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1.
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
2.
Medicine (Baltimore) ; 99(1): e18452, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895774

RESUMO

BACKGROUND: The aim of this study was to compare three intubation methods during cardiopulmonary resuscitation using an adult-manikin. METHODS: Thirty-nine paramedics were included in this study. Each participant performed endotracheal intubation during continuous chest compressions using 3 different methods: conventional Macintosh laryngoscope without additional intubation aids (MAC), conventional Macintosh laryngoscope with gum-elastic bougie (GEB), or flexible tip bougie (FTB). First attempt intubation success rate and intubation time was measured. RESULTS: Intubation success rate was 39% with the use of MAC, 92% with GEB and 95% with FTB. It was statistically lower with MAC than with GEB (P < .001) and FTB (P < .001). There was no difference between GEB and FTB in intubation success rate (P = .644). The mean(SD) intubation time was 28.43 (13.81)s with MAC, 25.69 (5.35)s with GEB and 21.41 (2.88)s with FTB. Intubation time was significantly longer with GEB than with FTB (P < .001). CONCLUSIONS: Within limitations, results of our study suggest that intubation aids facilitate tracheal intubation during continuous chest compressions. Using flexible tip bougie shortens the duration of the procedure compared to gum elastic bougie.


Assuntos
Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/instrumentação , Estudos Cross-Over , Humanos , Laringoscópios , Manequins , Estudos Prospectivos , Fatores de Tempo
3.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 94-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30606750

RESUMO

Neonatal intubation is an essential but difficult skill to learn. Videolaryngoscopy allows the airway view to be shared by the intubator and supervisor and improves intubation success. Ideally, a videolaryngoscope (VL) should be usable as a conventional laryngoscope (CL). The aims of this report were to describe differences in the shape of currently available CL and VL blades and to compare the direct airway view obtainable on a neonatal manikin with different laryngoscope blades.Three main differences were observed; compared with CL, the VL blades have a reduced vertical height, a curved tip and curved body. The direct airway view obtained by the VL is narrower than that obtained with the CL, although the corresponding view on the VL screen is maintained.Minor adaptation of intubation technique may be required when using a VL. Modifying VL blades to reduce these differences may improve their usefulness as an intubation training tool.


Assuntos
Laringoscópios , Laringoscopia/instrumentação , Gravação em Vídeo , Desenho de Equipamento , Humanos , Recém-Nascido , Intubação Intratraqueal , Laringoscopia/educação , Manequins
4.
Artigo em Alemão | MEDLINE | ID: mdl-31639857

RESUMO

Rapid sequence induction and intubation (RSII) is the appropriate method of inducing general anaesthesia in patients who are at a risk of aspiration. The classical RSII is limited to a few treatment recommendations which are rarely based on evidence-based findings. New techniques (e.g., video laryngoscopy) as well as new means of diagnostics (e.g., sonography) require reevaluation of traditional techniques. In this article non-pharmacological treatment strategies of RSII are described. Furthermore, old and new methods to minimise the risk of aspiration are discussed. This includes gastric tube and gastric sonography as well as modalities for anaesthesia induction, e.g. patient positioning, face mask ventilation, relaxometry, cricoid and left-paratracheal pressure. In-hospital, RSII treatment standards must be familiar to all team members and treatment processes have to be well established and practiced regularly. The aim of this article is to present systematics that can be used as a decision-making basis for local operating procedures.


Assuntos
Intubação Intratraqueal , Laringoscópios , Posicionamento do Paciente , Anestesia Geral , Humanos , Intubação Intratraqueal/efeitos adversos
6.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 305-310, July-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1040015

RESUMO

Abstract Introduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL. Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL. Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutiveminutes. The incidence of postoperative complications was calculated and analyzed with respect to gender, smoking status, dentition, laryngoscope type, and suspension system. Results A total of 213 consecutive SL cases were reviewed, including 174 patients (94 male, 80 female). The overall postoperative complication rate was of 3.8%. Four patients experienced tongue-related complications, two experienced oral mucosal alterations, one had a dental injury, and one experienced a minor facial burn. The complication incidence was greater with the Zeitels system(12.5%) compared with the Lewy suspension system (3.3%), although it was not significant (p = 0.4). Likewise, the association of complications with other patient factors was not statistically significant. Conclusion Only 8 out of 213 cases in the present series experienced complications, which is significantly less than the complication rates observed in other reports. Consistent and conscientious protection of the dentition and of the oral mucosa and limiting suspension times to 30 minutes are factors unique to our series that appear to reduce complications in endolaryngeal surgery.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias , Laringoscopia/efeitos adversos , Laringoscopia/métodos , Tabagismo , Odontopatias/prevenção & controle , Fatores Sexuais , Estudos Retrospectivos , Laringoscópios , Doenças da Boca/prevenção & controle
7.
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
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 742-747, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420633

RESUMO

OBJECTIVE: To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. METHODS: In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses I-II, aged 19-66 years, scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS), respectively. Invasive blood pressure (BP), heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction, immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure product (RPP) was calculated. RESULTS: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values , and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000. CONCLUSION: During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.


