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PubMed2002

Acute vision impairment: does it affect an anesthesiologist's ability to intubate the trachea?

UNLABELLED: The result of impaired vision on an anesthesiologist's ability to intubate the trachea is unknown. We studied 12 attending staff anesthesiologists as they intubated 2 anesthesia mannequins (A and B) under 6 conditions. The conditions were: 1) usual vision, 2) central-vision loss with 20/500 bilaterally and a 24 degrees central scotoma, 3) peripheral-field loss with 20/20 bilaterally and a 7 degrees visual field, 4) peripheral-field loss with 20/20 bilaterally and a 3.5 degrees visual field, 5) central-vision loss with 20/200 bilaterally and a 12 degrees central scotoma, and 6) right eye ocular media opacity and 20/70 left eye usual acuity. The time to intubation was recorded by stopwatch from gripping the laryngoscope until the anesthesiologist signaled that the endotracheal tube was properly placed in the trachea. The mean +/- SD times to intubation for Mannequins A and B were 16.0 +/- 3.3, 31.9 +/- 10.4, 26.4 +/- 9.0, 26.4 +/- 7.7, 22.4 +/- 5.1, 25.5 +/- 16.9 and 16.6 +/- 6.6, 26.9 +/- 10.0, 21.4 +/- 9.2, 21.4 +/- 5.8, 21.5 +/- 7.7, 17.7 +/- 5.1 s for the 6 conditions, respectively. Multiple analysis of variance revealed a highly significant difference for the time to successful intubation between the anesthesiologists' usual vision and the vision-impaired conditions. There was a significant improvement in time to successful intubation from the first to subsequent intubation attempts. There were also more esophageal intubations in the vision-impaired conditions. This implies that anesthesiologists who develop acute severe vision impairment might have more difficulty intubating the trachea, which could initiate more critical incidents. The results of this study cannot be applied to anesthesiologists with chronic vision impairment. IMPLICATIONS: We found that acute severe vision impairment adversely affects the anesthesiologist's ability to intubate the trachea. This implies that anesthesiologists with acute onset of severe visual handicaps might have more difficulty intubating the trachea, which could initiate more critical incidents.

Acute Disease↗
PubMed2006

Short thyromental distance: a predictor of difficult intubation or an indicator for small blade selection?

BACKGROUND: Short thyromental distance (TMD; < 5 cm) has been correlated with difficult direct laryngoscopic intubation in adult patients. The authors hypothesized that a smaller Macintosh curved blade (No. 2 MCB) would improve the predicted difficult laryngoscopy in short-TMD patients over that with a standard Macintosh curved blade (No. 3 MCB). METHODS: In a preliminary study of 11 consenting adults (7 females and 4 males), American Society of Anesthesiologists physical status I and TMD < or = 5 cm, lateral neck radiographs were recorded during laryngoscopy with a No. 2 and No. 3 MCB in sequential fashion. In a prospective clinical study, laryngoscopy and tracheal intubation were evaluated in 83 adult patients with TMD < or = 5 cm by randomly assigning them to two groups for the blade used at first intubation. Those who failed intubation with the first blade were switched to the alternate blade. In total 100 laryngoscopies and intubations were performed: the No. 2 MCB (n = 50) and the No. 3 MCB (n = 50). RESULTS: Lateral neck radiographs recorded at the best laryngeal view revealed that the tip of the No. 2 MCB was proximal to the hyoid body with the No. 2 MCB and distal to it with the No. 3 MCB. The intubation distance (C5 to blade tip) on neck radiographs with the No. 2 MCB was significantly greater than it was with the No. 3 MCB for similar anterior jaw displacement. In the clinical study, the laryngoscopic grade with the No. 2 blade was considered easy (median, 2B), better than the grade with the No. 3 MCB (median, 3). When the No. 2 MCB was used, external laryngeal pressure improved the laryngoscopic grade (1, full glottic view) in 46% of patients. In contrast, when the No. 3 MCB was used, pressure improved the grade in only 10% of the patients. Intubation time with the No. 2 MCB was significantly (P < 0.05) less than it was in patients with No. 3 MCB. Overall, 14 patients who failed intubation with the No. 3 MCB were switched to the No. 2 MCB, and intubation was successful with an easy laryngoscopic grade. Three patients who failed intubation with the No. 2 MCB were switched to the No. 3 MCB. CONCLUSIONS: The predicted difficult laryngoscopy and intubation with the use of the adult No. 3 MCB in standard adult patients with a TMD < or = 5 cm is significantly easier with use of the smaller No. 2 MCB.

