עבודה זו ממומנת על ידי מחלקת ההרדמה בבית החולים לילדים של מישיגן.

1. ציוד הכנה <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> מד היתוך עבור משאבת אינפוזיה propofol </li><li style=";text-align:right;direction:rtl"> המקום צינורות nasotracheal מתחת למזרן חימום </li><li style=";text-align:right;direction:rtl"> חיבור המצלמה היקף לבדוק אוריינטציה </li><li style=";text-align:right;direction:rtl"> שלוש תנועות להשפיע על דרך נוף היקף: <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> פנימה והחוצה. </li><li style=";text-align:right;direction:rtl"> סיבוב באמצעות תמרון בשתי ידיים. </li><li style=";text-align:right;direction:rtl"> כיפוף והרחבה של הטיפ של היקף. </li></ol></li></ol> 2. ציוד נוסף <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> פנטניל 0.5-1.0 מ&quot;ג / ק&quot;ג </li><li style=";text-align:right;direction:rtl"> 12F יניקה אדום גומי קטטר </li><li style=";text-align:right;direction:rtl"> Glycopyrrolate 0.1-0.2 מ&quot;ג </li><li style=";text-align:right;direction:rtl"> מתכת וו הפחה </li><li style=";text-align:right;direction:rtl"> Afrin תרסיס לאף </li><li style=";text-align:right;direction:rtl"> חומר סיכה </li><li style=";text-align:right;direction:rtl"> לידוקאין 2% או 4% עבור ריסוס nares </li></ol> 3. הכנת החולה <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> בצע אינדוקציה מסכה שמירה על אוורור ספונטנית. </li><li style=";text-align:right;direction:rtl"> התחל IV ולתת פנטניל ו glycopyrrolate IV. </li><li style=";text-align:right;direction:rtl"> תן propofol בולוס 1 ק&quot;ג מ&quot;ג / ולהתחיל עירוי propofol 200 מק&quot;ג / ק&quot;ג / דקה. </li><li style=";text-align:right;direction:rtl"> Tape העיניים לפני ריסוס Afrin כדי למנוע התרחבות של האישונים. </li><li style=";text-align:right;direction:rtl"> תרסיס Afrin ו לידוקאין nares שניהם. </li><li style=";text-align:right;direction:rtl"> מסכת לאוורר את המטופל להפיץ Afrin ו לידוקאין distally. </li><li style=";text-align:right;direction:rtl"> פס גומי אדום קטטר לתוך nares הן כדי לבדוק patency. </li><li style=";text-align:right;direction:rtl"> בחר את הנחיר פטנט יותר עבור היקף סיב אופטי. </li><li style=";text-align:right;direction:rtl"> שמור את הגומי האדום הנחיר השני עם קצה ב hypopharynx עבור O 2. </li><li style=";text-align:right;direction:rtl"> השתמש וו הפחה להתחבר גומי אדום למעגל ולנהל 2 L / min של O 2 (לא insufflate גבוה זורם לתוך hypopharynx). </li></ol> 4. אינטובציה fiberoptic בפועל <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> קח מחבר את הצינור nasotracheal. </li><li style=";text-align:right;direction:rtl"> צינור מראש כל הדרך עד להיקף fiberoptic משומנים. </li><li style=";text-align:right;direction:rtl"> טיפ fiberoptic נקה עם אלכוהול </li><li style=";text-align:right;direction:rtl"> שים עקומה קלה על קצה היקף לעקוב הרצפה של האף. </li><li style=";text-align:right;direction:rtl"> נושא סיב אופטי אל הגרון בצורה עיוורת. </li><li style=";text-align:right;direction:rtl"> חפש את כל המבנים האנטומיים לזיהוי. עצור! </li><li style=";text-align:right;direction:rtl"> תביאו מבנים אנטומיים למרכז השדה ולשמור אותם שם. </li><li style=";text-align:right;direction:rtl"> כאשר מתקרבים מיתרי הקול, לתת בולוס של propofol 1 מ&quot;ג / ק&quot;ג IV. </li><li style=";text-align:right;direction:rtl"> לאחר דרך מיתרי, לעשות תפנית כלפי מטה לתוך קנה הנשימה. </li><li style=";text-align:right;direction:rtl"> עקוב אחר טבעות קנה הנשימה לרמה של קארינה. </li><li style=";text-align:right;direction:rtl"> אתה רשאי לדרוש בולוס propofol נוספים של IV 1 מ&quot;ג / ק&quot;ג. </li><li style=";text-align:right;direction:rtl"> ודא את קצה היקף fiberoptic נמצאת בעמדה ניטרלית. </li><li style=";text-align:right;direction:rtl"> נושא ETT. אם ETT מקבל ניתק על הגרון, לתת סיבוב 360 מעלות של הצינור לסובב אותו לתוך קנה הנשימה. </li></ol> 5. נציג תוצאות וידאו זה מראה טכניקה יעילה אינטובציה fiberoptic בחירה מטופלים ילדים אשר למיד בקלות התושבים העמיתים לשחזור. המפתח העיקרי הוא לשמור על אוורור ספונטני בכל עת. הכנת ציוד טוב לפני היד הוא גם חשוב.

