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At least 811 records · Page 45Linked to original sources
PubMed2005

Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy.

The GlideScope is a new video laryngoscope developed for management of the difficult airway. We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator. In the simulated easy laryngoscopy scenarios, the anaesthetists took longer to intubate using the GlideScope than the Macintosh laryngoscope (mean (SD) 19.0 (9.7) s vs. 12.7 (5.9) s, respectively; p = 0.006). There was no difference in the number of successful intubations, ease of intubation or choice of intubating device. In the simulated difficult laryngoscopy scenarios, the anaesthetists took less time to intubate using the GlideScope (23.5 (12.7) s vs. 70.5 (101.2) s, respectively; p = 0.001). The slightly higher success rate with the GlideScope was not statistically significant (20/20 vs. 18/20, respectively; p = 0.5). However, the anaesthetists found it easier to intubate using the GlideScope (median (interquartile range [range]) 1 (1-2 [1-2]) vs. 2 (2-3 [1-3]), respectively; p < 0.0001).

Attitude of Health Personnel↗
PubMed2006

Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method.

Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to baseline values in both groups. Blood pressure and heart rate at intubation, and the maximum values of blood pressure during the observation were significantly higher in the fibreoptic bronchoscope group. However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.

Adult↗
PubMed1987

Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation.

Laryngoscopy and endotracheal intubation cause a stress reaction resulting in an increase in heart rate and systemic blood pressure. This haemodynamic response is considered to be due to a sympathetic discharge caused by stimulation of the upper respiratory tract. This stress reaction during laryngoscopy and endotracheal intubation was studied in patients with total thoracolumbar epidural anaesthesia (EDA). Nine patients with thoracolumbar EDA including at least the segments T1 to L2 were compared to seven patients without EDA during induction of general anaesthesia. The epidural anaesthesia was achieved with 2% mepivacaine with adrenaline. General anaesthesia was induced with thiopentone 4-5 mg/kg followed by 100 mg suxamethonium. The highest blood pressure value during the first 2 min after intubation was compared to the value immediately before intubation. The epidural anaesthesia caused a reduction of the mean arterial blood pressure (MAP) by 25%, and a reduction of the heart rate (HR) by 7%, but neither the induction with thiopentone nor the laryngoscopy and intubation caused any changes in mean arterial blood pressure or heart rate. However, in the control group MAP increased 29% and HR 16% following intubation. Thus, the T1-L2 epidural anaesthesia with 2% mepivacaine with adrenaline blocked the blood pressure reaction to laryngoscopy and intubation, and consequently the efferent sympathetic nervous system was completely blocked.

Adult↗
PubMed1995

Intubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.

In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. Eighty-two per cent of patients were successfully intubated on the first attempt after 60-90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found. We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.

Adolescent↗
PubMed1997

Management of the difficult airway. A case of failed fiberoptic intubation.

BACKGROUND: Fiberoptic intubation is the current gold standard for the management of difficult intubation. Nevertheless, in rare circumstances even fiberoptic intubation fails. METHODS: We describe the case of a female patient suffering from neurofibromatosis Recklinghausen and a giant malignant schwannoma on the neck obstructing the pharynx and compromising respiration. Based on the clinical presentation and the MRI findings, difficulties in airway management were anticipated and fiberoptic intubation of the awake patient was planned. RESULTS: After localizing the vocal cords it was not possible to advance the tube into the trachea due to the severe deviation of the glottis. A decision was made to cancel any further fiberoptic intubation attempts and a conventional tracheotomy was performed under local anaesthesia without problems. CONCLUSION: This case illustrates that even awake fiberoptic intubation has its failure rate, due to inability to visualize the larynx, inability to advance the tube over the fiberscope (as in the present case), or inability to direct the tube towards the larynx. Due to the extreme deviation of the larynx other established techniques for difficult intubation were not deemed appropriate in this case. Therefore, weighing the risks and benefits, a decision was made to perform a tracheotomy under local anaesthesia.

Airway Obstruction↗
PubMed2004

Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection.

