RESUMO
Hyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre-anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.
Assuntos
Intubação Intratraqueal , Laringoscópios , Laringoscopia , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Laringoscopia/métodos , Laringoscopia/instrumentação , Gravação em Vídeo , Adulto , Faringite/etiologia , Faringite/epidemiologia , Desenho de Equipamento , Anestesia Geral/métodos , Resultado do Tratamento , Rouquidão/etiologiaAssuntos
Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/administração & dosagem , Transtornos de Enxaqueca/tratamento farmacológico , Piperidinas/administração & dosagem , Piridinas/administração & dosagem , Pirróis/administração & dosagem , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/efeitos dos fármacos , Compostos de Espiro/administração & dosagem , Administração Oral , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Interações Medicamentosas , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/metabolismo , Piperidinas/efeitos adversos , Piridinas/efeitos adversos , Pirróis/efeitos adversos , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/metabolismo , Transdução de Sinais , Compostos de Espiro/efeitos adversos , Resultado do TratamentoAssuntos
Benzamidas/administração & dosagem , Transtornos de Enxaqueca/tratamento farmacológico , Piperidinas/administração & dosagem , Piridinas/administração & dosagem , Pirróis/administração & dosagem , Animais , Benzamidas/efeitos adversos , Benzamidas/farmacologia , Humanos , Transtornos de Enxaqueca/fisiopatologia , Piperidinas/efeitos adversos , Piperidinas/farmacologia , Piridinas/efeitos adversos , Piridinas/farmacologia , Pirróis/efeitos adversos , Pirróis/farmacologiaRESUMO
BACKGROUND AND AIMS: Successful intubation with video laryngoscopes necessitates good hand-eye coordination and the use of intubation adjuncts like bougie and stylet. We proposed this study to find whether using Frova introducer with C-MAC video laryngoscope will reduce the intubation time in trainee anesthesiologists. MATERIAL AND METHODS: We enrolled 140 adults without any difficult airway predictors. They were randomly assigned to undergo C-MAC video laryngoscope guided intubation by anesthesia residents using tracheal tube preloaded over Frova introducer (n = 70) or without Frova introducer (n = 70). Primary outcome was the intubation time. Secondary outcomes were the number of redirections of tracheal tube or Frova introducer toward glottis, need for external laryngeal maneuvers (ELMs), first attempt intubation success rate, and ease of intubation. RESULTS: The median actual intubation time (IQR) in Frova and non-Frova group, respectively, were 25.46 (28.11-19.80) and 19.96 (26.59-15.52) s (P = 0.001). The number of redirections of TT or Frova introducer toward glottis, first attempt success rate, and ease of intubation were comparable. The need for ELMs [n (%)] was 15 (21.4) and 26 (37.1) in Frova and non-Frova group, respectively (P = 0.04). CONCLUSION: Frova introducer guided endotracheal intubation with C-MAC videolaryngoscope in patients with normal airways had a marginally prolonged intubation time with a significant reduction in the need of external laryngeal manoeuvres but with a comparable number of redirections and attempts. Further research is needed to generalize these findings to patients with difficult airways.
Assuntos
Analgésicos/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Triptaminas/uso terapêutico , Terapia por Acupuntura , Adulto , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Interações Medicamentosas , Alcaloides de Claviceps/efeitos adversos , Alcaloides de Claviceps/uso terapêutico , Feminino , Humanos , Transtornos de Enxaqueca/prevenção & controle , Gravidez , Antagonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Triptaminas/administração & dosagem , Triptaminas/efeitos adversosRESUMO
INTRODUCTION: A difficult airway is one of the main causes of morbidity and mortality in patients who undergo surgical interventions. Therefore, many devices and algorithms have been developed for the management of a difficult airway. However no study has been conducted comparing Frova catheter (FC) and a Bonfils fiberoscope (BF) to date. AIM: To compare the effectiveness and success of two devices, a FC and BF, in difficult intubation cases. MATERIAL AND METHODS: Design: Single-centre randomized controlled trial in patients with difficult airways. The assignment order was created by unplanned number charts, and the assignment was hidden in closed covers, which were not unlocked until case permission had been provided. Setting: The trial was undertaken in a university hospital in Turkey. The primary analysis was based on 60 participants (n = 30, n = 30) with difficult intubation. The main outcomes were the success rates of placement of the tracheal tube in the trachea and the duration of the tracheal intubation process. RESULTS: In the BF group, successful intubation was carried out in 25 of the 30 (83.3%) patients, whereas intubation was successful in 28 of the 30 patients (93.3%) in the FC group. Patients who could not be intubated with the first device were intubated with the other device. The mean duration of intubation was 109 (85-140) s in the BF group, whereas it was 38.8 (26-60) s in the FC group. CONCLUSIONS: Both devices were successful in difficult intubation cases. However, given the shorter duration of intubation using the FC and its lower cost as compared with that of the BF, the FC can be considered superior to the BF in difficult intubation cases.
RESUMO
Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.
RESUMO
Parapharyngeal tumors are rare head and neck tumors which can present as an intraoral mass and can pose great challenge to anesthesiologists. The primary concern is the difficult airway due to gross anatomical distortion of the upper airway. Securing the airway in an awake state should be the primary goal of anesthesiologists to avoid catastrophic complications. Herewith, we report the successful use of C-MAC® video laryngoscope with the acute-angle D-BLADE™ in combination with Frova introducer for awake intubation in a patient with parapharyngeal mass after multiple attempts of failed fiber-optic intubation.
RESUMO
We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.