Tracheal injury: late symptom after double-lumen tube intubation - A case report.

As a basic skill, endotracheal intubation, performed throughout the world by health care professionals is a relatively safe and effective maneuver. However, this technique is not risk free and could lead to many serious complications. We wanted to report that in a patient with double lumen tube intubation, airway trauma can cause late symptoms . We thought that such complications must be published to share experiences.

[Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial]. / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado.

BACKGROUND: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. METHODS: Eighty patients with ASA physical status I-III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. RESULTS: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9±22.1s vs. 50.7±21.2s; p<0.001). A significant difference was found when the times of total intubation were compared (29.9±22.1s vs. 97.4±42.7s; p<0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p<0.05). CONCLUSIONS: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Intubation of a Paediatric Manikin in Tongue Oedema and Face-to-Face Simulations by Novice Personnel: a Comparison of Glidescope, Airtraq and Direct Laryngoscopy.

OBJECTIVE: Glidescope and Airtraq were designed for facilitating intubation and for teaching regarding the airway anatomy. We aimed to evaluate their efficacy in normal airway, tongue oedema and face-to-face orotracheal intubation models when used by novice personnel. METHODS: After the local human research ethics committee approval, 36 medical students who were in the beginning of their third year were enrolled in this study. After watching a video regarding intubation using one of these devices, the students intubated a paediatric manikin with a Glidescope or Airtraq via the normal airway, tongue oedema and face-to-face approach. RESULTS: Although the insertion and intubation times were similar among the groups, the intubation success rate of the Glidescope was higher in the normal airway (100% vs 67%) and tongue oedema (89% vs. 50%) compared with the Airtraq (p=0.008 and p=0.009). The success rates with the paediatric manikin by the face-to-face approach were similar among the groups (50%) (p=0.7). The need for manoeuvres in the Glidescope was lower in the normal and tongue oedema models (p=0.02 and p=0.002). In addition, oesophageal intubation was low in the control and tongue oedema models with the Glidescope (p=0.03 and p<0.001). CONCLUSION: Novice personnel could more easily intubate the trachea with the Glidescope than with the Airtraq. Intubation with the Glidescope was superior to that with the Airtraq in the normal and tongue oedema models. The face-to-face intubation success rates were both low with both the Glidescope and Airtraq groups.

Treatment of Posterior Reversible Encephalopathy Syndrome that Occurred in a Patient with Systemic Lupus Erythematosus by Plasmapheresis.

Posterior reversible encephalopathy syndrome is characterized by visual and mental disturbances, nausea and vomiting and generalized or focal convulsions and often represents itself with parietal and occipital oedema formation. We want to report the treatment of posterior reversible encephalopathy syndrome with plasmapheresis, which developed in a 35-year-old woman with systemic lupus erythematosus diagnosed by renal biopsy 3 years ago. She has been followed up in the intensive care unit three times. However, she had been transferred to the nephrology department of our university hospital because of her uncontrolled blood pressure. Oral antihypertensive therapy, corticosteroid 500 mg 1 × 1 and cyclophosphamide were started for the activation of lupus. After the detection of low complement levels, systemic lupus erythematosus activation was suspected. She developed mental deterioration after her first plasmapheresis treatment and was then consulted by the neurology and intensive care unit doctors. Diffusion cranial magnetic resonance imaging was found compatible with posterior reversible encephalopathy syndrome. The patient was transferred to our intensive care unit. The patient gained consciousness after her second plasmapheresis. After 5 days of follow-up in our intensive care unit and after significant regression was observed in the magnetic resonance imaging analysis, the patient was transferred to the nephrology service conscious, cooperated and orientated. At the nephrology service, after a total of 13 times of plasmapheresis, complement levels were increased and she was discharged with corticosteroid therapy. Posterior reversible encephalopathy syndrome can be observed in patients with systemic lupus erythematosus and intensive care unit treatment may be required. To control the hypertension, plasmapheresis should be kept in mind in addition to the multiple antihypertensive therapy in these patients.

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.