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At least 577 records · Page 32Linked to original sources
PubMed2002

The effect of propofol infusion on minimum alveolar concentration of sevoflurane for smooth tracheal intubation.

PURPOSE: This study was conducted to determine the effect of propofol infusion on the minimum alveolar concentration necessary for smooth tracheal intubation (MACEI) of sevoflurane. METHODS: Sixty-nine patients, American Society of Anesthesiologists (ASA) status I, aged 30-49 years, were randomly assigned to one of three groups according to the agents used for tracheal intubation (n = 23 for each group): the SP group, in whom the intubation was attempted under sevoflurane plus propofol infusion; the S group, tracheal intubation under sevoflurane alone; and the P group, tracheal intubation under propofol infusion alone. Anesthesia was induced with propofol 2.5 mg.kg(-1) i.v. bolus. Prior to the tracheal intubation attempt, propofol infusion, 10 mg.kg(-1).h(-1), was given for 15 min in the SP and P groups, and sevoflurane equilibration was established in the SP and S groups. All tracheal intubation attempts were made 15 min after anesthetic induction. The end-tidal sevoflurane concentration at which tracheal intubation was attempted was predetermined by the up-and-down method (with 0.5% as a step size). MACEI was determined using a logistic regression test. RESULTS: The MACEI of sevoflurane was 1.73% in the SP group, and 2.99% in the S group. Laryngoscopy was not possible in the P group patients. CONCLUSION: Propofol infusion reduced sevoflurane MACEI. This finding suggests that propofol would be an excellent adjuvant to use with sevoflurane for tracheal intubation.

Clinical Trial↗
PubMed1991

[Ocular circulatory changes in halothane-nitrous oxide intubation anesthesia with special reference to arterial CO2 partial pressure. I. Phenomenology of changes].

UNLABELLED: In 20 patients (5 with cataract, 15 with strabismus), general anesthesia was performed using halothane (inspiratory concentration: 0.5 vol.%) and nitrous oxide (65 vol.%); thiopental was employed for induction of anesthesia, vecuronium and succinylcholine were used for neuromuscular blockade prior to intubation. In series 1, the patients were slightly hyperventilated (PCO2 33 mmHg, on average). In series 2, the arterial PCO2 was changed in a range between 20 and 45 mmHg. By means of oculo-oscillo-dynamography, we determined the systolic retinal and ciliary perfusion pressures (PPs,ret and PPs,cil) as well as the respective ocular blood pressures (Ps,ret and Ps,cil), the ocular pulsation volume (PVoc) and the pulsatile ocular blood flow (Fp,oc = PVoc x heart rate). The intraocular pressure (Pio) was measured with the Draeger hand-applanation tonometer. Results of series 1: Measured 5 and 15 min after intubation, PPs,ret was reduced by averages of 12.5 and 20.2 mmHg, respectively, corresponding to decreases of 13.1 and 21.2% compared to the initial values. Ps,ret was decreased by 15.4 mmHg (14.2%) 5 min after intubation and by 27.1 mmHg (25.0%) 15 min after intubation. The ciliary pressures (PPs,cil and Ps,cil) were changed by similar amounts. PVoc was reduced by 0.3 microliters (50.8%) during both time periods after intubation. Fp,oc was lowered by 19.5 microliters/min (41.0%) and by 26.4 microliters/min (55.5%), measured 5 and 15 min after intubation, respectively. Pio was decreased by 1.6 mmHg (11.3%) and by 7.6 mmHg (53.5%), respectively. The systolic brachial artery pressure was reduced by 12.6 mmHg (9.5%) 5 min after intubation and by 29.1 mmHg (21.9%) 15 min after intubation. The diastolic branchial artery pressure showed a slight initial increase, followed by a small decrease. All changes were highly significant (P less than 0.001; 1-factor analysis of variance plus Scheffé test). Results of series 2: In a PCO2 range between 40 and 45 mmHg (normo-until slight hypoventilation; determined 5 min after intubation), PVoc and Fp,oc averaged 0.43 microliter and 42.9 microliters/min, respectively. In a PCO2 range between 30 and 35 mmHg (slight hyperventilation), PVoc and Fp,oc averaged 0.38 microliters and 36.1 microliters/min, respectively; and in a PCO2 range between 20 and 25 mmHg (forced hyperventilation), they averaged 0.21 microliter and 22.8 microliters/min, respectively. All other variables were not dependent on the PCO2 level. CONCLUSIONS: The lowering of PVoc and Fp,oc, observed during halothane-nitrous oxide anesthesia--especially with forced hyperventilation-, may be interpreted as reduced pulsatile choroidal blood flow.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed2026

