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1.
Anaesthesia ; 75(3): 359-365, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32022912

RESUMO

Anaesthesia and positive pressure ventilation cause ventral redistribution of regional ventilation, potentially caused by the tracheal tube. We used electrical impedance tomography to map regional ventilation during anaesthesia in 10 patients with and without a tracheal tube. We recorded impedance data in subjects who were awake, during bag-mask ventilation, with the tracheal tube positioned normally, rotated 90° to each side and advanced until in an endobronchial position. We recorded the following measurements: ventilation of the right lung (proportion, %); centre of ventilation (100% = entirely ventral); global inhomogeneity (0% = homogenous); and regional ventilation delay, an index of temporal heterogeneity. We compared the results using Student's t-tests. Relative to subjects who were awake, anaesthesia with bag-mask ventilation reduced right-sided ventilation by 5.6% (p = 0.002), reduced regional ventilation delay by 1.6% (p = 0.025), and moved the centre of ventilation ventrally from 51.4% to 58.2% (p = 0.0001). Tracheal tube ventilation caused a further centre of ventilation increase of 1.3% (p = 0.009). With the tube near the carina, right-sided ventilation increased by 3.2% (p = 0.031) and regional ventilation delay by 2.8% (p = 0.049). Tube rotation caused a 1.6% increase in right-sided ventilation compared with normal position (p = 0.043 left and p = 0.031 right). Global inhomogeneity remained mostly unchanged. Ventral ventilation with positive pressure ventilation occurred with bag-mask ventilation, but was exacerbated by a tracheal tube. Tube position influenced ventilation of the right and left lungs, while ventilation overall remained homogenous. Tube rotation in either direction resulted in ventilation patterns being closer to when awake than either bag-mask ventilation or a normally positioned tube. These results suggest that even ideal tube positioning cannot avoid the ventral shift in ventilation.


Assuntos
Intubação Intratraqueal/métodos , Ventilação Pulmonar , Adulto , Idoso , Anestesia/métodos , Impedância Elétrica , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Respiração Artificial , Tomografia , Adulto Jovem
2.
Rev Med Suisse ; 16(681): 325-330, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049456

RESUMO

The purpose of this article is to review the main airway devices available to the emergency physician in a prehospital setting. Since the risk of difficult intubation is increased under pre-hospital conditions; the emergency physician should be aware of alternatives to direct tracheal intubation such as supraglottic devices, video laryngoscopes and cricothyroidotomy. These different techniques and devices must be integrated into a strategy for the management of the upper airway. We propose a prehospital airways algorithm adapted from the Latin Airway Foundation (FLAVA).


Assuntos
Serviços Médicos de Emergência/métodos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Manuseio das Vias Aéreas , Humanos , Laringoscópios , Laringoscopia , Traqueia
3.
Anaesthesia ; 75(2): 179-186, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31631314

RESUMO

The aim of this study was to evaluate the effectiveness of cricoid and paralaryngeal force for oesophageal entrance occlusion during induction of anaesthesia. Seventy-four patients were included in this randomised, crossover study. The relative position of the glottis and outer anteroposterior diameter of the upper oesophageal entrance were assessed at baseline, after the application of 30 N cricoid and paralaryngeal force, and after induction of anaesthesia. The occlusion rate of the oesophageal entrance with cricoid and paralaryngeal force was assessed during direct laryngoscopy. The relative position of the upper oesophageal entrance to the glottis changed in 45 out of 74 patients after induction of anaesthesia and during direct laryngoscopy compared with the awake state. The application of cricoid and paralaryngeal force decreased the mean (SD) diameter of the upper oesophageal entrance to a similar degree in awake (8.5 (2.1) mm to 6.4 (1.7) mm and 6.5 (1.6) mm, respectively; p < 0.001) and anaesthetised (8.7 (2.2) mm to 6.5 (1.7) mm and (6.7 (1.9) mm, respectively; p < 0.001) states. During direct laryngoscopy, the occlusion rate of the oesophageal entrance was greater with cricoid compared with paralaryngeal force (46/74 vs. 26/74, respectively; p = 0.002). The relative position of the upper oesophageal entrance to the glottis may change after induction of anaesthesia and during direct laryngoscopy. Cricoid and paralaryngeal force both decrease the diameter of the upper oesophageal entrance in awake and anaesthetised states. Occlusion of the oesophageal entrance is achieved more frequently with cricoid force compared with paralaryngeal force during direct laryngoscopy.


