Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 47
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
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
2.
BMC Anesthesiol ; 18(1): 124, 2018 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-30193574

RESUMO

BACKGROUND: Direct laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury. Bonfils fiberscope and C-MAC videolaryngoscope are associated with little hemodynamic instability compared to DL. Scientific evidence comparing these two alternatives does not exist. We conducted this study to determine the hemodynamic effects of Bonfils compared to C-MAC in patients undergoing elective surgery. METHODS: Fifty (50) patients listed for elective surgery were randomly assigned to endotracheal intubation with Bonfils or C-MAC. After a standardized induction, intubation was done via the retromolar approach (Bonfils group) or via videolaryngoscopy (C-MAC group). A research assistant, who was not blinded to the intervention, recorded heart rate (HR) and arterial blood pressure (systolic, diastolic and mean arterial blood pressure [MAP]) at induction and at every minute during the 5 min post intubation. The primary outcome was the hemodynamic response to intubation, as verified every minute for the first 5 min compared to baseline value. RESULTS: After randomization, the two groups were comparable except for ASA I/II ratio which was slightly higher in the C-MAC group (p = 0.046). Heart rate (p = 0.40) and MAP (p = 0.30) were comparable between the two groups within 5 min post intubation. Intubation time was shorter with C-MAC than with Bonfils (30 ± 2 s vs 38 ± 2 s; p = 0.02). CONCLUSION: Hemodynamic responses to tracheal intubation using the Bonfils fiberscope is comparable to the C-MAC videolaryngoscope among patients scheduled for an elective surgery. In light of these findings, using either technique appears to be a reasonable course of action. TRIAL REGISTRATION: ISRCTN #34923 , retrospectively registered, 26/03/2018.


Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Intubação Intratraqueal/métodos , Laringoscópios , Cirurgia Vídeoassistida/métodos , Adulto , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscópios/normas , Masculino , Pessoa de Meia-Idade , Cirurgia Vídeoassistida/normas
3.
J Cardiothorac Vasc Anesth ; 32(1): 277-286, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29056498

RESUMO

OBJECTIVES: To test the hypothesis that laryngoscopy using the Airtraq (Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu A/S, Ballerup, Denmark) would result in a shorter time for successful double-lumen endobronchial tube (DLT) intubation by users with mixed experience than the time required using the Macintosh or GlideScope (Verathon Inc., Bothell, WA) laryngoscopes. DESIGN: A randomized, prospective, blind study. SETTING: A single university hospital. PARTICIPANTS: The study comprised 133 patients undergoing elective thoracic surgery. INTERVENTIONS: Patients were randomly allocated into the following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34), Airtraq (n = 35), or KVL (n = 32). MEASUREMENTS AND MAIN RESULTS: The following data were recorded: time required for achieving successful DLT intubation; glottis visualization; optimization maneuvers; first-pass success rate; intubation difficulty; failure to intubate, defined as an attempt taking >150 seconds to perform or if peripheral oxygen saturation <92% was noted; and postoperative sore throat and hoarseness were recorded. Compared with GlideScope, the Airtraq resulted in shorter times for achieving successful DLT intubation (median times: 21 s [95% confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval 46.2-89.1 s], respectively; p = 0.021); a lower score for difficult intubations (p = 0.023); and fewer optimization maneuvers. The 4 laryngoscopes were associated with comparable glottis visualization; first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p = 0.522); incidence of oropharyngeal trauma; postoperative sore throat; and hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures using the Airtraq due to the inability to advance the DLT through the glottis opening. The experience of the anesthesiologists in using the 4 devices had a statistically significant negative correlation with the time to confirmation of endobronchial intubation (Spearman r -0.392; p < 0.001). CONCLUSION: When used by operators with mixed experience, the channeled Airtraq required less time for DLT intubation and was easier to use than the GlideScope, although failures did occur with the Airtraq, whereas they did not occur with the other systems.