Re-evaluating pediatric laryngoscope blade size recommendations: Comparable intubation performance across blade sizes in pediatric manikin models.

BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.

Manikins↗
PubMed2002

The tracheal detecting-bulb: a new device to distinguish tracheal from esophageal intubation.

BACKGROUND: The tracheal detecting-bulb (TDB) is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography. METHODS: Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed. RESULTS: In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%. CONCLUSIONS: The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.

Adolescent↗
PubMed2003

Emergency intubation for respiratory failure in Guillain-Barré syndrome.

BACKGROUND: The consequences of emergency intubation in Guillain-Barré syndrome are not known. OBJECTIVE: To review data from patients admitted to the intensive care unit with recent diagnosis of Guillain-Barré syndrome and intubation for respiratory failure. DESIGN, SETTING, AND PATIENTS: The database of patients with Guillain-Barré syndrome admitted to the intensive care units during the past 2 decades was reviewed. Emergency intubation was defined as need for ventilation in a patient with sudden dyspnea, cyanosis, or respiratory arrest. Outcome and pulmonary morbidity were assessed by comparing these patients with patients intubated electively. RESULTS: Six patients were intubated for acute respiratory distress and 1 patient for respiratory arrest. Thirty-six patients were intubated electively. Prolonged weaning was twice as common in the emergent group as in the elective group; a larger sample size might have demonstrated statistical significance. One patient with respiratory arrest developed marked anoxic encephalopathy; in all others, no differences were found in mortality, pulmonary morbidity, or duration of ventilatory assistance. None of the emergency intubations occurred in the last 15 years of the study. CONCLUSIONS: Emergency intubation in Guillain-Barré syndrome is uncommon but, when associated with respiratory arrest, can lead to anoxic encephalopathy. Duration of ventilator use and pulmonary morbidity are not increased in these patients.

Emergency Treatment↗
PubMed1990

Rapid induction sequence with vecuronium: should we intubate after 60 or 90 seconds?

The purpose of the study was to determine intubating conditions after administration of either succinylcholine or vecuronium in a rapid induction sequence. Patients received either succinylcholine 1.5 mg.kg-1 (Groups I and II) after d-tubocurarine 0.05 mg.kg-1 four minutes earlier, or vecuronium (Groups III and IV) in an initial dose of 0.01 mg.kg-1 followed four minutes later by 0.1 mg.kg-1. In Groups I and III an apnoeic delay of one minute was allowed before intubation whereas in Groups II and IV the delay was 90 sec. There was no significant difference in intubating conditions between Groups I and IV. Intubating conditions in Group III (vecuronium-delay of one minute) were statistically worse than in any of the three other groups. A delay of 90 sec after succinylcholine improved intubating conditions in male patients. Considering that intubating conditions obtained after 90 sec in patients given a priming sequence with vecuronium (Group IV) were not different from those obtained 60 sec after succinylcholine (Group I), the authors conclude that vecuronium is an acceptable alternative for rapid tracheal intubation. In the doses used in this study, intubating conditions 60 sec after vecuronium were unacceptable for rapid induction of anaesthesia.

Adult↗
PubMed1995

Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients.