Assuntos
Intubação Intratraqueal , Laringoscópios , Adulto , Idoso , Nível de Alerta , Pressão Sanguínea , Frequência Cardíaca , Hemodinâmica , Humanos , Lidocaína , Pessoa de Meia-Idade , Adulto Jovem
10.
Emerg Med J ; 36(9): 520-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320332

RESUMO

BACKGROUND: Intubation is an essential, life-saving skill but associated with a high risk for adverse outcomes. Intubation protocols have been implemented to increase success and reduce complications, but the impact of protocol conformance is not known. Our study aimed to determine association between conformance with an intubation process model and outcomes. METHODS: An interdisciplinary expert panel developed a process model of tasks and sequencing deemed necessary for successful intubation. The model was then retrospectively used to review videos of intubations from 1 February, 2014, to 31 January, 2016, in a paediatric emergency department at a time when no process model or protocol was in existence. RESULTS: We evaluated 113 patients, 77 (68%) were successfully intubated on first attempt. Model conformance was associated with a higher likelihood of first attempt success when using direct laryngoscopy (OR 1.09, 95% CI 1.01 to 1.18). The use of video laryngoscopy was associated with an overall higher likelihood of success on first attempt (OR 2.54, 95% CI 1.10 to 5.88). Thirty-seven patients (33%) experienced adverse events. Model conformance was the only factor associated with a lower odds of adverse events (OR 0.94, 95% CI 0.88 to 0.99). CONCLUSIONS: Conformance with a task-based expert-derived process model for emergency intubation was associated with a higher rate of success on first intubation attempt when using direct laryngoscopy and a lower odds of associated adverse events. Further evaluation of the impact of human factors, such as teamwork and decision-making, on intubation process conformance and success and outcomes is needed.


Assuntos
Protocolos Clínicos/normas , Estado Terminal/terapia , Intubação Intratraqueal/normas , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Adolescente , Bradicardia/epidemiologia , Bradicardia/etiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/etiologia , Lactente , Recém-Nascido , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Laringoscópios/efeitos adversos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Estudos Retrospectivos , Gravação em Vídeo , Adulto Jovem
11.
J Craniofac Surg ; 30(5): e442-e446, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299808

RESUMO

Lingual thyroglossal duct cysts (LTDCs) are rare congenital anomalies of the neck. The authors described the presentation, management, and outcome of LTDC in pediatric and adult cases through a retrospective observational analysis between 2008 and 2018. Data included patients' demographics, main complaint, preoperative investigations, surgical management, and recurrences. Seventeen patients were included: 8 pediatric and 9 adult patients. The most common presenting symptom was foreign body sensation (35.3%). In all, 50% (4/8) of the children had respiratory problems, while the most common symptom in adults was difficulty swallowing (8/9). Five patients were of recurrent LTDC; 3 referred patients were suspected of having recurrent epiglottic cysts. The total misdiagnosis rate was 35.3% (6/17): 14.3% (1/7) in children and 55.6% (5/9) in adults. Fiber optic laryngoscopic examination revealed that LTDCs mostly occurred at the base of the tongue (53.3%) and vallecula epiglottica (33.3%). Ultrasound examination revealed low to anechoic masses on the root of the tongue; 50% were regular in shape and 50% were irregular. All pediatric patients had regular masses (100%), but most adults had irregular masses (85.7%). In total, 76.5% of the patients underwent the Sistrunk procedure, and 23.5% underwent marsupialization alone. The mean follow-up length was 37.5 ±â€Š32.8 months. All patients were well at follow-up. In conclusion, direct laryngoscopy and ultrasound examination are essential for diagnosis as LTDCs can be confused with vallecular cysts. Surgical treatment such as marsupialization or the Sistrunk operation must be performed thoroughly.


