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Stability of dacarbazine in amber glass vials and polyvinyl chloride bags.

The stability of dacarbazine in commercial glass vials and polyvinyl chloride (PVC) bags in various storage conditions and the emergence of 2-azahypoxanthine, a major degradation product possibly linked with some adverse effects, were studied. Triplicate samples of reconstituted (11 mg/mL) and diluted (1.40 mg/mL) dacarbazine admixtures were prepared and stored at 4 degrees C or at 25 degrees C in daylight, fluorescent light, or the dark. The effect of several light-protective measures (amber glass vials, aluminum foil wrapping, and opaque tubing) on dacarbazine stability in a simulated i.v. infusion system was also evaluated. Dacarbazine quantification and main degradation product determination were performed by high-performance liquid chromatography. Stability was defined as conservation of 90-105% of initial dacarbazine concentration without major variations in clarity, color, or pH and without precipitate formation. Reconstituted dacarbazine solutions were stable for 24 hours at room temperature and during light exposure and stable for at least 96 hours at 2-6 degrees C when stored in the dark. After dilution in PVC bags, stability time increased from 2 hours in daylight to 24 hours in fluorescent light and to 72 hours when covered with aluminum foil. After two hours of simulated infusion, dacarbazine remained stable. Diluted dacarbazine solutions stored at 2-6 degrees C were stable for at least 168 hours. The only degradation product found was 2-azahypoxanthine, which was detected in every sample. The storage and handling of dacarbazine should take into account both the loss of the drug and the production of its potentially toxic degradation product. Dacarbazine must be carefully protected from light, administered using opaque infusion tubing, and, if necessary, refrigerated before administration to reduce 2-azahypoxanthine formation.

Antineoplastic Agents, Alkylating↗

Stability of meropenem in polyvinyl chloride bags and an elastomeric infusion device.

PURPOSE: The stability of meropenem in i.v. solutions stored in polyvinyl chloride (PVC) bags and an elastomeric infusion device at concentrations commonly used in home care was studied. METHODS: Vials of meropenem were reconstituted with sterile water for injection and mixed with 0.9% sodium chloride injection (NS) to yield concentrations of 4, 10, and 20 mg/mL. Six replicate solutions were prepared in PVC containers and six in the Homepump ECLIPSE elastomeric infusion device. All solutions were stored at an average temperature of 5 degrees C and sampled immediately after preparation and at intervals up to 120 hours (five days); the 4-mg/mL solution was also sampled at 144 and 168 hours (seven days). Samples were assayed for meropenem concentration by stability-indicating high-performance liquid chromatography. RESULTS: All solutions of meropenem retained over 90% of the initial drug concentration at five days. The 4-mg/mL solutions retained over 93% of the initial concentration at seven days. The rate of meropenem decay did not differ significantly between PVC and elastomeric infusion containers for the 4- and 20-mg/mL solutions; however, there was a difference for the 10-mg/mL solutions. CONCLUSION: Meropenem 4 mg/mL in NS was stable for at least seven days in PVC bags and elastomeric infusion containers when stored at 5 degrees C, and meropenem 10 and 20 mg/mL in NS was stable for at least five days in both containers at 5 degrees C.

Chromatography, High Pressure Liquid↗

Polyvinyl alcohol and amino acids as substitutes for bovine serum albumin in culture media for mouse preimplantation embryos.

The effect of replacing bovine serum albumin (BSA) in a simple defined medium (KSOM) with polyvinyl alcohol (PVA) and/or amino acids on the percentages of mouse zygotes that develop to at least the blastocyst stage and that hatch at least partially or completely is reported. Blastocysts could form when BSA was replaced with only PVA, but at a moderately reduced rate; however, partial hatching, and hence complete hatching, were severely impaired when BSA was replaced with only PVA. The substitution of BSA with amino acids alone resulted in a high rate of blastocyst formation and moderate impairment of hatching. The addition of PVA to BSA-free KSOM supplemented with amino acids had no extra effect. BSA had significant effects when added to BSA-free KSOM supplemented with amino acids. The BSA caused a significant increase in the rate of partial hatching, and may even have had a small effect on the rate of blastocyst formation. The results also showed that glucose, at a high concentration of 5.56 mM, does not inhibit the development of mouse zygotes to hatched blastocysts when cultured in KSOM supplemented with amino acids.