Adolescent↗
PubMed2000

Prehospital intubation in patients with severe head injury.

BACKGROUND: Prehospital intubation and airway control is routinely performed by paramedics in critically injured patients. Despite the advantages provided by this procedure, numerous potential risks exist when this is performed in the field. We reviewed the outcome of patients with severe head injury, to determine whether prehospital intubation is associated with an improved outcome. METHODS: A retrospective review of registry data of patients admitted to an urban trauma center with severe head injury (field Glasgow Coma Scale score of < or =8 and head Abbreviated Injury Scale score of > or =3) was performed. Patients were stratified by methods of airway control performed by prehospital personnel: not intubated, intubated, or unsuccessful intubation. Mortality was determined for each group. To control for significant variables between these populations, matching and multivariate analysis were performed. RESULTS: Patients requiring prehospital intubation or in whom intubation was attempted had an increased mortality (81% and 77%, respectively) when compared with nonintubated patients (43%). The mortality for patients who had prehospital intubation performed did not demonstrate an improved survival using matching. In fact, intubated patients had a significantly higher relative risk (RR) of mortality when compared with nonintubation (RR = 1.74,p < 0.001) and unsuccessful intubation patients (RR = 1.53, p = 0.008) CONCLUSION: For patients with severe head injury, prehospital intubation did not demonstrate an improvement in survival. Further prospective randomized trials are necessary to confirm these results.

Adolescent↗
PubMed2002

Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the Trauma Registry of the German Trauma Society.

OBJECTIVE: On the basis of the data of a multicenter study, the impact of prehospital intubation and ventilation in the therapy of severe thoracic trauma without manifest respiratory insufficiency was analyzed. METHODS: Data were collected prospectively in the Trauma Registry of the German Trauma Society. In a matched-pair analysis, patients with severe thoracic trauma (Abbreviated Injury Scale score of 4) with and without prehospital intubation were compared. Patients were paired with respect to age, injury severity, and prognosis (according to the TRISS method). RESULTS: From a total of 3,814 patients, two groups (with/without prehospital intubation) of 44 matched patients each with comparable average age (36 vs. 36 years), Injury Severity Score (29 vs. 29), and TRISS (95.2 vs. 95.3) were identified. No patient was unconscious at the scene (all Glasgow Coma Scale scores > or = 8) or presented with severe respiratory insufficiency (all > or = 10 breaths/min). Time between injury and hospital admission was significantly longer (73 minutes; p < 0.05) in the group with prehospital intubation compared with the nonintubated group (47 minutes). Furthermore, fluid requirements in the prehospital period were significantly higher in the intubated patients (3,000 mL vs. 1,000 mL). In the prehospital intubation group, the number of patients with mass transfusion (9 vs. 4) as well as with emergency operations (10 vs. 4) were not significantly different from the nonintubated group. The prehospital intubation group showed a similar incidence of lung failure (17 vs. 14), kidney failure (6 vs. 2), and circulation failure (13 vs. 5). Except for two of the primarily nonintubated patients, all were intubated during their stay in the emergency room or on the intensive care unit. Days of ventilation (median, 7 days) as well as the length of stay on the ICU (median, 11 days) were comparable in both groups. Mortality in the prehospital intubation group was not significantly different between groups (six vs. two deceased). CONCLUSION: Prognosis with respect to organ failure, treatment time, and mortality is not adversely affected in the German trauma system, if patients with severe thoracic trauma without manifest respiratory insufficiency and without other indications for intubation are not treated with prehospital intubation.

