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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

[Association between ventilation index and time on mechanical ventilation in infants with acute viral bronchiolitis].

OBJECTIVE: To evaluate the association between time on mechanical ventilation and anthropometric, clinical and pulmonary function variables, measured early, in infants on invasive mechanical ventilation with acute respiratory failure due to viral bronchiolitis, and the temporal progression of variables with significant correlations. METHODS: Twenty-nine infants admitted to the pediatric intensive care unit of UNICAMP university hospital were studied. Acute viral bronchiolitis was defined according to clinical and radiological criteria. Children with chronic diseases and those that were hemodynamically unstable were excluded. All measurements were taken after 24 to 72 hours' mechanical ventilation, using volumetric capnography and blood gas analysis. Mechanical ventilation time was divided into: < or = 7 days and > 7 days. Association between time on mechanical ventilation and the variables analyzed was determined by Spearman's Correlation Coefficient (r(s)). RESULTS: Time on mechanical ventilation showed a significant positive correlation with PaCO(2) (rs = 0.45, p = 0.01) and ventilation index (rs = 0.51, p = 0.005), and a negative correlation with pH (rs = -0.40, p = 0.03). Ventilation indices of 37, measured between day one and day five, was associated with a progressively increased risk of more than 7 days on mechanical ventilation (OR = 4.2 on the first day to 15.71 on the fourth day). CONCLUSIONS: Ventilation index, PaCO(2) and pH, measured early, were associated with prolonged mechanical ventilation, reflecting the severity of ventilatory disturbance and the need for support.

Acute Disease↗
PubMedDate not supplied

[Telemedicine and cardiology].

INTRODUCTION: Telecommunications and information technology provide clinical care at distance by means of telemedicine. Hospitals and other health care facilities use medical telemetry devices for monitoring patients' vital signs. These portable devices are used for measuring patient vital signs such as ECG, blood pressure, heart rate, respiration, capnography (CO2) and other important parameters and then transmit these information to a remote location using a nearby receiver. APPLICATION OF TELEMETRY: Eliminating the need for wired connection with the patient, monitors allow, otherwise bedridden patients to be mobile, which shortens the recovery time. Wireless technology is also useful in the emergency care units, because emergency physicians need not leave their patients while consulting a handheld wireless device. This equipment also enables a paramedic to communicate with emergency physicians for early assessment, well before patients' arrive in hospital. TELEMEDICINE: Certain types of medical telemetry devices may be used in home conditions. Telemetry can provide monitoring and home health care services at distance, using advanced telecommunications and information technology in patients with reasonably stable, but a severe, chronic, difficult condition and caring home environment. This information can enable health-care providers to effectively manage treatment without need for acute emergency treatment and hospitalization. CONCLUSION: Hospitals worldwide are under constant pressure to decrease healthcare cost and to improve treatment outcome. Telemedicine and home health care may be one of the solutions for the problem.

Cardiology↗
PubMedDate not supplied

Capnographic monitoring of extubated postoperative patients.

Postoperative respiratory monitoring of surgical patients requires assessment of both oxygenation and ventilation. Arterial blood gas (ABG) measurements traditionally have been used to detect elevated arterial carbon dioxide (PaCO2) concentrations. The recent availability of a noninvasive technique for end-tidal CO2 measurements (EtCO2) may allow substitution of this real-time modality for the more cumbersome blood gas determinations. This study examines 41 extubated postoperative patients monitored with both modalities and evaluates whether capnography can replace routine blood gas determinations in selected patients. Paired ABG and EtCO2 measurements were obtained at 30 and 90 min after admission to the recovery room. A new nasopharyngeal catheter was employed to obtain exhaled gas samples for EtCO2 measurement. Overall, EtCO2 was lower than PaCO2 by 2.8 torr (p < .05), with a precision of +/- 2.6 torr. Correlation between EtCO2 and PaCO2 was excellent (r = 0.87, p < .01). We conclude that on-line EtCO2 measurements provide a useful substitute for routine ABG determinations of PaCO2 in selected patients. The nasopharyngeal catheter provides both a patent airway and undiluted gas for evaluation. This methodology can improve patient comfort and safety considerably while decreasing cost and discomfort.

Blood Gas Analysis↗
PubMed1990

Noninvasive assessment of gas exchange in the critically ill patient.

