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1.
A A Pract ; 13(3): 91-92, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985321

RESUMO

A patient with a base of tongue tumor was judged to be safe to intubate under general anesthesia, with a new flexible tip "bougie." This enabled rapid and easy navigation around the distorted anatomy caused by the tumor. The bougie's tip can be flexed or extended by activating a slide on the shaft and was intended for use with the hyperangulated blade of a videolaryngoscope.


Assuntos
Intubação Intratraqueal/instrumentação , Cirurgia Vídeoassistida/instrumentação , Anestesia Geral , Humanos , Laringoscópios , Masculino , Pessoa de Meia-Idade , Neoplasias da Língua/terapia , Gravação em Vídeo
2.
A A Pract ; 13(3): 88-90, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30920427

RESUMO

Video laryngoscopes are commonly used to manage difficult airways, among other devices. However, they present a challenge when inserting the blade in patients with a limited mouth opening, and an adequate visualization of the glottis does not always translate into successful intubation. The C-MAC Video-Stylet-with its small diameter and flexible tip-offers an effective alternative. We describe the successful use of the novel C-MAC Video-Stylet to secure the airway in a patient with minimal mouth opening due to the side effects of previous neck surgery and radiation therapy.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Gravação em Vídeo
3.
J Surg Res ; 239: 166-172, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30836298

RESUMO

BACKGROUND: To study the feasibility of laparo-endoscopic single-site (LESS) cholecystectomy through a 10-mm incision using a miniature magnetically anchored and controlled laparoscopy system and a grasper system. METHODS: The miniature magnetically anchored and controlled laparoscopy system consisted of a miniature magnetically anchored camera (MMAC), an external magnetic anchoring unit, and a vision output device. The camera weighed 9.8 g and measured Φ10 mm × 50 mm. The magnetically anchored and controlled grasper system consisted of a magnetically anchored grasper (MAG), an external magnetic anchoring unit, and a push-pull device. The MAG had a titanium alloy clip head and a magnetic tail. The laparoscopy system and grasper system were used simultaneously to perform LESS cholecystectomy through a single 10-mm incision in model canines. RESULTS: LESS cholecystectomy through a 10-mm incision using the MMAC and MAG was attempted in six dogs. The mean operative time was 85.75 ± 7.14 min. The operation was completed successfully in four cases, with failure occurring in one case due to gallbladder rupture and in another due to bile duct injury. The MMAC provided clear imaging, and the MAG provided sufficient exposure to perform the cholecystectomy. The use of multiple magnetically anchored and controlled instruments did not result in notable collisions. CONCLUSIONS: The designed MMAC and MAG system could be easily maneuvered. LESS cholecystectomy may be feasible through a single 10-mm incision with the simultaneous use of multiple magnetically anchored and controlled instruments.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Doenças da Vesícula Biliar/cirurgia , Imãs , Cirurgia Vídeoassistida/instrumentação , Animais , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Cães , Desenho de Equipamento , Estudos de Viabilidade , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Modelos Animais , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/métodos
4.
Eur J Anaesthesiol ; 36(3): 221-226, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30308524

RESUMO

BACKGROUND: In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE: The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN: A randomised study. SETTING: Toronto General Hospital, a university tertiary centre in Canada. PATIENTS: Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION: We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades.Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES: The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS: Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P < 0.001, respectively). Laryngoscopy time increased with the GlideScope (30 vs. 18 s, P < 0.001), resulting in similar median impulse forces (206 vs. 175 N, P = 0.92). CONCLUSION: GlideScope laryngoscopy resulted in reduced peak and average forces, but as the laryngoscopy duration increased, the product of force and time (impulse force) was similar with both devices. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01814176.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Desenho de Equipamento/instrumentação , Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Desenho de Equipamento/normas , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/métodos , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cirurgia Vídeoassistida/métodos , Cirurgia Vídeoassistida/normas
5.
J Invest Surg ; 32(5): 421-427, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29370544