Assuntos
Competência Clínica , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Ventilação Monopulmonar/métodos , Cirurgia Vídeoassistida/métodos , Adolescente , Adulto , Competência Clínica/normas , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/normas , Projetos Piloto , Estudos Prospectivos , Cirurgia Vídeoassistida/normas , Adulto Jovem
4.
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
5.
Crit Care ; 21(1): 330, 2017 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-29284503

RESUMO

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) in critically ill patients often involves bronchoscopic optical guidance. However, this procedure is not without disadvantages. Therefore, we aimed to study a recently introduced endotracheal tube-mounted camera (VivaSightTM-SL tube [VST]; ETView, Misgav, Israel) for guiding PDT. METHODS: This was a randomized controlled trial involving 46 critically ill patients who received PDT using optical guidance with a VST or with bronchoscopy. The primary outcome measure was visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) rated on 4-point Likert scales. Secondary measures were the quality of ventilation (before puncture and during the tracheostomy procedure rated on 4-point Likert scales) and blood gases sampled at standardized time points. RESULTS: The mean ratings for visualization (lower values better; values given for per-protocol analysis) were 5.4 (95% CI 4.5-6.3) for the VST group and 4.0 (95% CI 4.0-4.0) for the bronchoscopy group (p < 0.001). Mean ventilation ratings were 2.5 (95% CI 2.1-2.9) for VST and 5.0 (95% CI 4.4-5.7) for bronchoscopy (p < 0.001). Arterial carbon dioxide increased to 5.9 (95% CI 5.4-6.5) kPa in the VST group vs. 8.3 (95% CI 7.2-9.5) kPa in the bronchoscopy group (p < 0.001), and pH decreased to 7.40 (95% CI 7.36-7.43) in the VST group vs. 7.26 (95% CI 7.22-7.30) in the bronchoscopy group (p < 0.001), at the end of the intervention. CONCLUSIONS: Visualization of PDT with the VST is not noninferior to guidance by bronchoscopy. Ventilation is superior with less hypercarbia with the VST. Because visualization is not a prerequisite for PDT, patients requiring stable ventilation with normocarbia may benefit from PDT with the VST. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02861001 . Registered on 13 June 2016.


Assuntos
Broncoscopia/normas , Intubação Intratraqueal/métodos , Traqueostomia/instrumentação , Traqueostomia/métodos , Cirurgia Vídeoassistida/normas , Idoso , Broncoscopia/métodos , Feminino , Alemanha , Humanos , Intubação Intratraqueal/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cirurgia Vídeoassistida/métodos
7.
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
8.
J Endocrinol Invest ; 40(9): 979-983, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28374221

RESUMO

PURPOSE: Minimally invasive video-assisted parathyroidectomy (MIVAP) is one of the most widespread targeted parathyroid surgeries for primary hyperparathyroidism (PHP). The aim of this study was to assess its limits and propose an expansion of its indications in the management of parathyroid pathology. METHODS: A retrospective analysis of 77 consecutive patients who underwent MIVAP for PHP between Jan and Oct 2016 was conducted. The adequacy of the procedure and/or the need to convert to a standard cervicotomy was the main outcome of interest. Secondary outcomes of interest included: operative time, postoperative morbidity, postoperative pain assessed by the visual analogue scale (VAS) score, and the length of the surgical incision. RESULTS: There were 64 females and 13 males with a mean age of 51 years. In one patient a concomitant en bloc thyroid lobectomy was required due to features suspicious of parathyroid carcinoma while exploration was required in two other patients. None of these three cases required conversion to standard cervicotomy. The mean operative time, length of incision and VAS score was 31 min, 17 mm and 1.6, respectively. Biochemical cure was achieved in all patients, and no postoperative morbidities were reported. CONCLUSION: MIVAP offers the ability to perform a neck exploration and/or an en bloc thyroid lobectomy without the need to convert to a standard cervicotomy. Therefore, it not only serves as a targeted parathyroid procedure but also a potential alternative to full neck exploration.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/normas , Duração da Cirurgia , Paratireoidectomia/normas , Cirurgia Vídeoassistida/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paratireoidectomia/métodos , Estudos Retrospectivos , Fatores de Tempo , Cirurgia Vídeoassistida/métodos
9.
Rev Fac Cien Med Univ Nac Cordoba ; 74(4): 361-364, 2017 12 14.
Artigo em Espanhol | MEDLINE | ID: mdl-29902144

