Dissertation > Excellent graduate degree dissertation topics show

Study on Clinical Correlation of Airway Evaluation Methods and Clinical Efficacy and Safety of Laryngeal Tube

Author: HuShengHong
Tutor: LiYuanHai
School: Anhui Medical University,
Course: Anesthesiology
Keywords: Airway Evaluation methods Clinical correlation Laryngeal tube Clinical Efficacy Safety
CLC: R614
Type: Master's thesis
Year: 2010
Downloads: 35
Quote: 0
Read: Download Dissertation

Abstract

Objective To evaluate the clinical correlation of the several airway evaluation methods and investigate the feasibility of predicting difficult tracheal intubation of the ratio of height to thyromental distance for Chinese.Methods One hundred and thirty six ASAⅠorⅡpatients,aged 18-65yr,weight 42-95kg, height 149-183cm, body mass index 17.1-26.3kg/m2 scheduled for elective surgery under general anesthesia were studied. The airway condition was evaluated by the inter incisor gap, the Upper Lip Bite Test, the thyromental distance, the sternomental distance, the horizontal length of the mandible, the cervical part activity, the Wilson comprehensive risk assessment method, the ratio of height to thyromental distance, the modified Mallampati classification and the Comack-Lehane classification preoperatively. To measure and compare the sensitivity, the specificity, the positive predictive value, the false positive rate and the false negative rate of these airways evaluation methods for predictingr difficult tracheal intubation. The exposure of glottis was performed after anesthesia induction and evaluated with Comack-Lehane classification. The standard of difficult tracheal intubation was Cormack-Lehane classes III-IV or difficult in inserting the laryngoscope blade.Results One hundred and thirty six patients were studied.Difficult tracheal intubation was observed in 5 patients, there was no failed intubation. There were significant lower in the thyromental distance, the sternomental distance and the thecervical part activity while there was significant higher in the ratio of height to thyromental distance in patients in difficult tracheal intubation (P﹤0.05). The Upper Lip Bite Test and the ratio of height to thyromental distance were the most sensitive airway evaluation methods for predicting the difficult tracheal intubation(P﹤0.05). In addation to the thyromental distance, other airway evaluation methods were high specificit. The positive predictive value of the Upper Lip Bite Test was highest among these evaluation methods with a positive predictive value of 57.1%. The false positive rate of the thyromental distance was highest among these evaluation methods with a false positive rate of 93.7% while the Upper Lip Bite Test with a false positive rate of 42.9%. The false negative rate of the Upper Lip Bite Test and the ratio of height to thyromental distance were lowest in all evaluation methods with a false negative rate of 0.8%.Conclusions The clinical correlation of the Upper Lip Bite Test and the ratio of height to thyromental distance are better than anothers for predicting difficult tracheal intubation. The Upper Lip Bite Test and the ratio of height to thyromental distance are more reliable than anothers to predict difficult tracheal intubation at preoperative. Objective The laryngeal tube (LT) is a relatively new extraglottic airway which was designed to secure a patent airway management during either genenal anesthesia or cardiopulmonary resuscitation. However, the difference in efficacy and safety of the laryngeal tube, ProSeal laryngeal mask airway (PLMA) and tracheal intubation (TT) have not been reported. The purpose of this study was to compare the clinical efficacy and safety of LT with PLMA and TT.Methods Sixty ASAⅠ-Ⅱpatients undergoing elective gynecological hysterectomia surgery who had not serious cardiopulmonary and mouth disease were randomly divided into 3 groups (n=20): group L, group P and group T. Genenal anesthesia was induceded with midazolam 0.05 mg/kg, a target-controlled infusion of propofol at 1.5-2.0μg/ml, fentanyl 3μg/kg and vecuronium 0.12mg/kg. LT, PLMA or TT was inserted when muscles were completely relaxed after anesthesia induction. Anaesthesia was maintained with a continuous target-controlled infusion of propofol, inhalation of 1.5-2.0% sevoflurane, intermittent intravenous injection of fentanyl and vecuronium. The time of insertion, the successful rate of insertion at first attempt and the peak airway pressures were recorded. The partial pressure of oxygen (PO2) and the partial pressure of carbon dioxide (PCO2) were monitored at before anesthesia induction, 30min and 60min after skin incision. The hemodynamicses were recorded at immediately before anesthesia induction, immediately before insertion, 1 min, 3 min, 5 min after insertion, immediately before extubation, 1 min, 3 min and 5 min after extubation. The saturation of pulse oxygen (SpO2) was continuously recored during anesthesia.The pharyngeal adverse responses such as pharyngodynia, hoarseness and dysphagia within 24h after operation were recored.Results The time of insertion of the group L was longer than group P and group T, but the successful rate of insertion at first attempt of the group L was lower than group P and group T. The peak airway pressures of the there groups were within normal limits and comparable (P>0.05). The PO2 and PCO2 of the three groups were comparable (P>0.05). The hemodynamicses in group T were significantly increased after insertion and before extubation (P﹤0.05), which were not in group L and group P (P>0.05).The SpO2 of the three groups were comparable (P>0.05). Group T had two cases of pharyngodynia, group L and group P had not a case of pharyngeal adverse responses of pharyngodynia, hoarseness and dysphagia.Conclusion The study shows that the laryngeal tube can be safely used in airway management of paitent patients undergoing elective gynecological hysterectomia surgery, LT is superior to tracheal intubation in keeping stable hemodynamics and producing less pharyngeal adverse responses.

Study on Clinical Correlation of Airway Evaluation Methods and Clinical Efficacy and Safety of Laryngeal Tube

Abstract

Related Dissertations