Adult↗
PubMed1997

Effect of the size of a tracheal tube and the efficacy of the use of the laryngeal mask for fibrescope-aided tracheal intubation.

We randomly allocated 60 patients with normal airways into three groups to compare the ease of fibrescope-aided tracheal intubation using 8.0-mm internal diameter (group F8) and 6.0-mm (group F6) reinforced tracheal tubes and to evaluate the efficacy of the laryngeal mask as an aid for fibreoptic tracheal intubation (group L). In group F8 tracheal intubation was optimal in 2 of 20 patients and in two patients in whom intubation over the fibrescope was difficult the attempts resulted in inadvertent oesophageal intubation. In group F6 intubation was always successful and significantly easier than in group F8 (p < 0.005; 95% confidence interval for the difference in the proportion of the optimal intubation grade: 20-70%). In group L tracheal intubation was optimal in 18 of 20 patients and easier than in group F6 (p = 0.014; 95% confidence interval for difference: 10-60%). In both groups F6 and L tracheal intubation was completed within less than about 1 min. We conclude that conventional fibrescope-aided tracheal intubation with a 6.0-mm tracheal tube is easier than with an 8.0-mm tube and that the laryngeal mask facilitates fibrescope-aided tracheal intubation.

Adult↗
PubMed2006

Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.

Airway Obstruction↗
PubMed2006

The circulatory responses to fibreoptic intubation: a comparison of oral and nasal routes.

The circulatory responses to fibreoptic intubation under general anaesthesia were studied in 60 adult female patients who were randomly assigned to receive either the oral or nasal route for insertion. Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline values), immediately after anaesthesia induction (post-induction values), at intubation and every minute for a further 5 min. The product of heart rate and systolic blood pressure (rate pressure product) at every time point was also calculated. The results showed that both fibreoptic orotracheal intubation and fibreoptic nasotracheal intubation resulted in significant increases in blood pressure, heart rate and rate pressure product compared to baseline and post-induction values. The times required to reach the maximum values of systolic blood pressure and heart rate were significantly longer in the fibreoptic nasotracheal intubation group than in the fibreoptic orotracheal intubation group. There were no significant differences between the two groups in blood pressure, heart rate and rate pressure product at any measuring point, or in the maximum values during observation. The time required for recovery of systolic blood pressure to the post-induction value was not significantly different between the two groups, but the time required for recovery of heart rate to post-induction value was significantly longer in the fibreoptic orotracheal intubation group than in the fibreoptic nasotracheal intubation group. It was concluded that both fibreoptic orotracheal and fibreoptic nasotracheal intubations could cause a similar magnitude of circulatory responses in general anaesthetised, female adults, but the tachycardic response to fibreoptic orotracheal intubation lasted longer than that to fibreoptic nasotracheal intubation.

Adolescent↗
PubMed2006

A comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children.

BACKGROUND: The purposes of this study were to further identify the hemodynamic responses to orotracheal intubation in children, using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS), and to validate whether the FOB can attenuate the hemodynamic response to orotracheal intubation compared with the DLS. METHODS: Forty-three children, ASA PS I-II scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either the DLS group (n = 20) or the FOB group (n = 23). Noninvasive systolic blood pressure (SBP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for the first 5 min after intubation. The maximal values of SBP and HR during the observation were also recorded. The product of HR and SBP [rate pressure product (RPP)] at each time point was calculated. RESULTS: In the DLS group, SBP, HR, and RPP at intubation and 1 min after intubation were significantly higher than postinduction values, but did not exceed baseline values. In the FOB group, SBP, HR, and RPP at intubation increased significantly compared with baseline and postinduction values. In the two groups, the maximal values of SBP, HR, and RPP during the observation were significantly higher than baseline values. Except for the HR at intubation, there were no significant differences in other hemodynamic parameters during the observation and the time required to reach maximal values of SBP, HR, and RPP between the two groups. CONCLUSIONS: Orotracheal intubation using FOB and DLS in children may cause similar increases in SBP and HR. Compared with the DLS, the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation.

