Any episode of cough was classified as coughing and the onset time of cough (the time of the first episode of cough) was observed for one minute after fentanyl administration by a blinded observer. Severity of coughing was graded based on the number of episodes of coughing (mild, 1-2; moderate, 3-5; and severe, >5). Blood pressure, heart rate, and pulse oximetry oxygen saturation (Spo2) were recorded before giving ketamine or 0.9% saline and 1 minute after fentanyl injections. MAIN RESULTS: After the intravenous injection of fentanyl bolus, patients in the placebo group showed significantly higher frequency cough than those in the ketamine pretreatment group (21.6% vs 7.2%, P<0.05), and onset time of the ketamine group was significantly longer than that of the control group (20+/-8 vs 15+/-10 seconds, P<0.01). However, no difference in cough severity was observed between the two groups. CONCLUSION: Low-dose ketamine (0.15 mg/kg IV) effectively reduces fentanyl-induced cough and delays the onset time of cough.     

儿童腹腔镜阑尾切除术CO2气腹对呼吸的影响

目的:探讨儿童腹腔镜阑尾切除术(LA)CO2气腹对呼吸的影响。方法:47例小儿行LA,观察气腹前后PETCO2、SpO2、Ppeak的变化。结果:气腹后比气腹前患儿SpO2下降;而Ppeak、PETCO2上升。放气后PETCO2、SpO2、Ppeak基本恢复至气腹前水平。PETCO2气腹前后有显著差异,术终拔管前降至近气腹前水平。无低氧血症发生。结论:加强呼吸循环监测,术中合理用药,能使腹腔镜手术麻醉顺利完成,儿童腹腔镜手术将更安全可靠。     

A comparison of intravenous ranitidine and omeprazole on gastric volume and pH in women undergoing emergency Caesarean section

We have compared the effect of intravenously administered omeprazole and ranitidine on gastric contents in a double-blind study in 80 consecutive women undergoing emergency Caesarean section. When the decision to perform emergency Caesarean section was made, patients were randomly assigned to receive either ranitidine 50 mg or omeprazole 40 mg intravenously. The volume and pH of the gastric contents were measured immediately after tracheal intubation and again before extubation. The gastric pH was found to be higher after omeprazole than after ranitidine immediately after intubation (5.89 ± 1.46 and 5.21 ± 1.36 respectively) (P < 0.05) and before extubation (5.97 ± 1.38 and 5.32 ± 1.24 respectively) (P < 0.05). However, the gastric volumes were comparable in both the groups. The number of patients with gastric volume > 25 ml and pH < 2.5 were 3 (7.5%) in the ranitidine group and 1 (2.5%) in the omeprazole group after intubation and none in either of the groups before extubation. We conclude that omeprazole 40 mg iv administered at the time of the decision to operate, results in higher gastric pH than ranitidine in obstetric patients undergoing emergency Caesarean section. Une étude à double insu nous a permis de comparer l’effet de l’oméprazole et de la ranitidine sur le contenu gastrique de 80 parturientes subissant une césarienne d’urgence. Au moment de h prise de décision en faveur de la césarienne, les patientes ont été réparties aléatoirement pour recevoir soit de la ranitidine 50 mg, soit de l’oméprazole 40 mg par la voie intraveineuse. Le volume et le pH du contenu gastrique ont été mesurés immédiatement après l’intubation et avant l’extubation. Le pH gastrique était plus élevé après l’oméprazole qu’après la ranitidine immédiatement après l’intubation (respectivement 5,89 ± 1,46 et 5,21 ± 1,36, P < 0,05) et avant l’extubation (respectivement 5,97 ± 1,38 et 5,32 ± 1,24, P < 0,05). Cependant, le volume gastrique était comparable entre les deux groupes. Après l’intubation, le nombre de patientes avec un volume gastrique > 25 ml et un pH <2,5 était de trois (7,5%) dans le groupe ranitidine, et de une (2,5%) dans le groupe omeprazole et d’aucune des deux groupes avant l’extubation. Les auteurs concluent que l’oméprazole 40 mg iv administré au moment de la décision d’opérer procurait un pH gastrique plus élevé que la ranitidine chez des parturientes subissant une césarienne en urgence.     

Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation

Background: The purpose of this study was to determine the predictive value of an endotracheal tube cuff leak for the development of postextubation stridor and the need for reintubation.

Study Design: Consecutive trauma patients who required intubation at a level I trauma center from July 1997 to July 1998 were studied prospectively. Pediatric patients and those who did not meet the standard weaning protocol criteria established by the Division of Trauma and Surgical Critical Care were excluded. Injury Severity Score, endotracheal tube size, reason for intubation, and the number of days intubated before the initial extubation attempt were recorded. At the time of extubation, the difference in exhaled tidal volume from before to after endotracheal tube cuff deflation was calculated. This number was then divided by the exhaled tidal volume before cuff deflation and was recorded as the percent cuff leak. Patients were followed for 24 hours after extubation for the development of stridor or need for reintubation. Statistical analysis to compare subgroups of patients was performed using ANOVA with Scheffé post hoc analysis.

Results: Among the 110 patients analyzed, the most common reason for intubation was closed-head injury. Seven patients (6.4%) developed stridor alone and had a mean cuff leak of 58 mL (8.4% of tidal volume before cuff deflation). Six patients (5.5%) experienced stridor that required reintubation and had a mean cuff leak of 68 mL (9.2% of tidal volume before cuff deflation). Patients who developed stridor or needed reintubation had been intubated for a significantly greater length of time than those not developing stridor or requiring reintubation (2.6 versus 3.0 days, p < 0.001). There were no differences in Injury Severity Score, endotracheal tube size, or reason for intubation between these groups.

Conclusions: A cuff leak of less than 10% of tidal volume before cuff deflation is useful in identifying patients at risk for stridor or reintubation (96% specificity). It appears that the amount of cuff leak decreases after intubation for more than 3 days, increasing the risk of stridor and need for reintubation. This information may be helpful in identifying those patients who need treatment for laryngotracheal edema, ie, use of steroids or anesthesia during extubation, the efficacy of which remains to be determined.     

Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.

BACKGROUND: Adaptive support ventilation (ASV) is a microprocessor-controlled mode of mechanical ventilation that maintains a predefined minute ventilation with an optimal breathing pattern (tidal volume and rate) by automatically adapting inspiratory pressure and ventilator rate to changes in the patient's condition. The aim of the current study was to test the hypothesis that a protocol of respiratory weaning based on ASV could reduce the duration of tracheal intubation after uncomplicated cardiac surgery ("fast-track" surgery). METHODS: A group of patients being given ASV (group ASV) was compared with a control group (group control) in a randomized controlled study. After coronary artery bypass grafting during general anesthesia with midazolam and fentanyl, patients were randomly assigned to group ASV or group control. Both protocols were divided into three predefined phases, and weaning progressed according to arterial blood gas and clinical criteria. In phase 1, ASV mode was set at 100% of the theoretical value of volume/minute in group ASV, and synchronized intermittent mandatory ventilation mode was used in group control. When spontaneous breathing occurred, ASV setting was reduced by 50% of minute ventilation (phase 2) and again by 50% (phase 3), and the trachea was extubated. In group control, the ventilator was switched to 10 cm H2O inspiratory pressure support (phase 2), then to 5 cm H2O (phase 3) until extubation. RESULTS: Forty-nine patients were enrolled. Sixteen patients completed the ASV protocol, and 20 the standard protocol; 7 patients were excluded in group ASV and 6 in group control according to explicit, predefined criteria. There were no differences between groups in perioperative characteristics or in the doses of sedation. The primary outcome of the study, that is, the duration of tracheal intubation, was shorter in group ASV than in group control (median [quartiles]: 3.2 [2.5-4.6] vs. 4.1 [3.1-8.6] h; P < 0.02). Fewer arterial blood analyses were performed in group ASV (median number [quartiles]: 3 [3-4] vs. 4 [3-6]), suggesting that fewer changes in the settings of the ventilator were required in this group. CONCLUSIONS: A respiratory weaning protocol based on ASV is practicable; it may accelerate tracheal extubation and simplify ventilatory management in fast-track patients after cardiac surgery. The evaluation of potential advantages of the use of such technology on patient outcome and resource utilization deserves further studies.