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1.
BMJ Case Rep ; 14(10)2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625438

RESUMO

We describe the use of a Total Control Introducer (TCI) in combination with video laryngoscopy (VL) to place a left-sided double-lumen endotracheal tube (DLT) in a patient with a history of difficult laryngoscopy undergoing video-assisted thoracoscopic surgery (VATS). VL was used to obtain visualisation of the glottis and a TCI articulating introducer was used to dynamically navigate the airway and access the trachea. A 39 French DLT was subsequently passed over the TCI shaft and into the trachea under indirect visualisation. The TCI shaft was removed and the DLT was gently guided into the left main bronchus. Successful endobronchial intubation was confirmed with capnography, auscultation and fibreoptic bronchoscopy. We propose that the combined use of VL and a TCI can facilitate placement of a DLT in a patient with a known difficult airway who may otherwise be limited to a bronchial blocker placement for lung isolation during VATS.


Assuntos
Laringoscópios , Laringoscopia , Brônquios , Broncoscopia , Humanos , Intubação Intratraqueal
2.
BMJ Open ; 11(10): e052977, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615684

RESUMO

INTRODUCTION: Rapid sequence induction of anaesthesia is indicated in patients with an increased risk of pulmonary aspiration. The main objective of the technique is to reduce the critical time period between loss of airway protective reflexes and rapid inflation of the cuff of the endotracheal tube to minimise the chance of aspiration of gastric contents. The COVID-19 pandemic has reinforced the importance of first-pass intubation success to ensure patient and healthcare worker safety. The aim of this study is to compare the first-pass intubation success rate (FPS) using the videolaryngoscopy compared with conventional direct laryngoscopy in surgical patients with a high risk of pulmonary aspiration. METHODS AND ANALYSIS: The LARA trial is a multicentre, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath MAC videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of FPS is 92% in the McGrath group and 82% in the Macintosh group. Each group must include a total of 500 patients to achieve 90% power for detecting a difference at the 5% significance level. Successful intubation with the FPS is the primary endpoint. The secondary endpoints are the time to intubation, the number of intubation attempts, the necessity of airway management alternatives, the visualisation of the glottis using the Cormack and Lehane Score and the Percentage Of Glottic Opening Score and definite adverse events. ETHICS AND DISSEMINATION: The project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (registration number: 2020-15502) and medical ethics committee of the University of Freiburg (registration number: 21-1303). The results of this study will be made available in form of manuscripts for publication and presentations at national and international meetings. TRIAL REGISTRATION: NCT04794764.


Assuntos
Anestesia , COVID-19 , Laringoscópios , Humanos , Intubação Intratraqueal/efeitos adversos , Laringoscopia , Estudos Multicêntricos como Assunto , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução e Intubação de Sequência Rápida , SARS-CoV-2
3.
Trials ; 22(1): 684, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625111

RESUMO

BACKGROUND: Endotracheal intubation by direct laryngoscopy is a widely performed lifesaving technique. Although there are guidelines for optimal size and depth of insertion of an endotracheal tube (ETT) for successful intubation, there is no consensus on the point at which it should be held along its length. This will arguably affect the time, ease, and success of the technique due to a difference in visualization and torque applied to the ETT after glottic visualization. We aim to compare the effect of 2 different sites of holding the ETT on time to intubation (TTI), intubation difficulty scale (IDS), and complications. METHODS: ASA 1-2 patients (>18 years) posted for surgery under general anesthesia, undergoing supervised intubation by anesthesia trainees (experience < 18 months), will be included. Patients with an anticipated difficult airway or unanticipated difficulty-CL grade 3 or 4 requiring the use of airway adjuncts-will be excluded. Patients will be randomized by a computer-generated number list, and allocation concealed with opaque sealed envelopes. The two sites for holding the ETT will be group 1 at 19 cm and group 2 at 24 cm. ETT marked at the selected site will be handed by the technician once the optimum position of the table, patient, and laryngoscopic view is confirmed by the intubator. The entire procedure will be video recorded. Two blinded assessors will independently review the videos to document the time to intubation and intubation difficulty score. A postoperative sore throat will be recorded. SAMPLE SIZE: To detect a 20% difference in time to intubation between groups with a significance level of 5% and power of 85%, we will need a total of 298 patients. Accounting for data loss, we plan to recruit 180 patients in each group. DISCUSSION: This will be the first study to assess whether the site of holding the tube has any impact on the ease and time taken for intubation. The findings of this study will provide scientific evidence for suggesting an appropriate place for holding the ETT during direct laryngoscopy procedures. TRIAL REGISTRATION: Clinical Trials Registry India CTRI/2019/09/021201.


