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At least 19 recordsLinked to original sources
PubMed1995

Comparison of cardiovascular responses to airway management: fiberoptic intubation using a new adapter, laryngeal mask insertion, or conventional laryngoscopic intubation.

STUDY OBJECTIVES: To evaluate the circulatory effects of fiberoptic intubation with a newly developed mask adapter and to compare these effects with those obtained with a conventional laryngoscope and laryngeal mask airway with general anesthesia. DESIGN: Randomized study. SETTING: Operating room at a university hospital. PATIENTS: 30 ASA physical status I adult patients scheduled for minor elective surgery. INTERVENTIONS: A Macintosh laryngoscope was used for intubation in Group L (n = 10), a fiberoptic bronchoscope with newly developed mask adapter was used in Group FI (n = 10), and a laryngeal mask airway was used in Group LMA (n = 10). Anesthesia was induced with thiamylal, fentanyl, and vecuronium. Patients were manually ventilated for 4 minutes with sevoflurane. Then their tracheas were intubated with a laryngoscope or fiberoptic bronchoscope, or a laryngeal mask airway was inserted. MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate (HR) were measured continuously. After intubation, the magnitude of change of both BP and HR was greatest in Group L, next highest in Group FI, and lowest in Group LMA. CONCLUSION: Fiberoptic intubation with general anesthesia using the newly developed mask adapter offers an advantage over the standard laryngoscope for patients in whom pressor response of intubation is potentially hazardous.

Adult↗
PubMed2026

Less Invasive Surfactant Administration Using Video Laryngoscope to Decrease Pain in Neonates: A Randomized Controlled Trial.

OBJECTIVES: To assess whether the use of video laryngoscope, when compared to conventional laryngoscope decreases pain (assessed by Faceless Acute Neonatal Pain Scale) in preterm neonates while administering surfactant by LISA. METHODS: Preterm neonates <&#x2009;35 weeks requiring FiO2&#x2009;>&#x2009;0.3 on CPAP pressure of at least 6&#x2009;cm of H2O were administered surfactant by LISA technique either by video laryngoscope (Intervention) or conventional laryngoscope (Control). Faceless Acute Neonatal Pain Scale was used to determine pain 5&#x2009;min before the procedure, immediately, 5&#x2009;min, and 10&#x2009;min after the procedure. The primary outcome was severity of pain; secondary outcomes were time taken to complete the procedure, number of attempts, incidence of IVH, and adverse events during the procedure. RESULTS: In total, 42 neonates of <&#x2009;35 weeks gestation with comparable baseline demographics were randomized into 2 groups. The median (IQR) FANS score immediately post-procedure in the intervention arm was 2 (2-4) versus 2 (1-4) in the control arm, p&#x2009;=&#x2009;0.79. There was no statistical difference in the secondary outcomes studied. CONCLUSION: The two groups had no difference in the pain score. The pain experienced by neonates during the LISA procedure was moderate and of short duration and it did not depend on the type of laryngoscope used. Moderate pain during the procedure can be managed with nonpharmacological measures; thereby, the use of sedatives or analgesics can be avoided, which might be of concern. There was no difference in the number of attempts or in time taken to complete the procedure when performed by neonatologists experienced in using conventional laryngoscopes compared to video laryngoscopes. TRIAL REGISTRATION: Clinical Trial Registry of India: CTRI/2022/09/045204 on 05.09.2022.

Humans↗
PubMed1995

Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes.

BACKGROUND: Direct laryngoscopy requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomic reasons or because of cervical spine injury. The Bullard laryngoscope, a rigid fiberoptic laryngoscope, may cause less neck flexion and head extension than conventional laryngoscopes. The purpose of this study was to compare head extension (measured externally), cervical spine extension (measured radiographically), and laryngeal view obtained with the Bullard, Macintosh, and Miller laryngoscopes. METHODS: Anesthesia was induced in 35 ASA 1-3 elective surgery patients. Patients lay on a rigid board with head in neutral position. Laryngoscopy was performed three times, changing between the Bullard, Macintosh, and Miller laryngoscopes. Head extension was measured with an angle finder attached to goggles worn by the patient. The best laryngeal view with each laryngoscope was assessed by the laryngoscopist. In eight patients, lateral cervical spine radiographs were taken before and during laryngoscopy with the Bullard and Macintosh blades. RESULTS: Median values for external head extension were 11 degrees, 10 degrees, and 2 degrees with the Macintosh, Miller, and Bullard laryngoscopy (P < 0.01), respectively. Significant reductions in radiographic cervical spine extension were found for the Bullard compared to the Macintosh blade at the atlantooccipital joint, atlantoaxial joint, and C3-C4. Median atlantooccipital extension angles were 6 degrees and 12 degrees for the Bullard and Macintosh laryngoscopes, respectively. The larynx could be exposed in all patients with the Bullard but only in 90% with conventional laryngoscope (P < 0.01). CONCLUSIONS: The Bullard laryngoscope caused less head extension and cervical spine extension than conventional laryngoscopes and resulted in a better view. It may be useful in care of patients in whom cervical spine movement is limited or undesirable.