A variety of technologies is available to noninvasively evaluate arterial oxygen saturation and partial pressure of serum oxygen (PaO2) and carbon dioxide (PaCO2) in the critically ill patient. These include pulse oximeters, transcutaneous monitoring devices, capnometry, and capnography. Understanding the technology, the clinical significance of the data, and the associated limitations is fundamental in optimizing patient assessment and management. Accordingly, critical care nurses have increasing responsibilities related to these aspects of patient care.

Adult↗
PubMed2002

The cardiovascular and respiratory effects of medetomidine and thiopentone anaesthesia in dogs breathing at an altitude of 1486 m.

The purpose of this study was to evaluate the cardio-respiratory effects of the combination of medetomidine and thiopentone followed by reversal with atipamezole as a combination for anaesthesia in 10 healthy German Shepherd dogs breathing spontaneously in a room at an altitude of 1486 m above sea level with an ambient air pressure of 651 mmHg. After the placement of intravenous and intra-arterial catheters, baseline samples were collected. Medetomidine (0.010 mg/kg) was administered intravenously and blood pressure and heart rate were recorded every minute for 5 minutes. Thiopentone was then slowly administered until intubation conditions were ideal. An endotracheal tube was placed and the dogs breathed room air spontaneously. Blood pressure, pulse oximetry, respiratory and heart rate, capnography, blood gas analysis and arterial lactate were performed or recorded every 10 minutes for the duration of the trial. Thiopentone was administered to maintain anaesthesia. After 60 minutes, atipamezole (0.025 mg/kg) was given intramuscularly. Data were recorded for the next 30 minutes. A dose of 8.7 mg/kg of thiopentone was required to anaesthetise the dogs after the administration of 0.010 mg/kg of medetomidine. Heart rate decreased from 96.7 at baseline to 38.5 5 minutes after the administration of medetomidine (P < 0.05). Heart rate then increased with the administration of thiopentone to 103.2 (P < 0.05). Blood pressure increased from 169.4/86.2 mmHg to 253.2/143.0 mmHg 5 minutes after the administration of medetomidine (P < 0.05). Blood pressure then slowly returned towards normal. Heart rate and blood pressure returned to baseline values after the administration of atipamezole. Arterial oxygen tension decreased from baseline levels (84.1 mmHg) to 57.8 mmHg after the administration of medetomidine and thiopentone (P < 0.05). This was accompanied by arterial desaturation from 94.7 to 79.7% (P < 0.05). A decrease in respiratory rate from 71.8 bpm to 12.2 bpm was seen during the same period. Respiratory rates slowly increased over the next hour to 27.0 bpm and a further increases 51.4 bpm after the administration of atipamezole was seen (P < 0.05). This was maintained until the end of the observation period. Arterial oxygen tension slowly returned towards normal over the observation period. No significant changes in blood lactate were seen. No correlation was found between arterial saturation as determined by blood gas analysis and pulse oximetry. Recovery after the administration of atipamezole was rapid (5.9 minutes). In healthy dogs, anaesthesia can be maintained with a combination of medetomidine and thiopentone, significant anaesthetic sparing effects have been noted and recovery from anaesthesia is not unduly delayed. Hypoxaemia may be problematic. Appropriate monitoring should be done and oxygen supplementation and ventilatory support should be available. A poor correlation between SpO2 and SaO2 and ETCO2 and PaCO2 was found.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

A critical incident reporting system in anaesthesia.

OBJECTIVE: To audit the recently established Critical Incident Reporting System in the Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe Medical School. The system was set up with the purpose of improving the quality of care delivered by the department. DESIGN: Cross sectional study. A critical incident was defined as 'any adverse and reversible event in theatre, during or immediately after surgery that if it persisted without correction would cause harm to the patient'. The anaesthetic or recovery room staff filled a critical incident form anonymously. Data was collected from critical incident reporting forms for analysis. SETTING: The anaesthetic service in the two teaching hospitals of Harare Central and Parirenyatwa General Hospitals. SUBJECTS: Between May and October 2000, 62 completed critical incident forms were collected. MAIN OUTCOME MEASURES: The nature of the incident and the monitoring used were recorded, the cause was classified as human, equipment or monitoring failure and the outcome for each patient reported. There was no formal system for reminding staff to fill in their critical incident forms. RESULTS: A total of 14,165 operations were performed over the reporting period: 62 critical incident forms were collected, reporting 130 incidents, giving a rate of 0.92% (130/14,165). Of these, 42 patients were emergencies and 20 elective. The incidents were hypotension, hypoxia, bradycardia, ECG changes, aspiration, laryngospasm, high spinal, and cardiac arrest. Monitoring present on patients who had critical incidents was: capnography 57%, oxymetry 90% and ECG 100%. Other monitors are not reported. Human error contributed in 32/62 of patients and equipment failure in 31/62 of patients. Patient outcome showed 15% died, 23% were unplanned admissions to HDU while 62% were discharged to the ward with little or no adverse outcome. CONCLUSION: Despite some under reporting, the critical incident rate was within the range reported in the literature. Supervision of juniors is not adequate, especially on call. The stress under which everyone has to work includes poor morale, drug shortages, poor equipment and power cuts with no backup generator. Despite this, the challenge for senior personnel is to improve quality of care. In other countries similar audits have led to change of practice and improvement in the safety features of the service provided by the hospital and staff.