Amino Acids↗

Identity of the ribonuclease from bovine seminal plasma with ribonuclease BS-1, and its sensitivity to polyvinyl sulphate.

A ribonuclease (RNAase BSD) isolated by us earlier from bovine seminal plasma by DNA-affinity chromatography is shown to be homogeneous on polyacrylamide gel electrophoresis, analytical ultracentrifuge and high performance liquid chromatography. From amino acid analysis, high performance liquid chromatography and enzymatic and physicochemical studies, this enzyme is shown to be identical to RNAase BS-1 reported by D'Alessio et al. ((1972) Eur. J. Biochem. 26, 153-161). Immunological studies support this observation. It has also been shown that, as compared to RNAase A, this enzyme is more sensitive to polyvinyl sulphate inhibition.

Amino Acids↗

Role of residual additives in the cytotoxicity and cytokine release caused by polyvinyl chloride particles in pulmonary cell cultures.

Occupational exposure to polyvinyl chloride (PVC) dust has been linked to pulmonary disease. The aim of the present study was to investigate, in vitro, the role of additives in the cytotoxicity and the release of inflammatory mediators caused by PVC particles in different cells. We compared two types of emulsion PVC particles (E3 and E8) with their washed (hence, "additive-free") counterparts (W3 and W8). A positive control (crystalline SiO2, Min-U-Sil) and the pure additives, sodium lauryl sulfate (A3) and sodium alkylbenzenesulfonate (A8), were tested concurrently. Cytotoxicity (MTT assay) was assessed in primary cultures of rat alveolar macrophages, rat type II pneumocytes, and human alveolar macrophages (h-AM), and cultures of the A549 cell line (type II cell-derived) and the differentiated THP-1 cell line (macrophage-like). Hemolytic potential was assessed after a 2-h incubation with human erythrocytes. Cytokine release (IL-8, IL-6, and TNF-alpha) by A549 cells, THP-1 cells, and h-AM, was measured by ELISA after 4, 16, 24 and/or 48 h of exposure. Cytotoxicity and hemolytic activity of the washed particles were abolished or markedly decreased compared with their nonwashed forms. In A549 cells, E3 and E8 (2.5 mg/ml) caused a 3-fold increase in IL-8 release and a more than 10-fold increase in IL-6 release, whereas W3 and W8 did not elicit any significant response at similar concentrations. Compared with Min-U-Sil (0.1, 0.5, and 2.5 mg/ml), the response to E3 and E8 occurred later and was slightly lower (IL-8) or much more pronounced (IL-6). A3 and A8 exhibited similar responses to E3 and E8, at concentrations corresponding to those present in the particles. In conclusion, the in vitro cytotoxicity and inflammatory potential of some PVC particles appear to be mostly due to their residual additives.

Animals↗

Visualization of injected embolic material (polyvinyl alcohol) in paraffin sections with Verhoeff-Van Gieson elastica stain.

Therapeutic embolization of blood vessels is widely used to treat vascular malformations and to preoperatively decrease the size of bulky tumors by creating iatrogenic infarction. Surgical pathologists are often called upon to identify the presence of embolized material in microscopic slides. Polyvinyl alcohol particles are often used as the material for embolization. On hematoxylin-eosin and other routine stains this substance is almost invisible. These particles stain black and can be sharply outlined by using the Verhoeff-Van Gieson stain.

Embolization, Therapeutic↗

Kasabach-Merritt syndrome treated by therapeutic embolization with polyvinyl alcohol.

The authors describe a 6 1/2-month-old boy with a large hemangioma involving the left buttock associated with a severe consumptive coagulopathy. Cosmetic improvement and resolution of the coagulation defect followed occlusion of the nutrient vessels to the hemangioma with polyvinyl alcohol. This is the first report of successful treatment of this condition with therapeutic embolization.

Blood Coagulation Disorders↗

Phase I/II randomized trial of intrahepatic arterial infusion chemotherapy with cisplatin and chemoembolization with cisplatin and polyvinyl sponge in patients with ocular melanoma metastatic to the liver.