Assuntos
Anestesia/métodos , Cartilagem Cricoide/anatomia & histologia , Esôfago/anatomia & histologia , Laringoscopia/métodos , Laringe/anatomia & histologia , Ultrassonografia/métodos , Estudos Cross-Over , Feminino , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Pressão
4.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 417-418, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185141

RESUMO

En la actualidad, el uso de los dispositivos supraglóticos (DSG) para el manejo de la vía aérea está ampliamente extendido en urgencias y emergencias por su fácil manejo. El objetivo de la presente revisión es comparar los dispositivos supraglóticos para el manejo de la vía aérea, tubo laríngeo (TL) y máscara laríngea (ML), en sus diferentes versiones, para determinar cuál de ellos reúne las mejores condiciones para un uso eficiente en la atención a urgencias y emergencias. Se realiza una revisión sistemática de la literatura a través de la consulta en 9 bases de datos bibliográficas: Biblioteca Cochrane Plus, Medline, CINAHL, Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, Web of Science y ScienceDirect. Fueron seleccionados registros que estaban comprendidos entre los años 2014 y 2019, en español, inglés, francés y portugués, donde se realizara una comparación entre los DSG, TL y ML, en sus diferentes versiones. Se identificaron un total de 18 estudios válidos tras la lectura crítica. En la mayoría de aspectos evaluados, no se apreciaron diferencias significativas entre ambos dispositivos. Destancaba una presión de sellado orofaríngeo y velocidad de inserción superior en determinados contextos en la utilización del TL, y existía además una visión menor de la glotis mediante la utilización del broncoscopio. Los diferentes contextos en que se puede presentar la utilización de los DSG y la escasez de registros que comparan el TL con las ML en sus diferentes versiones no permite una clara diferenciación en cuanto a eficacia. No obstante, sí parece evidenciarse una visión menor de la glotis en la utilización del TL tras ser valorado con el fibroscopio, factor a tener en cuenta si se tiene presente que en la atención secundaria la intubación selectiva mediante la intubación traqueal, considerada el "patrón oro", puede llegar a ser una necesidad


Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a systematic review of the literature comparing laryngeal tubes and various laryngeal mask airway devices (LMAs) to determine which ones can be used most efficiently in emergencies. Nine databases were searched, as follows: Cochrane Library Plus, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, the Web of Science, and ScienceDirect. We collected studies published between 2014 and 2019 in Spanish, English, French, and Portuguese that compared laryngeal tubes to LMAs of different types for supraglottic airway management. Eighteen studies were selected for analysis after critical reading. Significant differences were not seen between tubes and LMAs with respect to most variables, but in certain contexts the oropharyngeal seal and speed of insertion were superior with laryngeal tubes; however, when fiberoptic bronchoscopes were then inserted the view of the glottis was poor. The different contexts in which these devices are used and the scarcity of studies comparing laryngeal tubes to LMAs does not allow us to identify clear differences among them with respect to efficiency. However, tubes seem to offer poorer visibility of the glottis according to evaluation with fiberoptic scopes, a factor to bear in mind if tracheal intubation, which is considered the gold standard, might become necessary


Assuntos
Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Manuseio das Vias Aéreas/instrumentação , Máscaras Laríngeas , Intubação Intratraqueal/instrumentação , Manuseio das Vias Aéreas/métodos , Intubação Intratraqueal/métodos , Desenho de Equipamento
5.
Medicine (Baltimore) ; 98(51): e18287, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860976

RESUMO

RATIONALE: Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. PATIENT CONCERNS: A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. DIAGNOSES: Laryngoscopy-guided endotracheal intubation was expected to be difficult in LDP. INTERVENTIONS: After the induction of anesthesia, a non-inflatable LMA was introduced into the laryngopharynx with the patient in LDP. He was then maneuvered into a supine position and removal of the LMA was followed by endotracheal intubation. OUTCOMES: The surgery for the removal of the hematoma was performed in a prone position. The airway intubated with an endotracheal tube was well maintained during the entire surgery. LESSONS: LMA is a useful device for airway management in patients in LDP who cannot lie supine.


