The Clinical Experience of Tracheal Intubation Guided by Fiberoptic Bronchoscope Under Rapid Sequence Intravenous Anesthetic Induction<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 孙海涛 薛富善 孙海燕 杨 冬 李成文 刘鲲鹏 李玄英 中国医学科学院中国协和医科大学整形外科 医院麻醉科,北京100041 Haitao Sun, Fushan Xue, Haiyan Sun, Dong Yang, Chengwen Li, Kunpeng Liu, Xuanying Li Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical college,Beijing 100041
ABSTRACT Objective: To introduce the clinical experience of tracheal intubation guided by fiberoptic bronchoscope under rapid sequence intravenous anesthetic induction. Methods:86 adult patients, ASA classⅠ-Ⅱ, aged 18 -62years, and scheduled for elective plastic surgery, were included. The tracheal intubation was done with fiberoptic bronchoscope under total intravenous anesthetic induction. Noninvasive SBP, DBP, HR and SpO2 were recorded before and after anesthetic induction, at intubation and 5min after intubation with 1minute interval. The times required by FOB being inserted into tracheal, the times that tracheal intubation was completed, and the times needed to recover spontaneous respiration were also recorded. Results: The incidence of successful inserting FOB into tracheal was 100%. Its time was 10~126s, with a mean time of 25.38±9.94s. The incidence of successful intubation was 97.8%. The intubation time was 20~144s, with a mean time of 43.65±14.88s. Of all the patients, the duration of intubation manipulation was less than 1 min in 73 patients(84.9%), less than 2min in 10 patients( 11.6%),and more than 2min in 1 patients(2%), respectively. SBP, DBP and HR at intubation were significantly higher than the basic values before anesthetic induction. Conclusion: The rapid sequence intravenous anesthetic induction in our study can adequately satisfy the needs of the skilled FOB operator performing intubation guided by FOB in regard to duration and anesthetic effect. But it cannot effectively prevent the hemodynamic responses to intubation guided by FOB. Key words: Intravenous anesthesia; Fiberoptic bronchoscope; Intubation Corresponding author: Fushan Xue; MD; E-mail: Xuebai@fescomail.net
光导纤维支气管镜(fiberoptic bronchoscope,FOB)于1969年开始应用于临床,目前已是检查呼吸道病变、处理困难气道和挽救危重症患者的重要工具[1]。我们根据国外报道的常用操作方法对一些患者实施了FOB引导气管插管处理,取得了十分有效的操作经验,现将其报道如下,旨在为临床麻醉中安全应用FOB提供资料。 临床资料 本组共包括86例施择期整形外科手术的患者,全部患者为ASAⅠ~Ⅱ级,其中男性31例,女性55例,患者的年龄为17~62岁,体重44~132kg,身高156~185cm。其中包括小口畸形患者3例,颈颏颈粘连患者2例,面颈部扩张器植入术后患者13例,其他手术患者68例。经口气管插管者61例,经鼻气管插管者25例。 |