Assuntos
Laringoscópios , Faringite , Anestesia Geral/efeitos adversos , Ensaios Clínicos como Assunto , Humanos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos
4.
JNMA J Nepal Med Assoc ; 59(238): 554-557, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508397

RESUMO

INTRODUCTION: Laryngoscopy and intubation are stressful as they lead to a rise in heart rate and blood pressure. Though transient, it may be detrimental to the cardiac and neurosurgical patients. There is a need to explore the possibility of obtunding the pressor response to laryngoscopy and intubation with the use of McCoy blade laryngoscope. We aimed to find out the hemodynamic response to laryngoscopy and intubation using McCoy laryngoscope in adult patients undergoing general anesthesia. METHODS: The descriptive cross-sectional study was conducted in 37 American Society of Anesthesiologists' Physical Status I/IIpatients, with normal airway from December 2019- May 2020 in a tertiary care hospital. Ethical approval was obtained from Institutional Research Committee (reference number.: MEMG/IRC/290/GA). Convenience sampling method was used. The mean systolic and diastolic blood pressures were measured at baseline, one, three and five minutes after laryngoscopy and intubation. Data were analyzed using the Statistical Package for the Social Sciences Version 21.0. RESULTS: In the first minute after laryngoscopy and intubation, the rise in mean blood pressure was noted in 14 (37.83%) cases. The peak rise in mean blood pressure was 3%, note done minute after laryngoscopy and intubation. CONCLUSIONS: We noted better attenuation of pressor response to laryngoscopy and intubation using McCoy blade laryngoscope in adult patients undergoing general anesthesia.


Assuntos
Laringoscópios , Laringoscopia , Adulto , Estudos Transversais , Hemodinâmica , Humanos , Intubação Intratraqueal
5.
Pediatr Emerg Care ; 37(10): 528-532, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34570081

RESUMO

OBJECTIVE: Because of the abundance of complications associated with peri-intubation hypoxia, maintaining adequate oxygen saturation during endotracheal intubation (ETI) is of great concern. In addition to standard preoxygenation techniques, apneic oxygenation (AO), the continuous flow of passive oxygenation, is a potential tool that can be used to eliminate hypoxia during ETI. Although scarcely studied in the pediatric population, AO has proven effective in reducing the incidence of hypoxia in adult patients with minimal side effects. The objective of this study is to evaluate the use of apneic oxygenation in pediatric patients and to determine its efficacy in preventing or delaying oxygen desaturation during the apneic period of ETI. METHODS: This literature review examines 4 studies that evaluate the practice of AO in pediatric patients. A total of 712 patients across 3 randomized control trials and 1 observational study were assigned to either a control group that did not receive any form of AO, a group that did not receive 100% fraction of inspired oxygen (FiO2), or an intervention group where various methods of AO were delivered. RESULTS: Each AO method that provided 100% FiO2 saw a significantly longer time until initial desaturation when compared with those that did not receive any form of AO or those not receiving 100% FiO2. CONCLUSIONS: The findings in this study confirm that the practice of AO is not only efficacious in increasing the time until initial desaturation but also reduces the overall incidence of hypoxia during laryngoscopy in children.