Ocular melanoma has a unique metastatic predilection for the liver and is refractory to most forms of therapy. The dual blood supply of the liver with differential perfusion of metastatic lesions and normal hepatocytes by the hepatic artery and portal vein, respectively, has led to the evaluation of intrahepatic chemotherapy and chemoembolization in this disease. Despite suggestion of efficacy in phase II trials, this therapy has not been systematically evaluated. We conducted a randomized phase I/II trial evaluating escalating doses of intrahepatic chemotherapy with cisplatin with or without polyvinyl sponge (PVS) in 19 patients with ocular melanoma and liver metastases. The cisplatin dose was initiated at 100 mg/m and was increased in 25% increments. Patients were randomized to receive cisplatin alone or cisplatin plus PVS. Seven patients were treated with intrahepatic cisplatin at 100 mg/m: four with PVS, and three without. The dose was escalated to 125 mg/m with or without PVS in the remaining 12 patients. The maximum tolerated dose for intra-hepatic cisplatin was determined to be 125 mg/m with or without PVS. The overall response rate was 16%. Dose-limiting toxicities included renal, hepatic and haematological effects. This therapy produces a modest response rate in patients with ocular melanoma and liver metastases.

Adult↗

Uterine artery embolization of leiomyomas with trisacryl gelatin microspheres (TGM): pathologic features and comparison with polyvinyl alcohol emboli.

In recent years, uterine artery embolization (UAE) has gained popularity as an alternative to surgery for the treatment of symptomatic uterine leiomyomas. Polyvinyl alcohol (PVA) particles have been the principal agent used for UAE. Recently, trisacryl gelatin microspheres (TGM) have been advocated as a preferable occlusive material for UAE. It is the first embolic agent to be cleared specifically by the United States Food and Drug Administration for this use. To date, information on the tissue effects, distribution, and morphology of UAE with TGM in resected human organs is very limited. Herein, we document the pathologic findings in a 46-year-old woman who underwent hysterectomy and bilateral salpingo-oophorectomy and omentectomy for metastatic colonic adenocarcinoma 19 months after UAE with TGM (microsphere size = 500-700 micron) for uterine leiomyomas. Histologically, a submucosal leiomyoma and an intramural uterine leiomyoma showed massive coagulative necrosis of the infarct-type with a peripheral zone of hyalinized fibrous tissue. Aggregates of TGM were within the necrotic leiomyomas and throughout the myometrium. Non-targeted extrauterine sites also contained TGM, including the paracervical soft tissue and the mesosalpinx as well as the ovaries and omentum where they were adjacent to metastatic colonic carcinoma. Other than the myomas, none of the embolized organs showed ischemic necrosis. Although some TGM were intravascular, most were extravascular. Typically, the microspheres were adjacent to muscular arteries from which they appeared to have been extruded following localized dissolution of the arterial wall. A thin rim of foreign body-type giant cells and mononuclear macrophages surrounded many of the TGM and focally involved the arterial wall. No vascular thrombosis was seen. TGM are believed to have advantages over PVA emboli for UAE. Hence, additional examples of surgical specimens following treatment of leiomyomas with TGM can be expected. Pathologists should be aware of the morphology of TGM in resected genital tract tissues. Although TGM are easily distinguished from embolic PVA particles, they may be mistaken for PVA microspheres if not carefully studied. Elastic stains are useful in the differential diagnosis of embolic agents.

Adult↗

Arterial distribution of calibrated tris-acryl gelatin and polyvinyl alcohol microspheres in a sheep kidney model.

OBJECTIVE: The objective of this study was to compare the repartition in the renal arterial vasculature of tris-acryl gelatin microspheres (TGMS) and polyvinyl alcohol microspheres (PVAMS) of 3 calibers (500-700, 700-900, and 900-1200 microm). MATERIALS AND METHODS: Twelve kidneys from 6 adult sheep were embolized and histologically analyzed. The number and size of microspheres and vessels were measured, as well as the deformation of TGMS and PVAMS, and the histologic location according to a classification in 5 zones of the kidney. RESULTS: Two hundred eighty-four vessels were measured. The diameter of the occluded vessels increased when the caliber used for embolization was larger for TGMS and for PVAMS (P < 0.0001, each). The location of TGMS and PVAMS within the vasculature was different for each caliber, because PVAMS blocked significantly more distally than TGMS (P < 0.0001 each). The deformation within the tissue was greater for PVAMS (18.0 +/- 12.3%) than for TGMS (9.0 +/- 8.3%) in general (P < 0.001) and for each caliber of injected microspheres (P < 0.001 each). CONCLUSION: The repartition of a spherical embolic agent in a given vascular network can be influenced by its size and also by its deformation within the vascular bed.