Adult↗
PubMed2004

[EasyScope - an alternative to the conventional Macintosh laryngoscope?].

OBJECTIVE: This study was conducted to compare two different techniques used for tracheal intubation (TI). We evaluated airway management conditions for a conventional Macintosh laryngoscope and the Brummert EasyScope, a new device. METHODS: A prospective trial was conducted with 20 medical students who had no prior airway management experience. Intubation was performed on an Ambu manikin. Following didactic instruction, each participant took turns performing TI using the Macintosh and EasyScope devices under direct supervision. Time required for TI, the number of attempts, and the number of times teeth were contacted were documented for each device. All participants also completed a questionnaire to determine self-assessed comfort and skill level for both the Macintosh and EasyScope devices. RESULTS: Time required for TI was comparable for both devices, although a trend toward slightly lower times for the EasyScope was observed. There was a lower rate of tooth contact during laryngoscopy and a lower rate of unsuccessful intubation attempts while using the EasyScope. Furthermore, the students felt the EasyScope was subjectively easier to use and required less effort during TI when compared with the Macintosh laryngoscope. CONCLUSION: Personnel not accustomed to a particular airway management technique achieved comparable outcomes when using either the Macintosh laryngoscope or the EasyScope device for TI. Possible reduction of effort required for tracheal intubation or better dental protection have to be evaluated for the EasyScope in further clinical studies.

Adult↗
PubMed2001

Use of the fibreoptic stylet scope (Styletscope) reduces the hemodynamic response to intubation in normotensive and hypertensive patients.

PURPOSE: To compare hemodynamic changes after tracheal intubation when using a new fibreoptic stylet scope (Styletscope) and a conventional laryngoscope in normotensive and hypertensive patients. METHODS: Normotensive (N; n=30) and hypertensive (H; n=30) patients undergoing general anesthesia participated in this study. Each group was divided into two groups. In one group, patients were intubated by using a stylet scope with a laryngoscope as an adjuvant (S; n=15 each), while patients in the other group were intubated using a laryngoscope by the usual technique (L; n=15 each). The time necessary for intubation, hemodynamic changes, and adverse effects were recorded. RESULTS: Patients in the normotensive groups (SN and LN groups) showed significant increases in both systolic and diastolic blood pressures from before induction to one minute after intubation; however, blood pressures in the SN group were significantly lower than those in the LN group. Both systolic and diastolic blood pressures increased after intubation in the LH group, but not in the SH group. Heart rates in all four groups showed significant increases, and there were no differences between heart rates in the stylet scope and laryngoscope groups or between the normotensive and hypertensive groups. The number of patients who complained of sore throat was greater in the laryngoscope groups. CONCLUSIONS: Tracheal intubation with a stylet scope can attenuate hemodynamic changes and reduce the incidence of sore throat in comparison with the conventional laryngoscope technique in both normotensive and hypertensive patients.

Anesthesia, General↗
PubMed1998

Minimally invasive long saphenous vein harvesting using a laryngoscope.

BACKGROUND: Traditional open incisions for long saphenous vein (LSV) harvesting are common sources of post operative complications after coronary artery bypass grafting (CABG). To reduce pain and wound healing complications, minimally invasive harvesting techniques are being developed. We have investigated the use of a conventional laryngoscope for cost effective saphenous removal using short incisions and long subcutaneous tunnels. METHODS: The LSV was exposed through small incisions connected by long subcutaneous tunnels. Soft tissue retraction, visualization and illumination were provided by a sterilized laryngoscope with a #3 or #4 Macintosh blade. Dissection was performed with standard instruments while branch ligation was performed with vascular clips. Thirty two patients undergoing CABG between October 1997 and January 1998 underwent minimally invasive vein harvesting assisted by a laryngoscope. Clinical outcomes were evaluated. RESULTS: There were 27 males and 5 females with a mean age of 62.6 +/- 9.3 years in this study. Adequate saphenous vein was removed in 29 of 32 cases. (In three patients, the vein was so superficial that an open incision proved easier). The length of harvested conduit averaged 38.2 +/- 11.01 centimeters (21-55 centimeters). Harvesting time average 37.1 minutes (+/-10.8 minutes; range from 20 to 62 minutes). Postoperatively, There were no wound dehiscences, infections, cellulitis, or major hematomas. Pain and leg edema were considerably less than with traditional open harvest. CONCLUSIONS: Minimally invasive vein harvesting is less traumatic to the extremity with fewer complications and superior patient satisfaction. Although commercial disposable systems are now available to permit minimally invasive harvesting of the saphenous vein, a conventional laryngoscope can be used with much reduced costs.