Anesthesia, General↗
PubMed2006

Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital.

BACKGROUND: Despite increased emphasis on endoscopic performance indicators, e.g., cecal intubation rates, limited data from actual clinical practice have been published. OBJECTIVES: Retrospective database review to determine the rate and documentation of cecal intubation during colonoscopy at the University of Maryland Medical Center. METHODS: We reviewed 5,477 consecutive colonoscopies performed by 10 faculty gastroenterologists at a University hospital over a 6-yr period (March 1, 1999 to February 28, 2005). Unadjusted cecal intubation rates were analyzed as were rates that were adjusted based on the U.S. Multi-Society Task Force on Colorectal Cancer recommendations. We analyzed trends in overall and individual cecal intubation rates, circumstances that impact these rates, and the quality of documentation of cecal intubation. RESULTS: The overall adjusted cecal intubation rate for the entire 6 yr was 90.3%, and increased over the study period with the highest adjusted rate (93.7%) in the most recent year studied. There was no correlation between cecal intubation rate and patient age, gastroenterology fellow involvement, or endoscopist experience and number of procedures/year. In contrast, colon cancer screening, male gender, outpatient colonoscopy, and adequate bowel preparation predicted a higher cecal intubation rate. Written and photographic documentation of cecal intubation improved significantly after 2002. CONCLUSIONS: Our analysis revealed cecal intubation and documentation rates that meet current guidelines, and identified factors that may cause substantial variance in these rates depending on the nature of the practice. The present analysis confirms that computerized databases can be used to assess individual and group cecal intubation and documentation rates on an annual basis, and to make these data available to the public.

Aged↗
PubMed1995

Elective intubation for neurologic deterioration after stroke.

OBJECTIVE: To provide data to guide physicians and family when deciding whether a patient should be electively intubated after ischemic stroke. DESIGN: Chart review and patient interview. Clinical course, neurologic outcome, and financial and psychosocial effect of the decision to intubate were determined. SETTING: Neurology/Neurosurgery critical care unit. PATIENTS: Of our last 250 acute carotid territory ischemic stroke cases, we found 20 patients (8%) who were electively intubated, after CT and neurologic assessment, for neurologic deterioration. INTERVENTIONS: All patients received standard medical therapy. RESULTS: Intubation occurred 3 hours to 7 days (mean, 41 hours) after the onset of symptoms; six of 20 patients required intubation within the first 6 hours. Once clinical deterioration began, 10 of 20 patients required intubation within 1 hour. Six of 20 patients were discharged alive; two subsequently died, one is mostly dependent, two became mostly independent (one of these had a hemicraniectomy and is still improving, and the other died of an intercurrent illness 4 years after her stroke), and one is totally independent. The four "good" outcome survivors were distinguished by higher Glasgow Coma Scale scores (9.2 versus 5.9), and extubation was usually possible within 72 hours. For nonsurvivors, mean hospitalization after intubation was 6.4 days. In survivors, the monthly uninsured cost was $0 to $2,000, and caregivers experienced moderate stress. The same decision would be repeated by 76% of caregivers; 53% of caregivers would want intubation for themselves. CONCLUSIONS: Satisfactory outcome is possible in the 8% of ischemic stroke patients requiring elective intubation. Possible predictors of good outcome include less severe depression of consciousness at the time of intubation, extubation within 3 days, and hemicraniectomy. In retrospect, most families would repeat the decision to intubate. Further study in more patients of the cost/benefit of cerebral resuscitation after stroke is greatly needed.

Adult↗
PubMed1990

Emergency tracheal intubation in the postanesthesia care unit: physician error or patient disease?

Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the postanesthesia care unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October 1988. Twenty-six patients (26/13,593 = 0.19%) required the insertion of an endotracheal tube while in the PACU. Seventy-seven percent (20/26) of the intubations occurred within 1 h of extubation and/or admission to the PACU. Intubation was more common at the extremes of age; 54% of those intubated were more than 60 yr old (P = 0.003); 19% were less than 3 yr old (P less than 0.05). Twenty-three percent of the intubated patients had undergone otolaryngologic procedures (P = 0.008). Interestingly, 73% of the intubations occurred during the months of January through June (P = 0.016). Median PACU admission scores were lower for the intubated group (P less than 0.001). There was no association between intubation and gender (P = 0.74), anesthetic technique (P = 0.41), or anesthetic agent (P = 0.49). Of the 26 intubations, 18 (69%) were considered to be directly related to anesthetic management. Despite the extremely low incidence of emergency tracheal intubation in a heterogeneous group of patients admitted to our PACU, preventable anesthesia-related etiologic factors including excessive sedative or anesthetic effect, inappropriate fluid management, persistent muscle relaxant effect, and upper airway obstruction contributed to the majority of these intubations.

Adolescent↗
PubMed2005

Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases.

When anesthesia is induced with propofol in elective cases, endotracheal intubation conditions are not different between succinylcholine and rocuronium approximately 60 s after the injection of the neuromuscular relaxant. In the present study, we investigated whether, in emergent cases, endotracheal intubation conditions obtained at the actual moment of intubation under succinylcholine differ from those obtained 60 s after the injection of rocuronium. One-hundred-eighty adult patients requiring rapid sequence induction of anesthesia for emergent surgery received propofol (1.5 mg/kg) and either rocuronium (0.6 mg/kg; endotracheal intubation 60 s after injection) or succinylcholine (1 mg/kg; endotracheal intubation as soon as possible). The time from beginning of the induction until completion of the intubation was shorter after the administration of succinylcholine than after rocuronium (median time 95 s versus 130 s; P < 0.0001). Endotracheal intubation conditions, rated with a 9-point scale, were better after succinylcholine administration than after rocuronium (8.6 +/- 1.1 versus 8.0 +/- 1.5; P < 0.001). There was no significant difference in patients with poor intubation conditions (7 versus 12) or in patients with failed first intubation attempt (4 versus 5) between the groups. We conclude that during rapid sequence induction of anesthesia in emergent cases, succinylcholine allows for a more rapid endotracheal intubation sequence and creates superior intubation conditions compared with rocuronium.

Adult↗
PubMed2000

Morbid results of prolonged intubation after coronary artery bypass surgery.

OBJECTIVES: This study evaluated the morbid results of prolonged intubation after coronary artery bypass grafting (CABG). METHODS: Over 30 months, 66 of 1,112 patients undergoing CABG required prolonged intubation. They were matched with 66 patients who did not require prolonged intubation. Preoperative and operative variables were evaluated to determine which would predict prolonged intubation. The postoperative courses were then compared to evaluate the effect of prolonged intubation. The study population was divided into three groups: those who underwent early extubation, but required reintubation (n = 24); those who required initial prolonged intubation, but no reintubation (n = 22); and those who required initial prolonged intubation and reintubation (n = 20). RESULTS: Univariate analysis revealed unstable angina (p = 0.037), elevated creatinine (p = 0.001), reduced FEV(1) (p = 0.019), longer cardiopulmonary bypass time (p = 0.009), and a greater positive fluid balance at 24 h (p = 0.0001) as predictors of postoperative prolonged intubation. Multivariate regression analysis revealed elevated creatinine (p = 0.011), FEV(1) (p = 0.022), and fluid balance (p = 0.001) as predictors of prolonged intubation. The study population had longer ICU and hospital stays (p = 0.0001), with more infectious complications (p = 0.0001) and higher mortality (p = 0. 001). In the subgroups of the study population, patients not requiring reintubation had shorter ICU (p = 0.001) and hospital stays (p = 0.0001), fewer infectious complications (p = 0.0001), and reduced mortality (p = 0.0001). CONCLUSIONS: Patients undergoing CABG with reduced FEV(1), renal failure, and positive fluid balance 24 h postoperatively are at risk for prolonged intubation. Prolonged intubation results in significant acute and midterm morbidity and mortality. Early extubation followed by reintubation further increases morbidity and mortality rates in these patients.

