Double-lumen endobronchial tube intubation in patients with difficult airways using Trachlight and a modified technique.

We present a modified method for the insertion of double-lumen endobronchial tubes with Trachlight in patients with difficult airways. We also discuss whether our method is applicable to smaller double-lumen endobronchial tubes.

The use of portable computer for information acquirement during anesthesiologist's ward round in acute pain service.

BACKGROUND: The Acute Pain Service Information Management System (APSIMS), as we coined, is the utilization of a portable computer to register the data of the patients who need acute pain management during anesthesiologist's ward round. Initially, the data of the daily acute pain assessment at the ward are recorded on a sheet of paper by the rounding anesthesiologist, which are subsequently entered into the hospital main frame computer by an anesthetic nurse. In order to save manpower in data entry, we planned to introduce the personal digital assistant (PDA) into acute pain assessment. The anesthesiologist can record a patient's data directly into the PDA device at the bedside. After acute pain assessment is finished, we can directly up load the data from the PDA to the hospital mainframe computer without the need of further manpower for doing data input. This study was to evaluate the use of PDA for acute pain assessment and compare the PDA-based method with that of the current paper-transcription method in work efficiency. METHODS: Two computer applications were developed: the APS Mobile Assistant and the Data Transformation Wizard (DTW). The APS Mobile Assistant is a PDA application running on a portable computer with Windows Mobile 2003 operation system. The anesthesiologist can use this application to perform APS assessment at the bedside. The Data Transformation Wizard is a PC application which can transfer data from the PDA device to the hospital mainframe computer, by which the data in the PDA system can be integrated into the hospital information system. The evaluation included the reckoning of the timings of two periods i.e. the time spent by the physician to perform acute pain assessment at the bedside and the time required for data management by the nurse. To compare the paper-transcription method with the PDA-based technique, the Student's t test was performed to assess the data of time of each category collected. A P value less than 0.05 was considered to be significant. RESULTS: When the time required for assessment of acute pain was determined, no statistically significant difference was observed between the use of the paper-transcription-based system and the PDA system (P = 0.258). In comparison the PDA system was clearly shown to facilitate faster management of data (Paper-transcription method: 1.57 +/- 0.08 min per patient compared with PDA-based method: 0.24 +/- 0.01 min per patient, P < 0.0001). CONCLUSIONS: Implementation of PDA device during APS assessment can provide the anesthesiologists with more time to acquire information during APS visits. Using the PDA technology in clinical settings can increase work efficiency. We can save manpower and are convinced that data collection is more complete with the use of a PDA system.

Acute pain service management system. The successful experience of the hospital computerization and utilization of personal digital assistant.

Personal digital assistants (PDA) are increasingly being used in many medical fields. The object of this study is to introduce how the hospital computerization and the utilization of PDA can help to reduce the time of data processing for Acute Pain Service. After this study completed, we found that the use of PDA can dramatically reduce the time of data management and improve the quality of medical records.

Blind nasotracheal intubation is facilitated by neutral head position and endotracheal tube cuff inflation in spontaneously breathing patients.

PURPOSE: To evaluate, using an endotracheal tube mounted on a flexible lighted stylet, how the patient's head-neck position and inflation of the endotracheal cuff affect correct alignment of the tube tip with the glottis. METHODS: Eighty-two patients were enrolled. The course of the endotracheal tube in the pharynx was examined by observing the anterior neck for transillumination in each patient under four different intubating conditions. These were: patient's head on pad (8 cm) with the cuff deflated (HP-deflation group); patient's head on pad with the cuff inflated (HP-inflation group); patient's head on bed with the cuff deflated (HB-deflation group); and patient's head on bed with the cuff inflated (HB-inflation group). RESULTS: Both a head on bed (neutral) position or endotracheal tube cuff inflation (15 mL of air) significantly increased the frequency of correct alignment of the tip of the endotracheal tube with the glottis. Blind nasotracheal intubation (BNTI) was successful in 69 patients (84%). Lightwand-assisted nasotracheal intubation was required in 11 of the remaining 13 patients (13%) and fibreoptic bronchoscopy-assisted intubation was performed in the last two patients. CONCLUSION: A neutral position of the head combined with endotracheal tube cuff inflation is recommended for BNTI.

Frequent use of alternative airway techniques makes difficult intubations less and easier.

BACKGROUND: This study is to evaluate how alternative airway techniques work at different scenarios of difficult airways in our department where those techniques are popularized in daily practice. METHODS: This is an open and observational study. Ten thousand two hundred and twenty nine adult patients were included in the 7-month period of investigation. When a difficult intubation was recognized, the responsible anesthesiologist would complete a questionnaire that was designed to explore the possible causes relative to the difficulty, i.e. the laryngoscopic view grade, the muscle relaxant administered during induction, any difficulty of mask ventilation, the eventually successful intubation technique, and the recommendation on the next intubation to the same patient. RESULTS: About 22% of the patients received various airway techniques for intubation other than laryngoscopic technique in general anesthesia. Laryngoscopic intubation was planned firstly on 8,058 cases; the incidence of difficult intubation was 0.44% (36/8058). Laryngoscopic view was found to be grade 2 in 10 patients, grade 3 in 24, and grade 4 in 2 patients, respectively. In these difficult airway intubations were accomplished ultimately with a conventional laryngoscope in 13 patients, a lighting stylet in 20 patients, a laryngeal mask airway (LMA) in 2 patients, and surface tactile oral intubation (STOI) in 1 patient. As to these patients with difficult airways who would undergo general anesthesia with endotracheal intubation next time awake intubation was suggested only to 4 patients. CONCLUSIONS: In elective general anesthesia, frequent use of the alternative airway techniques, such as LMA for a surgical procedure of short duration and lighting stylet for a possibly difficult airway, will decrease the events of difficult intubations. Lighting stylet seems more advantageous than laryngoscope in management of difficult intubation caused by poor laryngoscopic view.