[Preoperative predictive airway procedual factors influencing successful fiberoptic oral intubation under general anesthesia].

BACKGROUND: Although preoperative airway assessment is important for airway management, preoperative predictive factors influencing successful fiberoptic oral intubation (FOI) have not been well investigated. Here, we assessed the factors for successful FOI. METHODS: In 30 adult patients, we assessed gender, age, snoring habit, body mass index, Mallampati classification, upper-lip-bite-tests, and length around necks. First we attempted FOI under general anesthesia in a neutral position. When a gap was observed between the epiglottis and posterior pharyngeal wall, we advanced the instrument into the gap. We added airway procedures without observing the gap until it was visible and intubation successful. Multiple regression analysis was performed to determine factors for successful FOI with scores of the factors. RESULTS: Intubation was successful in 0 at neutral position, in 16 at head tilt, in 5 at sniffing position and in the residual 9 at jaw thrust. Snore was the most influencing factor for successful FOI, according to determined linear regression analysis. CONCLUSIONS: We require additional airway procedures and assistance to succeed in FOI in patients who snore.

Adjusting Pediatric Endotracheal Tube Depths Relative to the Cricoid by Using Longitudinal Ultrasound Images of the Saline-Inflated Cuff in the Trachea: Two Case Reports.

Cuff positions of endotracheal tubes should be confirmed to ensure safe anesthesia. However, determining the cuff positions relative to the cricoid by using chest radiography or fiberoptic bronchoscopy is difficult. We identified the cephalad edges of saline-inflated pediatric endotracheal tube cuffs relative to the cricoid on longitudinal ultrasound images over the larynx and trachea in 2 children. Thereafter, we adjusted the endotracheal tube depths and confirmed the cuff positions relative to the cricoid. Longitudinal ultrasound images over the larynx and trachea can help confirm the distance from the caudal edge of the cricoid to the saline-inflated cuff.

In-plane ultrasound imaging of the vertebral artery for safe pediatric internal jugular vein cannulation.

Before cannulation of the internal jugular vein (IJV) in 4 pediatric patients, we obtained in-plane and out-of-plane ultrasound images of the vertebral artery (VA). In 2 of 4 patients, abnormalities were identified and best imaged in the in-plane view. In one patient, the right VA had an anomalous origin and course behind the IJV. In another patient, the in-plane image of both the IJV and the VA clearly showed a narrowed IJV. In some cases, the relationship between the VA and IJV may be more clearly understood with in-plane imaging.