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PubMed1998

Softened endothracheal tube reduces the incidence and severity of epistaxis following nasotracheal intubation.

BACKGROUND: Many complications were reported to be related with nasotracheal intubation. Various chemical or mechanical techniques have been proposed to decrease hemorrhage and trauma associated with nasotracheal intubation but the results remain controversial. We conducted a prospective, randomized, single-blind study to elucidate the effect of an endotracheal tube softened with warm water before use on the incidence and severity of epistaxis following nasotracheal intubation. METHODS: Sixty-two healthy, (ASA class I or II) patients scheduled for elective surgery were randomly assigned into two groups. Patients in the treatment group were intubated with a softened endotracheal tube made possible by heating it in warm water while those in the control group were intubated with unsoftened (intact) tube. Epistaxis was evaluated immediately after intubation and its severity was graded as none, mild, moderate and severe. The use of Magill forceps and postoperative nasal morbidity were also recorded. RESULTS: The total incidence of epistaxis in the "unsoftened" group was significantly higher than that of "softened" group (76.7% vs. 43.8%, P = 0.0002). The severity of nasal hemorrhage was also significantly lightened in the "softened" group. No technical difficulty was encountered in intubation with a softened endotracheal tube by prewarming. The morbidity referable to nasal intubation, however, did not differ in both groups. CONCLUSIONS: In conclusion, our study shows that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during the act of nasotracheal intubation. It is an effective way and worth a try.

Adolescent↗
PubMed1999

[A multicenter study for evaluating a new intubating laryngeal mask airway].

A multicenter study was performed to evaluate the success of endotracheal intubation using an intubating laryngeal mask (ILM, Fastrach) in patients in ASA status I or II, aged 20 years or more, who underwent general anesthesia. A total of 191 patients were studied, and 24 of them were estimated difficult to intubate by the ordinary method with laryngoscope. Endotracheal intubation was successfully performed through ILM in 162 of the 191 (success rate of 84.8%). The mean time required for intubation in these successful cases was 19.1 seconds. The success rate did not depend on the clinical experience of anesthesiologists, and the individual success rate was improved as they became more experienced. Of the 24 patients who had been estimated difficult to intubate with laryngoscope, 23 were successfully intubated with success rate of 95.8%. In summary, endotracheal intubation through ILM was easy regardless of the anesthesiologist's experience, and seemed to be valuable for patients who were difficult to intubate.

Adult↗
PubMed1999

Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients.

UNLABELLED: In patients with difficult airways, the standard of care involves fiberoptic intubation under spontaneous ventilation. However, the safety and feasibility of a fiberoptic intubation teaching program has only been documented in paralyzed and apneic patients, whereas data obtained in patients under spontaneous respiration are limited and conflicting. We evaluated 100 anesthetized patients undergoing orotracheal fiberoptic intubation. Five anesthesia residents with no prior experience in fiberoptic laryngoscopy participated in the study. In a randomized fashion, each participant tracheally intubated 10 spontaneously breathing patients (Group A: sevoflurane anesthesia via an airway endoscopy mask) and 10 paralyzed patients (Group B: total IV anesthesia with propofol, fentanyl, atracurium). Overall rate of success (96%), defined as successful intubation of the trachea within two attempts, was not different between groups. During fiberoptic intubation, Spo2 values remained >95% in Group A, whereas Spo2 decreased to <95% in two patients in Group B. Failure to pass the tube into the trachea over the bronchoscope was encountered in four patients in Group A and in no patient in Group B. Our data suggest that it is safe to teach the use of fiberoptic intubation in anesthetized, spontaneously breathing patients with normal airway anatomy. IMPLICATIONS: Fiberoptic intubation under spontaneous respiration is a well established technique for management of difficult airways. Our study demonstrates the feasibility and safety of a novice training program for fiberoptic intubation under general anesthesia, not only in paralyzed patients but also in those breathing spontaneously.

Adult↗
PubMed1999

Pressures exerted against the cervical vertebrae by the standard and intubating laryngeal mask airways: a randomized, controlled, cross-over study in fresh cadavers.

