No abstract available.
Laryngoscopy*

The problem of difficult intubation is well known to anesthesiologists. However, difficulties associated with the extubation of endotracheal tubes are not common, and few reports exist. However, untoward incidents of diverse etiology can occur and the complications of difficult extubation may be fatal. We experienced 2 cases of difficult extubations. One was due to adhesion of the tube to the tracheal wall and the other was due to a fold in the deflated cuff of an excessively large-sized tube. We managed these difficult extubations by rotating the tube with a MaGill forcep under direct laryngoscopy. We report upon these clinical experiences and include a brief review of the literature.
Intubation ; Laryngoscopy ; Surgical Instruments

BACKGROUND: This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for cases of difficult tracheal intubation. MATERIALS AND METHODS: For patients with an ASA physical status 1 or 2 betwen the ages of 20-90, direct laryngoscopy was performed and the layngoscopic view graded according to the Cormack and Lehane classification. Forty patients with Cormack and Lehane grade 3 or 4 were intubated using the Bonfils intubation fibrescope. During intubation, the success rates for tracheal intubation, overall time to intubation, number of attempts and adverse effects were recorded. The Thyromental and sternomental distances were recorded after the orotracheal intubation. RESULTS: The success rates were significantly higher in Cormack and Lehane grade 3 (96.9%) patients compared to grade 4 (50%) (P<0.01). The time to intubation was significantly faster in patients with grade 3 compared to grade 4 (20 (10-49[7-300]) sec vs. 180 (31-300[10-300]) sec, P=0.01). The number of cases with a SpO2<90% was significantly lower in patients with grade 3 (3.1%) compared to grade 4 (50%) (P<0.01). CONCLUSION: In patients with Cormack and Lehane grade 3, tracheal intubation using the Bonfils intubation fibrescope appears to be an effective technique for the management of a difficult intubation. However, the Bonfils intubation fibrescope can not always be used for the management of a difficult intubation in grade 4 patients; for these patients other effective instruments should be considered for difficult intubations.
Classification ; Humans ; Intubation* ; Laryngoscopy

In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube.
Humans ; Intubation ; Laryngoscopy ; Methods

Acute epiglottitis (AE), an inflammation of the epiglottis and adjacent supraglottic structures, can lead to a fatal airway obstruction. We report the case of a 47­year­old male who developed AE after experiencing a sore throat, odynophagia, and high­grade fever for a week. The patient came in with late signs of AE, suggesting a poor prognosis. Laryngoscopy revealed a swollen epiglottis obstructing the patient’s tracheal opening. He had cardiopulmonary arrest due to the airway obstruction. The patient was successfully resuscitated but had several episodes of generalized seizure after the return of spontaneous circulation. He was discharged in a persistent vegetative state. Because AE is unusual in the adult population, a clinician's high index of suspicion for the diagnosis and the emergency team’s prompt intervention are crucial factors in the management approach to AE. Physicians working in the emergency room must be equipped with skills in establishing a definitive airway, especially in securing a surgical airway.
Epiglottitis ; Laryngoscopy ; Tracheostomy ;

BACKGROUND AND OBJECTIVES: Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not been objectively measured yet. The objective of this study is to measure suspension force continuously during suspension laryngoscopy. SUBJECTS AND METHOD: Sixteen patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle between the laryngoscope and the chest holder(angle alpha), and the angle between the chest holder and the horizontal plane (angle beta) were gauged. RESULTS: The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle alpha and angle beta were 124.0+/-4.3 degrees, and 19.0+/-2.6 degrees, respectively. CONCLUSION: The continuous measurement of the suspension force was executed successfully and quantitatively with a simple method.
Humans ; Laryngoscopes ; Laryngoscopy* ; Methods ; Thorax