Anesthesia↗
PubMed1992

Systemic absorption of glycine irrigation solution during endometrial ablation by transcervical endometrial resection.

OBJECTIVE: To study systemic absorption of glycine irrigation solution and its consequences during transcervical endometrial resection (TCER). DESIGN, SETTING, PATIENTS: A prospective study of 20 consecutive female patients who underwent elective TCER in a teaching hospital. METHOD: During the operation, patients were monitored with electrocardiography, automated oscillotonometry, pulse oximetry, capnography and a central venous pressure recorder. Plasma sodium and potassium levels were measured at 15-minute intervals. Blood haemoglobin concentration, serum osmolality, and plasma sodium, potassium and glycine concentrations were measured before and after surgery. RESULTS: Plasma glycine concentration increased in all patients after TCER. The highest concentration recorded was 5575 mumol/L. The increase correlated only with the maximum intraoperative decrease in plasma sodium, which was 7 mmol/L in two patients whose plasma glycine level increased by 3001 mumol/L and 5335 mumol/L. CONCLUSION: Systemic absorption of glycine irrigation solution occurred in all patients during TCER. Serial measurement of plasma sodium was necessary to detect this complication. A decrease in plasma sodium level by 7 mmol/L or more during surgery would indicate fluid absorption that could cause severe hyperglycinaemia and other potential complications.

Absorption↗
PubMedDate not supplied

An update on pulse oximetry. Part II: limitations and future applications.

The pulse oximeter can be used in all clinical situations in which the patient is at risk for hypoxemia. Now standard in the operating room, pulse oximetry is beginning to be used in prehospital transport, emergency department, postanesthesia recovery room, intensive care unit, endoscopy and catheterization suites, and delivery room, as well as for ambulatory monitoring and preoperative screening. The pulse oximeter is an invaluable monitor for the anesthesiologist and may allow better health care delivery to the patient, especially when combined with capnography and mixed venous oximetry. This article presents an update on its limitations and future applications.

Carbon Dioxide↗
PubMed1999

[Anesthesia accidents: accidental esophageal intubation].

Accidental oesophageal intubation is a common mistake in inexperienced anaesthetists, but unrecognized oesophageal intubation is fortunately a rare event because, in anaesthetic malpractice claims, it frequently resulted in death or brain damage. The connection of these complications with the lack of experience of the anaesthetist and/or the difficult intubation is not so evident in the literature. The precocious detection of tube dislocation depends on the systematic verification of endotracheal tube position after insertion. The paper describes the clinical and instrumental tests used for detecting tracheal or oesophageal intubation. Clinical signs are often unreliable and, between technical tests, capnography is the most reliable of correct tracheal positioning if waves are regular and repeated; when unavailable, the negative pressure aspiration test is a simple and reliable alternative.

Anesthesia↗
PubMed1998

Comparison of the cuffed oropharyngeal airway and laryngeal mask airway in spontaneous breathing anesthesia.