Angiography↗

Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model.

PURPOSE: To evaluate the effects of a spherical embolic agent consisting of polyvinyl alcohol (PVA) and to compare this agent with commercially available embolization agents. MATERIALS AND METHODS: Eleven miniature pigs were included in the study population. The upper poles of both kidneys were selected as the target organs for embolization. PVA spheres (700-900 micro m) were used in nine kidneys, PVA particles (500-710 micro m) were used in six kidneys, gelatin spheres (700-900 micro m) were used in five kidneys, and gold-colored gelatin spheres (700-900 micro m) were used in three kidneys. Two animals were killed immediately after embolization. In the remaining animals, angiography was performed before sacrifice 7 days (in five pigs) or 28 days (in four pigs) after embolization. Pathologic and histologic evaluation of the kidneys was performed. RESULTS: All agents resulted in target vessel occlusion and end-organ infarction. All arteries embolized with spherical agents were recanalized at follow-up angiography. In vessels embolized with PVA particles, the occluding plug consisted of thrombus and PVA. In vessels embolized with spherical agents, the occluding plug consisted mostly of the embolic agent. PVA spheres were associated with the mildest inflammatory responses at 7 and 28 days when compared with PVA particles and gelatin-based microspheres. Arterial wall destruction was seen to a greater extent in kidneys embolized with gelatin-based microspheres than in those embolized with PVA-based agents. CONCLUSIONS: The spherical, PVA-based embolization agent resulted in target organ infarction and temporary arterial occlusion. The inflammatory response to PVA spheres was significantly less aggressive than the response to other agents tested. Further study with clinical and long-term pathologic follow-up is suggested to determine if these findings may have favorable clinical implications for patients undergoing embolization procedures.

Angiography↗

Relative rates of blood flow reduction during transcatheter arterial embolization with tris-acryl gelatin microspheres or polyvinyl alcohol: quantitative comparison in a swine model.

PURPOSE: To determine whether two commonly used embolic agents have differing rates of blood flow reduction during transcatheter embolization of the renal arteries in an animal model. MATERIALS AND METHODS: The renal arteries of 10 pigs were embolized with either polyvinyl alcohol (300-500 or 500-700- micro m) or tris-acryl gelatin microspheres (300-500 or 700-900- micro m). Equivalent unit doses of each agent were suspended in 40 mL of fluid and injected in 1-mL aliquots for 20 mL and then in 5-mL aliquots for 20 mL. Blood flow was measured after each aliquot with an intraarterial Doppler flow wire placed through the embolization catheter. RESULTS: Renal arterial blood flow was most rapidly and reliably decreased by 300-500- and 700-900- micro m microspheres, both of which had achieved >90% reduction from baseline flow after the injection of 6 mL of suspension. An equivalent reduction in flow required 25 mL of 300-500- micro m PVA suspension and 30 mL of 500-700- micro m PVA suspension. The reduction in blood flow with microspheres was significantly greater (P <.05) than that with PVA between 5 and 19 mL of suspension delivered. Differences between larger and smaller particle sizes of the same agent were not statistically significant. CONCLUSIONS: Tris-acryl gelatin microspheres reduced renal blood flow more quickly and reliably than did PVA. The type of agent used in embolization had a greater impact on the rate of flow reduction than did particle size in the range of sizes tested.

Angiography, Digital Subtraction↗

Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study.

PURPOSE: To determine if the type of embolic material used for uterine artery embolization (UAE) for leiomyomas has an impact on short-term recovery or the effectiveness of embolization. MATERIALS AND METHODS: One hundred patients were randomly assigned to undergo UAE with polyvinyl alcohol (PVA) particles or tris-acryl gelatin microspheres. Short-term, in-hospital medication use and pain levels were recorded. After discharge, symptom severity, temperature, and medications used were recorded daily for 1 week and symptom levels were measured for weeks 2-4. Three months after embolization, contrast material-enhanced magnetic resonance imaging examinations were evaluated blindly to determine the extent of leiomyoma infarction. Symptom and quality of life (QOL) status was determined with use of questionnaires. Analysis was completed with use of chi(2) analysis, Fisher exact tests, Student t tests, and analysis of variance as appropriate. Regression analysis was used to analyze the impact on outcome of baseline factors (other than type of embolic agent). RESULTS: No significant differences were noted at baseline between the two treatment groups. On average, there were significantly higher volumes of tris-acryl microspheres used (9.0 mL vs 3.0 mL; P =.0001), whereas microcatheter occlusion was more common with PVA (28% vs 4%, P =.001). There were no differences in pain severity, other postprocedural symptoms, or medication use between the two treatment groups. There were also no differences in the frequency of incompletely infarcted leiomyomas, degree of improvement in symptom score, patient satisfaction, or QOL. CONCLUSION: No substantive differences were detected between outcomes of embolization with PVA particles or tris-acryl gelatin microspheres.