RESUMO

Background: The development of endoscopic techniques motivated surgeons to search for alternative and more cosmetic approaches for thyroid and parathyroid surgery. Several variations of transoral access to the anterior neck areas were applied in recent years. One of them is a premandibular access proposed by Nakajo et al, it is performed through the oral vestibule by creating the working space by means of the lifting method. Materials and methods: Nineteen unfixed human cadavers were used to develop the endoscopic access to the thyroid gland and surgical techniques of its resection. The Nakajo access was modified by altering the spatial location of the working instruments, resulting in practically no impact on the cosmetic outcome but providing a more comfortable operation for the thyroid gland. We determined evaluation criteria of the cadaver model before initiation of the experimental trial. Parameters that influence on alteration of these criteria were registered. Results: Of the 19 operated objects, the first 7 were used to practice the access technique from the incision in the oral vestibule to the thyroid gland in order to evaluate the possibility of endoscopic dissection of the important anatomical. The next 12 surgeries were carried out by manipulating the thyroid gland in the settings maximally close to real. Access implied good cosmetic results, less surgical traumatic due to a smaller area of detachment of the musculocutaneous flap. Conclusions: The achieved results show feasibility of introducing the described modification of transoral thyroidectomy into clinical practice.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca , Cirurgia Endoscópica por Orifício Natural/instrumentação , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Tireoidectomia/instrumentação , Cirurgia Vídeoassistida/instrumentação
6.
A A Pract ; 12(1): 28-29, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30036275

RESUMO

As technology progresses, our clinical treatment options rise steadily. We are comfortable now with the handling of ready-to-use high-quality videolaryngoscopes and fiber optics, and there is increasing knowledge and practice that the combination of these 2 techniques has a high "rescue rate" in situations when fiber-optic intubation or videolaryngoscopic intubation fails. Therefore, we would recommend to specifically include this technique in the "difficult airway algorithm-nonemergency pathway," so it comes routinely into mind when faced with a "can ventilate, but cannot intubate" situation that warrants intubation for the surgical operation.


Assuntos
Tecnologia de Fibra Óptica/instrumentação , Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Algoritmos , Pré-Escolar , Terapia Combinada/instrumentação , Tecnologia de Fibra Óptica/métodos , Humanos , Lactente , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Cirurgia Vídeoassistida/métodos
7.
G Chir ; 34(5): 291-296, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30444477

RESUMO

BACKGROUND: We know that benefits of MIVAT are related to a better cosmetic result and lower post-operative pain in comparison to CT. The incidence of nerve cold palsy is related to a correct identification of the recurrent laringeal nerve (RLN) as standard procedure in thyroid surgery. From September 2014 we have introduced the use of intraoperative neural monitoring(I-IONM) in all thyroidectomies in the Unit of General Surgery of University Hospital of Parma, including in MIVAT. PATIENTS AND METHODS: We have considered all patients treated from September 2014 to September 2017 for thyroid diseases using MIVAT and IONM. Intermittent neuromonitoring with NIM-3.0 equipment (Medtronic, Jacksonville, FL, USA) was used during all operations. We have recorded all data about age, sex, diagnosis, surgical time, i-IONM signal, postoperative pain, postoperative hypocalcemia after 24 hours, haematoma and vocal cord palsy. The mean hospital stay was collected from surgical procedure to hospital discharge. We have considered vocal dysfunctions that persist six months after surgery as permanent. RESULTS: From September 2014 to September 2017 we treated consecutively with both MIVAT and i-IONM 100 patients. Considering the extent of surgery, 26 pts underwent to hemithyroidectomy and 74 pts to total thyroidectomy. The mean surgical time was 61.8 minutes. In 7 cases the patients were affected by preoperative clinical dysphonia. Using I-IONM during thyroidectomy, we recorded in 5 cases (5%) a loss of signal; in two cases (2%) we experienced a temporary postoperative vocal cord palsy. DISCUSSION: In our experience the use of IONM has improved the safety during thyroidectomy because precision that can be achieved by endoscopic procedures is further improved by complementary use of IONM. The costs associated to a potential reduction of medical litigation have not been investigated.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Monitorização Neurofisiológica Intraoperatória/economia , Monitorização Neurofisiológica Intraoperatória/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Tireoidectomia/economia , Cirurgia Vídeoassistida/economia , Cirurgia Vídeoassistida/instrumentação , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/prevenção & controle
8.
BMC Anesthesiol ; 18(1): 119, 2018 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-30170540