Assuntos
Cisto Tireoglosso/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Transtornos de Deglutição/cirurgia , Demografia , Erros de Diagnóstico , Feminino , Humanos , Laringoscópios , Laringoscopia , Masculino , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Glândula Tireoide , Doenças da Língua/cirurgia , Ultrassonografia
12.
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
13.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(3): 379-382, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31282333

RESUMO

Objective To compare the impacts of different nostril on nasotracheal intubation with video laryngoscopy.Methods Totally 120 ASA grade I maxillofacial surgery patients were equally randomized into two groups:group A(left nostril)and group B(right nostril).After rapid induction of anesthesia,the nasal intubation was completed by Tosight video laryngoscope,and the success rate of the first attempt of the tube passing through the nasal cavity was recorded and compared between these two groups.In addition,time of tube through nasal cavity,time of glottis exposure,total intubation time,intubation success rate,and nasal bleeding were recorded.Results The success rate of the first attempt of tube passing through the nasal cavity was not significantly different between groups A and B(84.7% vs. 81.7%;χ 2=0.202,P=0.653).The time of tube passing through nasal cavity [(7.3±4.6)s vs.(7.5±4.1)s;t=-0.223,P=0.824] and the time of glottic exposure [(6.6±1.4)s vs.(6.7±1.4)s;t=-0.348,P=0.728] had no significant differences between two groups.The success rates of first intubation attempt were 100% in both groups.The total intubation time was(35.1±9.2)s in group A and(34.0±7.8)s in group B(t=0.663,P=0.509).Intubation-related epistaxis was found in 16 cases(27.1%)in group A and in 17 cases(28.3%)in group B(χ 2 =0.022,P=0.882).Conclusion Different nasal approaches have no effect on nasal intubation.


Assuntos
Intubação Intratraqueal/métodos , Laringoscopia , Cavidade Nasal , Glote , Humanos , Laringoscópios , Procedimentos Cirúrgicos Bucais
14.
Pol Merkur Lekarski ; 46(275): 205-208, 2019 May 27.
Artigo em Polonês | MEDLINE | ID: mdl-31152531

RESUMO

Laryngoscope Duoscope (LD) is a disposable, plastic laryngoscope consisting of two different spoons connected by proximal parts, so that one alternately serves as a handle. AIM: The aim of study was to compare classical laryngoscope with the one-time Duoscope type. MATERIALS AND METHODS: The study was carried out on 30 patients of the third year of Medical Emergency, previously trained in instrumental airway clearance. It consisted of intubation of the phantom using a standard metal laryngoscope (MR) and a disposable plastic laryngoscope with a double spoon - Duoscope Laryngoscope (LD). After the intubation, each student completed an anonymous questionnaire regarding the time and effectiveness of intubation and the visibility of vocal folds and the general assessment of both laryngoscopes. RESULTS: The minimum time needed to perform intubation with MR is 16.02 s, and the maximum is 44.17 s, for LD analogically - 17.92 sec. 52.72 s. Mean MR intubation time was shorter than LD (26.43±6.22 s vs. 32.24±8.51 s, statistical significance level p <0.001). The average difference between the time of MR and LD intubation was 7.12 s. The second analyzed factor was the effectiveness of intubation; significantly higher with MR in relation to LD (90% vs. 43.3% efficiency, statistical significance level p<0.0001). The next analyzed factor was the visibility of vocal folds at laryngoscopy. It was after averaging for MR 84.3%, for LD 23%. The average LD score in the 10-point scale of the subjective assessment of the usability of the laryngoscope for intubation was 3.13 points (standard deviation 1.92, median 3 points). CONCLUSIONS: The results of the study strongly support the predominance of the classical laryngoscope over the one-time Duoscope type.


Assuntos
Intubação Intratraqueal , Laringoscópios , Manequins , Desenho de Equipamento , Humanos , Intubação Intratraqueal/métodos , Laringoscopia , Prega Vocal
15.
Medicina (Kaunas) ; 55(6)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31146497

RESUMO

Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17-2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios/normas , Ressuscitação/instrumentação , Idoso , Manuseio das Vias Aéreas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscópios/efeitos adversos , Masculino , Pessoa de Meia-Idade , /estatística & dados numéricos , Ressuscitação/métodos , Estudos Retrospectivos
16.
Eur J Pediatr ; 178(8): 1219-1227, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177289

RESUMO

This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists.Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI. What is Known: • Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality. • Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure. What is New: • This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children. • In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary.


Assuntos
Anestesistas/normas , Competência Clínica/estatística & dados numéricos , Intubação Intratraqueal , Pediatras/normas , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscópios , Masculino , Manequins , Pessoa de Meia-Idade , Autoeficácia , Método Simples-Cego , Gravação em Vídeo
17.
Ann Otol Rhinol Laryngol ; 128(11): 1023-1029, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220916

RESUMO

OBJECTIVES: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. METHODS: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. RESULTS: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. CONCLUSIONS: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringoscópios , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Idoso , Cadáver , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Boca
18.
Crit Care ; 23(1): 221, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208469