Adult↗
PubMed2001

Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases.

STUDY OBJECTIVE: To clarify the efficacy of the lightwand technique compared with that of the conventional laryngoscopic technique for awake endotracheal intubation in patients requiring emergency surgery. DESIGN: Prospective clinical study. SETTING: Anesthesia department of a teaching hospital. PATIENTS: 60 ASA physical status IE patients undergoing emergency surgery. INTERVENTIONS: Awake intubations using the lightwand technique (LW group) and a laryngoscope (LS group) were performed with conscious sedation with midazolam and fentanyl. MEASUREMENTS AND MAIN RESULTS: Time to intubation and number of intubation attempts in the LW group were significantly shorter and smaller, respectively, than those in the LS group (p < 0.01). Fewer LW group patients complained of a sore throat than in the LS group. DeltaP [changes from "before intubation" to "immediately after intubation" in mean arterial pressure (MAP)] in the LS group was significantly larger than that in the LW group (p < 0.05), although doses of sedatives in the two groups were not different. No hypoxemia or apnea associated with sedation was found in either of the groups. CONCLUSIONS: The lightwand technique produces less magnitude of stress following tracheal intubation than does the conventional laryngoscopic technique for awake intubation. Lightwand-assisted awake intubation is thought to be a useful means for induction of anesthesia in cases of emergency surgery.

Analgesics, Opioid↗
PubMed2002

A new video laryngoscope-an aid to intubation and teaching.

In recent decades, video techniques have been employed in the majority of endoscopic procedures because of several distinct advantages provided. These include the following: The displayed anatomy is magnified. Recognition of the anatomical structures and anomalies is easier, and manipulation of airway devices is facilitated. When assistance is required, the operator and assistant can coordinate their movements because each sees exactly the same image on the video monitor. As a result, video techniques have become the method of choice in teaching. The Video Macintosh Intubating Laryngoscope System (VMS) was designed employing a standard Macintosh blade and laryngoscope handle. A camera was incorporated into the handle with a short image and light bundle. The magnified anatomy is displayed on an 8-inch monitor, which is attached to a swivel arm on a small cart. Observation and manipulation can be performed in one axis.A total of 235 patients were studied and were divided into two groups: Group A (n = 217), in whom intubation was thought unlikely to be difficult, and Group B (n = 18), in whom difficulty with intubation was anticipated. External laryngeal manipulation (ELM) was required in 22 of the 217 Group A patients (10%). All intubations but one in this group were successful. In the second group (B) of 18 patients who had anatomical conditions that suggested that direct laryngoscopy might be challenging, all 18 cases required ELM but all were successfully intubated using the VMS. The improved coordination afforded by an image on a video monitor seen by both the assistant providing laryngeal manipulation and the anesthesiologist handling the laryngoscope results in a significant advantage over the conventional laryngoscope technique. As a consequence, the learning curve is short. In our view, video laryngoscopy will become the method of choice in teaching.

Anesthesiology↗
PubMed2003

Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease.

PURPOSE: To asses the cardiovascular changes after either lightwand or conventional laryngoscopic endotracheal intubation (EI) in patients with coronary artery disease. METHODS: Following Institutional approval and informed consent, 80 consecutive patients undergoing elective coronary artery bypass grafting were enrolled in this prospective, controlled, single-blinded study. General anesthesia was induced with fentanyl 5 micro x kg(-1) and thiopental 5 mg x kg(-1) followed by pancuronium 0.1 mg x kg(-1). After loss-of-eyelash reflex the lungs were manually ventilated with 2% isoflurane in oxygen for five minutes. Patients were then randomly allocated to receive either the lightwand (lightwand group, n = 41) or direct-vision laryngoscopy (laryngoscopy group, n = 39). Heart rate (HR) and direct blood pressure were recorded before induction, after induction but before EI, during EI, immediately after EI and at ten-second intervals for the following five minutes. Hemodynamic management during induction was standardized. Hypotension was treated with volume replacement, ephedrine, or phenylephrine as indicated; hypertension was treated with iv nitroglycerin; tachycardia was treated with boluses of esmolol; and, bradycardia was treated with atropine or ephedrine. RESULTS: In both groups, mean arterial blood pressures and HR increased significantly after EI. There was a tendency for the lightwand group to have lower arterial blood pressures and slower HR. However, the differences between the two groups did not reach statistical significance. Requirements for drugs to control HR and mean arterial pressure were similar in both groups. CONCLUSION: In patients with coronary artery disease using a lightwand intubation technique does not modify the hemodynamic response associated with EI as compared with standard direct-vision laryngoscopy.