RESUMO

BACKGROUND: In infants, securing the airway is time-critical because of anatomical and physiological differences related to airway management in children less than 1 year old. The aim of this study was to compare the time to ventilation using two different hyperangulated video laryngoscope blades with the time to ventilation via conventional direct laryngoscopy in a normal airway [NA] and in a simulated difficult airway [DA]. METHODS: This study was a comparative, bicentric, open-label, randomized controlled evaluation. An infant high-fidelity simulator (SimBaby™; Laerdal® Medical, Stavanger, Norway) was used, and two scenarios were proposed, as follows: NA and DA evoked with tongue edema and cervical collar. After theoretical and practical briefing, each participant compared in the two airway scenarios the novel King Vision™ Pediatric aBlade (KV) (Ambu® A/S, Bad Nauheim, Germany) video laryngoscope and the C-MAC™ D-blade Ped (DB) (Karl Storz® SE & Co. KG, Tuttlingen, Germany) video laryngoscope to conventional laryngoscopy using the Miller Blade (MiB) and the Macintosh Blade (MaB) in a random sequence. RESULTS: Eighty physicians (65 AN and 15 PCCM staff) were included. In the NA scenario, the median [IQR] time to successful time to ventilation (TTV) was significantly shorter for the KV at 13 s [12-15 s] than for the MaB at 14.5 s [13-16 s], DB at 14.5 s [13-16] and MiB at 16 s [14-19] (p < 0.001). In DA, the KV also shortened TTV to 14 s [13-16], whereas TTV was 23 s with the MaB [20-26], 19 s with the DB [16-21], and 27 s with the MiB [22-31] (p < 0.001). There were no differences in first-pass intubation success rates (FPAs) between hyperangulated blades and direct laryngoscopes in NA. In DA, the hyperangulated blades enabled 92 (DB) to 100% (KV) FPAs compared with 65 (MiB) to 76% (MaB) for conventional laryngoscopy (p < 0.001). CONCLUSION: Video laryngoscopes with hyperangulated blades were associated with shorter TTV in normal and difficult infant airway situations. The higher FPAs of hyperangulated blades in DA may avoid desaturations and decrease adverse events in pediatric airway management.


Assuntos
Laringoscópios/estatística & dados numéricos , Laringoscopia/instrumentação , Manequins , Ventilação Pulmonar , Humanos , Lactente , Distribuição Aleatória , Fatores de Tempo , Cirurgia Vídeoassistida/instrumentação
10.
Ann Biomed Eng ; 46(10): 1663-1675, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29948372

RESUMO

Endoscopic procedures have transformed minimally invasive surgery as they allow the examination and intervention on a patient's anatomy through natural orifices, without the need for external incisions. However, the complexity of anatomical pathways and the limited dexterity of existing instruments, limit such procedures mainly to diagnosis and biopsies. This paper proposes a new robotic platform: the Intuitive imaging sensing navigated and kinematically enhanced ([Formula: see text]) robot that aims to improve the field of endoscopic surgery. The proposed robotic platform includes a snake-like robotic endoscope equipped with a camera, a light-source and two robotic instruments, supported with a robotic arm for global positioning and for insertion of the [Formula: see text] and a master interface for master-slave teleoperation. The proposed robotic platform design focuses on ergonomics and intuitive control. The control workflow was first validated in simulation and then implemented on the robotic platform. The results are consistent with the simulation and show the clear clinical potential of the system. Limitations such as tendon backlash and elongation over time will be further investigated by means of combined hardware and software solutions. In conclusion, the proposed system contributes to the field of endoscopic surgical robots and could allow to perform more complex endoscopic surgical procedures while reducing patient trauma and recovery time.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Vídeoassistida/instrumentação , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Vídeoassistida/métodos
11.
Medicine (Baltimore) ; 97(22): e10921, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851824