BACKGROUND: This study was conducted to evaluate the effectiveness of the Bonfils intubation fibrescope for endotracheal intubation. METHODS: 78 patients aged 21 to 85 years underwent direct laryngoscopy and the laryngoscopic view was then graded according to the Cormack & Lehane classification. The patients were subsequently intubated with a Bonfils intubation fibrescope and the success rate for tracheal intubation, time to intubation, number of attempts and adverse effects were recorded. In addition, the thyromental distance was recorded following the orotracheal intubation. RESULTS: The success rate for tracheal intubation was > 95% in patients graded 1 to 3 and 63.5% in patients with a grade of 4. The time to intubation was significantly faster in patients graded 1 to 3 than in those with a grade of 4 (175.2 +/- 137.1) (P < 0.01). Third attempts were required more often in patients with a higher grade. The number of patients with a SpO2 < 90% was below 5% in patients with a grade of 1 to 3 and 58.8% in patients with a grade of 4. CONCLUSIONS: The Bonfils intubation fibrescope is an effective instrument for endotracheal intubation in patients with a grade of 1 to 3, however, tracheal intubation using the Bonfils intubation fibrescope was unsuccessful in some patients with a grade of 4. Therefore, other effective instruments should be considered for use in cases of failed direct laryngoscopy or in patients for which a difficult airway is predicted.
Aged ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy

BACKGROUND: The insertion of a nasogastric tube can be difficult in an anesthetized patient who has a cuffed endotracheal tube in place. The placement of a silastic nasogastric (NG) tube can lead to nasal bleeding or a submucosal dissection in the posterior pharynx. The aim of this study was to determine if the insertion of a nasogastric tube with a nasophryngeal airway can be made easy. METHODS: Sixty patients were randomly assigned to one of two groups; Group 1 and Group 2. For Group 1, a nasogastric tube was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube with a nasopharyngeal airway was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. For Group 2, a nasogastric tube with a nasopharyngeal airway was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. RESULTS: The success rate of the 1st pass in Group 2 was significantly higher than in Group 1 (P < 0.05). The success rate with the 1st intended method in Group 2 was significantly higher than in Group 1 (P < 0.05). The rate of using Magill forceps was not significantly different between the two groups. CONCLUSIONS: The insertion of a nasogastric tube with a nasopharyngeal airway in anesthetized and intubated patients is effective in increasing success rate of insertion. Nasopharyngeal airway traverses the nasopharynx atraumatically and serves as a conduit for the smaller nasogastric tube.
Epistaxis ; Humans ; Laryngoscopy ; Nasopharynx ; Pharynx ; Surgical Instruments

BACKGROUND: Dental trauma is one of the most common complications during laryngoscopy, especially by novice. As the chance of making direct contact with the teeth is decreased during laryngoscopy, the chance of applying direct pressure to the teeth is decreased, thus the injury by the blade also can be decreased. The purpose of this study was to determine the effectiveness of a modified Macintosh blade on reducing dental contact and the risk of dental trauma by novice laryngoscopists in anticipated difficult airway. METHODS: Sixty-six patients scheduled for elective surgery were divided into Easy group and Difficult group according to Wilson's risk sum score. Laryngoscopy was performed twice on each patient by novice, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We compared the blade-tooth distances and the chance of directly contacting the tooth between two blades. RESULTS: The modified blade provided more distance than the regular Macintosh blade in both group (P < 0.001). It is also associated with decreased chance of directly contacting the teeth, especially in Difficult group (73.7% with regular blade vs 10.6% with the modified blade) (P < 0.001). CONCLUSIONS: The modified Macintosh blade used in this study proved to be an effective device for novice laryngoscopists in reducing likelihood of dental injuries in anticipated difficult intubation.
Humans ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Tooth

BACKGROUND: Dental trauma is one of the most common complications during laryngoscopy, especially by novice. As the chance of making direct contact with the teeth is decreased during laryngoscopy, the chance of applying direct pressure to the teeth is decreased, thus the injury by the blade also can be decreased. The purpose of this study was to determine the effectiveness of a modified Macintosh blade on reducing dental contact and the risk of dental trauma by novice laryngoscopists in anticipated difficult airway. METHODS: Sixty-six patients scheduled for elective surgery were divided into Easy group and Difficult group according to Wilson's risk sum score. Laryngoscopy was performed twice on each patient by novice, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We compared the blade-tooth distances and the chance of directly contacting the tooth between two blades. RESULTS: The modified blade provided more distance than the regular Macintosh blade in both group (P < 0.001). It is also associated with decreased chance of directly contacting the teeth, especially in Difficult group (73.7% with regular blade vs 10.6% with the modified blade) (P < 0.001). CONCLUSIONS: The modified Macintosh blade used in this study proved to be an effective device for novice laryngoscopists in reducing likelihood of dental injuries in anticipated difficult intubation.
Humans ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Tooth