BACKGROUND: The cuffed oropharyngeal airway (COPA) is a modified Guedel airway with a cuff at its distal end and a standard 15 mm connector at its proximal end. This study was performed to determine if the COPA would offer any advantage over the laryngeal mask airway (LMA). METHODS: Eighty ASA class I to II adult patients scheduled for short elective procedures (less than 1 h) were randomly allocated into two groups. All patients were given atropine 0.01 mg/kg, fentanyl 2 micrograms/kg and propofol 2 mg/kg intravenously for induction of anesthesia. The COPA or LMA was inserted following the loss of eyelash reflex. If the jaw was not relaxed enough for insertion of a COPA or LMA, succinylcholine 1 mg/kg was given to facilitate the insertion. When correctly positioned, the cuff was immediately inflated with an appropriate volume. Gentle positive pressure ventilation was applied before spontaneous breathing resumed. Capnography was used to assess the patency of the airway. Anesthesia was maintained with isoflurane-N2O-O2 until the end of surgery. The success rate, vital signs, and adverse events were evaluated and compared. RESULTS: The success rate in the LMA group (95%) was higher than the COPA group (85%). The increase in circulatory response after the LMA insertion was greater than that after the COPA insertion (P < 0.05). Nine patients (22.5%) in the LMA group needed succinylcholine to facilitate insertion compared with only two patients (5%) in the COPA group. Additional manipulation was frequently (57.5%) needed after inserting the COPA to maintain the patency of the airways, but none needed so in the LMA group. Two patients had laryngospasms upon removal of the LMA, but none had laryngospasm in the COPA group. The incidence of sore throat in the LMA group was higher than in the COPA group (18% vs. 10%). CONCLUSIONS: We demonstrated that the COPA could be easily inserted without the need of muscle relaxants in most patients. But the COPA needed airway intervention to provide an effective airway in most patients. Compared with the LMA, the COPA caused less stimulation than the LMA.

Adult↗
PubMed1999

Do we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)

BACKGROUND: The laryngeal mask airway (LMA) has been widely studied for both conventional and nonconventional uses, while the literature on the cuffed oropharyngeal airway (COPA) is still limited. The purpose of this manuscript was to review the initial appraisal of efficacy, safety, effects on hemodynamics and respiratory function, induction agents and drug requirements of this new supraglottic device. METHODS: We reviewed main results of studies recently published on peer reviewed journals concerning the clinical uses of COPA. RESULTS: When used in healthy adults undergoing general anesthesia for routine minor procedures, the COPA and LMA are substantially equivalent. The LMA is associated with a higher first-time placement rate and fewer manipulations during usage, but the incidence of airway untoward events during COPA anesthesia is equivalent to that reported when using an LMA. The quality of breathing and capnography during COPA ventilation is similar to that provided by the LMA ventilation, with clinically relevant decrease in the physiological deadspace/tidal volume ratio and arterial to end-tidal CO2 tension difference compared with facemask ventilation. In selected patients without risk factors for regurgitation of gastric content, positive-pressure ventilation is similarly successful and safe with the COPA as with the LMA. The COPA seems to be less stimulating than LMA because it has been demonstrated to cause a lower incidence of pharyngeal trauma and sore throat in the immediate postoperative period, requires shorter exposure to an inhalational anesthetic and lower concentrations of propofol to be successfully placed, and is associated with lower effects on the patient's hemodynamic homeostasis than LMA. CONCLUSIONS: More extensive clinical evaluations should be advocated to better understand the risk/benefit ratio of this new supraglottic device; however, it may be concluded that in healthy adults receiving general anesthesia for short procedures the COPA allows for an effective and safe control of the patient's airway and ventilation.

Adult↗
PubMed2000

Fibre-optic aided bougie (FAB) for simulated difficult tracheal intubation.

INTRODUCTION: Difficult intubation remains a key problem and the value of the gum elastic bougie as a first approach is well recognised. MATERIALS AND METHODS: A fine fibre-optic endoscope (Rapiscope, Cook Critical Care) was used in 50 patients to verify placement of a custom-designed hollow plastic bougie prior to "rail-roading" a tracheal tube. Following induction and muscle relaxation, direct laryngoscopy was performed after two-minutes of assisted ventilation. The laryngoscope blade was lowered to simulate difficult intubation and the bougie passed behind the epiglottis. The position of the introducer bougie was then checked using the Rapiscope. Following correct bronchoscopic identification of the tracheobronchial anatomy, a tracheal tube was then "rail-roaded" following withdrawal of the scope. RESULTS: All patients were successfully intubated following identification of the bronchial tree by the Rapiscope: three on the second attempt and the rest on the first. Mean (SD, range) time to successful bronchoscopic confirmation of correct placement of the bougie was 38 s (9.1 s, 19 to 60 s). All bronchoscopic assisted intubation were subsequently confirmed by capnography after tracheal tube insertion. Mean (SD, range) time to successful intubation was 106 s (14 s, 52 to 132 s). CONCLUSION: The fibre-optic assisted bougie (FAB) offers a promising technique in patients who may be difficult to intubate but who can be ventilated. Further developments are required to achieve a faster intubation time but oxygenation may be achieved by jetting down the hollow bougie.

Adolescent↗
PubMed2000

[The use of alfentanil for short duration surgery in pediatric anesthesia].