RESUMO

BACKGROUND: The aim of this study was to investigate the clinical effectiveness of rocuronium in low doses on conditions during rapid tracheal intubation using video laryngoscope. METHODS: Ninety-eight patients undergoing otolaryngologic surgery were randomly divided into 2 groups: group L using 0.3 mg/kg of rocuronium intravenously (n = 49) and group C using 0.6 mg/kg of rocuronium (n = 49). Sixty seconds after rocuronium administration, tracheal intubation was performed using a video laryngoscope. The overall intubation condition was evaluated along with specific conditions, including laryngoscopy condition, vocal cord position, and intubation response. Intubation profiles, including Cormack-Lehane grade, 1st attempt success rate, and intubation time, were also evaluated. RESULTS: Overall intubation conditions showed a significant difference between group L and group C (P = .003). Although the incidence of vigorous response after tracheal intubation was higher in group L than in group C (P = .022), laryngoscopy condition and vocal cord position were similar between the 2 groups (P = .145 and .070, respectively). Intubation profiles showed no differences between the 2 groups. The frequency and amount of additional rocuronium administration during surgery were also similar. CONCLUSIONS: Low-dose rocuronium provided significantly worse overall intubation conditions compared to the conventional dose of rocuronium for rapid tracheal intubation. However, when using a video laryngoscope, it may provide clinically acceptable laryngeal muscle relaxation.


Assuntos
Androstanóis/administração & dosagem , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Cirurgia Vídeoassistida/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Músculos Laríngeos/efeitos dos fármacos , Laringoscópios , Laringoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Rocurônio , Fatores de Tempo , Resultado do Tratamento , Cirurgia Vídeoassistida/instrumentação , Prega Vocal/efeitos dos fármacos
13.
Med Image Anal ; 46: 244-265, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29631089

RESUMO

Localizing instrument parts in video-assisted surgeries is an attractive and open computer vision problem. A working algorithm would immediately find applications in computer-aided interventions in the operating theater. Knowing the location of tool parts could help virtually augment visual faculty of surgeons, assess skills of novice surgeons, and increase autonomy of surgical robots. A surgical tool varies in appearance due to articulation, viewpoint changes, and noise. We introduce a new method for detection and pose estimation of multiple non-rigid and robotic tools in surgical videos. The method uses a rigidly structured, bipartite model of end-effector and shaft parts that consistently encode diverse, pose-specific appearance mixtures of the tool. This rigid part mixtures model then jointly explains the evolving tool structure by switching between mixture components. Rigidly capturing end-effector appearance allows explicit transfer of keypoint meta-data of the detected components for full 2D pose estimation. The detector can as well delineate precise skeleton of the end-effector by transferring additional keypoints. To this end, we propose effective procedure for learning such rigid mixtures from videos and for pooling the modeled shaft part that undergoes frequent truncation at the border of the imaged scene. Notably, extensive diagnostic experiments inform that feature regularization is a key to fine-tune the model in the presence of inherent appearance bias in videos. Experiments further illustrate that estimation of end-effector pose improves upon including the shaft part in the model. We then evaluate our approach on publicly available datasets of in-vivo sequences of non-rigid tools and demonstrate state-of-the-art results.


Assuntos
Diagnóstico por Imagem , Instrumentos Cirúrgicos , Cirurgia Vídeoassistida/instrumentação , Algoritmos , Humanos , Robótica/instrumentação
15.
Plast Reconstr Surg ; 141(6): 1485-1500, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29579024

RESUMO

BACKGROUND: This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise. METHODS: Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale. RESULTS: The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard. CONCLUSIONS: A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.


Assuntos
Fissura Palatina/cirurgia , Treinamento por Simulação/métodos , Competência Clínica/normas , Endoscópios , Endoscopia/educação , Desenho de Equipamento , Docentes de Medicina/educação , Bolsas de Estudo , Lateralidade Funcional , Humanos , Internato e Residência , Curva de Aprendizado , Variações Dependentes do Observador , Duração da Cirurgia , Cirurgia Vídeoassistida/instrumentação
16.
J Cardiothorac Vasc Anesth ; 32(1): 290-296, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29132804