The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. In both normotensive and hypertensive patients, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product increased after tracheal intubation or LMA insertion compared with baseline (P < 0.05). The haemodynamic changes were greater after intubation than after LMA insertion (P < 0.05). Following intubation of the trachea or insertion of the LMA, HR increased more markedly in hypertensive patients than in normotensive patients (P < 0.05). Plasma adrenaline and noradrenaline concentrations after tracheal intubation or LMA insertion increased compared with baseline values (P < 0.05) in normotensive and hypertensive patients. The increase in noradrenaline concentration after tracheal intubation was greater than that after LMA insertion (P < 0.05). No patient revealed ECG evidence of myocardial ischaemia. We conclude that insertion of LMA is associated with less circulatory responses than tracheal intubation in both normotensive and hypertensive patients.

Adult↗
PubMed1998

Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl.

PURPOSE: To observe the changes in EEG bispectral index (BIS), 95% spectral edge frequency (95% SEF) and median frequency (MF) with haemodynamic changes to intubation during induction with propofol or propofol and 2 micrograms.kg-1 fentanyl i.v. METHODS: Twenty four ASA I-II patients were randomized to receive either propofol infusion preceded by normal saline (group P, n = 12) or propofol preceded by 2 micrograms.kg-1 fentanyl (group PF, n = 12). Intubation was performed five minutes after maintenance of BIS within 45 +/- 5. EEG and haemodynamic variables were recorded at before induction, and before and after intubation. RESULTS: Haemodynamic responses to intubation were greater in group P than in group PF (P < 0.05). Postintubation SBP, DBP and HR increased, compared with preinduction values, more in group P than in group PF. Postintubation BIS values increased from 45.5 +/- 3.5 and 44.2 +/- 4.1 to 51.1 +/- 4.1 and 50.9 +/- 5.3 in groups P and PF, respectively, compared with preintubation values. The BIS values were not different between treatment groups before and after intubation, and 95% SEF and MF values did not increase after intubation. CONCLUSION: Fentanyl, 2 micrograms.kg-1 i.v., blunted the haemodynamic responses to intubation, but failed to attenuate the arousal of cerebral cortical activity. The different haemodynamic responses postintubation but similar BIS and 95% SEF changes in the two groups suggest that BIS or 95% SEF cannot predict the haemodynamic responses to intubation during anaesthesia induction with propofol and fentanyl.

Adolescent↗
PubMed2001

Improving styletted oral tracheal intubation: rational use of the OTSU.

PURPOSE: To introduce an improved method of styletted oral laryngoscopic tracheal intubation. DESCRIPTION OF THE TECHNIQUE: The oral tracheal stylet unit (OTSU) is constructed using a commonly available intubating stylet combined with an ordinary endotracheal tube (ETT). The ETT/stylet is created by a series of specific steps to form an OTSU, each with a standard shape and design that allows the tracheal tube to separate freely from the stylet. After construction, every unit is tested to confirm that the frictional resistance created by the tracheal tube, as it slides along the stationary stylet, is at an absolute minimum. Successful tracheal intubation is based on the following concepts: (a) The j-shaped OTSU, when correctly directed through the airway, passes freely from the mouth to the larynx, the laryngoscopic channel; (b) The tip of the ETT must first be placed between the vocal cords with every intubation. The tracheal tube is then launched and advanced into the trachea by sliding along and off a stationary stylette; (c) Only minimal force is required to propel the ETT during intubation; (d) Resistance to placement, launch or advancement means the tip of the OTSU has come into physical contact with the patient's airway; (e) When the epiglottis obscures the larynx, the tip of the OTSU is used to explore the hypopharynx and identify the glottis. The ability to differentiate where the ETT tip is located depends primarily on interpreting the sensations of touch and pressure transmitted from the bevel of the OTSU to the hand. Successful tracheal intubation is accomplished when all criteria for placement, launch, and advancement are met. CONCLUSION: Styletted oral tracheal intubation is well known. However, we describe an improvement of the technique, based on solid physical principles and years of experience, that should prove useful both for routine intubations and unexpected difficult airways.

Equipment Design↗
PubMedDate not supplied

Cricoid pressure decreases ease of tracheal intubation using fibreoptic laryngoscopy (WuScope System.