RESUMO

Objective: Show our experience performing the minimally invasive video-assisted parathyroidectomy with central approach for the treatment of patients with primary hyperparathyroidism without using intraoperative parathyroid hormone monitoring (IPTHM) based solely on the concordance of two preoperative localization studies. Material and methods: An informed consent for the accomplishment of a minimally invasive approach was performed on 27 selected patients diagnosed with primary hyperparathyroidism who underwent pre-operative cervical ultrasound and sesta-MIBI scintigraphy studies, which were consistent across them. None had a family history that might indicate a multiple endocrine neoplasia (MEN), known thyroid disease, previous neck incision, or suspicion of carcinoma. Surgery was performed through a 1.5 cm central cervical incision and the use of harmonic scalpel. IPTHM was not performed in either case. Results: In all cases the topographic location of the adenoma was confirmed. No signs of hyperparathyroidism persistence or recurrence were registered after a follow-up period of 42 months. There were no recurrent nerve lesions. The average operative time was 24.5 minutes and all patients were discharged within 24 hours. The analgesic requirement was minimal and the cosmetic result satisfactory. Conclusion: The minimally invasive unilateral exploration of the parathyroids with video-assisted magnification without IPTHM, under the guidance of two concordant localization studies is safe and feasible, with comparable results to those of standard technique as well as aesthetic advantages, less postoperative pain and reduced hospitalization.


Assuntos
Adenoma/cirurgia , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/métodos , Neoplasias da Glândula Tireoide/cirurgia , Cirurgia Vídeoassistida/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Paratireoidectomia/normas , Período Pós-Operatório , Resultado do Tratamento , Cirurgia Vídeoassistida/normas
10.
Intern Emerg Med ; 12(1): 91-97, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27001885

RESUMO

The aim of the this study is to evaluate the intubation success rates of emergency medical technicians using a Macintosh laryngoscope (ML), McCoy laryngoscope (MCL), and C MAC D-Blade (CMDB) video laryngoscope on manikin models with immobilized cervical spines. This randomized crossover study included 40 EMTs with at least 2 years' active service in ambulances. All participating technicians completed intubations in three scenarios-a normal airway model, a rigid cervical collar model, and a manual in-line cervical stabilization model-with three different laryngoscopes. The scenario and laryngoscope model were determined randomly. We recorded the scenario, laryngoscope method, intubation time in seconds, tooth pressure, and intubation on a previously prepared study form. We performed Friedman tests to determine whether there is a significant change in the intubation success rate, duration of tracheal intubation, tooth pressure, and visual analog scale scores due to violations of parametric test assumptions. We performed the Wilcoxon test to determine the significance of pairwise differences for multiple comparisons. An overall 5 % type I error level was used to infer statistical significance. We considered a p value of less than 0.05 statistically significant. The CMDB and MCL success rates were significantly higher than the ML rates in all scenario models (p < 0.05). The CMDB intubation duration was significantly shorter when compared with ML and MCL in all models. CMDB and MCL may provide an easier, faster intubation by prehospital emergency health care workers in patients with immobilized cervical spines.


Assuntos
Serviços Médicos de Emergência , Intubação Intratraqueal/instrumentação , Laringoscópios/normas , Cirurgia Vídeoassistida/métodos , Adulto , Serviços Médicos de Emergência/estatística & dados numéricos , Desenho de Equipamento/normas , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/estatística & dados numéricos , Laringoscópios/estatística & dados numéricos , Masculino , Manequins , Treinamento por Simulação/métodos , Treinamento por Simulação/estatística & dados numéricos , Cirurgia Vídeoassistida/normas , Cirurgia Vídeoassistida/estatística & dados numéricos , Recursos Humanos
12.
Eur J Anaesthesiol ; 33(12): 943-948, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27533711

