Conscious Sedation ; Humans ; Intubation, Intratracheal ; instrumentation ; methods

OBJECTIVETo evaluate the feasibility of the Shikani Optical Stylet (SOS)-guided intubation through a new Intubating Laryngeal Airway (ILA) in anticipated difficult airways caused by scar contracture of the face and neck.

METHODSThirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea.

RESULTSThe ILA provided an effective airway in all patients. Intubation was successful at the first attempt on 22/33(66.7%) occasions and at the second attempt on 6/33 (18.2%). Intubation failed in 5 (15.1%) patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients' tracheas were finally intubated using a fibreoptic bronchoscope via the ILA.

CONCLUSIONSThe SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.

Adolescent ; Adult ; Cicatrix ; complications ; Contracture ; complications ; Face ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Middle Aged ; Neck

The technique of submental intubation in patients with multiple facial fractures and skull base fracture was originally described by Altemir. This technique provides a secure airway and allows intermaxillary fixation while avoiding the complications of nasotracheal intubation or tracheostomy. However, when the endotracheal pilot balloon and endotracheal tube are pulled through the submental incision site using this technique, soft tissues or blood may enter the endotracheal tube and trauma may result in the surrounding tissues. To overcome these problems, we carried out a modification of submental orotracheal intubation using the blue cap on the end of the thoracic catheter in a patient with mandibular fractures and injury to the skull base and found that this modification resulted in a safer and less traumatic intubation.
Catheterization ; Female ; Human ; Intubation, Intratracheal/instrumentation/*methods ; Mandibular Fractures/*surgery ; Middle Aged

Submental endotracheal intubation for surgery was used as an alternative to nasotracheal intubation in patients with craniomaxillofacial injury. Generally extubation was performed in the operation room by pulling the tube through the submental incision site. When extubation is not indicated, intraoral indwelling is preferred to submental intubation. We report a case of a 35-year-old male patient with multiple facial bone fractures. At the end of the surgery, we noticed the oropharyngeal edema, and so the submental intubation was converted into a standard orotracheal intubation. During that procedure, the pilot balloon was accidentally detached from the endotracheal tube. The situation was managed by cutting a pilot tube from a new, unused endotracheal tube and connecting it to the intubated tube using a needle connector.
Adult ; Humans ; Intubation, Intratracheal/*instrumentation/*methods ; Male ; Maxillofacial Injuries/*surgery ; Mouth ; Oral Surgical Procedures

OBJECTIVETo compare the hemodynamic responses to orotracheal intubation via Upsher-scope (USSP) or Macintosh direct laryngoscope (MDLS) under general anesthesia.

METHODSFifty patients with ASA grade I-II and undergoing the elective plastic surgery and requiring orotracheal intubation were randomly allocated to either the USSP (U group) (n=25) or MDLS (M group) (n=25). After standard intravenous anesthetic induction, orotracheal intubation was performed using a USSP or a MDLS. Noninvasive systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded before and after anesthetic induction, at intubation and every minute thereafter for 5 minutes. The time spent in tracheal intubation was recorded. The mean blood pressure (MBP) and rate-pressure product (RPP) were calculated.

RESULTSThe intubation time was not significantly different between these two groups (P > 0.05). After anesthetic induction, SBP, DBP, MAP, and RPP in these two groups decreased significantly as compared with preinduction values. The orotracheal intubation caused significant increases in SBP, DBP, MAP, and RPP in these two groups in comparision with postinduction values (P < 0.05), but these hemodynamic changes lasted only 1 to 2 minutes and then decreased gradually to the postinduction level. The blood pressure changes caused by orotracheal intubation did not exceed the preinduction values (P > 0.05). As compared to, the maximal HR values in these two groups during observation (from the beginning of intravenous anesthetic induction to 5 min after intubation) were significantly higher than their preinduction values (P < 0.05). The maximal RPP values in M group during observation were significantly higher than their preinduction values (P < 0.05), but no such significant difference was observed in U group (P > 0.05). The hemodynamic data at each time point during the observation had no significant differences between these two groups. (P > 0.05).

CONCLUSIONSOrotracheal intubation using the USSP and MDLS may result in similar hemodynamic responses. The standard general anaesthesia can effectively inhibit the pressor, but not the tachycardiac responses caused by orotracheal intubation via USSP or MDLS. USSP is not superior than MDLS in palliating the adverse cardiovascular stress responses to orotracheal intubation.

