[Comparison between the Airtraq, X-Lite, and direct laryngoscopes for thyroid surgery: a randomized clinical trial]. / Comparaison de l'Airtraq, du X-Lite et du laryngoscope standardpour la chirurgie thyroïdienne: une étude clinique randomisée

PURPOSE: To compare the performance of the Airtraq, X-Lite, and direct laryngoscopes for tracheal intubation for elective thyroid surgery. METHODS: In this randomized prospective study, Patients who were ASA (American Society of Anesthesiologists) I or II physical status I or II and patients undergoing thyroid surgery were included in this randomized prospective study. Patients with attributes for difficult intubation criteria were excluded. After induction of anesthesia with fentanyl, propofol, and cisatracurium, patients were randomized into three groups according to the intubating device used: Airtraq laryngoscope (Airtraq), X-Lite video laryngoscope (X-lLite), and direct laryngoscope with a Macintosh blade (Direct). The primary outcome measurement was the time needed for tracheal intubation. Secondary outcomes included intubation difficulty score (IDS), Cormack-Lehane classification, as well as hemodynamic and respiratory effects. RESULTS: One hundred and five patients were included. Mean (standard deviation) time for intubation was 28.2 (2.1) sec in the Airtraq group vs 36.6 (3.7) sec in the X-Lite group (P < 0.001), and 41.1 (4.4) sec in the Direct group (P < 0.001). Compared with to the direct laryngoscope, the Airtraq provided better visualization of the glottis (P = 0.003) with fewer attempts (P < 0.001) and lower IDS (P < 0.001). The intubation difficulty score was lower with the Airtraq than with the X-Lite (P = 0.003). Patients in the X-Lite and Direct groups showed more hemodynamic variations than those in the Airtraq group. There was only one failed intubation, in the direct group. CONCLUSION: In thyroid surgery, the Airtraq and X-Lite laryngoscopes decrease time to intubation when compared with direct laryngoscopy.

[Spontaneous pneumomediastinum in an asthmatic patient]. / Pneumomediastin spontané chez un asthmatique.

Spontaneous pneumomediastinum is a rare disease. It especially affects young adults. The onset is usually sudden, involving chest pain, subcutaneous emphysema and dyspnea. We report the case of a 24-year old asthmatic patient with pneumomediastinum after coughing effort. The patient presented with acute respiratory failure associated with retrosternal chest pain. Chest X-ray confirmed the diagnosis of pneumomediastinum. The patient evolved favorably within 4 days after exsufflation, oxygen therapy and conventional medical treatment.