BACKGROUND: In the present paper, the effectiveness of the alfentanyl-propofol combination versus fentanyl-propofol association in pediatric anesthesia during short surgical procedures was investigated. METHODS EXPERIMENTAL DESIGN: randomized study. SETTING: This study was carried out at the Surgical-Division of the Pediatric Clinic of the University "La Sapienza", Rome. PATIENT: 100 children (age 4.95 +/- 0.26 yr, body weight 21.13 +/- 0.86 kg) undergone to short anesthesia (50 +/- 0.01 min), were examined. PATIENTs were divided randomly into two groups, A and B, each composed of 50 children. PATIENTs in group A received an alfentanyl bolus dose of 50 micrograms.kg-1 and a continuous infusion of 0.50 microgram.kg-1.min-1, whereas patients in group B received a fentanyl bolus dose of 5 micrograms.kg-1 and a continuous infusion of 0.16 microgram.kg-1.min-1. In all patients, propofol was given in the same dose (bolus dose 1 mg.kg-1; continuous infusion 0.1 mg.kg-1.min-1) in association with opioid analgesic. MEASUREMENTS: non-invasive arterial pressure, EKG, heart rate, rectal temperature, oxygen saturation, capnography; during the postoperative course, we evaluated the motor activity response, the degree of weakfulness and consciousness. RESULTS: No significant differences between two groups in the systolic, diastolic and mean arterial pressure were pointed out whereas a decrease in heart rate in the group B and a better and more rapid restoration of breathing in group A was observed. Children of group A, after awakening, were more quiet and answered more readily to simple orders (64%). In group B 50% of children showed psychomotor unrest and 10% of them cried. The group that received alfentanyl answered more readily than group B (42% versus 26%). CONCLUSIONS: The present study shows that alfentanyl allows a better control of the surgical analgesia and it assures a good analgesic cover for all short surgical procedures without risk of early respiratory depression in postoperative period. Furthermore alfentanyl assures an early postoperative recovery due to the minimal pool, minimal undesired effects, and a cardiocirculatory stability.

Alfentanil↗
PubMedDate not supplied

[Anesthesiological care in removal of bulky formations from functionally important hemispheric zones: craniotomy in conscious state].

A method of anesthesia allowing patient's awakening to the level of verbal contact after trephination and opening of the dura mater was used in 37 patients with bulky formations (33 patients with tumors and 4 with arteriovenous malformations) in the speech zones of speech-dominant hemisphere. Speech mapping of the brain, carried out in alert patients, helped eliminate permanent speech deficiency during the postoperative period in all patients. The protocol of anesthesia was as follows: locoregional anesthesia of soft tissues of the head with a mixture of 2% xylocaine and 0.5% marcaine with epinephrine intravenous diprivan at stages requiring no patient's alertness, clopheline, fractionated midazolam (after identification of speech zones). The study showed that this protocol helps solve the problem and adequately protects the organism from surgical stress, provides good conditions for manipulations on the brain, involves no unpleasant sensations for the patient, and in 70% patients helps attain complete amnesia of the perioperative period. The most severe complication is an epileptic attack. Respiratory monitoring (pulse oximetry and capnography in the lateral duct) is obligatory for preventing respiratory disorders in patients on spontaneous respiration who were not intubated.

Adolescent↗
PubMedDate not supplied

[Sevoflurane inhalation anesthesia for short surgical interventions].

Sevoflurane, a new halogen inhalation anesthetic for mononarcosis, was used in 33 patients aged 22-57 years subjected to noncavitary general surgical and urological operations lasting for 50 +/- 9 min. Induction anesthesia consisted in sevoflurane inhalation in a semi-open contour. The anesthetic was delivered first in a dose of 0.2 vol% which was increased to 3-4 vol% by the end of induction (1.5-1.8 MAC). Laryngeal mask was used in 28 patients, in the rest tracheal intubation was carried out after succinyl choline. Maintenance dose of sevoflurane was 2-3 vol%. Electrocardiogram was recorded and arterial pressure monitored by indirect methods, pulse oxymetry and capnography were carried out. For evaluating the probable toxic effect, serum levels of total bilirubin, SGPT, creatinine, alkaline phosphatase, urea, albumin, potassium, and sodium were measured. Sevoflurane did not suppress the respiration and allowed assisted ventilation of the lungs, if necessary. No appreciable changes in the hemodynamics were observed, though heart rate was to be monitored. There were no biochemical shifts indicative of hepatic or renal involvement. Sevoflurane is recommended for total anesthesia in short non-cavitary interventions as mononarcosis, that is, such anesthesia requires virtually no extra narcotics, neuroleptics, or ataractics.