BACKGROUND: Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions. METHODS: Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study. Five minutes after midazolam 30 microg kg(-1), patients were randomized into two groups: group PR received propofol 2.5 mg kg(-1) followed by remifentanil 1 microg kg(-1), and group RP received remifentanil 1 microg kg(-1) followed by propofol 2.5 mg kg(-1). Intubating conditions were compared using a well-validated score, and continuous arterial pressure was recorded non-invasively. RESULTS: Compared with group RP, intubating conditions were significantly better in group PR. The mean arterial pressure decrease was more pronounced in group RP. CONCLUSIONS: We therefore conclude that in premedicated healthy patients with no anticipated risk of difficult intubation, intubating and haemodynamic conditions are better when remifentanil is injected after propofol.

Adolescent↗
PubMed2005

Decreased tongue mobility -- an explanation for difficult endotracheal intubation?

Established parameters predictive of difficulty in airway management were inconclusive in five ear, nose and throat (ENT) patients. All presented with degrees of tongue fixation - restriction of movement. Initially, experienced anaesthetists concluded that conventional endotracheal intubation would present no problems. Later, there were adjustments to this conclusion, with the ultimate being that four of the patients underwent fibre-optic intubation: one electively, two after repeated failed conventional attempts and one after a failed attempt of retrograde intubation. The last patient underwent elective retrograde intubation. All intubations were performed uneventfully in anaesthetized or sedated patients under spontaneous respiration. We found that tongue fixation was a direct cause of failed conventional endotracheal intubation, and recommend that a detailed tongue status investigation should be routine during Mallampati evaluation. Any abnormality should be seen as predictive of difficult/impossible conventional direct laryngoscopic intubation.

Aged↗
PubMed2005

Investigation of bacteremia following nasotracheal intubation.

BACKGROUND: The aim of this study was to detect the risk of bacteremia from nasotracheal intubation in children undergoing dental treatment under general anesthesia. METHODS: Two 10 ml blood samples were taken, the first as a baseline and the second within 30 s following the nasotracheal intubation. The samples were inoculated into 5 ml aerobic and 5 ml anaerobic blood culture bottles. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Mc Nemar's test was used to assess the findings statistically. RESULTS: Of 74 patients only nine (12.3%) had positive blood cultures after the intubation and seven of these had been intubated without trauma. The incidence of bacteremia was significantly higher after atraumatic intubation (7/9) compared with traumatic intubation (2/9) (P < 0.05). The most common bacteria in positive cultures were Streptococcus viridans, four of 74 (5.4%). CONCLUSIONS: Since the occurrence of bacteremia after nasotracheal intubation is hazardous for patients at risk for developing infective endocarditis, to prevent further complications prophylactic antibiotic treatment is recommended.

Adolescent↗
PubMed1999

Comparison of topical anesthetics and vasoconstrictors vs lubricants prior to nasogastric intubation: a randomized, controlled trial.

OBJECTIVE: To determine whether pre-treatment of the nose and throat with topical anesthetics and vasoconstrictors would reduce the pain associated with nasogastric (NG) intubation. METHODS: This was a prospective, randomized, controlled trial assessing the pain of NG intubation in patients pretreated with topical anesthetics and vasoconstrictors vs surgical lubricants alone. The subjects were 40 alert, cooperative adult patients requiring NG intubation without allergies to the study medications or contraindications to their use from a suburban university-based ED. The patients in the experimental group had phenylephrine 0.5% sprayed in their noses followed by instillation of 5 mL of 2% lidocaine jelly. Their throats were sprayed with 2% tetracaine and 14% benzocaine. The control patients received intranasal lubrication only. The primary outcome measured was pain of NG intubation on a 100-mm visual analog scale. Other outcomes included nasal pain, discomfort from gagging, and the incidences of vomiting, choking, and epistaxis. RESULTS: The mean age (+/-SD) was 54.8+/-22.3 years; 20 (50%) were female. The patients who had a combination of topical anesthetics and vasoconstrictors inserted prior to NG intubation experienced significantly less overall pain/ discomfort than did the control patients [28.6 mm (95% CI = 17.3 to 39.9 mm) vs 57.5 mm (95% CI = 44.9 to 70.1 mm), p = 0.001]. The patients in the experimental group also experienced significantly less nasal pain than did the patients in the control group [18.1 mm (95% CI = 8.0 to 28.2 mm) vs 44.4 mm (95% CI = 30.4 to 58.6 mm), p = 0.003] and significantly less discomfort from gagging than the patients receiving pretreatment with a lubricant alone [24.1 mm (95% CI = 11.1 to 37.1 mm) vs 50.9 mm (95% CI = 36.7 to 65.1 mm), p = 0.006]. There was no between-group difference in the frequencies of adverse effects. CONCLUSIONS: Use of topical lidocaine and phenylephrine for the nose and tetracaine with benzocaine spray for the throat prior to NG intubation results in significantly less pain and discomfort than use of a nasal surgical lubricant alone. Widespread use of topical anesthetics and vasoconstrictors prior to NG intubation is recommended.