Assuntos
Intubação Intratraqueal , Laringoscopia , Apneia/terapia , Criança , Humanos , Hipóxia/etiologia , Hipóxia/prevenção & controle , Estudos Observacionais como Assunto , Oxigênio , Oxigenoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial
6.
Am J Case Rep ; 22: e931974, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34480792

RESUMO

BACKGROUND Treacher Collins syndrome is a rare autosomal dominant disorder characterized by micrognathia and abnormal development of the zygomatic arch, which may result in significant upper airway obstruction. As patients who have it age, their upper airway obstruction may worsen. Therefore, they typically require several surgeries throughout their lives to correct specific facial abnormalities. Anesthetic and airway management of patients with Treacher Collins syndrome can be challenging for anesthesia providers, especially in ambulatory settings. CASE REPORT A 15-year-old patient with Treacher Collins syndrome presented to our outpatient surgery center for midface fat grafting. He had undergone multiple surgical procedures at Nationwide Children's Hospital, which is affiliated with The Ohio State University Wexner Medical Center. A decision was made to proceed with the grafting surgery after: (1) the literature was thoroughly reviewed; (2) multidisciplinary planning had been done utilizing our comprehensive preoperative screening and assessment process; (3) the scope of care at our ambulatory surgery center, the patient's medical history, and relevant airway notes had been reviewed; (4) the case was discussed with the surgeon; and (5) relevant images of the patient had been gathered. Evaluation of the patient's airway on the day of surgery was reassuring and a plan for managing a potentially difficult airway had been developed. After anesthetic induction, mask ventilation without adjuvants was successful. Video and direct laryngoscopy (for purposes of education) revealed grade 1 views. Supraglottic airway device placement resulted in an effective seal and the remainder of the surgery and the patient's subsequent course were uneventful. CONCLUSIONS Improved airway approaches, combined with thorough preoperative screening and multidisciplinary planning and communication, may make it possible to perform ambulatory surgery on patients with Treacher Collins syndrome, whose condition typically represents a significant challenge to anesthesia providers.


Assuntos
Anestésicos , Disostose Mandibulofacial , Adolescente , Criança , Face , Humanos , Laringoscopia , Masculino , Disostose Mandibulofacial/cirurgia , Pacientes Ambulatoriais
7.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493558

RESUMO

Paediatric upper airway obstruction is an emergency that requires immediate intervention. Among the myriad factors that leads to upper airway obstruction in paediatric age group, bilateral vocal cord palsy is not commonly encountered in clinical practice. The underlying cause of bilateral vocal cord palsy requires thorough investigation prior to deciding on the appropriate intervention. Herein, we report a 4-month-old baby boy who presented with recurrent inspiratory stridor with bilateral vocal cord palsy secondary to Arnold Chiari II malformation. Immediate intervention to drain the hydrocephalous resulted in complete resolution of stridor without having to perform a tracheostomy. We highlight the importance of meticulous and thorough investigations especially in children, as emergent airway intervention such as tracheostomy may result in detrimental effect to speech, swallowing as well as quality of life.


Assuntos
Malformação de Arnold-Chiari , Paralisia das Pregas Vocais , Criança , Humanos , Lactente , Laringoscopia , Masculino , Qualidade de Vida , Sons Respiratórios/etiologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia
9.
Med Clin North Am ; 105(5): 917-938, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391543

RESUMO

Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to consider a wide differential and refer to an otolaryngologist. This article discusses the physiology of the voice and possible causes of dysphonia, and explores when it warrants further work-up by ENT. A discussion of diagnostic techniques and the myriad of tools to treat hoarseness follows. Additionally, the role of reflux in dysphonia is examined with a critical eye to aid in accurate assessment of the patient's complaint.


Assuntos
Rouquidão/patologia , Diagnóstico Diferencial , Disfonia/diagnóstico , Disfonia/patologia , Rouquidão/diagnóstico , Rouquidão/etiologia , Rouquidão/terapia , Humanos , Laringoscopia , Atenção Primária à Saúde
10.
BMJ Case Rep ; 14(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353829

RESUMO

We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of Candida albicans requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.


Assuntos
Obstrução das Vias Respiratórias , Candidíase , Laringe , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Candidíase/complicações , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Feminino , Humanos , Intubação Intratraqueal , Laringoscopia , Laringe/diagnóstico por imagem , Traqueostomia
11.
Ann Saudi Med ; 41(4): 216-221, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34420401

RESUMO

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway. OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB). DESIGN: Retrospective, cross-sectional. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded. MAIN OUTCOME MEASURES: Findings of FFL. SAMPLE SIZE: 217 pediatric patients. RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P<.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P<.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB. CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor. LIMITATIONS: Retrospective design and single-centered. CONFLICTS OF INTEREST: None.