PURPOSE: Cricoid pressure is commonly used during rapid sequence induction and intubation to minimize the risk of aspiration. The objective of the study was to evaluate the ease of fibreoptic (WuScope System(TM)) intubation in anesthetized adults receiving cricoid pressure. METHODS: The intubation difficulty scale (IDS) was used to measure tracheal intubation difficulties in 33 patients undergoing elective surgery with general anesthesia and complete neuromuscular blockade. Each patient had their trachea intubated under two conditions: with and without cricoid pressure. The order of conditions was determined randomly. Cricoid pressure was applied by an experienced anesthesia provider. MAIN RESULTS: An IDS value of 0 (ideal intubation, that is one performed by the first operator on the first attempt, using the first technique with full visualization of the glottis and no vocal cord compression) occurred in 30 of 33 patients (91%) without cricoid pressure and in 22 of 33 patients (67%) with cricoid pressure (P < 0.05). Cricoid pressure compressed the vocal cords in nine patients (27%) and impeded tracheal tube placement in five (15%). In three patients (9%), pressure had to be released in order to successfully intubate. CONCLUSION: Cricoid pressure may impede or even prevent fibreoptic laryngoscopic intubation with the WuScope System(TM).

Adult↗
PubMedDate not supplied

The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet.

PURPOSE: To compare the ease of tracheal intubation facilitated by the gum elastic bougie or the malleable stylet while applying cricoid pressure. METHODS: Sixty American Society of Anesthesiologists I-III adult patients undergoing elective surgeries participated in this study. After induction of anesthesia with 2.5 mg x kg(-1) propofol and vecuronium 0.1 mg x kg(-1), the laryngeal view was assessed without and with cricoid pressure. Patients were allocated randomly into two groups: a gum elastic bougie or stylet group. One of the two devices was used for tracheal intubation while applying cricoid pressure. The duration and ease of tracheal intubation was recorded. MAIN RESULTS: In 58 patients, the trachea was intubated at the first attempt. In the stylet group, tracheal intubation was difficult and needed more time, especially when the glottic opening was not visible. In the bougie group, the duration and ease of intubation was not influenced by laryngeal view. In the remaining two patients with Cook's modified 3b laryngeal view, it was impossible to intubate the trachea with these devices. CONCLUSIONS: Applying cricoid pressure worsened laryngeal view. The use of a gum elastic bougie was more effective than the use of a stylet to facilitate intubation.

Adult↗
PubMed2000

Tracheal intubation after induction of anesthesia in children with propofol--remifentanil or propofol-rocuronium.

PURPOSE: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil. METHODS: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 microgxkg(-1) remifentanil (Re2 or Re4); 2 microgxkg(-1) remifentanil and 0.2 mgxkg(-1) rocuronium (Re2-Ro0.2); 0.4 mgxkg(-1) rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mgxkg(-1) propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation. RESULTS: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. CONCLUSION: The best intubating conditions were produced by the combination of 4 microgxkg(-1) remifentanil and 3.5 mgxkg(-1) propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.

Androstanols↗
PubMed2002

Effective nasotracheal intubation using a modified transillumination technique.

PURPOSE: Difficult intubation is a major problem in anesthesia. In case of limited mouth opening only a few intubating devices are available. Our study was designed to evaluate the effectiveness and safety of a modified transillumination technique for nasotracheal intubation (NTI). METHODS: One hundred twenty-three patients needing NTI were studied, 76 in group A: NTI with no expected intubation difficulty; and 47 in group B: limited mouth opening (<20 mm). All intubations were performed with the Trachlight(TM). Patients in group A were under general anesthesia while deep sedation (maintaining spontaneous breathing) was used in patients in group B. The standard transillumination technique was modified by keeping the metallic stylet in place and personalizing the length and the angle of the short arm of the J shaped endotracheal tube-transillumination lightwand (ETT-TL) assembly. RESULTS: The overall rate of success was 98.4% and 92.6% of intubations were successful on the first attempt. The average duration of intubation was 28 sec +/- 15 sec. Success rate and duration of intubation were similar in both groups. CONCLUSION: Modification of the technique facilitated transillumination and placement of the ETT. The simplicity and high success rate of NTI by transillumination with the TL suggest our modified technique is a valuable alternative for NTI in patients with difficult airway.