Adult↗
PubMed2001

[ Ambulatory laparoscopic gynecological surgery in Africa: feasibility].

We report a prospective survey conduced between March 1998 and February 1999 among 100 women classes ASA I and II who underwent laparoscopic surgery for gynecological disorders under general anesthesia. Among these laparoscopies 85 (85%) were performed for operative purposes and 12 (10.7%) for diagnostic purposes. Minimal monitoring was used (no capnography) so prophylacti fluid loading with 0.9% saline was used before insufflation to reduce hemodynamic changes induced by abdominal overpressure and to avoid potential massive air embolism. Insufflation pressure was limited to 14 mmHg. The main agent used for all procedures was propofol. Mean duration of the procedures was 55 minutes. There were no cases of complications or delayed recovery. Complete exsufflation by abdominal compression at the end of the procedures induced minimal abdominal pain and scapulalgia. Ketoprofen as effective postoperatively. Twenty-five patients (25%) complained of nausea and vomiting in the recovery room and were treated effectively with metoclopramide. All patients were discharged and accompanied to their home six hours later after a well-tolerated light meal. The postoperative course was uneventful.

Adult↗
PubMed2001

A modified method for intubation of a patient with ankylosing spondylitis using intubating laryngeal mask airway (LMA-Fastrach)--a case report.

We present an instance of successful use of an intubating laryngeal mask airway (LMA-Fastrach) and a Cook airway exchanger (CAE) for ventilation and intubation in a patient with severe ankylosing spondilitis (AS) receiving total hip arthroplasty. This measure may serve as an effective alternative for airway management in patients with difficult airway. A 61-year-old male was scheduled for right total hip arthroplasty because of degenerative osteoarthritis. He had been suffering from extensive ankylosing spondylitis, with the cervical spine markedly fixed in anterior flexion. Besides he could not open his mouth widely (35 mm when fully open) also because of ankylosis of jaw. Although we advised an awake fiberoptic tracheal intubation for anesthesia but he refused owing to a previous painful experience. After induction of anesthesia with glycopyrrolate, fentanyl, thiamylal sodium and succinylcholine, we inserted a # 5 Fastrach ILMA for primary airway maintenance. Then through the lumen of the ILMA we introduced the CAE as a guide for endotracheal tube (ETT) intubation. After applying the RAPI-FIT adapter to the CAE, we connected it to the capnography monitor for the confirmation of airway. We finally inserted an endotracheal tube into the trachea using the CAE as a guide. The whole procedure was uneventful and smooth. In sum, the modified Fastrach intubation method may facilitate tracheal intubation in patients with severe ankylosing spondilitis. It may be an alternative way for successful airway management in patients with difficult airway.

Arthroplasty, Replacement, Hip↗
PubMed2002

Detection and correction of accidental oesophageal intubation during flexible lightwand-guided intubation via the intubating laryngeal mask.

In the following two-part study, we determined the efficacy of observation of the light glow to detect correct placement of the tracheal tube after lightwand-guided tracheal intubation via the intubating laryngeal mask (ILM). We also determined the efficacy of a protocol to correct oesophageal intubation in this situation. In study 1, 80 ASA 1-3, anaesthetized, paralysed patients were randomly assigned to have a tracheal tube, preloaded with a flexible lightwand, placed into either the trachea (n=40) or oesophagus (n=40) under laryngoscope guidance. A blinded observer experienced with the lightwand technique determined whether oesophageal or tracheal intubation had occurred by observation of the light glow. In study 2, 1,000 patients, 400 of whom were included in a previous study, underwent flexible lightwand-guided intubation via the ILM. Placement of the tracheal tube in oesophagus or trachea was determined by observation of the glow and verified by capnography. Oesophageal intubation was corrected by adjusting the ILM position using a protocol comprising two adjusting manoeuvres. Observation, verification and correction were by experienced anaesthetists conducting the case. In study 1, oesophageal and tracheal intubation was correctly detected in 38/40 (95%) and 37/40 (92.5%) patients respectively. In study 2, oesophageal and tracheal intubation was correctly detected in 55/55 (100%) and 945/945 (100%) patients respectively. In 40/55 (73%) patients, tracheal intubation was successful at the second attempt and in 13/55 (24%) at the third or fourth attempt. In 2/55 (4%) patients, persistent oesophageal intubation occurred. The sensitivity, specificity and positive predictive value were 95%, 92.5% and 92.7% respectively in study 1, and were all 100% in study 2.

Adolescent↗