Aged↗
PubMed2000

[A comparison of bullard laryngoscope and intubating laryngeal mask using fiberoptic guidance for tracheal intubation].

The purpose of this study is to compare the success rate of tracheal intubation, intubation time and laryngoscopic view of the larynx by Bullard laryngoscope or by intubating laryngeal mask using fiberoptic guidance in 50 patients. Following a standardized induction protocol, conventional laryngoscopic view by Macintosh's laryngoscope was obtained and classified by Cormack's grades. We measured the times from incertion of laryngoscopy or laryngeal mask until obtaining the best view of the larynx and until tracheal intubation. A best view by Bullard laryngoscopy or by fiberoscopy through the laryngeal mask was classified by Cormack's grades. The success rate of tracheal intubation was higher by Bullard laryngoscopy than by intubating laryngeal mask. The durations of laryngoscopy and tracheal intubation were significantly shorter and Cormack's grades were significantly lower by Bullard laryngoscopy than by laryngeal mask and fiberscopy. These results demonstrate that tracheal intubation by Bullard laryngoscope is faster and more successful compared with intubating laryngeal mask using fiberoptic guidance.

Adolescent↗
PubMed2005

Caring for the patients with cervical spine injuries: what have we learned?

PURPOSE: Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors related to initial management, diagnosis, airway and anesthetic management of patients with CSI are presented. SOURCE: Medline search was performed to seek out the English-language literature using the following phrases and keywords: spine trauma; cervical spine; airway management after CSI. PRINCIPAL FINDINGS: Cervical spine injury occurs in up to 3% to 6% of all patients with trauma. The initial management of a patient with potential spine injury requires a high degree of suspicion for CSI so that early stabilization of the spine can be used to prevent further neurological damage. Diagnostic radiology has a critical role to play; however, clinical evaluation is equally important in excluding CSI in a conscious and cooperative patient. Although in-line stabilization reduces the movement at C-spine, traction causes clinically significant distraction and should be avoided. CONCLUSION: A high level of suspicion and anticipation are the major components of decision making and management in a patient with CSI. Endotracheal intubation using the Bullard laryngoscope may have some advantages over other techniques as it causes less head and C-spine extension than the conventional laryngoscope, and this results in a better view. However, the current opinion is that oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI. In summation caution, close care and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique.

Anesthesia↗
PubMed2002

Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway.

UNLABELLED: Lightwand devices are effective and safe as an aid to tracheal intubation. Theoretically, avoiding direct-vision laryngoscopy could allow for less stimulation by intubation than the conventional laryngoscopic procedure. We designed this prospective randomized study to assess the cardiovascular changes after either lightwand or direct laryngoscopic tracheal intubation in adult patients anesthetized with sevoflurane. Sixty healthy adult patients with normal airways were randomly assigned to one of three groups according to intubating procedure under sevoflurane/nitrous oxide anesthesia (fraction of inspired oxygen = 0.33) (n = 20 each). The lightwand group received tracheal intubation with Trachlight, the laryngoscope-intubation group received tracheal intubation with a direct-vision laryngoscope (Macintosh blade), and the laryngoscopy-alone group received the laryngoscope alone. Heart rate and systolic blood pressure were recorded continuously for 5 min after tracheal intubation or laryngoscopy with enough time to intubate. All procedures were successful on the first attempt. The maximum heart rate and systolic blood pressure values obtained after intubation with Trachlight (114 +/- 20 bpm and 143 +/- 30 mm Hg, respectively) did not differ from those with the Macintosh laryngoscope (114 +/- 20 bpm and 138 +/- 23 mm Hg), but they were significantly larger than those in the laryngoscopy-alone group (94 +/- 19 bpm and 112 +/- 21 mm Hg) (P < 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation. IMPLICATIONS: The magnitude of hemodynamic changes associated with tracheal intubation with the Trachlight is almost the same as that which occurs with the direct laryngoscope. Hemodynamic changes are likely to occur because of direct tracheal irritation rather than direct stimulation of the larynx.