<ol>
	<li>Kinouchi, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+difficult+pediatric+airway.">Management of difficult pediatric airway.</a> Masui. 55, 24-32 (2006).</li><li>Chen, Y. L., Wu, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+management+of+patients+with+craniofacial+abnormalities:+10-year+experience+at+a+teaching+hospital+in+Taiwan.">Airway management of patients with craniofacial abnormalities: 10-year experience at a teaching hospital in Taiwan.</a> J Chin Med Assoc. 72, 468-470 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+for+management+of+the+difficult+airway:+an+updated+report+by+the+American+Society+of+Anesthesiologists+Task+Force+on+Management+of+the+Difficult+Airway.">Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.</a> Anesthesiology. 98, 1269-1277 (2003).</li><li>Fiadjoe, J., Stricker, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+difficult+airway+management:+current+devices+and+techniques.">Pediatric difficult airway management: current devices and techniques.</a> Anesthesiol Clin. 27, 185-195 (2009).</li><li>Wheeler, M., Roth, A. G., Dsida, R. M., Rae, B., Seshadri, R., Sullivan, C. L., Heffner, C. L., Cote, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+residents+pediatric+fiberoptic+intubation+of+the+trachea:+traditional+fiberscope+with+an+eyepiece+versus+a+video-assisted+technique+using+a+fiberscope+with+an+integrated+camera.">Teaching residents pediatric fiberoptic intubation of the trachea: traditional fiberscope with an eyepiece versus a video-assisted technique using a fiberscope with an integrated camera.</a> Anesthesiology. 101, 842-846 (2004).</li><li>Roth, A. G., Wheeler, M., Stevenson, G. W., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+rigid+laryngoscope+with+the+ultrathin+fibreoptic+laryngoscope+for+tracheal+intubation+in+infants.">Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.</a> Can J Anaesth. 41, 1069-1073 (1994).</li><li>Ovassapian, A., Dykes, M. H., Golmon, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+training+programme+for+fibreoptic+nasotracheal+intubation.+Use+of+model+and+live+patients.">A training programme for fibreoptic nasotracheal intubation. Use of model and live patients.</a> Anaesthesia. 38, 795-798 (1983).</li><li>Stevenson, G. W., Roth, A. G., Wheeler, M., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+Olympus+LF-P+fibreoptic+laryngoscope+by+trainees+in+paediatric+anaesthesia.">Use of the Olympus LF-P fibreoptic laryngoscope by trainees in paediatric anaesthesia.</a> Anaesthesia. 51, (1996).</li><li>Taguchi, S., Kusunoki, S., Fukuda, H., Hamada, H., Kawamoto, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+tracheal+intubation+using+airway+scope+in+a+pediatric+patient+with+Hunter+syndrome.">Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome.</a> Masui. 58, 1278-1281 (2009).</li></ol>

אין ניגודי אינטרסים הכריז.