UNLABELLED: In this randomized, controlled, cross-over study, we measured the pressures exerted by the standard laryngeal mask airway (LMA) and the intubating laryngeal mask airway (ILM) against the cervical vertebrae during insertion, intubation, and maneuvers commonly used to facilitate intubation. We also assessed the effect of these pressures on cervical spine (C-spine) movement. Twenty cadavers (6-24 h postmortem) without cervical abnormality were initially studied. Three microchip pressure sensors were implanted into the pharyngeal surface of C2-3. The size 5 ILM and LMA were inserted in random order into each cadaver with the head-neck in the neutral position. Maximal cervical pressures (CPmax) were recorded for both devices during cuff inflation from 0-40 mL and with the intracuff pressure (ICP) at 60 cm H2O, insertion, fiberscope-guided intubation, partial withdrawal/reinsertion (ILM only), elevation/depression of the handle with 20 N of force applied (ILM only). In five additional matched cadavers, the effect of pressure on posterior displacement of C3 was assessed, and CPmax was measured during laryngoscope- and fiberscope-guided oro/nasotracheal intubation (controls). CPmax was higher for the ILM than the LMA over the inflation range (96 vs 15 cm H2O; P < 0.0001) and with the ICP at 60 cm H2O (95 vs 10 cm H2O; P < 0.0001). During cuff inflation, CPmax was generally unchanged for the ILM but was always increased for the LMA. CPmax for the LMA and ILM was similar during insertion (224 vs 273 cm H2O) but higher for the ILM during fiberscope-guided intubation (96 vs 43 cm H2O; P < 0.0001). At 60 cm H2O ICP, CPmax increased during LMA (224 cm H2O; P < 0.0001) and ILM insertion (273 cm H2O; P < 0.0001) and increased for the LMA (43 cm H2O; P < 0.0001) but was unchanged for the ILM (96 cm H2O) during fiberscope-guided intubation. For the ILM, CP-max increased during handle depression (394 cm H2O; P < 0.0001) and partial withdrawal/reinsertion (265 cm H2O; P < 0.0001) but decreased during handle elevation (6 cm H2O; P < 0.00001). CPmax for the controls was usually zero and was always less than the LMA/ ILM (P < 0.0001). The mean (range) for posterior displacement of C3 was 0.8 (0-2) mm at 100 cm H2O and 2.8 (1-5) mm at 400 cm H2O. Laryngeal mask devices exert greater pressures against the cervical vertebrae than established intubation techniques and can produce posterior displacement of the C-spine. IMPLICATIONS: Laryngeal mask devices exert greater pressures against the cervical vertebrae than established intubation techniques and can produce posterior displacement of the cervical spine. We recommend that laryngeal mask devices only be used in the unstable cervical spine if difficulties are anticipated or encountered with established techniques, pending the results of studies demonstrating its relative safety.

Aged↗
PubMed2000

[Post-intubation subglottal stenosis in children: risk factors and prevention in pediatric intensive care].

BACKGROUND: Endotracheal intubation (EI) may result in significant injury to the larynx and trachea; subglottic stenosis is the most dangerous consequence of this injury in the pediatric age. It is well known that there are potential risk factors for post-intubation subglottic stenosis, and namely the underlying disease requiring EI, the age and body weight at EI, the duration and number of EI, the absence of sedation and the occurrence of infectious, hypotensive or hypoxic events during the period of EI and the traumatic EI. On the basis of our data an attempt is made to understand which factors are more important in the pathogenesis of this complication and whether post-intubation subglottic stenosis is a preventable complication of EI in children. METHODS: The clinical records of 32 out of 35 children with post-intubation subglottic stenosis referred to our institution because of this complication in the period 1990-1997 (8 years) have been examined. Three children were excluded from the study because of partial data. Our surgical division is specialized in the diagnosis and the management of pediatric laryngotracheal diseases. The diagnosis was confirmed by videolaryngotracheoscopy under general anesthesia and by computerized tomography or magnetic resonance imaging in 10 children whose tracheal stenosis was critical. The degree of the stenosis was determined according to Cotton's classification. RESULTS: The analysis of our data confirms that post-intubation subglottic stenosis is a more frequent complication in infants and particularly in low birth weight infants. It occurred after long lasting EI, but after short lasting EI too. Many of the children observed had their trachea intubated several times during their illness and many EI were traumatic. Sedation during EI was only seldom took into account by pediatric intensivists. CONCLUSIONS: Prevention of post-intubation subglottic stenosis is possible through a better management of the EI and of the child with a tracheal tube. Sedation of intubated children and skill in the EI technique and in the tube size selection are very important. Many intubations can be avoided with a better attention to the tube fixation and to extubation criteria. Some children at high risk for this complication can be identified.