RESUMO

BACKGROUND: Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. OBJECTIVE: The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting. DESIGN: A randomised clinical trial. SETTING: Emergency Department of the University Hospital, Zurich, Switzerland. PATIENTS: With approval of the local ethics committee, we prospectively enrolled 150 patients between 18 and 99 years of age requiring emergency rapid sequence intubation in the emergency room of the University Hospital Zurich. Patients were randomised (1 : 1) to undergo tracheal intubation using the C-MAC videolaryngoscope or by direct laryngoscopy. INTERVENTIONS: Owing to ethical considerations, patients who had sustained maxillo-facial trauma, immobilised cervical spine, known difficult airway or ongoing cardiopulmonary resuscitation were excluded from our study. All intubations were performed by one of three very experienced anaesthesia consultants. MAIN OUTCOME MEASURES: First-attempt success rate served as our primary outcome parameter. Secondary outcome parameters were time to intubation; total number of intubation attempts; Cormack and Lehane score; inadvertent oesophageal intubation; ease of intubation; complications including violations of the teeth, injury/bleeding of the larynx/pharynx and aspiration/regurgitation of gastric contents; necessity of using further alternative airway devices for successful intubation; maximum decrease of oxygen saturation and technical problems with the device. RESULTS: A total of 150 patients were enrolled, but three patients had to be excluded from the analysis, resulting in 74 patients in the C-MAC videolaryngoscopy group and 73 patients in the direct laryngoscopy group. Tracheal intubation was achieved successfully at the first attempt in 73 of 74 patients in the C-MAC group and all patients in the direct laryngoscopy group (P = 1.0). Time to intubation was similar (32 ±â€Š11 vs. 31 ±â€Š9 s, P = 0.51) in both groups. Visualisation of the vocal cords, represented as the Cormack and Lehane score, was significantly better using the C-MAC videolaryngoscope (P < 0.001). CONCLUSION: Our study demonstrates that visualisation of the vocal cords was improved by using the C-MAC videolaryngoscope compared with direct laryngoscopy. Better visualisation did not improve first-attempt success rate, which in turn was probably based on the high level of experience of the participating anaesthesia consultants. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02297113.


Assuntos
Serviço Hospitalar de Emergência , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Cirurgia Vídeoassistida/normas
13.
PLoS One ; 11(5): e0155997, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27195693

RESUMO

INTRODUCTION: Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. METHODS: Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. RESULTS: The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. CONCLUSION: As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.


Assuntos
Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Reanimação Cardiopulmonar/normas , Estudos Cross-Over , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscopia/normas , Masculino , Manequins , Duração da Cirurgia , Distribuição Aleatória , Cirurgia Vídeoassistida/normas
14.
A A Case Rep ; 6(10): 299-304, 2016 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-27075422

RESUMO

The Glidescope® is one of the most widely used video laryngoscopes in the market. It is often used with a purpose-built, reusable, "nonmalleable" stainless steel stylet, the GlideRite®. In this study, we investigated whether this stylet retains its original curvature with repeated use and sterilization. To evaluate the shape and curvature of the stylets, high-resolution digital photographs were made of 55 GlideRite stylets (5 new and 50 randomly selected from operating room stock) laid on a grid background and analyzed using Adobe Photoshop®. In a similar fashion, 1 new stylet was inserted into and removed 100 times from an endotracheal tube and photographed every 20 cycles to determine the impact of use on stylet shape. For the 5 new stylets, the handle-to-tip angle was very consistent (23.44° ± 1.04°). The stylets in clinical use varied widely in their configuration. For analysis, they were divided into 3 groups based on the handle-to-tip angle: ±1 SD of the new stylets, those with a shallower angle (straighter), and those with a steeper angle (more curved). The handle-to-tip angles were as follows: 23.07° ± 0.80° (±1 SD), 18.39° ± 2.59° (straighter), and 27.65° ± 2.73° (more curved). Analysis of variance showed that the new and ±1 SD groups were not significantly different, but both the straighter (P = 0.0002) and more curved (P = 0.0048) groups were significantly different from new. The repeated insertion and removal of a new stylet resulted in gradual straightening of the curve of the stylet from 22° at baseline to 19.2° after 100 insertion/removal cycles. Used GlideRite reusable stylets are not reliably equivalent to new ones in terms of their shape or curvature. Given that the repeated insertion and removal of a new stylet from an endotracheal tube resulted in their straightening, it is likely that clinical use has the same effect. Because many used stylets were actually more curved than the new ones, we hypothesize that practitioners likely bend the nonmalleable stylets to improve clinical utility, but often fail to recapture the manufacturer-intended curve. The clinical relevance of the change in shape of the GlideRite stylet remains to be determined; it is that possible intubation may be more difficult than expected compared with the use of new stylets.