Assuntos
Laringoscopia , Sons Respiratórios , Adolescente , Criança , Estudos Transversais , Humanos , Lactente , Sons Respiratórios/etiologia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Atenção Terciária à Saúde
12.
Arch. argent. pediatr ; 119(4): 270-273, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280932

RESUMO

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica


In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice


Assuntos
Humanos , Lactente , Pediatria/educação , Laringoscópios/economia , Treinamento por Simulação/métodos , COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscopia/economia , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo , Custos de Cuidados de Saúde , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Curva de Aprendizado , COVID-19/transmissão , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/educação , Laringoscopia/instrumentação , Laringoscopia/métodos , Manequins
14.
Biomed Res Int ; 2021: 6694150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395624

RESUMO

Background: Hemodynamic responses to laryngoscopy and endotracheal intubation are transient in most patients. However, in some patients with a history of heart disease, systemic hypertension, or cerebrovascular disease, these may lead to dangerous complications. This study is aimed at determining the effectiveness of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Material and Method. In this double-blind randomized controlled trial, 78 patients aged 18 to 65 years were randomly divided into three groups: 1 µg/kg dose of nitroglycerin (first group), 2 µg/kg dose of nitroglycerin (second group), and normal saline or placebo (third group). 26 samples were allocated for each group. Patients' hemodynamic responses to laryngoscopy and endotracheal intubation were measured at different times. Data were analyzed using SPSS V 16. Results: Patients in the three study groups were similar in terms of age, sex, and weight. There was no significant difference between the mean saturation of peripheral oxygen (SPO2) and the mean heart rate between the three groups before endotracheal intubation and 1 to 10 minutes after intubation (P > 0.05). The difference of mean arterial blood pressure between study groups was only significant in the first and fifth minutes after intubation. Mean systolic and diastolic blood pressure in the first, third, and fifth minutes after intubation was significantly lower in the intervention groups than the control group (P < 0.05). However, no significant difference was observed between the intervention groups. The frequency of systolic blood pressure decrease was significantly different in the first and fifth minutes after intubation in the three study groups (P < 0.05). Conclusion: Bolus doses of 1 and 2 µg/kg nitroglycerin in noncardiac elective surgery prevents the increase of mean systolic, diastolic, and arterial blood pressure but has no significant effect on heart rate after intubation.


Assuntos
Hemodinâmica/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Nitroglicerina/administração & dosagem , Adulto , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Nitroglicerina/farmacologia , Resultado do Tratamento , Adulto Jovem
15.
Curr Opin Anaesthesiol ; 34(5): 597-602, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34325462

RESUMO

PURPOSE OF REVIEW: The ideal airway management of patients with unstable spinal injury presents a perennial challenge for anaesthesiologists. With competing interests, potentially catastrophic complications, and a scarcity of evidence to support common practices, it is an area rich with dogma and devoid of data. This review seeks to highlight recent evidence that improves our assurance that what we do to manage the airway in the unstable cervical spine is supported by data. RECENT FINDINGS: The increasing range of available technology for intubation provides important opportunities to investigate the superiority (or otherwise) of various techniques - and a chance to challenge accepted practice. Long-held assumptions regarding spinal immobilisation in the context of airway management may require refinement as a true base of evidence develops. SUMMARY: Video laryngoscopy may replace direct laryngoscopy as the default technique for endotracheal intubation in patients with suspected or confirmed spinal instability. Immobilisation of the unstable cervical spine, manually or with rigid cervical collars, is increasingly controversial. It may be that hard collars are used in specific circumstances, rather than as universal precaution in the future.There are no recent data of significantly high quality to warrant wholesale changes to recommended airway management practice and in the absence of new information, limiting movement (in the suspected or confirmed unstable cervical spine) remains the mainstay of clinical practice advice.