אינטובציה fiberoptic ב מטופלים ילדים עם דרכי הנשימה קשה יכול להיות משימה מאתגרת 1,2 ואת הנוכחות של dysmorphisms craniofacial מציב אתגרים נוספים אינטובציה לקנה הנשימה 3. קשה יותר לבצע הליך זה בקרב ילדים מאשר אצל מבוגרים בעיקר בגלל דרכי הנשימה בקרב ילדים קטנים אשר עושים מניפולציה של סיב אופטי קשה יותר שכן כל תנועה קטנה של קצה של היקף firberoptic מסתכן נגיעה של רירית לוע האף / קנה הנשימה. זה ימנע ראיה טובה של דרכי הנשימה ולגרום לבצע תמרונים הלוך ושוב היקף סיב אופטי כדי לקבל תמונה טובה יותר. בעוד מנסה לעקוף בעיה זו, ילדים יש שיעור גבוה יותר של צריכת החמצן, באופן משמעותי לקיצור תקופת דום נשימה כי יכול להיות נסבל בבטחה. המרדים יהיה להפסיק את ההליך כדי להתחיל אוורור ולהימנע desatruation חמורה של המטופל. אינטובציה fiberoptic Awake מומלץ אינטובציה של חולים עם דרכי הנשימה קשה 4. אמנם זה אפשרי בחולים מבוגרים, קשה יותר לבצע על מטופלים ילדים בעוד ער בגלל חוסר שיתוף פעולה 5. כמה מתרגלים לבצע אינטובציה fiberoptic על חולים בהרדמה ומשותק 2,6. למרות רכישת מיומנויות אינטובציה fiberoptic בחולים מורדמים ולא מטופלים ער נתמכת גם בספרות 7-9, עדיין עקומת למידה בידי רופא הניסיון, מסתכן desaturation המטופל אשר עלולות להיות השלכות חמורות אם החולה יש דרכי הנשימה קשה קשה לאוורר או לצנרר 10. פיתחנו הנחיות לבצע אינטובציה fiberoptic בטוח בזמן שהמטופל ממשיך לנשום באופן ספונטני במהלך ההליך, ובכך ימנע את הסיכון desaturation.

<ul style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> מד היתוך עבור משאבת אינפוזיה propofol </li><li style=";text-align:right;direction:rtl"> פנטניל 0.5-1.0 מ&quot;ג / ק&quot;ג </li><li style=";text-align:right;direction:rtl"> 12F יניקה אדום גומי קטטר </li><li style=";text-align:right;direction:rtl"> Glycopyrrolate 0.1-0.2 מ&quot;ג </li><li style=";text-align:right;direction:rtl"> מתכת וו הפחה </li><li style=";text-align:right;direction:rtl"> Afrin תרסיס לאף </li><li style=";text-align:right;direction:rtl"> חומר סיכה </li><li style=";text-align:right;direction:rtl"> לידוקאין 2% או 4% עבור ריסוס nares </li></ul>

guidelines for elective pediatric fiberoptic intubation

אינטובציה fiberoptic בקרב ילדים נדרש לעתים קרובות במיוחד בדרכי הנשימה הקשים של חולי תסמונת syndromic כלומר רובין פייר. תינוקות קטנים לא desaturate מהר מאוד אם אוורור נקטע בעיקר קצב חילוף החומרים גבוה. אנו מתארים הנחיות לבצע אינטובציה fiberoptic בטוח תוך שמירה על נשימה ספונטנית במהלך ההליך. צעדים המחייבים את השימוש של המשאבה propofol, פנטניל, קטטר glycopyrrolate, גומי אדום, insuflation וו מתכת, afrin, חומר סיכה ו לידוקאין ספריי מוצגים.

Watch this Scientific Journal Video about Guidelines for Elective Pediatric Fiberoptic Intubation at JoVE.com

Guidelines for Elective Pediatric Fiberoptic Intubation

אנו מתארים הנחיות לבצע אינטובציה בטוח ויעיל fiberoptic בחירה מטופלים ילדים, תוך שמירה על אוורור ספונטנית.

הנחיות אינטובציה בחירה fiberoptic ילדים

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

guidelines-for-elective-pediatric-fiberoptic-intubation

Nanyang Technological University

Research

JoVE Journal

Medicine

17.4K Views.  St. Jude Children's Research Hospital. אנו מתארים הנחיות לבצע אינטובציה בטוח ויעיל fiberoptic בחירה מטופלים ילדים, תוך שמירה על אוורור ספונטנית.

