Efficacy of the transillumination method for appropriate tracheal tube placement in small children: a randomized controlled trial.

STUDY OBJECTIVE: To evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method. DESIGN: Prospective, randomized, controlled study. SETTING: Operating room, university hospital. PATIENTS: Eighty children <2 years old scheduled for elective surgery undergoing general anesthesia. INTERVENTIONS: Trachlight was used for the transillumination method. After intubation, patients were randomly assigned to 1 of 2 groups: (1) deliberate bronchial intubation with subsequent withdrawal of the TT to 2 cm above the carina (main-stem group) or (2) transmitted visual signal from a bright light at the TT tip on the skin at the suprasternal notch after inserting the Trachlight into the TT (transillumination group). MEASUREMENTS: The TT tip position was assessed by chest radiograph after the procedure. Appropriate TT placement was defined when the TT tip was located between the sternoclavicular junction and 1 cm above the carina. MAIN RESULTS: Appropriate TT placement was found in 31 (80%) of 39 patients in the transillumination group and 26 (65%) of 40 in the main-stem group. The transillumination method had higher rate of appropriate TT placement than the main-stem method (P = .15; risk ratio, 1.22; 95% confidence interval, 0.93-1.61). Seven patients (18%) had proximal TT placement, and 1 (3%) had distal TT placement in the transillumination group. In the main-stem group, 7 patients (18%) had proximal TT placement, and 7 (18%) had distal TT placement. CONCLUSIONS: The transillumination method was reliable for appropriate TT placement in small children <2 years old undergoing general anesthesia, although the transillumination method was not found to be better compared with the main-stem method.

[Effects of catheter size and fixation device on central venous catheter fixation].

The risk of accidental removal of a central venous catheter is a major concern in anesthesia and intensive care. We hypothesized that the force required to remove a fixed catheter depends on the size of the catheter (diameter) or use of a dry or wet catheter. In this study, the force required for accidental removal of dry and wet catheters was compared by dividing the subjects into 2 groups: dry group (patients in whom dry catheters were used) and wet group (patients in whom wet catheters were used). The force required for the accidental removal of dry catheters was greater than that required for the accidental removal of wet catheters, regardless of catheter diameter. Therefore, it is essential to use dry catheters and fixtures to prevent accidental removal of central venous catheters.

[Anesthesia for cardiac resynchronization therapy in a child after cardiac surgery with dilated cardiomyopathy].

We report a case of anesthesia for cardiac resynchronization therapy (CRT) in a child with dilated cardiomyopathy who had undergone cardiac surgery for double outlet right ventricle. The patient was a 23-month-old boy, who had undergone pacing lead implantation as a part of CRT. His postoperative interventricular synchronization was improved significantly, and he was placed off mechanical ventilation at the early stage. However, heart failure developed slowly and his cardiac function deteriorated. Mechanical ventilation was required in consequence. We conclude that optimal time to initiate CRT as well as indications for CRT should be carefully examined.