Aged↗
PubMed2003

[Fiberoptic intubation via laryngeal mask airway under general anesthesia in the patients with halo vest].

Since 1991, we gave anesthesia to 155 patients with halo vest. All of 128 whose airways could be kept patent by laryngeal mask airway (LMA) were successfully intubated fiberoptically via LMA using the tube exchange catheter under general anesthesia. Four patients developed airway obstruction during the induction of anesthesia, two of whom were awakened and subsequently intubated by awake fiberoptic intubation. In one patient LMA could keep the airway patent. In the other patient, cervical immobilization by halo device was released and the intubation was performed with a laryngoscope. For 8 patients, awake fiberoptic intubation was chosen from the preoperative evaluation of the positioning of head and neck. Fifteen patients were intubated with a laryngoscope without trying LMA fiberoptic intubation. No patient developed neurological injury attributed to the intubation. LMA fiberoptic intubation has several advantages. Patients do not feel discomfort under general anesthesia. Ventilation is kept continued until LMA is removed. Even less experienced residents can intubate easily and safely without assistance. However, we must carefully diagnose and select the patient whose airway can be kept patent under general anesthesia. The motionless pictures of the intubation procedures can be seen on the web site: www.hosp.go.jp/~kobe/.

Adult↗
PubMed1990

[Clinical study of awake fiberoptic nasotracheal intubation for difficult opening mouth patients].

The intubation technique for those surgical patients considered to be difficult intubation were classically managed by blind nasotracheal intubation, tracheostomy and so forth. These procedures are rather invasive and resulted in post-operative complications. 30 adult patients of ASA class II-III with difficulty in intubation were chosen to receive awake fiberoptic nasotracheal intubation. Our aim of study is to evaluate the change of blood pressure, heart rate and SaO2 of these patients at 4 stages: I) preanesthesia II) transtracheal local block III) during intubation IV) post-intubation. As a result, there were no significant difference in comparing the parameters among these 4 stages. Additionally, fiberoptic guiding provide a direct vision on the way of intubation, enhance the successful rate of difficult intubation and minimize further trauma and discomfort to the patients. Therefore fiberoptic intubation may suitable in patients with difficult intubation.

Adult↗
PubMed1989

[The Tube-Stat: a useful aid in difficult intubation].

A patient (ASA class I) scheduled for an elective gynecological operation, could not be intubated by conventional means, as no part of the glottis could be seen on direct laryngoscopy. Endotracheal intubation was successful on the first attempt using a lighted intubation stylet (Tube-Stat, Concept Corporation, Clearwater, Florida, USA). Transillumination of the neck tissues acted as a guide for correct placement of the endotracheal tube. Postoperatively, the patient complained of hoarseness and sore throat that cleared up completely within 5 days. Cases of difficult-intubation are often impossible to recognize preoperatively [3]. When problems arise, a difficult-intubation drill should be instituted without delay. The view obtained at laryngoscopy in our patient corresponded to a Grade III case according to the classification of Cormack and Lehane [3]. Our usual routine in such cases calls for blind intubation using a flexible introducer passed posteriorly to the epiglottis or blind nasal intubation. Recent reports testify to the potential dangers of blind procedures [4, 19, 23]. Light-wand-guided intubation has been reported to be an easily learned, atraumatic alternative to laryngoscopic or blind nasal intubation [6, 9]. We employed the Tube-Stat light-wand in a series of routine surgical cases with encouraging results. Our case report documents our first patient intubated with the light-wand after failure of conventional larnygoscopy. The first lighted stylet was described some 30 years ago, and the method of transillumination as an aid in difficult intubation developed over the following years.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Mechanomyographic and electromyographic studies of endotracheal intubation with 2 different rocuronium dosages].