Assuntos
Desenho de Equipamento/normas , Laringoscópios/normas , Laringoscopia/normas , Cirurgia Vídeoassistida/normas , Humanos , Laringoscopia/instrumentação , Laringoscopia/métodos , Cirurgia Vídeoassistida/instrumentação , Cirurgia Vídeoassistida/métodos
15.
Ir J Med Sci ; 185(3): 729-33, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26732694

RESUMO

AIM: Endotracheal intubation procedure employed during general anaesthesia is the most effective way for keeping the airways and respiration under control and has low risk of complications. We have aimed in this study to compare the first-attempt success and duration of the endotracheal intubation process and its effects on haemodynamics using the Macintosh laryngoscope and the GlideScope video laryngoscope. METHODS: In this prospective randomized single-centre study, 100 patients of 18-65 years of age, and classified within the American Society of Anaesthesiologists' (ASA) I-II risk groups before elective ear-nose and throat surgery were included. The patients were randomly divided into two groups, designated as Group M, to be intubated using the Macintosh laryngoscope, and as Group G, to be intubated using the GlideScope video laryngoscope. The Mallampati scores, Cormack-Lehane classifications, intubation duration, number of attempts at intubation, the haemodynamic response and the complications were recorded. RESULTS: There were not intergroup differences with respect to the number of intubation attempts, the Mallampati and Cormack-Lehane classifications. Duration of intubation was found to be longer in group G. The haemodynamic response values of group M were higher than those of group G. Although there was no statistically significant difference between the two groups in the number of intubation attempts, two of the patients in group M were intubated in the second attempt. CONCLUSION: In our study, despite the longer intubation times in group G, the haemodynamic response was significantly lower in this group. It is believed that especially in cases with vital requirement of haemodynamic stability, the GlideScope video laryngoscope would be safer to employ.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Adulto , Idoso , Anestesia Geral/métodos , Pressão Sanguínea/fisiologia , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Desenho de Equipamento , Feminino , Frequência Cardíaca/fisiologia , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/instrumentação , Laringoscopia/métodos , Laringoscopia/normas , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Estudos Prospectivos , Cirurgia Vídeoassistida/instrumentação , Cirurgia Vídeoassistida/métodos , Cirurgia Vídeoassistida/normas
16.
Surg Technol Int ; 26: 43-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26054990

RESUMO

Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.


Assuntos
Cateteres , Segurança de Equipamentos/instrumentação , Laparoscopia/instrumentação , Lentes , Cirurgia Vídeoassistida/instrumentação , Desenho de Equipamento , Segurança de Equipamentos/métodos , Humanos , Laparoscopia/normas , Cirurgia Vídeoassistida/normas
17.
Eur Rev Med Pharmacol Sci ; 19(8): 1381-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25967712

RESUMO

OBJECTIVE: Comparing the minimally invasive video-assisted thyroidectomy (MIVAT) with conventional thyroidectomy in safety and clinical application. STUDY DESIGN: A systematic review of the literature and meta-analysis. MATERIALS AND METHODS: Randomized controlled trials comparing the MIVAT with conventional thyroidectomy were ascertained by methodical search using Medline, Embase, Pubmed, and The Cochrane Library. The trials data were extracted and statistical analyzed using STATA 11.0. RESULTS: Nine trials were identified. Operative time was significantly less with conventional thyroidectomy than with MIVAT, while MIVAT was associated with less pain at 24 hours postoperatively. MIVAT was associated with less scarring and greater cosmetic result. There were no statistically significant differences for the presence of transient recurrent laryngeal nerve palsy and the presence of transient hypoparathyroidism. CONCLUSIONS: MIVAT is a feasible, practical, and safe procedure with cosmetic benefit. It is a promising new technique for modern patients, with benefits over the established surgery.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/normas , Tireoidectomia/normas , Cirurgia Vídeoassistida/normas , Cicatriz/diagnóstico , Cicatriz/prevenção & controle , Humanos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos
18.
Eur J Anaesthesiol ; 32(6): 425-31, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25886716