Child↗
PubMed2000

[The effects of remifentanil on hemodynamic response to intubation. A comparative study with fentanyl] .

BACKGROUND: The aim of this study was to evaluate the effects of remifentanil in comparison with those of fentanyl on the hemodynamic response to orotracheal intubation. METHODS EXPERIMENTAL DESIGN: prospective comparative and randomized study. SETTING: operating room in a neurosurgery department at University. PATIENTS: 50 patients, ASA I or II with age ranging from 32 to 64 years were divided in two groups randomly. INTERVENTIONS: 25 patients received fentanyl as single bolus dose of 2.0 micrograms/kg and atropine 0.01 mg/kg i.v. as premedication while the remainders received atropine 0.01 mg/kg i.v. and remifentanil 0.2 microgram/kg/min as infusion. All patients were induced with propofol 2.0 mg/kg and cisatracurium 0.15 mg/kg for muscle relaxation and were intubated 4 min after induction of anesthesia. MEASUREMENTS: Heart rate, SAP, DAP, MAP and RPP were recorded at different times: baseline, induction, intubation, 1, 2, 3 and 4 min after intubation; ECG and pulsoximetry were monitored continuously. Statistical analysis was carried out using ANOVA for repeated measures and Bonferroni t-test a value of p < 0.05 was considered to be significant. RESULTS: Significant increases in PAS were recorded, at intubation and at 1 min after in patients treated with fentanyl; in the remifentanil group significant decreases in SAP at induction and at 4 min after intubation were recorded. HR increased significantly at intubation and at 1, 2 and 3 min after in the fentanyl group. RPP showed a significant decrease at induction in the remifentanil group and significant increases at intubation and at 1, 2 and 3 min after in patients treated with fentanyl. CONCLUSION: In conclusion remifentanil was found to properly control the hemodynamic response to intubation in comparison with fentanyl.

Adult↗
PubMed2002

The train of four ratio decreases to zero in anesthetized children is the guide to achieve a satisfactory intubation condition.

The purpose of this study is to investigate the satisfactory (excellent or good) intubation conditions attained when the TOF ratio was zero in anesthetized children. Sixty children undergoing elective ophthalmic surgery were allocated randomly into three groups. Anesthesia was induced with thiopentone 4 mg/kg and halothane in combination with 66% N2O and O2 (2 L/min). Patients maintained spontaneous breathing with assisted ventilation to limit the values of end tidal CO2 within the range of 36-44 mmHg, maintained the stable end tidal expiratory 1 MAC halothane concentration for three minutes and followed by 0.1 mg/kg vecuronium in group 1, 0.6 mg/kg rocuronium in group 2, and 0.9 mg/kg rocuronium in group 3. Intubation was attempted as the TOF ratio decreased from 1.0 to 0. The intubation condition was scored by assessing the degree of jaw relaxation, vocal cord opening grades, and cough responses. The overall intubation conditions were graded as excellent, good, fair, and poor on the basis of the scores. Excellent or good intubation conditions were considered satisfactory. After neuromuscular blockade administration, TOF ratio required 160.5 +/- 28.9 seconds in group 1, 70.7 +/- 18.5 seconds in group 2, and 55.7 +/- 13.5 seconds in group 3 to decrease to zero. There is a significant difference between group 1 and group 2 and 3 (p < 0.001, group 1 vs group 2 and group 3). All children were intubated, during which procedures satisfactory intubation conditions were observed in all of the group 3 patients, in 17 of the 20 group 2, and in 16 of the 20 group 1 patients. We concluded that zero of TOF from monitoring the adductor pollicis muscle indicated the proper moment for intubation in anesthetized pediatric patients and it was a reliable guide in adequately anesthetized children to achieve satisfactory intubation conditions following 0.9 mg/kg rocuronium administration.