Acrylic Resins↗

Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study.

PURPOSE: To compare the outcomes of uterine artery embolization (UAE) for leiomyomas with use of tris-acryl gelatin microspheres (TAGM) versus spherical polyvinyl alcohol (PVA) particles. MATERIALS AND METHODS: Patients undergoing UAE were randomly assigned to receive TAGMs or PVA. Embolization was performed in a standardized manner. Outcome data were collected at 3 months after embolization, including assessment of clinical symptoms, scores from a fibroid tumor-specific symptom and quality of life (QOL) questionnaire, and findings on contrast material-enhanced magnetic resonance (MR) imaging, including the degree of tumor infarction and volume reduction. Data were analyzed with use of t tests, the Mann-Whitney U test, and chi2 tests as appropriate. RESULTS: Thirty-six patients were treated. There were no differences in the two treatment groups at baseline. Clinical follow-up was obtained in 35 patients. Among the clinical outcome measures, QOL score improvement was greater for UAE with TAGMs compared with PVA (49.0 vs 27.9; P = .02), but no other differences were noted. Of the 25 patients in whom 3-month MR imaging follow-up was completed, those treated with TAGM were significantly more likely to have complete infarction of all leiomyomas (six patients vs one patient; P = .02), were more likely to have at least 90% tumor infarction (eight patients vs four patients; P = .03), and had a lower mean percent of residual perfused fibroid tumor tissue (9.6% vs 44.3%; P = .004) compared with patients treated with PVA. Based on these differences between the embolic agents, enrollment in this study was terminated. CONCLUSION: The use of spherical PVA particles in the manner described herein results in an unacceptably high rate of failed tumor infarction in UAE.

Acrylic Resins↗

A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in patients with symptomatic uterine fibroids.

PURPOSE: To prospectively evaluate the safety and effectiveness of polyvinyl alcohol (PVA) microspheres in patients undergoing uterine artery embolization (UAE) to treat uterine fibroid tumors and to compare the long-term changes in health-related quality of life (QOL) after UAE with the changes seen after myomectomy. MATERIALS AND METHODS: One hundred forty-six patients with uterine myomas were enrolled into this multicenter study, with 77 patients undergoing UAE with PVA and 69 patients undergoing myomectomy. Six-month follow-up was completed for the myomectomy, whereas 2-year follow-up was completed for the UAE group. Outcomes were assessed with the Uterine Fibroid QOL Questionnaire and based on adverse event incidence, time to return to normal activity, and changes in tumor symptom scores, QOL scores, and menorrhagia bleeding scores. For the UAE cohort, changes in total uterine volume and dominant tumor size on magnetic resonance (MR) imaging were assessed. RESULTS: In the UAE cohort, 88.3% of patients experienced a reduction of tumor-related symptoms (increase >or=5 points from baseline measurement) at 6 months, with 75.4% of patients in the myomectomy group experiencing similar improvement. Median QOL questionnaire scores at 6 months were found to be significantly higher in patients treated with UAE (P = .041), with sustained improvement seen at 12 and 24 months. Both procedures resulted in significant reductions in 6-month menorrhagia bleeding scores, with sustained improvement in the UAE cohort at 12 and 24 months. MR imaging at 6 months revealed significant uterine and tumor volume reductions after UAE (P < .05). At least one adverse event occurred in 42% of patients in the myomectomy group, compared with 26% in the UAE group (P < .05). CONCLUSIONS: UAE performed with PVA microspheres was associated with greater sustained improvements in symptom severity and health-related QOL and with fewer complications compared with myomectomy. Six-month MR imaging data demonstrated significant reductions in uterine and tumor volumes, although the degree of tissue infarction after UAE was not assessed with contrast medium-enhanced MR imaging.