Aged↗
PubMed2005

[Influence of gender on the intubation conditions with rocuronium].

PURPOSE: There is increasing evidence for gender differences in the pharmacokinetics and pharmacodynamics of anaesthetic drugs and neuromuscular blocking agents, e.g. rocuronium (Roc). Females require 30% less Roc than males to achieve the same degree of neuromuscular block and onset times are shorter. However, whether this leads to an improvement of the intubation conditions in females is unclear. METHODS: After approval of the ethics committee 60 female and 60 male patients were each randomised into 2 groups to receive 0.6 mg/kg body weight Roc or 1.0 mg/kg succinylcholine (Sux; control group). Induction: thiopentone (5 mg/kg), fentanyl (3 microg/kg) then Roc (Roc groups) or Sux (Sux groups) and tracheal intubation after 60 s. Time to intubation, glottic exposure and intubating conditions were assessed. RESULTS: Men were significantly larger and heavier (p<0.001) than women, but the body mass index was comparable (ns). Number of attempts, time to intubation, and Cormack grades were comparable (ns). However, the rate of clinically acceptable intubation conditions was significantly higher in the female compared to the male Roc group: 80% vs 47%, p<0.05. The incidence of clinically acceptable intubation conditions in the female Roc and Sux groups were similar (80%). CONCLUSION: The intubation conditions after Roc were significantly better in women than in men. The differences were Roc-related and did not occur in the control groups.

Adult↗
PubMed1995

[Intubation conditions and circulatory effects 90 seconds after a divided mivacurium dose with three different TIVA induction methods].

UNLABELLED: The aim of this study was to compare the intubating conditions of a mivacurium-induced neuromuscular block 90 s after a divided administration with three different methods of induction of anaesthesia. METHODS: After approval by the local ethics committee, we investigated 36 ASA I and II patients undergoing a 2-h scheduled, elective surgery, in whom a TIVA was induced by one of three different drugs, edomidate, methohexital or propofol. After stable anaesthesia was reached, 0.15 mg/kg and 0.1 mg/kg of mivacurium, spaced 30 s apart, was injected. Endotracheal intubation was performed 90 s after the first micacurium injection and the intubation conditions were graded (1: excellent, 2: good, 3: poor; 4: impossible). The neuromuscular function was stimulated every 20 s by a nerve stimulator in a train-of-four (TOF) pattern, and the time to complete distinction of a TOF response as well as the time of reoccurrence of the first twitch was taken. A minute prior to injection of the relaxant and every minute for 5 min, the systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate were measured. The neuromuscular block was maintained with a mivacurium infusion on a level of one twitch response. After cessation of the mivacurium infusion we recorded the time of reappearance of the second, third and fourth twitch responses. RESULTS: All patients could be intubated 90 s after mivacurium except for one, who was excluded for abnormal difficult intubation conditions. The etomidate group had significantly (chi 2 test) worse intubation grades than the methohexital group. In none of the groups did we observe any significant cardiovascular response due to the mivacurium injection, neither in blood pressure nor in heart rate. All groups showed similar onset of the maximal neuromuscular block (4 +/- 1.8 min) and recovery of the first TOF reaction (11.3 +/- 3.4 min). There was no difference in recovery from neuromuscular block maintained by infusion at the end of surgery. CONCLUSIONS: A dose of mivacurium 3.57 times the ED95 does not produce any haemodynamic instability, if it is divided into two parts to induce a TIVA. After this dose, all patients could be safely intubated within 90 s. A prolongation of the neuromuscular block after higher mivacurium doses could not be seen, and this dose did not produce a more rapid onset of the maximal block in any group. The time for recovery from a mivacurium infusion did not differ among the groups. Etomidate, due to its short half-life, seems not ideal for induction of a TIVA together with mivacurium in the dosage used. Mivacurium meets the demands of good controllability as required for a TIVA and can be recommended for a 90-s injection-intubation interval as well as for maintenance of the neuromuscular block.

Anesthesia, Intravenous↗
PubMed1997

[The Mallampati Score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati Score].