Assuntos
Manuseio das Vias Aéreas/métodos , Máscaras Laríngeas , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/instrumentação , Dorso/cirurgia , Hematoma/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Masculino , Neurofibromatose 1/terapia , Decúbito Dorsal
6.
Medicine (Baltimore) ; 98(46): e17846, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725624

RESUMO

BACKGROUND: Failed intubation and ventilation during cesarean deliveries are important causes of anesthetic-related maternal mortality. Due to the physiological changes in airway anatomy, parturient had higher incidences of difficult airway than non-obstetric population. Accurate airway assessment is the first step and the most important in airway management. However, the common clinical screening tests, shown low sensitivity and specificity with a limited predictive value. Ultrasound is a quick, noninvasive, inexpensive tool, with the advancement of ultrasound technology, modern ultrasound machine is more portable with better resolution and enhanced tissue penetration, provide better imaging in tissues like epiglottis, vocal cords, ring-shaped membrane, and can be used in airway assessment. Here, the aim of the current study was to find whether preoperative ultrasound assessment of neck anatomy can predict difficult airway in parturient, and provide new ideas and a theoretical basis in the airway management of obstetric anesthesia. METHODS: This is a prospective, observational single-blinded study in a single-center. Subjects will be recruited from patients aged from 18 to 60 years, gestational age ≥ 36 weeks, scheduled for cesarean section under general anesthesia and tracheal intubation. Ultrasound measurement will be performed to detect anterior cervical soft tissue thickness at five anatomical levels (hyoid bone, epiglottis, cricothyroid membrane, thyroid isthmus and suprasternal notch) in the upper airway. The thickness of the soft tissue in the front of the neck and clinical airway measurements will be compared between the "easy intubation" and "difficult intubation" group divided by Cormack-Lehane grade. Receiver-operating characteristic curves were used to determine the sensitivity and specificity of "difficulty prediction capability" of each sonographic and physical measurements. Clinical factors associated with difficult intubation will be determined by univariate analyses. Multiple logistic regression analysis performed to determine independent predictors of difficult intubation. CONCLUSIONS: The study outlined in this protocol will explore the possibility of ultrasound for predicting difficult airway in obstetric anesthesia. This may provide new insight into the practice of airway management. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800018949.


Assuntos
Anestesia Obstétrica/métodos , Cesárea/métodos , Intubação Intratraqueal/métodos , Pescoço/anatomia & histologia , Pescoço/diagnóstico por imagem , Adolescente , Adulto , Protocolos Clínicos , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Método Simples-Cego , Ultrassonografia , Adulto Jovem
7.
Medicine (Baltimore) ; 98(46): e17898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725637

RESUMO

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.


Assuntos
Auxiliares de Emergência/educação , Intubação Intratraqueal/métodos , Laringoscopia/educação , Sucção/educação , Vômito/terapia , Adulto , Competência Clínica , Estudos Controlados Antes e Depois , Descontaminação , Desenho de Equipamento , Feminino , Humanos , Capacitação em Serviço , Laringoscopia/métodos , Masculino , Manequins , Pessoa de Meia-Idade , Projetos Piloto , Sucção/métodos
8.
Einstein (Sao Paulo) ; 18: eAO4805, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644676

RESUMO

OBJECTIVE: To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. METHODS: Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. RESULTS: The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. CONCLUSION: This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.


Assuntos
Simulação por Computador , Desenho de Equipamento/instrumentação , Intubação Intratraqueal/instrumentação , Resistência das Vias Respiratórias , Intubação Intratraqueal/métodos , Respiração Artificial/instrumentação
9.
Medicine (Baltimore) ; 98(42): e17650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626151

RESUMO

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.


