Twelve-Year Experience of Lester Jones Tubes­Results and Comparison of 3 Different Tube Types.

PURPOSE: Conjunctivodacryorhinostomy with insertion of a bypass Lester Jones tube is effective in treating epiphora due to canalicular failure. There is little information in the literature that directly compares different types of tubes. We report our results of Jones tube placements over a 12-year period with comparison of 3 tube types: plain, frosted, and a new tube with an additional flexible internal silicone flange (StopLoss Jones tube). METHODS: Case notes review of a single surgeon consecutive series of patients having Jones tube placement. RESULTS: One hundred twenty-seven tubes were inserted in 81 eyes of 65 patients. Information on 121 tubes was available for comparison (67 plain, 25 frosted, 29 StopLoos Jones Tube [SLJT]), with flange sizes 3.5 and 4.0 mm. There were 31 males, 34 females, mean age 59 years. After mean follow up of 20 months (range 0.5-108), there were no complications in 50% of tube insertions. Forty-three percentage of tubes needed replacing. The overall rate of complications was higher with a 3.5-mm flange tube than with a 4.0-mm flange (67% vs. 43%). There were no cases of extrusion in the SLJT group after follow up to a maximum of 25 months. The risk of extrusion for both frosted and plain tubes was significantly higher than for SLJT (p = 0.0040). There was no significant difference in the risk of extrusion between frosted and plain tubes. Overall, the risk of complications requiring tube replacement was not significantly different between frosted and plain tubes; however, the risk was significantly higher with both frosted and plain tubes compared with the SLJT (p = 0.036 and p = 0.042, respectively). Patient satisfaction was full in 86% and moderate in a further 5% of patients. CONCLUSIONS: Although patient satisfaction with LJT surgery is high, complications occur frequently, although seem to be less common with the larger 4.0 mm flange. Frosted tubes do not protect against tube displacement. The addition of the internal silicone flange on the SLJT seems to prevent the previously common problem of extrusion.

Pruebas predictoras de vía aérea difícil y clasificación cormack-lehane en adultos. ¿mito o realidad? / Predictive tests of difficult airway and cormack- lehane classification in adults. ¿myth or reality?

El manejo de la vía aérea es de preocupación del anestesiólogo y es su deber anticipar las dificultades al realizar una intubación. Existen múltiples pruebas para predecir la vía aérea difícil. Objetivo: Describir los resultados de las escalas de Mallampati, distancia interincisivos, distancia esternomentoniana y circunferencia de cuello y la clasificación de Cormack-Lehane en pacientes adultos sometidos a cirugía electiva bajo anestesia general. Pacientes y Métodos: Estudio cuantitativo, descriptivo, de corte transversal; método de recolección de datos fue: cuestionario; en el Hospital Nacional Doctor Mario Catarino Rivas. Un total de 50 pacientes mayores de 18 años. Resultados: En la escala de Mallampati 4 (44%) de los pacientes fueron intubación difícil coincidiendo conlos resultados de la escala de Cormack-Lehane. En la apertura mayor de 3 cm el 32 (94%) fueron intubación fácil. De los pacientes con distancia esternomentoniana mayor de 13 cm el 41 (89.1%) fueron intubación fácil. En el grosor del cuello menor o igual a 36 cm, 32 (94%) fueron intubación fácil. Conclusión: Al comparar los resultados de pruebas predictoras de via aérea difícil y la clasificación de Cormack-Lehane se encontró que la clasificación de Mallampati y apertura bucal fueron similares a la clasificación Cormack-Lehane...(AU)

Ultrasonographic bedside evaluation of maxillary sinus disease in mechanically ventilated patients.

OBJECTIVE: Evaluate A-mode ultrasonographic examination of maxillary sinus disease in mechanically ventilated, critically ill patients using sinoscopy as criterion standard. DESIGN: Prospective case series. SETTING: The intensive care units of a tertiary care hospital. PATIENTS: 25 mechanically ventilated, critically ill patients with nasotracheal intubation or a tracheotomy were followed up by ultrasonographic examination of the maxillary sinuses in supine and semirecumbent positions. Infectious sinusitis was suspected in 15 patients, who were bilaterally sinoscoped combined with sampling for bacterial culture. RESULTS: The frequency of oedema and/or secretions was high: 29 antra of 30 examined. Only 2 of 30 antra showed bacterial infection. Ultrasonographic examinations were sensitive to general pathological changes but less accurate in specific diagnostics such as the presence of secretions (sensitivity for fluid 75%, oedema 81%). The sensitivity of ultrasonographic diagnosis improved when the examination was made in the semirecumbent position (sensitivity for fluid 91%, oedema 81%). CONCLUSIONS: A-mode ultrasonography is a useful method for daily use, being easy to perform and without discomfort to the patient. It is fast and gives an immediate diagnosis. In intensive care unit patients, it should be the method of choice for day-to-day studies of effects and changes in the upper airways. For the differential diagnosis of oedema and/or secretions, it is not reliable enough to be used as the sole diagnostic method. A complementary investigation, such as computed tomography or sinoscopy, which also provides the opportunity to take samples, is needed for diagnostic confidence.

Estudio prospectivo, aleatorizado y cruzado que compara 2 tubos endotraqueales de polivinilo. ¿Son todos los tubos iguales? / A prospective, randomised, cross-over trial comparing two standard polyvinyl chloride tracheal tubes. Are all the tubes the same?

Introducción. Los autores comparan de forma aleatorizada el número de intentos durante la intubación endotraqueal convencional de un maniquí utilizando 2 tubos de polivinilo (PVC) aparentemente similares pero de distinto fabricante: Intersurgical (IS; Intersurgical S.L., Madrid, España) y Mallinckrodt (ML; Mallinkrodt Medical S.A., Madrid, España). Método. Veintiséis anestesiólogos experimentados intubaron 2 veces un maniquí utilizando un tubo diferente en cada ocasión y cuyo orden fue establecido de forma aleatoria (secuencia aleatoria generada por Epidat 3.1.). El tubo fue pintado para enmascararlo y no ser reconocido por el participante. El objetivo principal del estudio era comparar el número de intentos necesarios para completar la maniobra con cada tubo. El tiempo de intubación y las intubaciones fallidas también fueron recogidos. Resultados. El número de intentos con el tubo de ML fue significativamente menor que con el tubo de IS. Con el de ML se completó la intubación al primer intento en el 93,3% de los casos, mientras que con el de IS el porcentaje se redujo al 30,8% (test exacto de Fisher, p < 0,001). El tiempo necesario para completar la maniobra fue mayor con el tubo de IS (mediana 10,8 s, rango intercuartílico 6-22) que con el tubo de ML (mediana 4,4 s, rango intercuartílico 3,5-6,3). Conclusiones. El tubo de PVC de la casa ML se mostró superior al compararlo con el de IS, asociándose este último a la necesidad de un mayor número de intentos para completar la intubación de un maniquí. Los autores han atribuido estos resultados a un defecto en la curvatura de la punta del tubo de IS (AU)

Background. A randomised study was conducted on the number of attempts made during the conventional endotracheal intubation of a mannequin using two polyvinyl (PVC) tracheal tubes, apparently similar but from different manufactures: INTERSURGICAL (IS; Intersurgical S.L., Madrid, Spain) and Mallinckrodt (ML; Mallinkrodt Medical S.A., Madrid, Spain). Methods. A total of 26 anaesthesiologists, in randomly established order (generated by Epidat 3.1) intubated a mannequin twice using a different tube each time. The tubes were masked by painting them to prevent recognition. The main outcome of the study was to compare the number of attempts needed to complete the manoeuvre for each tube. Data on intubation time and failed intubations were also collected. Results. The number of attempts with the ML tube was significantly lower than with the IS tube. Intubation was completed on the first attempt with the ML tube in 93.3% of cases, while using the IS tube the percentage fell to 30.8% (Fisher exact test, P < .001). The time required to complete the manoeuvre was greater with the IS tube (median 10.8 seconds, interquartile range 6-22) than with the ML tube (median 4.4 seconds, interquartile range 3.5 to 6.3). Conclusions. The PVC tube from the ML manufacturer was superior when compared with the IS, the latter was also associated with a larger number of attempts to complete intubation using a conventional Macintosh blade (AU)

Vías respiratorias de difícil intubación / Difficult intubation airways

La intubación difícil es una entidad poco frecuente, pero no rara, que debe ser investigada sistemáticamente en el preoperatorio por un examen clínico riguroso. Se estudian las diferentes etapas del examen clínico y las etiologías responsables haciendo especial referencia a las del área otorrinolaringológica (AU)