Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury

BackgroundThe Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury.MethodsFifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2 mg iv and midazolam 1 mg iv that be repeated up to 0.05 mg/kg followed with a bolus dose of remifentanil 1.5 μg/kg then a continuous remifentanil infusion of 0.15 μg/kg/min for 3 min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO₂ < 90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded.ResultsIntubating time was significantly lower in G group compared with F group (26 ± 5 versus 72 ± 11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups.ConclusionThe GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation.     

Alternative techniques for tracheal intubation

Alternative rigid blade intubation devices available in recent years include the Glidescope, Airtraq and Bonfils laryngoscopes. The Macintosh blade works by displacing the tongue to one side and into the submandibular space while the tip of the device sits in the vallecula lifting the hyoid and so the epiglottis forward to reveal the laryngeal inlet. Under less favourable intubating conditions, the tongue is not accommodated in the submandibular space and tends to be compressed downwards. As a result the vallecula is not accessible and the blade tip is less able to be drawn forward. The retro-molar Bonfils avoids this problem by starting from a posterior position in the mouth and approaching the larynx below and alongside the tongue. The Bonfils also serves as a rigid stylet inside the tracheal tube again producing minimal tongue displacement. Airtraq also compresses the tongue less and usually sits on the posterior pharyngeal wall where it maintains the laryngeal view with a minimum of effort. It houses the tracheal tube in a channel that delivers it into the device's field of view. While better optical systems have tended to improve visualization of the laryngeal inlet, this has not necessarily resulted in easier intubation conditions, shorter intubation times or improved overall success rates. Part of the problem has been that they have limited fields of view compared with the stereoscopic view of tube advancement down to the larynx as afforded by Macintosh.     

Anesthetic care and perioperative complications of children with Morquio syndrome

Objectives: Our objective was to make recommendations based on our experience and findings from this study regarding the anesthetic care of children with Morquio syndrome (MS). We emphasize information not readily available in the Anesthesiology literature. Aim: To describe the unique nature of difficulties, especially the relationship of the head and neck to airway patency. In addition, we aim to examine 83 intubations performed in 28 patients and report on observed preferences. Background: Much of the available literature in Anesthesiology consists of case reports of single or small groups of cases, many describing a nonhomogenous population inclusive of many mucopolysaccharidoses. Methods/Materials: We retrospectively studied 28 children with MS who underwent 108 surgical procedures at our pediatric hospital, which provides multidisciplinary, comprehensive care to children with skeletal dysplasia. Results: Cervical fusion was performed in 22 of 28 patients in our study. Eight children after cervical fusion became difficult to intubate for subsequent surgical procedures. In addition, we found airway abnormalities including tortuous appearance of the trachea and bronchi, evident on chest radiograph, as a result of the abnormalities in the hyaline cartilage and deposits of glycosaminoglycans. Conclusion: Morquio syndrome results in abnormalities of not only upper airway but also of large airways. Information from 83 intubations of 108 anesthetics (in 28 patients) shows a preference for Glidescope when intubating children with MS. Displacing the tongue anteriorly prior to intubation by manual retraction using a ring forceps or a piece of gauze helps to access the larynx in children with MS.     

LINX■ reflux management system to bridge the “treatment gap” in gastroesophageal reflux disease: A systematic review of 35 studies

BACKGROUND Gastroesophageal reflux disease(GERD) occurs when the reflux of stomach contents causes troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is indicated and, until now, Laparoscopic fundoplication(LF) constitutes the gold-standard method. However, magnetic sphincter augmentation(MSA) using the LINX^® Reflux Management System has recently emerged and disputes the standard therapeutic approach.AIM To investigate the device’s safety and efficacy in resolving GERD symptoms.METHODS This is a systematic review conducted in accordance to the PRISMA guidelines.We searched MEDLINE, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases from inception until September 2019.RESULTS Overall, 35 studies with a total number of 2511 MSA patients were included and analyzed. Post-operative proton-pump inhibitor(PPI) cessation rates reached 100%, with less bloating symptoms and a better ability to belch or vomit in comparison to LF. Special patient groups(e.g., bariatric or large hiatal-hernias)had promising results too. The most common postoperative complication was dysphagia ranging between 6% and 83%. Dilation due to dysphagia occurred in 8% of patients with typical inclusion criteria. Esophageal erosion may occur in up to 0.03% of patients. Furthermore, a recent trial indicated MSA as an efficient alternative to double-dose PPIs in moderate-to-severe GERD.CONCLUSION The findings of our review suggest that MSA has the potential to bridge the treatment gap between maxed-out medical treatment and LF. However, further studies with longer follow-up are needed for a better elucidation of these results.     