Assuntos
Anestesia Geral/métodos , Oxigenação por Membrana Extracorpórea/métodos , Bócio Subesternal/cirurgia , Posicionamento do Paciente , Tireoidectomia/métodos , Estenose Traqueal/cirurgia , Idoso , Broncoscopia/métodos , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Humanos , Intubação Intratraqueal/métodos , Masculino , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estenose Traqueal/complicações
10.
Medicine (Baltimore) ; 98(42): e17713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626153

RESUMO

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a "cannot intubate, cannot oxygenate" (CICO) situation at university hospitals in Korea.This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Data regarding patient characteristics and outcomes were analyzed using descriptive statistics.During the study period, a total of 10,187 tracheal intubations were attempted and 23 patients received cricothyrotomy. Hospitalwide incidence of cricothyrotomy was 2.3 per 1000 tracheal intubations (0.23%). The majority of cricothyrotomy procedures (22 cases, 95.7%) were performed in the emergency department (ED); 1 cricothyrotomy was attempted in the endoscopy room. In the ED, 5663 intubations were attempted and the incidence of cricothyrotomy was 3.9 per 1000 tracheal intubations (0.39%). Survival rate at hospital discharge was 47.8% (11 of 23 cases). Except for cardiac arrest at admission, survival rate was 62.5% (10 of 16 cases). Successful cricothyrotomy was performed in 17 patients (73.9%) and 9 patients (52.9%) were survived. Among 6 patients of failed cricothyrotomy (26.1%), 2 patients (33.3%) were survived. After failure of cricothyrotomy, various methods of securing airway were established: 3 tracheal intubations, 1 nasotracheal intubation, and 1 tracheostomy.The success rate of cricothyrotomy and survival rate in the CICO situation were not high. After failure of cricothyrotomy, various methods of securing airway were performed.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cartilagem Cricoide/cirurgia , Sistema de Registros , Cartilagem Tireóidea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/mortalidade , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
11.
Medicine (Baltimore) ; 98(42): e17450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626100

RESUMO

BACKGROUND: Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1ß, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Citocinas/efeitos dos fármacos , Aneurisma Intracraniano/cirurgia , Lidocaína/administração & dosagem , Adolescente , Adulto , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Craniotomia/métodos , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Feminino , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/líquido cefalorraquidiano , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Faringe , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Couro Cabeludo , Resultado do Tratamento , Adulto Jovem
14.
West J Emerg Med ; 20(5): 784-790, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31539335

RESUMO

INTRODUCTION: Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% - 0.11% in fasted patients undergoing general anesthesia and 0% - 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves maneuvering a suction catheter into the hypopharynx, while performing laryngoscopy and endotracheal intubation. Intentional esophageal intubation (IEI) involves blindly intubating the esophagus to control emesis before endotracheal intubation. Both are previously described techniques for endotracheal intubation in the setting of massive emesis. This study compares the SALAD and IEI techniques with the traditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis. METHODS: Senior anesthesiology and emergency medicine (EM) residents were randomized into three trial arms: the traditional, IEI, or SALAD. Each resident watched an instructional video on the assigned technique, performed the technique on a manikin, and completed the trial simulation with the SALAD simulation manikin. The primary trial outcome was aspirate volume collected in the manikin's lower airway. Secondary outcomes included successful intubation, intubation attempts, and time to successful intubation. We also collected pre- and post-simulation demographics and confidence questionnaire data. RESULTS: Thirty-one residents (21 anesthesiology and 10 EM residents) were randomized. Baseline group characteristics were similar. The mean aspirate volumes collected in the lower airway (standard deviation [SD]) in the traditional, IEI, and SALAD arms were 72 (45) milliliters per liter (mL), 100 (45) mL, and 83 (42) mL, respectively (p = 0.392). Intubation success was 100% in all groups. Times (SD) to successful intubation in the traditional, IEI, and SALAD groups were 1.69 (1.31) minutes, 1.74 (1.09) minutes, and 1.74 (0.93) minutes, respectively (p = 0.805). Overall, residents reported increased confidence (1.0 [0.0-1.0]; P = 0.002) and skill (1.0 [0.0-1.0]; P < 0.001) in airway management after completion of the study. CONCLUSION: The intubation techniques provided similar performance results in our study, suggesting any one of the three can be employed in the setting of massive emesis; although this conclusion deserves further study. Residents reported increased confidence and skill in airway management following the experience, suggesting use of the manikin provides a learning impact.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesiologia/educação , Descontaminação , Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Manequins , Vômito/terapia , Adulto , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Sucção/métodos
15.
Eur Arch Otorhinolaryngol ; 276(11): 3173-3177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489494