Androstanols↗
PubMed1992

[A new method for endotracheal intubation with the Bullard laryngoscope].

The Bullard laryngoscope is an anatomically shaped rigid fiber optic instrument designed for indirect laryngoscopy and intubation. It requires no neck extension nor flexion to perform laryngeal intubation. This characteristic is especially useful in the case of difficult airway. The Bullard laryngoscope, however, with which it is easy to visualize the cords, has not been popular yet, because using the intubating forceps mechanism requires a certain amount of skill. The intubation method developed by us with Bullard laryngoscope has been tried on 26 patients with difficult airway and ten patients with normal airway. An endotracheal tube is inserted through nostril, and intubation is performed viewing the tube and larynx during all the processes of intubation. Three kinds of endotracheal tubes, i.e. Magill type plain tubes, styletted tubes, and directional tip tubes, are compared. The method using a directional tip tube (Endotrol) is concluded as the best among them. The Endotrol tube itself has such a suitable shape for nasal intubation that it can be introduced to the larynx with little directional change. Therefore, our method is mastered with a shorter training period than the intubation method with fiber-optic laryngoscopes. In conclusion, our intubation method with the Bullard laryngoscopes using the directional tip tubes (Endotrol) is useful for patients with difficult airways, and is also nontraumatic and easy to perform.

Humans↗
PubMed2006

[Effects of continuous infusion of landiolol on the hemodynamic response to tracheal intubation].

BACKGROUND: The clinical effect of continuous infusion of landiolol with buprenorphine and lidocaine was evaluated for its effects an attenuating the cardiovascular responses to endotracheal intubation. METHODS: Tracheal intubation was performed by the same anesthesiologist after induction of anesthesia with propofol, ketamine, midazolam, buprenorphine and lidocaine, followed by administration of vecuronium, and continuous infusion of saline (Group C; n = 20) or landiolol 0.02 (Group L 2; n = 25) or landiolol 0.04 mg x kg(-1) x min(-1) (Group L4; n = 22). Heart rate (HR), systolic (sBP) and diastolic blood pressure (dBP) were recorded just before induction of anesthesia, just after and 10 min after tracheal intubation. RESULTS: Just after tracheal intubation, HR in the Groups C and L 2, but not in the group L 4, increased significantly from the baseline. Just after the tracheal intubation, sBP in the Group L 2 decreased from the baseline, and 10 min after intubation sBP in all groups decreased significantly from the baseline. Just after tracheal intubation, dBP in all groups was unchanged, and dBP in the Groups C and L 4 decreased from the baseline 10 min after the intubation. CONCLUSIONS: Continuous infusion of landiolol 0.04 mg x kg(-1) x h(-1) with buprenorphine and lidocaine can completely attenuate the hemodynamic response to tracheal intubation.

Adrenergic beta-Antagonists↗
PubMed1991

Evaluation of atropine, glucagon, and metoclopramide for facilitation of endoscopic intubation of the duodenum in dogs.

