Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2017-12-27 Cooperative journals: 《南方医科大学学报》
Abstract： Objective To investigate effect of lung protective ventilation on respiration and circulation in elderly patients receiving spinal operation performed in the prone position. Methods Sixty patients undergoing elective spinal surgery were randomized control group [with V T of 10 mL/kg (PBW) and RR of 10-12 /min] and test group [with V T of 6 mL/kg +RMs+PEEP:5 cmH 2 O (PBW) and RR of 12-18 /min]. Recruitment maneuver was performed once every 30 min. HR, MAP, P peak , P Plat , PaO 2 /FiO 2 , SpO 2 , PaCO 2 , WBC, NEUT%, CRP, VAS, pulmonary complications risk score, and clinical pulmonary infection score were recorded before the operation, upon entry in the operation room, at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position, and at 1 day and 3 days after the operation. Results Pulmonary complications risk score, HR, MAP, WBC,NEUT%, and P a CO 2 were all comparable between the two groups (P>0.05). P peak and P plat of the test group were lower than those of the control group after entering the operation room and at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position (P<0.05). Compared with those in the control group, the oxygenation index at 1 day after the operation was significantly higher and CRP and postoperative clinical pulmonary infection score at 1 day and 3 days after the operation ere significantly lower in the test group (P<0.05). Conclusion Lung protective ventilation can reduce the risk of barotrauma, reduce lung inflammation, and improve postoperative oxygenation in elderly patients undergoing spinal surgery in the prone position without affecting intraoperative hemodynamics or causing CO 2 retention .
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2017-12-07 Cooperative journals: 《南方医科大学学报》
Abstract： Objective To analyze the risk factors for difficult airway in laryngoscopy and mask ventilation. Methods A total of 300 patients receiving general anesthesia with tracheal intubation were examined preoperatively for height, thyromental and sternomental distance (TMD), range of neck movement, inter-incisor distance, and modified Mallampati class. Intubation Difficult Score was used to identify a difficult laryngoscopy. Difficult airway was defined as either difficult laryngoscopy or difficult mask ventilation. The association between the airway characteristics and difficult airway was analyzed by logistic regression analysis, and the cut-off values for the height-to-TMD ratio was determined by the ROC curve. Results and Conclusion Eight airway characteristics were identified to contribute to a difficult airway, including (OR [95% CI]) the height-to-TMD ratio (3.58[1.95-8.46]), modified Mallampati class (3.34 [1.82-7.14]), BMI (3.07 [1.64-6.69]), history of a previous difficult airway (2.79 [1.28-5.25]), a thick neck (2.15 [1.04-4.37]), range of neck movement (1.98 [0.96-3.89]), sternomental and angulus mandibulae distance (1.46 [0.67-3.04]), and inter-incisor distance (1.01 [0.49-2.54]). The optimal cut-off value for the height-to-TMD ratio was 22.8 for predicting a difficult airway.
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