Administration, Topical↗
PubMed2003

Rapid sequence intubation in Scottish urban emergency departments.

OBJECTIVE: Airway care is the cornerstone of resuscitation. In UK emergency department practice, this care is provided by anaesthetists and emergency physicians. The aim of this study was to determine current practice for rapid sequence intubation (RSI) in a sample of emergency departments in Scotland. METHODS: Two year, multicentre, prospective observational study of endotracheal intubation in the emergency departments of seven Scottish urban teaching hospitals. RESULTS: 1631 patients underwent an intubation attempt in the emergency department and 735 patients satisfied the criteria for RSI. Emergency physicians intubated 377 patients and anaesthetists intubated 355 patients. There was no difference in median age between the groups but there was a significantly greater proportion of men (73.2% versus 65.3%, p=0.024) and trauma patients (48.5% versus 37.4%, p=0.003) in the anaesthetic group. Anaesthetists had a higher initial success rate (91.8% versus 83.8%, p=0.001) and achieved more good (Cormack-Lehane Grade I and II) views at laryngoscopy (94.0% versus 89.3%, p=0.039). There was a non-significant trend to more complications in the group of patients intubated by emergency physicians (8.7% versus 12.7%, p=0.104). Emergency physicians intubated a higher proportion of patients with physiological compromise (91.8% versus 86.1%, p=0.027) and a higher proportion of patients within 15 minutes of arrival (32.6% versus 11.3%, p<0.0001). CONCLUSION: Anaesthetists achieve more good views at laryngoscopy with higher initial success rates during RSI. Emergency physicians perform RSI on a higher proportion of critically ill patients and a higher proportion of patients within 15 minutes of arrival. Complications may be fewer in the anaesthetists' group, but this could be related to differences in patient populations. Training issues for RSI and emergency airway care are discussed. Complication rates for both groups are in keeping with previous studies.

Adult↗
PubMed2001

Avoiding intubation in the injured subglottis: the role of heliox therapy.

Intubation in the child presenting with severe viral tracheobronchitis or prior subglottic injury can be detrimental to the child and the subglottis. Intubation may lead to further mucosal ischemia, scar, subglottic stenosis, or failed extubation requiring a tracheotomy. Heliox is a combination of helium and oxygen that produces less-dense gas exchange. Its use leads to a decrease in turbulent airflow, which may obviate the need for intubation. Here we report our experience using heliox as initial therapy in 14 consecutive children presenting with severe airway distress and the need for intubation. (Five had viral tracheobronchitis, 5 had inflammatory exacerbation of subglottic stenosis, and 4 had acute iatrogenic subglottic injury.) In 10 of the 14 children, intubation, which can lead to mucosal injury and scarring, was avoided by the use of heliox therapy. Of the 4 children in whom heliox therapy failed, 3 had a prior history of subglottic stenosis. Heliox is a relatively safe and reliable alternative to intubation of children with severe subglottic edema or injury. Heliox should be considered before intubation for selected children with subglottic inflammation and severe airway distress.

Bronchiolitis, Viral↗
PubMed1995

Subglottic ductal cysts in the preterm infant: association with laryngeal intubation trauma.