RESUMO

PURPOSE: In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. METHODS: We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. RESULTS: The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). CONCLUSION: Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients. LEVEL OF EVIDENCE: 2b.


Assuntos
Epiglotite , Intubação Intratraqueal , Assistência ao Paciente , Complicações Pós-Operatórias , Supraglotite , Traqueotomia , Doença Aguda , Adulto , Custos e Análise de Custo , Epiglotite/fisiopatologia , Epiglotite/cirurgia , Feminino , Finlândia , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Supraglotite/fisiopatologia , Supraglotite/cirurgia , Traqueotomia/efeitos adversos , Traqueotomia/economia , Traqueotomia/métodos , Resultado do Tratamento
16.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401573

RESUMO

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.


Assuntos
Intubação Intratraqueal/efeitos adversos , Laringoscopia/métodos , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/métodos , Pré-Escolar , Evolução Fatal , Feminino , Humanos , Lactente , Intubação Intratraqueal/métodos , Masculino
17.
Medicine (Baltimore) ; 98(33): e16869, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415423

RESUMO

RATIONALE: Precise lung isolation technique with visual confirmation is essential for thoracic surgeries to create a safe and clear surgical field. However, in certain situations, such as when patients have massive pulmonary secretion or when the fiberoptic bronchoscopy (FOB) is not applicable, lung isolation has been performed blindly. PATIENT CONCERN: A 52-year-old woman, whose airway was unable to visualize with FOB due to massive pulmonary secretion, was presented for bilateral sequential lung transplantation. Extracorporeal membranous oxygenation, tracheostomy, and mechanical ventilation were applied to the patient for 39 days preoperatively as a bridge for lung transplantation. DIAGNOSIS: Patient was diagnosed with an idiopathic pulmonary fibrosis and obesity. INTERVENTION: Initially, height-based blind positioning with a conventional double-lumen endobronchial tube (DLT) failed to ventilate the patient properly, and the confirmation of DLT positioning with FOB was impossible due to massive pulmonary secretion. Therefore, a novel DLT (ANKOR DLT) that has one more cuff, located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff, than conventional DLT was used for the lung isolation in the patient. OUTCOMES: After the completion of lung graft, FOB finding showed that the ANKOR DLT was optimally positioned at the tracheobronchial tree of the patient, and its depth was 2.5 cm shallower than that of the conventional tube. LESSONS: ANKOR DLT would be a feasible choice to achieve successful blind lung isolation when the use of FOB is impossible to achieve the optimal lung isolation.


Assuntos
Broncoscopia/instrumentação , Fibrose Pulmonar Idiopática/cirurgia , Intubação Intratraqueal/métodos , Ventilação Monopulmonar/métodos , Desenho de Equipamento , Feminino , Humanos , Fibrose Pulmonar Idiopática/complicações , Transplante de Pulmão/instrumentação , Transplante de Pulmão/métodos , Pessoa de Meia-Idade , Obesidade/complicações
18.
Anaesthesia ; 74(12): 1563-1571, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448404