UNLABELLED: The Mallampati score (MS), later modified by Samsoon and Young, is a common method used to predict difficult intubation. We tested its predictive value in otolaryngologic (ENT) laser surgery. METHODS: Ninety-one patients scheduled for elective ENT laser surgery had the modified MS noted prior to induction in the supine position, with the tongue fully protruded and phonating "ah"; 22 patients were female, 69 male. The mean age was 54 +/- 15 (6-84) years, height 171 +/- 9 (130-190) cm, and weight 72 +/- 21 (20-99) kg. After a standard induction, the laryngoscopic view was graded according to Cormack and Lehane (C&L). An intubation was considered difficult if the C&L score was > or = 3, i.e., no part of the glottis seen during laryngoscopy. The hypothesis tested was that a MS > or = 3 (i.e., only the base of the uvula or nine of the uvula was seen) is predictive of difficult intubation in this group of patients. This chi-square test was used for calculation of significance. RESULTS: All intubations were performed in less than three attempts, and no C&L score of 4 (i.e., not even the epiglottis seen during laryngoscopy) was observed; 10 patients had a C&L score > or = 3, i.e., a difficult intubation according to our definition. Sixty-two patients had a MS < or = 2; of these, 4 (= 6%) were difficult to intubate. Twenty-nine patients had MS > or = 3; of these, 6 (= 21%) were difficult to intubate. This difference was significant (chi-square = 4.1, P < 0.05). CONCLUSION: Difficult intubation was significantly more common in patients with MS > or = 3. Low sensitivity (60%) and specificity (72%) limit the clinical value of this test, however.

Adolescent↗
PubMed2001

[Fiberoptic intubation during remifentanil propofol sedation].

OBJECTIVE: Fiberoptic intubation for the management of the difficult airway is usually achieved with the patient under light sedation. The goal of the present study was to evaluate the combination of propofol and remifentanil for sedation during fiberoptic intubation. METHODS: Plans were made to use fiberoptic intubation in 40 patients with predictably difficult airways. After topical anaesthesia of the pharynx with lidocaine, oxygen was administered via nasal cannula. A capnograph was attached to determine the adequacy of ventilation and an infusion of remifentanil (0.05 microgram/kg/min) and propofol (2 mg/kg/h) was started. After the first signs of sedation, nasal fiberoptic intubation was carried out. The depth of sedation was guided by clinical observation and capnographic data and the remifentanil dose was adjusted as necessary. RESULTS: All patients, including some with very severe airway anomalies, were uneventfully intubated using the regimen we have described. Nasal capnography made it possible to monitor ventilation in all patients during bronchoscopy and intubation. The onset of hypoventilation was recognized in patients and appropriately treated by adjusting the narcotic dose. No subject became hypoxic or hypercarbic during the procedure. The changes of blood pressure and heart rate exceeded the 30% range in only one patient (a 37% blood pressure increase). Sedation was rated as good to very good in 35 patients. Coughing occurred only in 5 patients and 37 out of 40 patients had no recall that intubation had occurred. CONCLUSION: Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.

Adjuvants, Anesthesia↗
PubMed1995

Retrograde intubation training using a mannequin.

The purpose of this study was to determine the efficacy of a mannequin for training emergency caregivers in the technique of retrograde intubation. This was a descriptive study using duration of time needed for completion of intubation as a measure of success. A cohort of 88 Emergency Medical Service (EMS) personnel included prehospital caregivers, registered nurses, and respiratory care practitioners. Participants were trained in retrograde intubation by modeling. Students practiced before they were tested. Every subject successfully completed intubation on the first timed effort. Subjects performed retrograde intubation in a mean time of 71 seconds (95% confidence interval +/- 4 seconds), with a range of 42 to 129 seconds. It was concluded that retrograde intubation can be taught easily with a mannequin and that this skill can be learned by emergency caregivers by modeling. Bag-valve-mask ventilation can be performed at any time without the need to restart or interrupt the procedure. Retrograde intubation can be introduced as an intubation technique for the difficult airway encountered by EMS personnel.

Adult↗