Acquired subglottic ductal cysts following prolonged intubation in preterm infants have been reported with increasing frequency during the past two decades. This paper reviews the subglottic ductal cysts diagnosed in 15 pediatric patients between 1989 and 1993--the largest such review. Eighty percent were observed in preterm low-birth weight infants following prolonged intubation, and all but 3 of the patients had major intubation trauma of the larynx--an association not previously reported. The cysts were usually multiple and arose in the posterolateral subglottis. Most were small and did not cause significant airway obstruction, but associated intubation changes were sufficiently severe to necessitate tracheotomy in 10 patients. The cysts observed in our study did not enlarge and in 4 patients were observed to spontaneously resolve or shrink in size--trends not previously reported. Subglottic ductal cysts noted in preterm infants after prolonged intubation most commonly occur in association with laryngeal intubation trauma and are likely a component of intubation trauma. Although these cysts may resolve without therapy, careful follow-up and treatment of potentially obstructing subglottic ductal cysts is recommended.

Cysts↗
PubMedDate not supplied

When does metoclopramide facilitate transpyloric intubation?

Postpyloric feeding probably reduces the incidence of tracheobronchial aspiration and improves feeding tolerance. However, duodenal intubation is often unsuccessful in critically ill patients due to gastric atony. Metoclopramide improves gastric emptying. In a pilot study, 12 adult patients were administered 10 to 20 mg of intravenous metoclopramide after weighted nasal feeding tubes had failed to spontaneously pass distal to the pylorus. In no patient did metoclopramide induce transpyloric passage of the tube. A randomized prospective study involving 10 adult patients was conducted to examine the effect of preinsertion intravenous metoclopramide on transpyloric intubation. All patients had failed to achieve spontaneous duodenal intubation. Five patients received 20 mg of metoclopramide 10 min prior to nasal insertion of a weighed feeding tube. Five control patients received no premedication. Four metoclopramide patients achieved duodenal intubation immediately. In none of the control patients did transpyloric intubation occur (p = 0.048). Metoclopramide, administered after nasogastric intubation, is ineffective in promoting transpyloric advancement of feeding tubes. There is a significant increase in transpyloric intubation when metoclopramide is administered prior to tube insertion.

Adult↗
PubMed2001

Tracheal intubation without muscle relaxant--a technique using sevoflurane vital capacity induction and alfentanil.

This randomized controlled study examined intubating conditions and haemodynamic changes following sevoflurane nitrous oxide induction in four groups: three different doses of alfentanil compared with low-dose alfentanil and suxamethonium. All patients received atropine 0.3 mg i.v. before induction of anaesthesia with vital capacity breaths of sevoflurane 8% (more than 7% in the inspiratory gas) in 60% nitrous oxide and oxygen. Patients were allocated randomly to four groups of intravenous supplements: group SA20, alfentanil 20 microg x kg(-1); group SA25, alfentanil 25 microg x kg(-1); group SA30, alfentanil 30 microg x kg(-1); group SSA, alfentanil 10 microg x kg(-1) and suxamethonium 1 mg x kg(-1). Orotracheal intubation and assessment of intubating conditions was performed by one of the investigators who was blinded to the subject's group. Intubating conditions were satisfactory or excellent in 83%, 80%, 92% and 96% of patients in groups SA20, SA25, SA30 and SSA respectively. These differences were not statistically significant. The increase in heart rate associated with laryngoscopy and tracheal intubation was effectively attenuated in all groups. Mean arterial pressure decreased significantly and similarly after induction in all groups. Two minutes after intubation the mean arterial pressure was increased significantly (P<0.05) compared to the post-induction value in group SSA. The intubating conditions obtained with sevoflurane plus alfentanil 30 microg x kg(-1) were comparable to those provided by the sevoflurane, suxamethonium and alfentanil 10 microg x kg(-1) combination.

Adolescent↗
PubMed2005

Fibreoptic intubation skills among anaesthetists in New Zealand.