Adult↗
PubMed2004

Frequent use of alternative airway techniques makes difficult intubations less and easier.

BACKGROUND: This study is to evaluate how alternative airway techniques work at different scenarios of difficult airways in our department where those techniques are popularized in daily practice. METHODS: This is an open and observational study. Ten thousand two hundred and twenty nine adult patients were included in the 7-month period of investigation. When a difficult intubation was recognized, the responsible anesthesiologist would complete a questionnaire that was designed to explore the possible causes relative to the difficulty, i.e. the laryngoscopic view grade, the muscle relaxant administered during induction, any difficulty of mask ventilation, the eventually successful intubation technique, and the recommendation on the next intubation to the same patient. RESULTS: About 22% of the patients received various airway techniques for intubation other than laryngoscopic technique in general anesthesia. Laryngoscopic intubation was planned firstly on 8,058 cases; the incidence of difficult intubation was 0.44% (36/8058). Laryngoscopic view was found to be grade 2 in 10 patients, grade 3 in 24, and grade 4 in 2 patients, respectively. In these difficult airway intubations were accomplished ultimately with a conventional laryngoscope in 13 patients, a lighting stylet in 20 patients, a laryngeal mask airway (LMA) in 2 patients, and surface tactile oral intubation (STOI) in 1 patient. As to these patients with difficult airways who would undergo general anesthesia with endotracheal intubation next time awake intubation was suggested only to 4 patients. CONCLUSIONS: In elective general anesthesia, frequent use of the alternative airway techniques, such as LMA for a surgical procedure of short duration and lighting stylet for a possibly difficult airway, will decrease the events of difficult intubations. Lighting stylet seems more advantageous than laryngoscope in management of difficult intubation caused by poor laryngoscopic view.

Adult↗
PubMed2003

Management of the difficult airway: alternative airway techniques and adjuncts.

Rapid-sequence intubation using conventional laryngoscopic technique remains the standard of airway management in emergency medicine and continues to have a success rate of approximately 98%. Preparation and proper intubation technique must be optimized at the initial attempt using direct laryngoscopy. Failure causes multiple repeated attempts, leading to a failed airway. Each repeated attempt increases the likelihood of bleeding, oral, pharyngeal, and laryngeal edema, and malposition, causing decreased visualization of the glottic opening, equipment failure, and hypoxia. Preparation must be an ongoing process. Faulty suction, no oxygen source, choice of the wrong laryngoscopic blade or ETT, poor light source, or misplaced equipment can domino into mechanical failure. Intubation equipment stations must be inventoried constantly, organized, and kept simple in their layout to decrease confusion during selection. Medication for sedation and paralysis should be readily available and not kept distant from the intubation station in a medication-dispensing unit that would require time for acquisition. Proper positioning of the patient remains paramount for alignment of the oral, pharyngeal, and laryngeal axis to provide optimal visualization of the vocal cords. Proper technique during insertion of the laryngoscope blade in the oral cavity for displacement of the tongue must be ensured. Without proper technique, even with proper positioning, the glottic opening cannot be visualized. Laryngeal pressure to maneuver the larynx into position should be exerted initially by the laryngoscopist's right hand and, when in view, maintained by an assistant to free the laryngoscopist's hand for ETT insertion. With preparation and proper technique, the first attempt is the best attempt, and the vicious cycle of multiple attempts and complications will be averted.

Airway Obstruction↗
PubMed2003

Airway management of a patient with Weill-Marchesani syndrome.

Weill-Marchesani syndrome is a genetically determined rare systemic connective tissue disorder consisting of brachymorphy, brachydactyly, aortic stenosis, and ophthalmologic abnormalities, such as ectopia lentis, microspherophakia, and secondary glaucoma. The primary lesion is fibrous tissue hyperplasia. Airway control and intubation may be difficult in patients with WMS because of stiff joints, poorly aligned teeth, and maxillary hypoplasia with a narrow palate. We describe the successful airway management of a patient with WMS and laryngeal stenosis, using an intubating laryngeal mask following failed conventional laryngoscopic intubation.

Adult↗
PubMed1984

Curved laryngotelescope.

The purpose of this paper is to report on a newly developed curved laryngotelescope whose shape allows for smooth insertion through the oral and to the laryngeal cavity. Its principle of image processing involves lenses and prisms, which results in the maximum magnification of x6. Therefore, it is very useful for microscopic examination. We can obtain a clearer picture by this device than by conventional laryngoscopes. Examination with this laryngotelescope is easily performed after only topical application of a local anesthetic and patients experience less pain.

Fiber Optic Technology↗