Rocuronium is a new, intermediate-acting, nondepolarizing relaxant with rapid onset of action leading to both good and very good intubation conditions. It was the aim of our study to investigate the onset of action, the intubation conditions and the course of relaxation using two different dosage regimes. Thirty consenting ASA 1 and 2 patients received either 0.6 mg/kg (2 x ED 95; group 1) or 0.06 mg/kg as priming dose followed by an intubating dose of 0.24 mg/kg rocuronium (group 2) four min later. Anaesthesia was induced with propofol (2 mg/kg) and alfentanil (0.02 mg/kg) and maintained with nitrous oxide/oxygen and propofol (6 to 8 mg/kg/h). Neuromuscular function was monitored mechanomyographically and electromyographically with TOF stimulation at the wrist every 10 seconds. Intubation conditions were determined using a semiquantitative score system, and times to 90% block (intubation time), maximum block (onset time) and recovery from neuromuscular blockade to 25%, 50%, 75% and 90% were calculated and comparisons were made between the corresponding results of the two groups. The intubation dose of 2 x ED 95 (group 1) was followed by a significantly shorter intubation time (39.1 +/- 9.6 sec.) than in group 2 with priming and an intubation dose of 0.24 mg/kg (50.7 +/- 11.0 sec). The intubation conditions showed no differences. In both groups they were good or very good. The clinical duration of action was significantly longer in group 1 (28.4 +/- 8.0 min) than in group 2 (14.8 +/- 2.5 min). It can be concluded that rocuronium which has shorter intubation times than atracurium and vecuronium is very useful for endotracheal intubation in both dosage regimes in long and very long lasting operations. Using the "priming principle" the patient has to be carefully controlled during priming time.

Adult↗
PubMed1997

[Relationship between laryngoscopy degree and intubation difficulty].

OBJECTIVES: To determine the relation between difficult intubation and grade of direct laryngoscopy, as well as the factors that influence them, and prognosis. PATIENTS AND METHOD: In 1,336 patients receiving general anesthesia, seven airway measurements were made to reflect degree of difficulty and predictive value of presurgical tests on direct laryngoscopy and intubation. RESULTS: The incidences of difficult laryngoscopic and intubation procedures were 1.4 and 3.0%, respectively. Difficult intubation was more frequent in women and in patients between 40 and 65 years of age (p < 0.05). In 105 intubations (64.8%) performed with moderate difficulty (use of a stylette, external laryngeal pressure or two tries) and 17 (41.5%) performed with difficulty (three or more tries), the laryngoscopic procedure was graded as easy (Cormack-Lehane grade I-II). In these cases (easy laryngoscopy with moderate/difficult intubation), the causes recorded were size of endotracheal tube in comparison with the laryngeal opening (n = 11); anterior glotis (n = 36); insufficient relaxation (n = 31); disease in or beyond the vocal cords (n = 29); or undetermined (n = 15). In the easy intubation cases, the laryngoscopic procedures were grade III in 2.9%. Intubation was difficult in 16.3% (n = 39) of patients presenting some type of abnormality upon examination of the airway (p < 0.05). The airway characteristic that best predicted laryngoscopic difficulty was extension of the lower neck to 90 degrees (relative risk of 4.46), mouth opening less than 3.5 cm (3.92), presence of two airway abnormalities (4.25) and presence of three or more abnormalities (5.39) (p < 0.01). CONCLUSION: The fact that cases of easy laryngoscopy coincide with difficult intubation suggests that, to the degree of intubation difficulty must be added extrinsic factors (individual skill, maneuvers performed, instrumentation, relaxation of the laryngeal musculature and others) that are hard to standardize and reflect when predicting an intubation by the grade of difficulty in laryngoscopy.

Adolescent↗