RESUMO

BACKGROUND: Out-of-hospital tracheal intubation is associated with life-threatening complications. To date, no study has compared direct and video laryngoscopic views simultaneously in the same patients in an out-of-hospital setting. OBJECTIVES: The aim of this study was to determine the effect of C-MAC PM video laryngoscope on laryngeal view, compared with direct laryngoscopy, and to estimate possible consequences for patient safety. DESIGN: An observational, single-centre study. SETTING: Helicopter Emergency Medical Service (HEMS) 'CHRISTOPH 22', Ulm, Germany. PATIENTS: Two-hundrend and twenty-eight emergency patients undergoing airway management out of hospital. INTERVENTIONS: Laryngoscopy and tracheal intubation using C-MAC PM video laryngoscope. For all intubations, the HEMS physician used CMAC PM as the first-line device and performed an initial direct laryngoscopy followed by a video laryngoscopy, without changing the laryngoscope blade. MAIN OUTCOME MEASURES: The difference in laryngeal view was recorded as well as the number of intubation attempts along with the success rate and difficulties in airway management. Improvement in glottic visualisation from Cormack and Lehane grade III/IV to I/II was rated as being clinically relevant. RESULTS: During a 20-month study period, a total of 228 out-of-hospital emergency patients requiring tracheal intubation were included. The overall success rate in securing the airway was 100%. For 226 patients (99.1%), tracheal intubation was successful with two or fewer attempts. For comparison of direct and indirect laryngoscopic views, five patients were excluded because of the use of an indirect laryngoscope blade. Of 223 patients, 120 had a glottic view rated as Cormack and Lehane grade II to IV with direct laryngoscopy; in these patients, visualisation of the glottis was significantly improved with the C-MAC PM video laryngoscope (P < 0.001). In 56 patients (25.1%), improvement of glottic visualisation was clinically relevant (P < 0.001). CONCLUSION: Use of the C-MAC PM video laryngoscope is associated with improved visualisation of the glottis according to the Cormack and Lehane grading system and an excellent success rate for out-of-hospital tracheal intubation. These results suggest that the use of C-MAC PM as a first-line device for tracheal intubation by out-of-hospital emergency medical services is a safe procedure.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Serviços Médicos de Emergência , Glote , Intubação Intratraqueal/instrumentação , Laringoscópios/estatística & dados numéricos , Cirurgia Vídeoassistida/instrumentação , Adulto , Idoso , Manuseio das Vias Aéreas/normas , Serviços Médicos de Emergência/normas , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/instrumentação , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Cirurgia Vídeoassistida/normas
19.
Eur J Anaesthesiol ; 32(6): 400-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24675430