Modification of gastroduodenal motility has been proposed to aid endoscopic examination of the duodenum in dogs. The objective of this study was to evaluate the use of the following pharmacologic agents for facilitation of endoscopic intubation of the duodenum in 6 clinically normal dogs: metoclopramide HCl (0.2 mg/kg of body weight), atropine sulfate (0.045 mg/kg), glucagon (0.06 mg/kg), and isotonic saline solution. In a randomized, blinded, crossover design, the ease of endoscopic duodenal intubation was qualitatively scored by 3 endoscopists (in random order), using the following scale: 1 - immediate entry; 2 - rapid entry--moderate manipulation; 3 - difficult entry--multiple attempts; and 4 - no entry after 2 minutes [corrected]. Anesthesia was induced with thiopental and maintained with halothane. The 4 agents were diluted to a fixed volume and randomly administered. Duodenal intubation was attempted 2 minutes after IV injection of 1 of the agents. Four endoscopic procedures (1 for each agent) were performed on each dog with a minimum of 5 days between each procedure. In this study, no agent facilitated endoscopic duodenal intubation at the dose used. Instead, atropine and metoclopramide made duodenal intubation significantly more difficult, compared with use of saline solution. Difference between intubation after administration of glucagon and saline solution was not seen. On the basis of our findings, the use of these agents for facilitating endoscopic duodenal intubation is not recommended. In addition, in this study, we found that experience in endoscopic intubation is an important factor in determining the ease of duodenal intubation.

Animals↗
PubMed1989

[Effects of intravenous injections of lidocaine on hemodynamics and catecholamine levels during endotracheal intubation in infants and children].

It is known that during anesthesia, administering medication and endotracheal intubation often cause stress for the patient which induces sthenia of the endocrinal system as well as changes in hemodynamics, sometimes leading to further systemic complications. Various changes in hemodynamics caused by endotracheal intubation in infants and children were studied, including tachycardia and increased blood pressure. Changes in catecholamine levels in blood plasma and in cardiovascular parameters were observed, with patients divided into two groups for comparison. Anesthesia of nitrous oxide-oxygen-enflurane was administered to both groups. The second group, however, received intravenous injections of lidocaine in addition to the anesthesia. The results are summarized as follows. 1) Epinephrine and norepinephrine concentrations in the plasma rose significantly following endotracheal intubation, then diminished. 2) Dopamine concentrations in the plasma reached maximum levels in 1-3 minutes following intubation, then gradually diminished. 3) Following administration of nitrous oxide-oxygen-enflurane, increases in RPP were suppressed both immediately following intubation and one minute after intubation. From this study, it is clear that stimulation caused by endotracheal intubation in infants and children triggers instant sthenia in the functions of the sympathetic nervous-medulla glandulae suprarenalic systems. The results also indicate that systemic complications during the induction of general anesthesia may be due to an increased secretion of endogenous catecholamines. These results further suggest that an intravenous injection of lidocaine is not effective in suppressing the increase of catecholamines in the plasma during endotracheal intubation. The intravenous injection of lidocaine, however, inhibits tachycardia and also inhibits the increase in blood pressure often caused by endotracheal intubation, and also serves to reduce the general oxygen demand in the cardiac tissue.

Catecholamines↗
PubMed1994

A new device for blind oral intubation in routine and difficult airway management.

41 patients (ASA I-II) were intubated using a new device for blind oral intubation (Augustine Guide). A group of 33 consecutive patients (Mallampati I and II), was studied for routine intubation. Another group of eight patients (Mallampati III and IV) was selected to study the guide in difficult airway management. Intubation was successful in 31 of the 33 normal patients (two patients required a second attempt), and in seven of the eight patients in the difficult intubation group (three patients with two attempts). In the remaining three patients intubation had to be performed by direct laryngoscopy. One patient (Mallampati IV), was intubated by the Augustine guide after three unsuccessful attempts by direct laryngoscopy. The Augustine Guide proved to be helpful to intubating patients with an anterior larynx and receding mandible. However, blind oral intubation attempts required a median duration of 65 s (range 35-90 s). Patients with a low Mallampati score did not benefit from the new device.

Adolescent↗
PubMed1993

Cerebral arterial blood flow velocity during induction of general anesthesia: rapid intravenous induction versus awake intubation.

Changes in middle cerebral arterial flow velocity (MCAV) during rapid intravenous induction and awake intubation using transcranial Doppler sonography were investigated. The study involved 20 patients without disorders of the central nervous or cardiovascular systems who were scheduled for maxillofacial surgery. In the intravenous induction group, anesthesia was induced with sodium thiopental, and orotracheal or nasotracheal intubation was facilitated with succinylcholine chloride or alcuronium chloride. In the awake intubation group, orotracheal or nasotracheal intubation was performed under intravenous sedation with diazepam and topical anesthesia with 4% lidocaine. Arterial blood pressures, heart rate, and MCAV were monitored at specific intervals. During intravenous induction, blood pressures decreased after the administration of thiopental and muscle relaxants and increased during endotracheal intubation. MCAV was remarkably slowed after the administration of thiopental and during mask ventilation. During awake intubation, blood pressures were increased by endotracheal intubation. MCAV was decreased from the administration of diazepam to the transtracheal injection of lidocaine, but returned to the control value from endotracheal spray to endotracheal intubation. These results suggest that smooth awake intubation may be the safest method of induction for patients with cerebrovascular disorders.

Alcuronium↗
PubMed1993

[The study of anatomic factors in difficult intubations].

Endotracheal intubation is a common procedure in anesthesia which can usually be accomplished easily. However if the attempt is unexpectedly difficult the patient may be seriously at risk. If all difficult airways can be predicted confidently in the pre-operative period, anesthesiologists can plan the safest and most effective way of managing tracheal intubation. The purpose of this study was to analyze not only the incidence, anatomic factors, immediate complications and management of difficult intubation cases but also the view obtained at laryngoscope which was graded according to the Cormack's and Lehane's description. Patients who received general anesthesia with endotracheal tube within 1 year's period from November 1, 1991 to October 31, 1992 in Show Chwan Memorial Hospital were collected. All difficult intubations were performed by senior anesthesiologists. 3925 patients were intubated, 92 cases were noted to have difficult intubations and their overall incidence were 2.3%. Among the 92 patients, those with 2 anatomic factors (41 patients, 44.6%) represented the majority for patients with difficult intubations. On the other hand, the four most common anatomic factors and their incidences in order of frequency included short neck (48.9%), protruding teeth (38.0%), receding mandible (27.2%) and limited opening mouth (26.1%). According to Cormack's and Lehane's laryngoscopic grading, the results were shown respectively as follow: 4 cases (4.4%) for grade 1;2 cases (2.2%) for grade 2;82 case (89%) for grade 3 and 4 cases (4.4%) for grade 4. We also found that tachycardia/hypertension (70.7%), bleeding (37.0%) and esophageal intubation (33.7%) were the three most frequent immediate complications during difficult intubations.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1993

[Subglottal stenosis following intubation in children].

BACKGROUND: Subglottal stenosis following intubation of children is infrequent, but significant. It is therefore necessary to know more about predisposing factors. MATERIAL AND METHODS: The files of all the 1,006 children who were intubated from 1982 to 1989 were studied. The following data were analysed: weight, height, locality of intubation, type and diameter of tube, reason for intubation, duration of intubation, delay and type of clinical signs of subglottal stenosis, treatment of this complication. RESULTS: Twelve children (1.5%) developed subglottal stenosis; 9 were 5 months to 7 years old; the other 3 were neonates, 2 of them with a very low birth weight. The disease responsible for intubation was neurologic in origin in 6 cases, respiratory in 4 and hemodynamic in 2. The tube used for 4 children was too large, based on standards for age and weight. The mean duration of intubation was 21.1 days (1-129 days). Primary failure to extubate usually revealed subglottal stenosis, which was assessed by laryngoscopy. It was necessary to reinsert a tube for a mean duration of 20.2 days (4-41 days) in 11 of the 12 children; all patients received corticosteroids. 6 children required tracheostomy for 37 to 365 days. Dilation was necessary in 7 children. Finally, 9 children fully recovered, 1 has an asymptomatic persistent stenosis, 1 is still intubated with severe neurologic sequellae and 1 died accidentally, probably as a result of obstruction by tube dilation. CONCLUSION: Stenosis remains a severe complication of intubation. The diameter of the tube is probably the most aggressive factor. It seems preferable to use a smaller, therefore cuffed tube and to secure the airways, if necessary, by inflating the cuff.

Child↗
PubMedDate not supplied

[Difficult intubation in paediatric cardiac surgery. Significance of age. Association with Down's syndrome].

OBJECTIVE: To assess the relationship between the age of pediatric patients and the likelihood of difficult intubations and to confirm the importance of Down Syndrome causing difficult intubations. DESIGN: Retrospective study. SETTING: Pediatric cardiac surgery operating room. PATIENTS: 627 pediatric patients, suffering from congenital heart disease, operated in our hospital from 1992 to 1994, divided in three age groups (under 1 month, between 1 month and 1 year, over 1 year of age). INTERVENTIONS: Translaryngeal intubation performed in the operating room before the operation. MEASUREMENTS: The percentage of difficult intubations was assessed in the three age groups and the association with Down syndrome was also considered. The likelihood of orotracheal intubations in each of the preceding groups was also examined. CONCLUSIONS: The percentage of difficult intubation in our experience was estimated to be 4.62%. Intubation's difficulty increases with decreasing age of non Down patients. The risk of difficult intubation in Down patients is, irrespectively of age, nearly 27% higher than in non-Downs (5.77% versus 4.52). However Down Syndrome seems to be important only in the age group between one month and one year. The percentage of orotracheal intubations in the preceding groups, even if indirectly, seem to confirm this observation.

Age Factors↗
PubMed1998

Difficult tracheal intubation--analysis and management in 37 cases.

AIM: To analyse the anatomical features of difficult airways encountered during general anaesthesia and study how difficult intubation was circumvented during anaesthesia in our local population. METHOD: Difficult intubation was defined as failure to visualise the larynx during laryngoscopy after neck flexion and external cricoid pressure was applied. All cases of difficult intubation collected over 1 1/2 years during general anaesthesia were recorded prospectively and analysed. RESULTS: Thirty-seven cases of difficult intubation were identified among 5,379 cases of general anaesthesia requiring endotracheal intubation. 40.5% of the cases were not expected to be difficult pre-operatively. 5.4% of the cases were Lehane II, 91.9% Lehane III and 2.7% Lehane IV. The anatomical features encountered included receding chin, limited mouth opening, limited neck extension, abnormal dentition, short thyromental distance, large tongue, supraglottic mass and floppy epiglottis. Gum elastic bougie was commonly used to overcome the intubation difficulties. Laryngeal mask, blind nasal tracheal intubation, fiberoptic bronchoscopic intubation and sometimes an alternative anaesthetic technique, such as regional anaesthesia, were resorted to. CONCLUSION: Assessment of multiple anatomical features would improve prediction of difficult intubation. Assessment of receding chin, neck extension, mouth opening, teeth, tongue size, thyromental distance might pick up 81% of difficult airways. Unexpected problems with epiglottis and glottic inlet are the potential sources of danger that are difficult to predict pre-operatively.

Adolescent↗
PubMed1976

Endotracheal intubation and its relationship to bacterial colonization and systemic infection of newborn infants.

The role of antibiotics in preventing respiratory tract bacterial colonization and systemic infection after orotracheal intubation was prospectively studied in 54 newborn infants. Respiratory tract colonization was assessed from nasopharyngeal and tracheal aspirate cultures obtained at intubation and daily thereafter, while systemic infection was monitored by blood, cerebrospinal fluid, and suprapubic urine cultures performed initially and every three days thereafter while intubated. Colonization and systemic cultures were also obtained at extubation or death. The study group, provided with antibiotics at intubation, and the control group were similar in birthweight and gestational age, as well as race, sex, hospital or origin, and indication for intubation. Colonization at intubation was five times more common in infants intubated 12 or more hours after birth than in infants intubated earlier. Subsequent colonization was twice as frequent in infants intubated longer than 72 hours as well as in those requiring two or more reintubations. Systemic infection occurred only in those infants who were initially or subsequently colonized and was three times more frequent in the control group than in the study group.

Anti-Bacterial Agents↗