RESUMO

OBJECTIVE: To compare GlideScope and lighted stylet for double-lumen endobronchial tube (DLT) intubation in terms of intubation time, success rate of first attempt at intubation, difficulty in DLT advancement toward the glottis, and postoperative sore throat and hoarseness. DESIGN: A prospective, randomized study. SETTING: Medical center governed by a university hostpial. PARTICIPANTS: Sixty-two adult patients undergoing thoracic surgery using DLT intubation. INTERVENTION: After the induction of anesthesia, DLT intubation was performed using GlideScope (n = 32) or lighted stylet (n = 32). MEASUREMENTS AND MAIN RESULTS: Number of intubation attempts, difficulty of DLT advancement toward the glottis, time taken for DLT intubation, and the incidence and severity of postoperative sore throat and hoarseness at 1 and 24 hours after surgery were evaluated. Time taken for DLT intubation was shorter in the lighted stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53] s, median [interquartile range], respectively; p < 0.001). DLT advancement toward the glottis was easier in the lighted stylet group than in the GlideScope group (p = 0.016). The success rate of DLT intubation in the first attempt (96.9% v 90.6% for lighted stylet and GlideScope, respectively), and the incidence and severity of postoperative sore throat and hoarseness were not different between the two groups. CONCLUSIONS: The use of lighted stylet allowed easier advancement of the DLT toward the glottis in the oropharyngeal space and reduced time for achieving DLT intubation compared with GlideScope.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Vídeoassistida/instrumentação , Idoso , Feminino , Glote , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/normas , Laringoscópios/efeitos adversos , Laringoscópios/normas , Masculino , Pessoa de Meia-Idade , Faringite/etiologia , Faringite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/normas
17.
J Clin Anesth ; 44: 69-75, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29156438

RESUMO

STUDY OBJECTIVE: Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity. DESIGN: Systematic review, Meta-analysis SETTING: Operating room, Obesity patients MEASUREMENTS: Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI). MAIN RESULTS: Eleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR=1.11, 95% CI 1.04 to 1.18, p=0.001, I2=63%, Intubation time; WMD=-16.1, 95% CI -31.1 to -1.10, p=0.04, I2=97%, Glottic visualisation; RR=1.19, 95% CI 1.09 to 1.30, p<0.0001, I2=76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel. CONCLUSIONS: Videolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity. (GRADE score: low or very low.).


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Obesidade/complicações , Cirurgia Vídeoassistida/instrumentação , Adulto , Glote/diagnóstico por imagem , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Fatores de Tempo , Resultado do Tratamento , Cirurgia Vídeoassistida/métodos
20.
BMC Anesthesiol ; 17(1): 133, 2017 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-28969598

RESUMO

BACKGROUND: When encountering a difficult airway with an Airway Scope (AWS) a bougie can be inserted into the endotracheal tube in the AWS channel. The angulated tip of the bougie can be guided toward the glottis by rotating it. We tested the ease of rotating bougies (Venn reusable, Boussignac, Portex single-use, and Frova) in an endotracheal tube when placed in the AWS channel. METHODS: Bench study: Seven anesthesiologists inserted each of the four types of bougies into a 7.0 mm endotracheal tube in an AWS channel and rotated the bougie end (side of bougie operated by hand) clockwise or counterclockwise to an angle of 0°-180° in 45° increments. The rotation angle of the bougie tip (tracheal side) was measured for each bougie and the degree of force required to rotate them was examined. Manikin study: Using the same four bougies, the same seven anesthesiologists attempted to intubate a manikin that simulated a difficult airway. Success rate and time required for successful intubation were compared between the four bougies. RESULTS: Bench study: The difference in the rotation angle between the bougie tip and end was significantly larger with Portex single-use and Frova bougies than with Venn reusable and Boussignac bougies (P < 0.01). The rotation angles of the tips of Venn reusable, Boussignac, Portex single-use, and Frova bougies were 145°/123° (clockwise / counterclockwise), 92°/108°, 46°/56°, and 39°/51°, respectively, when their ends were rotated to an angle of 180°. Venn reusable and Boussignac bougies could be rotated in the endotracheal tube by clinically acceptable rotational force. Manikin study: Times to intubation with Venn reusable [25 (SD, 5) s] and Boussignac bougies [35 (6) s] were significantly shorter than with Portex single-use [61 (17) s] and Frova bougies [69 (22) s] (P < 0.01). There were no significant differences in success rate between the four bougies. CONCLUSIONS: Venn reusable and Boussignac bougies are a useful aid for intubation with an AWS. Portex single-use and Frova bougies seem to be less suitable for this technique. Different bougies may be of varying utility when used with an AWS or airway device with an endotracheal tube channel.


Assuntos
Anestesiologistas/normas , Competência Clínica/normas , Intubação Intratraqueal/normas , Laringoscópios/normas , Manequins , Anestesiologistas/educação , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Cirurgia Vídeoassistida/instrumentação , Cirurgia Vídeoassistida/métodos , Cirurgia Vídeoassistida/normas
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