The aim of this study was to investigate methods of practice, assess skill level, and evaluate attitudes towards fibreoptic intubation in the anaesthetic community of New Zealand. A postal survey questionnaire was sent to all vocationally registered anaesthetists in New Zealand and to all New Zealand anaesthetic trainees registered with the Australian and New Zealand College of Anaesthetists. There were 611 survey questionnaires posted and 386 (63%) respondents. Almost all respondents (98% of specialists, 100% of trainees) had access to fibreoptic equipment in public and 92% of respondents performed fibreoptic intubation. The median number of fibreoptic intubations performed per year was 3 for consultants and 4 for trainees. Respondents were either self taught or colleague taught (82%). Most learnt the technique on patients (92%). There were 14% who considered themselves experienced, 30% competent, 34% adequate and 20% novice. Skills were maintained by clinical patient mix in 73%. Fibreoptic intubation was considered a skill required by all anaesthetists in 87%, and 66% considered it the gold standard for expected difficult airways. Lack of clinical cases requiring the skill and lack of practice were identified as the primary barriers to skill development. Consultants had greater opportunity to learn fibreoptic intubation skills during daily practice than trainees. Only 18% of trainees had a formal airway management program available to them at their place of work. There appears to be a need to increase available opportunities to perform fibreoptic intubation to enable maintenance and improvement of fibreoptic skills in our community. A formalized program of teaching fibreoptic intubation may offer greater opportunity for learning and skill development.

Adult↗
PubMed2006

Bispectral index guided timing of intubation without neuromuscular blockade during sevoflurane induction of anaesthesia in adults.

The aim of this study was to assess the effectiveness of bispectral index monitoring (BIS) as a guide to the timing of intubation during sevoflurane induction of anaesthesia without the use of neuromuscular blocking agents in adults, and specifically, whether a target BIS value of 25 provides better intubating conditions than a target BIS of 40. Forty patients were randomized into one of two groups, a target BIS 25 (n =21) or a target BIS 40 (n =19). Patients received premedication with midazolam 20 microg/kg and fentanyl 0.5 microg/kg. Sevoflurane induction of anaesthesia was initiated and titrated to reach the target BIS value and maintained within the target range for two minutes. The trachea was then intubated, with intubating conditions being assessed using a standardized scale. The BIS 25 group had a superior median intubating score of 4 (range 3-9,[IQR 4-5]) vs the BIS 40 group with a median of 7 (5-10, [6-9], P<0.001). The time to reach target BIS values was not statistically different (BIS 25 group 6.6 min, BIS 40 group 5.1 min, P=0.054). End-tidal sevoflurane concentration upon reaching the target BIS was higher in the BIS 25 group (5.3% +/- 1.2%) vs the BIS 40 group (3.5% +/- 0.95) (P<0.001). There was no statistical difference in haemodynamic parameters between groups. A target BIS value of 25 provides good to excellent intubating conditions and better intubating conditions than a target BIS of 40 during sevoflurane induction of anaesthesia without the use of neuromuscular blocking agents.

Adjuvants, Anesthesia↗
PubMed1994

Clinical assessment of the Augustine Guide for endotracheal intubation.

The Augustine Guide (AG) allows oral endotracheal intubations to be performed blindly; head and neck manipulation are unnecessary. It is a premolded device designed to fit in a lock and key fashion in the glottis, thus serving as a guide to allow blind laryngeal insertion of an endotracheal tube. Intubation success rate with the AG was studied in 100 adults intubated by the same individual; head and neck were held neutral. Intubations were described as easy if they were successful in the first attempt and difficult when more than one attempt to position the AG was necessary. Endotracheal intubation was successful 94% of the time and was easy in 71%. Repositioning of the AG was necessary in 23%. Patients with jaw abnormalities required repositioning more often (P < 0.05). Esophageal intubation did not occur. Minor trauma was noted in 18% of subjects. The AG is a safe and effective tool for blind orotracheal intubation.

Adolescent↗
PubMed2005

Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening.

Submental intubation is useful for airway management during maxillofacial surgery when both nasal and orotracheal intubation are deemed unsuitable and to avoid a tracheostomy, especially when long-term ventilatory support is not required in the postoperative period. Adequate mouth opening is a prerequisite for all the techniques described for submental intubation, as the initial step is orotracheal intubation. Hence, this procedure has never been reported in a patient with the inability to open the mouth. We describe the technique of retrograde submental intubation with the help of a pharyngeal loop assembly for the first time in a patient with maxillofacial trauma and restricted mouth opening in whom oral and nasal intubations were not possible and tracheostomy was the only alternative. In this case report, with successful retrograde submental intubation, the potential complications associated with a short-term tracheostomy were avoided, as there was no indication for keeping a tracheostomy during the postoperative period.

Accidents, Traffic↗