RESUMO

Dental trauma is a common complication of tracheal intubation. As existing evidence is insufficient to validly assess the impact of different laryngoscopy techniques on the incidence of dental trauma, the force exerted onto dental structures during tracheal intubation was investigated. An intubation manikin was equipped with hidden force sensors in all maxillary incisors. Dental force was measured while 104 anaesthetists performed a series of tracheal intubations using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC® , or the hyperangulated GlideScope® or KingVision® laryngoscopes in both normal and difficult airway conditions. A total of 624 tracheal intubations were analysed. The median (IQR [range]) peak force of direct laryngoscopy in normal airways was 21.1 (14.0-32.8 [2.3-127.6]) N and 29.3 (17.7-44.8 [3.3-97.2]) N in difficult airways. In normal airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 4.6 N (p = 0.006) and 10.9 N (p < 0.001) compared with direct laryngoscopy, respectively. In difficult airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 9.8 N (p < 0.001) and 17.6 N (p < 0.001) compared with direct laryngoscopy, respectively. The use of the C-MAC did not have an impact on the median peak force. Although sex of anaesthetists did not affect peak force, more experienced anaesthetists generated a higher peak force than less experienced providers. We conclude that hyperangulated videolaryngoscopy was associated with a significantly decreased force exerted on maxillary incisors and might reduce the risk for dental injury in clinical settings.


Assuntos
Incisivo , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Maxila , Manuseio das Vias Aéreas , Algoritmos , Humanos , Incisivo/lesões , Laringoscópios , Manequins , Traumatismos Dentários/etiologia , Traumatismos Dentários/prevenção & controle
19.
Medicine (Baltimore) ; 98(31): e16678, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374047

RESUMO

RATIONALE: The benefits of prolonged endotracheal intubation (ETI) in comparison to early tracheotomy is still over the controversy. Little information is available in concern to prolonged ETI more than years. We report the consequence of oral ETI in a 95-year old man for 839 days. PATIENT CONCERNS: This patient was transferred to the intensive care unit due to sputum asphyxia and respiratory arrest. Timely ETI was performed. However, as a neurological insult, extubation had a high risk of failure due to the insufficient ability of sputum clearance. In addition, his family members refused further surgical interventions including tracheotomy. DIAGNOSES: Prolonged ETI occurred in this patient. On day 240 and 329 after ETI, 3D airway image did not reveal laryngeal stenosis or laryngeal lesions. On day 459 and 662, ET tube (ETT) exchanged was performed and the balloon became stiff and inelasticity. INTERVENTIONS: Although a possible tracheoesophageal fistula was suspected by imaging findings on day 547, the gastroscopy did not reveal the fistula on the esophagus. Enteral nutrition was delivered through the gastric tube, while the mediastinal infection was not observed during subsequent follow-up of computed tomography. OUTCOMES: He received tracheostomy due to acute sputum obstruction within ETT and abrupt oxygen desaturation on day 839. LESSONS: During prolonged ETI, more attention should focus on airway humidification, proper cuff pressure and optimal time for tube exchange in order to avoid severe complications.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Intubação Intratraqueal/métodos , Insuficiência Respiratória/terapia , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Esôfago/diagnóstico por imagem , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Qualidade de Vida , Tomografia Computadorizada por Raios X
20.
BMJ Case Rep ; 12(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308181

RESUMO

A cook airway exchange catheter is a long hollow and semirigid catheter which is routinely used for endotracheal tube (ETT) exchange in the intensive care unit setting or even in the operating room in an event of unexpected difficult airway. We describe a novel technique of using an ETT exchanger with the help of a rigid laryngoscope to facilitate intubation as a strategy in a patient with an anticipated difficult airway due to laryngeal cancer presenting as stridor with respiratory distress.


Assuntos
Intubação Intratraqueal/métodos , Neoplasias Laríngeas/complicações , Laringoscópios , Laringoscopia/instrumentação , Idoso , Obstrução das Vias Respiratórias/etiologia , Procedimentos Cirúrgicos de Citorredução/métodos , Glote/cirurgia , Humanos , Laringoestenose/etiologia , Laringoestenose/cirurgia , Masculino , Sons Respiratórios
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