Video: Guidelines for Elective Pediatric Fiberoptic Intubation

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

הצלה רומן טכניקה אינטובציה קשה אוורור קשה

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy

Birth asphyxia, which causes hypoxic-ischemic encephalopathy (HIE), accounts for 0.66 million deaths worldwide each year, about a quarter of the world&#8217;s 2.9 million neonatal deaths. Animal models of HIE have contributed to the understanding of the pathophysiology in HIE, and have highlighted the dynamic process that occur in brain injury due to perinatal asphyxia. Thus, animal studies have suggested a time-window for post-insult treatment strategies. Hypothermia has been tested as a treatment for HIE in pdiglet models and subsequently proven effective in clinical trials. Variations of the model have been applied in the study of adjunctive neuroprotective methods and piglet studies of xenon and melatonin have led to clinical phase I and II trials1,2. The piglet HIE model is further used for neonatal resuscitation- and hemodynamic studies as well as in investigations of cerebral hypoxia on a cellular level. However, it is a technically challenging model and variations in the protocol may result in either too mild or too severe brain injury. In this article, we demonstrate the technical procedures necessary for establishing a stable piglet model of neonatal HIE. First, the newborn piglet (&#60; 24 hr old, median weight 1500 g) is anesthetized, intubated, and monitored in a setup comparable to that found in a neonatal intensive care unit. Global hypoxia-ischemia is induced by lowering the inspiratory oxygen fraction to achieve global hypoxia, ischemia through hypotension and a flat trace amplitude integrated EEG (aEEG) indicative of cerebral hypoxia. Survival is promoted by adjusting oxygenation according to the aEEG response and blood pressure. Brain injury is quantified by histopathology and magnetic resonance imaging after 72 hr.

Hypoxic-ischemic encephalopathy following perinatal asphyxia can be studied using animal models. We demonstrate the procedures necessary for establishing a piglet model of neonatal hypoxic-ischemic encephalopathy.

דגם חזרזיר של ילודים חוסר חמצן-איסכמי אנצפלופתיה

Birth asphyxia, which causes hypoxic-ischemic encephalopathy (HIE), accounts for 0.66 million deaths worldwide each year, about a quarter of the ...

Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model

Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere with breathing. In recent years, intraoperative neural monitoring (IONM) has been widely adapted as an adjunct technique to localize the RLN, detect RLN injury, and predict vocal cord function during the operations. Many studies have also used animal models to investigate new applications of IONM technology and to develop reliable strategies for preventing intraoperative RLN injury. The aim of this article is to introduce a standard protocol for using a porcine model in IONM research. The article demonstrates the procedures for inducing general anesthesia, performing tracheal intubation, and experimental design to investigate the electrophysiological characteristics of RLN injuries. Applications of this protocol can improve overall efficacy in implementing the 3R principle (replacement, reduction and refinement) in porcine IONM studies.

This study aims to develop a standard protocol of intra-operative neural monitoring of thyroid surgery in a porcine model. Here, we present a protocol to demonstrate general anesthesia, to compare different types of electrodes, and to investigate the electrophysiological characteristics of the normal and injured recurrent laryngeal nerves.

ניטור עצבית אינטרה-פעיל של ניתוח בלוטת התריס במודל חזירי

Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere ...

The Rigid Tube as an Alternative in Controlling the Problematic Airway

The unexpected problematic airway represents a large proportion of anesthesia-related morbidity and mortality. The retromolar or paraglossal approach is an alternative to the majority of the rigid instruments used for tracheal intubation, which follow the midline to access the glottis. This single-center, prospective case-series study offers an option to conventional laryngoscopy in case of a poor glottic view, introducing an instrument (the rigid tube for laryngoscopy) that uses the retromolar approach to accomplish tracheal intubation. If after anesthesia induction, the modified Cormack-Lehane glottis view grade &#62;2b, the intubation is carried further with the rigid tube. The tube follows the direction of the thyroid cartilage while advancing from the labial commissure, displacing the tongue to the contralateral side. Adjusting the position of the larynx with the nondominant hand by gently pushing the thyroid cartilage and following an imaginary line towards it while advancing it improves the time needed for proper glottis visualization. Once the epiglottis is in sight, the practitioner progresses slowly, lifting the epiglottis and aiming the tip of the tube more anteriorly. When the glottis appears in the visual field, the intubating tube introducer is placed in the trachea, and a lubricated cuffed intubating tube is advanced over the introducer after the rigid tube is extracted. This tool was tested on 30 patients with an unsatisfactory glottic view when using the Macintosh laryngoscope and obtained excellent results with respect to intubation time and complications. The reduced visual field is the main limitation of this method, which requires a training period for reasonable expertise. This simple, robust, and cheap instrument could be a rescue option in case of a difficult airway.

Presented here is a protocol of tracheal intubation over an intubating tube introducer using a rigid tube for laryngoscopy with an attached light source. The main characteristics of this maneuver are the retromolar approach and the use of the thyroid cartilage as a landmark while advancing the rigid tube.

שפופרת נוקשה כחלופה בשליטה על נתיב אווירי בעייתי

The unexpected problematic airway represents a large proportion of anesthesia-related morbidity and mortality. The retromolar or paraglossal approach is ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

אינטובציה אנדוטרכאלית באמצעות אנדוסקופ אינטובציה גמיש כמודל סטנדרטי לניהול בטוח של דרכי הנשימה בחזירים

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

Early in the coronavirus disease 2019 (COVID-19) pandemic, it was reported that prone position was beneficial for mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). However, for staff in some small and large hospitals, experience with this intervention was low. Select hospitals were able to assemble proning teams; but, as facilities began to experience staffing shortages, they found proning teams unsustainable, and less specialized staff needed to learn how to safely prone patients.
Proning is a high-risk procedure-a lack of a standard approach can result in staff confusion and poor patient outcomes, including unintentional endotracheal tube (ET) loss, vascular access dislodgement, and skin breakdown. Given the acuity and high patient volume, translating a complex procedure into written policy may not be entirely effective. Critical care nurses, respiratory therapists, physical therapists, wound nurses, nurse practitioners, physician assistants, and medical doctors need to be prepared to safely perform this procedure for an acutely ill COVID-19 patient.
Communication, teamwork, and multidisciplinary collaboration are critical for complication avoidance. Interventions to prevent tube and vascular access dislodgement, skin breakdown, and brachial plexus and soft tissue injury must be implemented during the procedure. Repositioning the patient in the prone position, as well as returning the patient to supine positioning, should be components of a comprehensive proning plan.

Proning a critically ill patient with severe acute respiratory distress syndrome (ARDS) is a complex but beneficial procedure. Excellent communication skills, team work, and multidisciplinary collaboration are critical for patient and staff safety. A standard procedure should be utilized when proning ventilated patients with tubes, drains, and vascular access devices.

הדגמת וידאו חינוכית כיצד לטפל בחולה אנוש באינטובציה

Early in the coronavirus disease 2019 (COVID-19) pandemic, it was reported that prone position was beneficial for mechanically ventilated COVID-19 ...

A Piglet Perinatal Asphyxia Model to Study Cardiac Injury and Hemodynamics after Cardiac Arrest, Resuscitation, and the Return of Spontaneous Circulation

Neonatal piglets have been extensively used as translational models for perinatal asphyxia. In 2007, we adapted a well-established piglet asphyxia model by introducing cardiac arrest. This enabled us to study the impact of severe asphyxia on key outcomes, including the time taken for the return of spontaneous circulation (ROSC), as well as the effect of chest compressions according to alternative protocols for cardiopulmonary resuscitation. Due to the anatomical and physiological similarities between piglets and human neonates, piglets serve as good models in studies of cardiopulmonary resuscitation and hemodynamic monitoring. In fact, this cardiac arrest model has provided evidence for guideline development through research on resuscitation protocols, pathophysiology, biomarkers, and novel methods for hemodynamic monitoring. Notably, the incidental finding that a substantial fraction of piglets have pulseless electrical activity (PEA) during cardiac arrest may increase the applicability of the model (i.e., it may be used to study pathophysiology extending beyond the perinatal period). However, the model generation is technically challenging and requires various skill sets, dedicated personnel, and a fine balance of the measures, including the surgical protocols and the use of sedatives/analgesics, to ensure a reasonable rate of survival. In this paper, the protocol is described in detail, as well as experiences with adaptations to the protocol over the years.

This piglet model involves surgical instrumentation, asphyxiation until the cardiac arrest, resuscitation, and post-resuscitation observation. The model allows for multiple sampling per animal, and by using continuous invasive arterial blood pressure, ECG, and non-invasive cardiac output monitoring, it provides knowledge about hemodynamics and cardiac pathophysiology in perinatal asphyxia and neonatal cardiopulmonary resuscitation.

מודל חנק פרינטלי חזרזיר לחקר פגיעה לבבית והמודינמיקה לאחר דום לב, החייאה והחזרת מחזור הדם הספונטני

Neonatal piglets have been extensively used as translational models for perinatal asphyxia. In 2007, we adapted a well-established piglet asphyxia model ...

Endotracheal Intubation of Rabbits Using a Polypropylene Guide Catheter

Endotracheal intubation in rabbits can be challenging due to their unusual anatomy. Achieving a patent airway during anesthesia is critical for the avoidance of airway obstruction, prevention of gastric tympany, and to allow ventilatory support. Due to the difficulty of intubation, alternative methods such as the use of laryngeal mask airways or laryngeal tubes have been explored. However, these methods do not result in direct access to the trachea and thus may present a risk for development of complications. In addition, lack of direct intubation of the trachea can result in personnel exposure to waste anesthetic gases. Numerous methods for endotracheal intubation have been described, including blind placement, use of a fiberoptic laryngoscope or endoscope, and cricoid placement. Despite these numerous publications, many still struggle to achieve success. Here we provide a detailed description of an intubation technique that can be taught with minimal training with a short time to proficiency. Briefly, after administration of injectable anesthesia and proper positioning of the rabbit, a polypropylene catheter is placed into the trachea by direct visualization using a laryngoscope. The catheter is then used as a guide to direct the endotracheal tube into the trachea. This method allows for intubation without the need for expensive equipment and can be performed by a single individual without the need for an assistant. In conclusion, this technique can be easily taught and performed at very little cost in any clinical or research setting.

Endotracheal intubation in rabbits is challenging due to their unusual anatomy. Here we present a technique for direct intubation of the trachea using a polypropylene catheter as a guide. This method utilizes relatively inexpensive supplies, requires minimal training, and can be easily performed in any clinical setting.

צנרור אנדוטרכאליות ארנבים באמצעות צנתר מדריך פוליפרופילן

Endotracheal intubation in rabbits can be challenging due to their unusual anatomy. Achieving a patent airway during anesthesia is critical for the ...

Biology

<meta charset="utf8"></head><body>אינטובציה ערה בדרכי נשימה קשות: שיטת לרינגוסקופ וידאו גמישה

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies obstructing airway access are at risk of airway management failure once they lose spontaneous respiration. Awake flexible scope intubation is considered the gold standard for controlling the airway in such patients. Following a feasibility trial involving 25 patients with challenging airways, this article presents a step-by-step protocol for awake nasotracheal intubation using a flexible video rhino-laryngoscope, which is significantly shorter than conventional intubating flexible scopes. The flexible video laryngoscope only exceeds the intubating tube length by a few centimeters, allowing the tube to closely follow the flexible scope during the procedure. Once the scope reaches the pharynx, it can be easily manipulated with one hand, enabling the operator to focus on the safe advancement of the scope-intubating tube assembly through the glottis. Based on previous results and experience gained, this article highlights the potential benefits of the technique: the opportunity for a minimally invasive "quick look" preoperatively to establish a final management plan, a more convenient and safer tool for navigating distorted anatomy with a lower chance of intubating tube impingement and airway injury, and a fast and smooth procedure resulting in improved patient satisfaction.

<meta charset="utf8"></head><body>מחבר זרקור: קידום אינטובציה nasotracheal ער עם וידאו גמיש קרנף-laryngoscopes

Presented here is a protocol for awake nasotracheal intubation using a flexible rhino-laryngoscope with a 300 mm working length. As this tool is minimally invasive and easy to manipulate, awake intubation performed with a flexible rhino-laryngoscope is well-tolerated, fast, and safe for patients with difficult airways.

הקרנף-לרינגוסקופ הגמיש לאינטובציה ערה של האף

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies ...

הנחיות אינטובציה בחירה fiberoptic ילדים

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הצלה רומן טכניקה אינטובציה קשה אוורור קשה

דגם חזרזיר של ילודים חוסר חמצן-איסכמי אנצפלופתיה

ניטור עצבית אינטרה-פעיל של ניתוח בלוטת התריס במודל חזירי

שפופרת נוקשה כחלופה בשליטה על נתיב אווירי בעייתי

אינטובציה אנדוטרכאלית באמצעות אנדוסקופ אינטובציה גמיש כמודל סטנדרטי לניהול בטוח של דרכי הנשימה בחזירים

הדגמת וידאו חינוכית כיצד לטפל בחולה אנוש באינטובציה

מודל חנק פרינטלי חזרזיר לחקר פגיעה לבבית והמודינמיקה לאחר דום לב, החייאה והחזרת מחזור הדם הספונטני

צנרור אנדוטרכאליות ארנבים באמצעות צנתר מדריך פוליפרופילן

הקרנף-לרינגוסקופ הגמיש לאינטובציה ערה של האף

הקרנף-לרינגוסקופ הגמיש לאינטובציה ערה של האף