Following short-term intubation for general anesthesia, respiratory difficulty may result from laryngeal or subglottic edema after extubation. We have hypothesized that this problem could be pretreated by administering a high-dose of dexamethasone intravenously before extubation. After glottic injuries were made under direct laryngoscopic view, intubation was performed and maintained for 1 hour in 33 rabbits. The rabbits were divided into 3 groups; dexamethasone (1 mg/kg) was administered to group 1(n=12) immediately after intubation and group 2(n=10) just before extubation; group 3(n=11) received normal saline, just before extubation. After extubation, subglottic excursion pressure was measured for 4 hours. 15 injured rabbit larynges and 3 normal ones were extracted for histologic section. 2 of 12 rabbits in group 1; 3 of 10 in group 2; and 5 of 11 in group 3, showed mild stridor after extubation(p>0.05). All rabbits developed maximum increase in subglottic pressure within 2 hours after extubation. Group 1 and 2 showed less increase in pressure compared to group 3(p<0.05), but here was no statistical difference between group 1 and 2(p>0.05). Histologic sections of the larynges showed less submucosal edema, including other changes in group 1 and 2, than in group 3(p<0.05). In conclusion, administering a high-dose of dexamethasone before extubation, is effective in prophylaxis and treatment of laryngeal injuries following short-term intubation in rabbits. This is especially true in edema.
Animal ; Dexamethasone/administration & dosage/*therapeutic use ; Intubation, Intratracheal/*adverse effects ; Laryngeal Edema/etiology/*prevention & control ; Rabbits

Anesthesia, General ; Arytenoid Cartilage ; injuries ; Child ; Humans ; Intubation, Intratracheal ; adverse effects ; Joint Dislocations ; etiology

OBJECTIVETo initially observe the effect of classical endotracheal intubation on endotracheal bacterial contamination and evaluate the validity of protective endotracheal intubation on reducing endotracheal bacterial contamination.

METHODSNinety elective patients undergoing general anesthesia for hysterectomy were randomly assigned to two equal groups. Group II received endotracheal intubation protected by sterilized transparent sleeve while group I correspondingly adopted unprotective classical endotracheal intubation. Endotracheal swab sampling and bacterial counting were performed on the principle of aseptic processing before endotracheal intubation and extubation, respectively.

RESULTSBacteria were found in 62 of 180 samples. The difference of bacterial counting between before extubation and before intubation was (-0.3 +/- 35.6) 100 CFU/ ml in group II, lower than that in group I, which was (21.4 +/- 56.7) 100 CFU/ml (P<0.05).

CONCLUSIONEndotracheal bacterial contamination may be caused by unprotective classical endotracheal intubation and could be reduced by protective endotracheal intubation.

Anesthesia, General ; Bacteria ; isolation & purification ; Female ; Humans ; Hysterectomy ; Intubation, Intratracheal ; adverse effects ; methods ; Trachea ; microbiology

OBJECTIVETo investigate the risk factors for postoperative arytenoid dislocation.

METHODSFrom September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in terms of date and type of procedures were chosen as the controls (n=16). Recorded data for all patients were demographics, smoking status, alcoholic status, preoperative physical status, airway evaluation, intubation procedures, preoperative laboratory test results, anesthetic consumption and intensive care unit stay. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocation, and the outcomes of surgical repair and conservative treatment. Categorical variables were presented as frequencies and percentages, and were compared using the chi-squared test. Continuous variables were expressed as means±SD and compared using the Student's unpaired t-test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis.

RESULTSSixteen patients with postoperative arytenoid dislocation were enrolled, with a median age of 52 years. Most postoperative arytenoid dislocation patients (15/16, 93.75%) received surgical repair, except one patient who recovered after conservative treatment. None of the postoperative arytenoid dislocation patients were smokers. Red blood cell (P=0.044) and hemoglobin (P=0.031) levels were significantly lower among arytenoid dislocation cases compared with the controls.

CONCLUSIONSNon-smoking and anemic patients may be susceptible to postoperative arytenoid dislocation. However, neither of them was independent risk factor for postoperative arytenoid dislocation.

Arytenoid Cartilage ; surgery ; Case-Control Studies ; Humans ; Intubation, Intratracheal ; adverse effects ; Retrospective Studies ; Risk Factors

Adult ; Aged ; Female ; Granuloma, Laryngeal ; etiology ; Humans ; Intubation, Intratracheal ; adverse effects ; Male

Airway Obstruction ; etiology ; Child ; Humans ; Intubation, Intratracheal ; adverse effects ; Male ; Mucus

OBJECTIVE: In order to further decrease and reduce the serious adverse events of silicone rubber endotracheal intubation in clinical use, especially in anesthesia and intensive care. METHODS: Through the first stage analysis on the registration and certification of endotracheal intubation products in China, adverse events of products in recent five years in Zhejiang province, domestic and foreign literature of adverse events of products, retrieval of product citation standards, content integrity of product instructions, and expert seminar on serious adverse events, combined with the air leakage of endotracheal intubation products in recent two years, product material and clinical application with normative aspects. RESULTS: Silicone rubber endotracheal intubation products in clinical intensive care have certain clinical safety risks, especially for long-term use of critically ill patients. CONCLUSIONS According to the four cases of serious adverse events of silicone rubber endotracheal intubation in the clinical intensive care unit, we put forward some suggestions for the manufacturers, clinical users and regulatory agencies to further decrease and reduce the serious adverse events of silicone rubber endotracheal intubation.
China ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Intubation, Intratracheal/adverse effects*

INTRODUCTION: Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. METHODS: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO₂), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO₂), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared. RESULTS: The values of ETCO₂, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO₂ at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar. CONCLUSION During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.
Humans ; Laryngeal Masks ; Carbon Dioxide ; Retrospective Studies ; Intubation, Intratracheal ; Laparoscopy/adverse effects* ; Postoperative Complications/etiology* ; Oxygen

OBJECTIVE: To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia. METHODS: We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed. RESULTS: A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge. CONCLUSION Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
Arytenoid Cartilage/surgery* ; Hoarseness/etiology* ; Humans ; Intubation, Intratracheal/adverse effects* ; Retrospective Studies ; Vocal Cords

Humans ; Child ; Glucocorticoids/therapeutic use* ; Airway Extubation ; Airway Obstruction/prevention & control* ; Intubation, Intratracheal/adverse effects*