Adult↗

Evaluation of tris-acryl gelatin microsphere embolization with monochromatic X Rays: comparison with polyvinyl alcohol particles.

PURPOSE: Imaging of blood vessels 30 mum or smaller can be achieved with use of monochromatic x rays. The purpose of the present investigation was to use this method to evaluate the in vivo primary embolic effect of tris-acryl gelatin microspheres and polyvinyl alcohol (PVA) particles in small blood vessels, and specifically to assess the distribution of these particles and the resulting changes in circulation. MATERIALS AND METHODS: Twelve rabbits were divided into four groups: group 1 (PVA particles, 90-180 mum; n = 3), group 2 (tris-acryl gelatin microspheres, 40-120 mum; n = 3), group 3 (PVA, 300-500 mum; n = 3), and group 4 (tris-acryl gelatin microspheres, 300-500 mum; n = 3). After microangiography with monochromatic x rays, embolization was performed in normal auricular blood vessels, and immediately thereafter, postembolization microangiography was performed. Images acquired before and after embolization with the four embolic agents were compared, and the diameters of embolized blood vessels were measured. The mean embolized vascular diameter and its ratio to the midrange particle size of the embolic agent were calculated. RESULTS: Tris-acryl gelatin microspheres did not aggregate and tended to lodge in vessels close in size to the individual particle size, whereas PVA particles aggregated in vessels larger than the individual particle size. For tris-acryl gelatin microspheres, no blood flow was noted peripheral to the embolized region, whereas for PVA particles, blood flow was noted in regions peripheral to the embolized region. CONCLUSIONS: Monochromatic x rays allow direct visualization of in vivo embolic properties. This technique holds promise for comparative studies of embolic agents.

Acrylic Resins↗

Fungal colonization of soil-buried plasticized polyvinyl chloride (pPVC) and the impact of incorporated biocides.

Plasticized polyvinyl chloride (pPVC) with or without incorporated biocides was buried in grassland and forest soil for up to 10 months. The change with time in viable counts of fungi on the plastic surface was followed, together with the percentage capable of clearing the two plasticizers dioctyl adipate (DOA) and dioctyl phthalate (DOP). With time fungal total viable counts (TVC) on control pPVC increased and the fraction able to clear DOA was considerably higher than the average estimated in both soil types. A total of 92 fungal morphotypes were isolated from grassland soil and 42 from forest soil with the greatest variety of fungal isolates observed on control pPVC. The incorporation of biocides into pPVC affected both fungal TVC and the richness of species isolated. The biocides NCMP [n-(trichloromethylthio)phthalimide], OBPA (10,10'-oxybisphenoxarsine) and OIT (2-n-octyl-4-isothiazolin-3-one) were the most effective in grassland soil, and TCMP [2,3,5,6-tetrachloro-4-(methylsulphonyl)pyridine] and NCMP the most effective in forest soil. In grassland soil, Penicillium janthinellum established as a principal colonizer and was recovered from all pPVC types. DOP clearers were found at much lower levels than DOA clearers, with Doratomyces spp. being the most efficient. At the end of 10 months the physical properties of the pPVC were altered; changes in stiffness were the most significant for heavily colonized grassland-buried pPVC samples, whereas in forest soil, the extensibility of the pPVC was affected more than the stiffness. These results suggest that fungi are important colonizers of pPVC buried in soil and that enrichment of soil fungi capable of clearing DOA occurs during colonization of the plastic surface. The results also demonstrate that incorporated biocides have a marked impact on the richness of species colonizing the pPVC surface.

Adipates↗

Effect of orientation of a standard polyvinyl chloride tracheal tube on success rates during awake flexible fibreoptic intubation.

We conducted a randomised study in 70 patients to assess the effect of orientation of a standard polyvinyl chloride tracheal tube on the ease of railroading the tube during awake fiberoptic orotracheal intubation. Conventional orientation of the tube (with the bevel of the tube directed to the patient's left) was compared with orientation of the tube with the bevel facing posteriorly. The success rate of intubation at the first attempt was higher with the bevel oriented posteriorly (35/35; 100%) than with the conventional orientation (21/35; 60%; p = 0.0001), and the intubating time was shorter (median (range) 7 (5-11) s and 11 (5-60) s, respectively; p = 0.0001). We recommend that the tracheal tube should be aligned in this manner when railroading it over the fibrescope during awake fibreoptic orotracheal intubation.

Adult↗