Assuntos
Vértebras Cervicais , Traumatismos da Coluna Vertebral , Adulto , Manuseio das Vias Aéreas , Humanos , Intubação Intratraqueal/efeitos adversos , Laringoscopia
16.
HNO ; 69(9): 719-725, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34195859

RESUMO

Significant and new impulses regarding the treatment concept for outpatient phonosurgery on unsedated patients are currently coming from various Anglo-American authors. These "office-based procedures" have been propagated as an alternative to many conventional surgical interventions under anesthesia. The main reason for this remarkable development is the use of new endoscopic techniques in combination with photoangiolytic laser (KTP and blue laser), which allow safe and efficient phonosurgical procedures. Patient acceptance is high since outpatient procedures are considered to have a lower surgical risk. Despite the widespread euphoria, there is a lack of studies evaluating the medical decision criteria and safety management of office-based laryngeal surgery.


Assuntos
Doenças da Laringe , Laringoplastia , Laringe , Terapia a Laser , Procedimentos Cirúrgicos Ambulatórios , Humanos , Doenças da Laringe/cirurgia , Laringoscopia , Laringe/cirurgia
17.
BMJ Case Rep ; 14(7)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230044

RESUMO

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.


Assuntos
Doença dos Neurônios Motores , Paralisia das Pregas Vocais , Idoso , Vértebras Cervicais , Humanos , Laringoscopia , Masculino , Doença dos Neurônios Motores/complicações , Doença dos Neurônios Motores/diagnóstico , Sons Respiratórios/etiologia , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia
18.
Ulus Travma Acil Cerrahi Derg ; 27(4): 421-426, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212998

RESUMO

BACKGROUND: Endotracheal intubation is a key skill for clinicians and may be challenging in some patients due to various reasons. Nowadays, various kinds of videolaryngoscopes are available and usually used as a rescue device when direct laryngoscopy failed. Pediatric airway has some differences when compared with adults and may be challenging. This study aims to compare and evaluate C Mac D-Blade and commonly used Macintosh laryngoscope in pediatric patients. METHODS: In this study, 56 pediatric patients, 5-10 years old (10-40 kgs) who had undergone elective surgery and need endotracheal intubation were included after obtaining ethical board approval and informed consent from parents. The patients were randomized into two equal groups for laryngoscopy and intubation by either with Macintosh laryngoscope or C Mac D-Blade videolaryngoscope. Glottic view, number of attempts, intubation time, any complications and hemodynamic variables were recorded. A value of p<0.05 was considered significant. RESULTS: In pediatric patients with unanticipated difficult airway, the mean intubation time was significantly shorter with C Mac D-Blade (21±9 and 41±7 seconds, respectively (p<0.001). The results of the two groups were similar concerning the remaining parameters. CONCLUSION: C Mac D-Blade videolaryngoscope shortened intubation time about twice when compared to Macintosh blade C Mac D-Blade videolaryngoscope, Videolaryngoscopes may be a good alternative for routine intubation, education and a rescue device for difficult intubation.


Assuntos
Laringoscopia , Cirurgia Vídeoassistida , Criança , Pré-Escolar , Humanos , Laringoscópios/efeitos adversos , Laringoscopia/efeitos adversos , Laringoscopia/instrumentação , Duração da Cirurgia , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/instrumentação
19.
Emerg Med Clin North Am ; 39(3): 493-508, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215399

RESUMO

Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.


Assuntos
Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/terapia , Manuseio das Vias Aéreas , COVID-19/terapia , Criança , Anormalidades Craniofaciais/complicações , Cuidados Críticos , Desenho de Equipamento , Capacidade Residual Funcional , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Laringe/anatomia & histologia , Doenças Neuromusculares/terapia , Ventilação não Invasiva , Oxigenoterapia , Medicina de Emergência Pediátrica , Obesidade Pediátrica/complicações , Respiração com Pressão Positiva , Gravação em Vídeo
20.
Arch Argent Pediatr ; 119(4): 270-272, 2021 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34309304

RESUMO

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope. Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8- 148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001). A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice.


Assuntos
COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscópios/economia , Laringoscopia/educação , Pediatria/educação , Treinamento por Simulação/métodos , Argentina , COVID-19/transmissão , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Custos de Cuidados de Saúde , Humanos , Lactente , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/economia , Laringoscopia/instrumentação , Laringoscopia/métodos , Curva de Aprendizado , Manequins , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo
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