Adult ; Anesthesia, General ; Female ; Hemodynamics ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopes ; Male ; Reconstructive Surgical Procedures

OBJECTIVETo compare the modified and conventional methods in orotracheal intubation of GlideScope videolaryngoscope.

METHODSSixty patients aged 21-53 years with ASA physical status I-II were scheduled for elective abdominal operation under general anesthesia. After routine anesthesia induction orotracheal intubation was performed with GlideScope videolaryngoscope; the patients were randomly divided into two groups (n=30 in each): Group M received modified orotracheal intubation and Group C received conventional orotracheal intubation. Noninvasive blood pressure and heart rate were recorded before and after anesthesia induction, at intubation, 1 and 3 min after intubation.

RESULTSThe time of intubation procedure was significantly longer in Group C than in Group M. BP and HR significantly decreased after intubation, there were no differences between two groups.

CONCLUSIONThe modified method can improve the readiness of the procedure but it shows no advantages in prevention of adverse hemodynamic responses during the orotracheal intubetion of videolaryngoscopy.

Adult ; Anesthesia, General ; Female ; Hemodynamics ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopes ; Male ; Middle Aged ; Video-Assisted Surgery ; instrumentation ; Young Adult

AIMTo discuss the merits of "tubes treatment" for esophageal fistula (EF).

METHODSA 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome.

RESULTSThe two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint.

CONCLUSIONTubes treatment is an effective basic way for EF. It may be an alternative treatment option.

Aged ; Chest Tubes ; Combined Modality Therapy ; Drainage ; instrumentation ; methods ; Enteral Nutrition ; methods ; Esophageal Fistula ; Female ; Humans ; Intubation, Intratracheal ; methods ; Male ; Middle Aged ; Suction ; instrumentation ; methods ; Treatment Outcome

PURPOSE: Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated. MATERIALS AND METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways. RESULTS: Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique. CONCLUSION: The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.
Device Removal ; Humans ; Intubation, Intratracheal/instrumentation/*methods/standards ; *Laryngeal Masks ; Randomized Controlled Trials as Topic ; Reference Standards ; Risk ; *Rotation

OBJECTIVETo compare the hemodynamic responses to orotracheal intubation using a Shikani Optical Stylet (SOS) laryngoscope or a Macintosh direct laryngoscope (MDLS).

METHODSTotally 41 patients with American Society of Anesthesiologists ASA physical status -aged 20-60 years and scheduled for elective surgery under general anesthesia requiring orotracheal intubation, were randomly allocated to either the SOS group (n=21) or MDLS group (n=20). After an intravenous anesthetic induction the orotracheal intubation was performed using a SOS laryngoscope or a MDLS. Blood pressure and heart rate (HR) were recorded before and after anesthetic induction immediately after intubation, and 5 minutes after intubation. Rate pressure product RPP were calculated.

RESULTSBlood pressures and RPP in both two groups significantly decreased after anesthetic induction (P<0.05) while blood pressures HR, and RPP significantly increased after orotracheal intubation (P<0.05). HR in both groups after intubation were significantly higher than the pre-induction level (P<0.05)and such an increase lasted for 3 min. HR immediately after intubation was also significantly higher in MDLS group than in SOS group (P<0.05); however, such difference was not observed in other time points (P>0.05). In the MDLS group when compared with the occurrence time required for the maximum values of systolic blood pressure (SBP)the occurrence time required for the maximum values of HR after the start of intubation and success of intubation during the observation were significantly delayed (P<0.05). Compared with the MDLS group, the occurrence time required for the maximum values of SBP after the start of intubation and the success of intubation were significantly delayed in the SOS group (P<0.05). The incidences of SBP more than 130% of baseline value and RPP more than 22 000 were not significantly differently(P>0.05). Also, the intubation time was not significantly different (P>0.05).

CONCLUSIONThe hemodynamic responses to orotracheal intubation is milder in SOS laryngoscope than in MDLS.

Adult ; Blood Pressure ; physiology ; Female ; Heart Rate ; physiology ; Hemodynamics ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopes ; Male ; Middle Aged ; Young Adult

Adult ; Aged ; Female ; Humans ; Infection ; Infection Control ; instrumentation ; methods ; Intubation, Intratracheal ; instrumentation ; methods ; Male ; Middle Aged ; Suction ; Tracheostomy ; adverse effects ; Young Adult