RESUMO

Intubation is frequently required for patients in the intensive care unit (ICU) but is associated with high morbidity and mortality mainly in emergency procedures and in the presence of severe organ failures. Improving the intubation procedure is a major goal for all ICU physicians worldwide, and videolaryngoscopy may play a relevant role.Videolaryngoscopes are a heterogeneous entity, including Macintosh blade-shaped optical laryngoscopes, anatomically shaped blade without a tube guide and anatomically shaped blade with a tube guide, which might have theoretical benefits and pitfalls. Videolaryngoscope/videolaryngoscopy improves glottis view and allows supervision by an expert during the intubation process; however, randomized controlled trials in the ICU suggest that the systematic use of videolaryngoscopes for every intubation cannot yet be recommended, especially in non-expert hands. Nevertheless, a videolaryngoscope should be available in all ICUs as a powerful tool to rescue difficult intubation or unsuccessful first-pass laryngoscopy, especially in expert hands.The use of associated devices such as bougie or stylet, glottis view needed (full vs incomplete) and patient position during intubation (ramped, sniffed position) should be further evaluated. Future trials will better define the role of videolaryngoscopy in ICU.


Assuntos
Laringoscopia/métodos , Gravação em Vídeo/métodos , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Laringoscópios/tendências , Laringoscopia/instrumentação , Laringoscopia/tendências , Gravação em Vídeo/instrumentação
19.
Eur J Pediatr ; 178(7): 1125-1127, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037400

RESUMO

LARYNGOSCOPE BURNS IN NEONATAL INTUBATION: Following burns during neonatal intubation, we mounted an in vitro study of laryngoscopes to determine the temperatures reached during clinical use. The temperature of 10 different bulb laryngoscopes heads and two fibre optic heads were measured with a thermocouple, once opened, and upon closing. Within 60 s, all ten laryngoscopes, with light-bulb sources, had gained significant heat to cause thermal injury to neonatal skin. Laryngoscopes with LED light source and fibre optic heads did not. CONCLUSION: We recommend that the bulb laryngoscope blade, if used, is not left open prior to intubation and that it is closed between intubation attempts. What is Known: • The preterm epidermis is particularly vulnerable to injury. What is New: • Bulb laryngoscope light bulbs consistently reach temperatures sufficient to burn neonatal skin in less than 100 s in an in vitro study. • Bulb light safety advice should be incorporated into intubation guidelines.


Assuntos
Queimaduras/etiologia , Intubação Intratraqueal/efeitos adversos , Laringoscópios/efeitos adversos , Desenho de Equipamento , Temperatura Alta/efeitos adversos , Humanos , Recém-Nascido , Intubação Intratraqueal/instrumentação
20.
Anesth Analg ; 128(6): 1264-1271, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094798

RESUMO

BACKGROUND: Tracheal intubation failure in patients with difficult airway is still not uncommon. While videolaryngoscopes such as the Glidescope offer better glottic vision due to an acute-angled blade, this advantage does not always lead to an increased success rate because successful insertion of the tube through the vocal cords may be the limiting factor. We hypothesize that combined use of Glidescope and fiberscope used only as a dynamic guide facilitates tracheal intubation compared to a conventional Glidescope technique with a preshaped nondynamic stylet. METHODS: One hundred sixty adult patients with predicted difficult airway were randomly assigned to a conventional Glidescope (standard Glidescope group) or a combined Glidescope + fiberscope group intubation. In the Glidescope + fiberscope group under direct vision from the Glidescope, tracheal intubation was performed using the fiberscope as a guide without using fiberoptic vision, while in the standard Glidescope group, a conventional stylet-guided intubation technique was performed. We evaluated the rate of tracheal intubation success at first attempt as the primary end point (Fisher exact test). The difference between groups in airway injury, time to successful intubation, and the need for an alternative technique was also evaluated. RESULTS: First-attempt intubation success was higher in the Glidescope + fiberscope group than in the standard Glidescope group (91% vs 67%; P = .0012; fragility index, 8; absolute risk reduction, 24% [95% CI, 12%-36%]). Median time to successful tracheal intubation was shorter in the Glidescope + fiberscope group (50 vs 64 seconds; P = .035). Airway injury rate was lower in the Glidescope + fiberscope group than in the standard Glidescope group (1% vs 11%; P = .035; fragility index, 1; absolute risk reduction, 10% [95% CI, 3%-18%]). Alternative rescue technique requirements to achieve tracheal intubation were higher in the standard Glidescope group (24% vs 4%; P < .001; fragility index, 7). CONCLUSIONS: The use of a dynamic, flexible guide during a Glidescope laryngoscopy in patients with a predicted difficult airway compared to a standard intubation technique improves first-attempt intubation success, decreases the incidence of airway injury and time to successful intubation, as well as the need of an alternative technique to succeed.


Assuntos
Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/efeitos adversos , Laringoscopia/métodos , Adulto , Idoso , Desenho de Equipamento , Feminino , Tecnologia de Fibra Óptica , Glote , Humanos , Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Oximetria , Instrumentos Cirúrgicos , Gravação em Vídeo
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