RESUMO

BACKGROUND: The C-MAC D-blade is a new, highly angulated, videolaryngoscope blade designed for use in patients with difficult airways. Directing a tracheal tube into the trachea with any indirect viewing laryngoscope can be difficult, even with a good view of the laryngeal inlet. OBJECTIVE: To determine which introducing strategy is most suitable for use with the C-MAC D-blade videolaryngoscope. DESIGN: Observational manikin study. SETTING: Centre for Simulation and Patient Safety. PARTICIPANTS: Twenty-four anaesthetists of at least 12 months' of experience. INTERVENTIONS: Six tracheal tube introducer strategies (no tracheal tube introducer (TX); hockey stick stylet (SH); Gliderite stylet (SG); bougie with tube loaded distally, near its curved tip (BD); bougie with tube loaded proximally (BP); bougie unloaded until tracheal placement (BU)) for each of two laryngoscopy settings (easy and difficult) in a SimMan 3G manikin. Two intubation attempts, with a maximum time allowance of 60 s each, were allowed for all laryngoscopy setting/introducer combinations. MAIN OUTCOME MEASURES: Time to intubate in seconds. Secondary outcome was overall subjective difficulty using a visual analogue scale. RESULTS: In the easy laryngoscopy setting, time to intubation was [median (interquartile range): SH 8.5 sec (7 to 11); SG 10 (8 to 11.5); BD 11 (10 to 12.5); TX 11 (7 to 31.5); BP 12 (11 to 13.5); BU 13 (11 to 14.5). There was no evidence of an overall difference in introducer strategies for time to intubate (P <  .025) with SG and SH found to be favourable when compared with BU, and SH was also favourable when compared with BP. In the difficult laryngoscopy setting, time to intubation was: SG 11.5 (10 to 17.5); SH 14 (12 to 22); BD 15.5 (12 to 23.5); BU 16.5 (14 to 21); BP 16.5 (15.5 to 20.5); TX 60 (26.5 to 60). There was evidence of an overall difference in introducer strategies for time to intubate (P < 0.025) with all introducers found to be favourable compared with TX. SG was found to be favourable when compared with BU and BP. In groups TX and SH, anaesthetists failed to intubate in 13 of 24 cases and 1 of 24 cases, respectively. The visual analogue scores tended to reflect intubation times, more so in the difficult setting. CONCLUSION: The differences in time to intubate in both the easy and difficult laryngoscopy settings were minor for the different introducer strategies studied. The stylet introducers tended to take less time, but this did not result in important statistical differences. When using the C-MAC D-blade videolaryngoscope for simulated tracheal intubation, stylets and bougies performed in a similar fashion.


Assuntos
Competência Clínica/normas , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/normas , Manequins , Cirurgia Vídeoassistida/normas , Desenho de Equipamento/normas , Humanos , Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação
20.
Anesth Analg ; 117(1): 176-81, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23687227

RESUMO

BACKGROUND: GlideScope® video laryngoscope (GVL) has been proposed to be useful for airway management, but its efficacy for difficult airways has not been confirmed in pediatric patients. In this study, we evaluated the usefulness of the GVL for improving the laryngoscopic view in patients whose Cormack and Lehane grade (C&L grade) was ≥3 under direct laryngoscopy. We also assessed the effect of GVL blade size on the laryngoscopic view. METHODS: This randomized open trial was conducted in a tertiary pediatric center. Patients whose previous C&L grade was ≥3, or who were anticipated to have a difficult airway, were enrolled. The initial modified C&L grade was scored using a direct laryngoscope (DL). If the patient's C&L grade was ≥3, the laryngoscopic view was scored again using GVLw (selected based on weight) and GVLs (1 size smaller than GVLw) in random order by a single experienced anesthesiologist. All laryngoscopic views were graded both with and without the backward, upward, and right lateral displacement of the thyroid cartilage (BURP) maneuver. The primary outcome was the difference in the C&L grade between DL and GVLw, and the secondary outcome was that between GVLw and GVLs. For statistical analysis, the modified C&L grade was converted to an ordinal scale. RESULTS: Data from 23 pediatric patients were analyzed. When compared with DL, improvement of laryngoscopic view with the GVLw wa not obvious (98.3% confidence interval [CI] for differences of ordinal scale, 0-1 without BURP, P = 0.15 and 0-1 with BURP, P = 0.11). However, GVLs improved the laryngoscopic view in comparison with both DL (98.3% CI for differences, 3.5-5.0 without BURP, P = 0.00007 and 3.5-4.5 with BURP, P = 0.0001) and GVLw (98.3% CI for differences, 3.0-4.5 without BURP, P = 0.00007 and 2.5-4.0 with BURP, P = 0.0001). There was no adverse outcome during this study. CONCLUSIONS: In patients with C&L grade ≥3 under direct laryngoscopy, GVLs significantly improved the laryngoscopic view when compared with DL or GVLw. The GVLs is recommended for improving the laryngoscopic view in patients with a difficult airway.


Assuntos
Manuseio das Vias Aéreas/normas , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/normas , Cirurgia Vídeoassistida/normas , Adolescente , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Laringoscopia/instrumentação , Laringoscopia/métodos , Masculino , Cirurgia Vídeoassistida/instrumentação , Cirurgia Vídeoassistida/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA