Oral to nasal endotracheal tube exchange in a difficult airway: a novel method.
Oral to nasal endotracheal tube exchange in a difficult airway: a novel method.
复制标题
困难气道中的口鼻气管插管更换：一种新方法。
DOI：
10.1097/00000542-200211000-00048
复制
发表时间：
2002
期刊：
影响因子：
8.8
通讯作者：
Yogesh Manhas
中科院分区：
文献类型：
--
作者：
Amitabha Dutta;P. Chari;Ram A Mohan;Yogesh Manhas
编辑：-在Höhn等人最近的一篇文章中，得出结论，在心脏手术中，除了抑肽酶外，急性等容血液稀释(ANH)与单独使用抑肽酶相比，在预防同种异体输血方面没有好处。在这项随机对照试验中，患者在体外循环(CPB)前将血液稀释至28%的红细胞压积。CPB期间输血阈值为17%，CPB后输血阈值为25%。总补液量与自体血回收量的比值为6.42.1 L(晶体)和2.00.7(胶体)。这导致过度血液稀释，使ANH组的红细胞压积降至输血阈值以下。事实上，ANH组中50%的患者需要在体外循环期间输入全部(33%)或部分(22%)自体血液，因此否定了其对红细胞和凝血保护的积极作用。因此，两组患者的异基因红细胞输注率和外科出血的间接临床指标(细胞保存和24小时胸管引流)并无差异。ANH的目的之一是保护自体血液免受CPB的负面影响，并在肝素中和后将其返还。CPB开始时会出现额外的血液稀释；因此，应该使用血液滤过或超滤和/或利尿来去除多余的液体。或者，ANH可以在CPB开始前进行(通过将肝素化的血液转移到储存袋中)，从而防止过度的稀释性贫血。排除这项研究的标准是左主干疾病、严重的主动脉狭窄、最近的心肌梗死、不稳定心绞痛、射血分数低于30%、严重的颈动脉狭窄、冠状动脉搭桥术和瓣膜联合病例、呼吸功能不全、肾功能不全和贫血(血红蛋白12g/dl)。这一排除过程导致选择了一组我们知道风险较低的同种异体输血患者。我们的数据(如下所示)和其他研究人员的数据表明，出现足够的血红蛋白水平(平均起始红细胞压积为43.3%，体表面积为1.86)的患者很少需要异基因血液。在我们机构，心脏外科项目使用多学科的方法来保存血液。在300多例心脏手术(冠状动脉搭桥术、瓣膜移植和联合手术)中，我们平均每例去除1280毫升ANH血(根据公式在搭桥时达到20%的目标红细胞压积)。用于替换的平均液体量为1680毫升晶体和591毫升胶体(Hend，雅培实验室，伊利诺伊州芝加哥北部)。在体外循环中经常使用血液滤过或超滤和/或诱导利尿，以去除多余的液体并减少体外循环原液的稀释效应。起始红细胞压积平均为39%。我们对低风险病例使用-氨基己酸，对高危病例保留抑肽酶(Trasylol，Bayer，West Haven，CT)。总回收量约200毫升，24小时胸管引流428毫升，红细胞、新鲜冰冻血浆和冷沉淀物的异体输血率分别为11%、3%和不到1%。
To the Editor:—In a recent article by Höhn et al., it was concluded that acute normovolemic hemodilution (ANH) in addition to aprotinin was not beneficial in preventing allogeneic blood transfusions compared to aprotinin alone in cardiac surgery. In this randomized, controlled trial, the patients were hemodiluted to a hematocrit of 28% pre–cardiopulmonary bypass (CPB). The transfusion threshold was set at 17% during CPB and at 25% for post-CPB. The total fluid replacement was in excess relative to the amount of ANH (autologous blood) removed (6.4 2.1 l of crystalloid, 2.0 0.7 l of colloid). This led to excessive hemodilution, reducing the hematocrit below the transfusion threshold in the ANH group. Indeed, 50% of the patients in the ANH group required either all (33%) or a portion (22%) of the autologous blood to be transfused during CPB, thus negating its positive effects on erythrocytes and coagulation protection. Consequently, allogeneic erythrocyte transfusion rates and the indirect clinical markers for surgical bleeding (cell saver and 24-h chest tube drainage) were not different between the two groups. One of the goals of ANH is to protect the autologous blood from the negative effects of CPB and to return it after heparin neutralization. Additional hemodilution occurs with the onset of CPB; therefore, hemofiltration or ultrafiltration and/or diuresis should have been employed to remove excess fluid. Alternatively, ANH can be performed just prior to the onset of CPB (by diverting heparinized blood into a storage bag), thus preventing excessive dilutional anemia. The criteria for exclusion from this study were left main disease, severe aortic stenosis, recent myocardial infarction, unstable angina, ejection fraction below 30%, severe carotid stenosis, combined coronary artery bypass grafting and valve cases, respiratory insufficiency, renal insufficiency, and anemia (hemoglobin 12 g/dl). This exclusion process resulted in the selection of a group of patients that we know are at low risk for allogeneic transfusions. Our data (shown below) and those of other investigators demonstrate that patients presenting with adequate hemoglobin levels (average starting hematocrit of 43.3%, body surface area of 1.86) rarely require allogeneic blood. At our institution, the cardiac surgery program utilizes a multidisciplinary approach to blood conservation. In over 300 cardiac surgery cases (coronary artery bypass grafting, valves, and combined procedures), we remove on average 1280 ml of ANH blood per case (based on a formula to reach a target hematocrit on bypass of 20%). The average amount of fluid used for replacement was 1680 ml of crystalloid and 591 ml of colloid (Hextend, Abbott Laboratories, North Chicago, IL). Hemofiltration or ultrafiltration and/or induced diuresis is frequently utilized on CPB to remove excess fluids and to reduce the dilutional effect from the CPB prime. The starting hematocrit averages 39%. We use -aminocaproic acid for low-risk cases and reserve aprotinin (Trasylol, Bayer, West Haven, CT) for high-risk cases. The total amount of cell saver returned is approximately 200 ml, and 24-h chest tube drainage is 428 ml. Allogeneic transfusion rates for packed erythrocytes, fresh frozen plasma, and cryoprecipitate are 11%, 3%, and less than 1%, respectively.
两人技术对咽后气隙长而狭窄的患者进行纤维镜辅助气管插管。
DOI：
--
发表时间：
2001
期刊：
Anesth Analg 92
影响因子：
--
作者：
Kanaya N et al.;Kanaya N et al.;Kanaya N et al.
通讯作者：
Kanaya N et al.