Glidescope视频喉镜在头颈外科手术老年患者气管插管中的应用

目的评价Glidescope视频喉镜用于头颈外科手术老年患者气管插管的临床效果。方法择期行头颈外科手术的老年患者40例,随机分为Glidescope视频喉镜组(G组20例)和直接喉镜组(L组20例)。全部患者均于麻醉前进行改良Mallampati分级评估,分析比较两组患者声门暴露情况(Cormark-Lehane分级)、插管时间,记录麻醉诱导前(T0)、诱导后(T1)、插管后不同时点(T2～T5)的血流动力学变化。结果与L组比较,G组患者获得较好的声门暴露,且插管时间缩短(P<0.05)。两组患者T1时点MAP、HR较T0时点有所降低(P<0.05),T2～T5不同时点MAP、HR较T0时点有不同程度增加(P<0.05),两组比较差异无统计学意义(P>0.05)。结论 Glidescope视频喉镜可以为头颈外科手术老年患者创造更好的插管条件,提高插管成功率。     

Comparison between Glidescope,Airtraq and Macintosh laryngoscopy for emergency endotracheal intubation in intensive care unit: Randomized controlled trial

Background

Emergency endotracheal intubation in intensive care is a major challenge that can be associated with life-threatening complications. The aim of this study was to evaluate the success of the first attempt of endotracheal intubation and incidence of complications using Macintosh laryngoscopy, Airtraq or Glidescope during emergency intubation in intensive care.

A clinical assessment of the Glidescope videolaryngoscope in nasotracheal intubation with general anesthesia

STUDY OBJECTIVES: To evaluate the efficacy and safety of the Glidescope videolaryngoscope as a device to aid nasotracheal intubation, and to determine whether the GSVL provides a better laryngeal view in patients with difficult laryngoscopy compared with the Macintosh laryngoscope. DESIGN: Prospective, clinical study. SETTING: Two university hospitals. PATIENTS: 156 healthy adult ASA physical status I and II undergoing elective plastic and intraoral surgery with general anesthesia. INTERVENTIONS: After anesthesia induction with intravenous injection of fentanyl 2 microg/kg, propofol 2 mg/kg, and vecuronium 0.1 mg/kg, nasotracheal intubation was performed using GSVL. MEASUREMENTS: Preoperative airway measurements were taken to predict potential difficult airways. During nasotracheal intubation using GSVL, laryngeal views, times required for full visualization of glottis and successful intubation, difficulty encountered and auxiliary maneuvers adopted, and upper airway trauma were recorded. The laryngeal views obtained by GSVL and by Macintosh laryngoscope were compared. MAIN RESULTS: The laryngeal views obtained by GSVL in all patients were Cormack and Lehane (C&L) grades I and II, and the success rate of intubation using GSVL at one attempt was 98.1%. The times required for visualization of the glottis and successful intubation were 40.2 +/- 11.5 s and 52.7 +/- 12.3 seconds, respectively. Patients with C&L grade II needed more auxiliary maneuvers to achieve successful intubation than did those with C&L grade I (P < 0.001). In 36 patients with potential difficult airways, the frequency of difficult laryngoscopy (C&L grades III and IV) with the Macintosh laryngoscope (58.3%) was significantly higher than with the GSVL (0%, P < 0.05). The frequency of minor upper airway trauma was 4.5%. CONCLUSIONS: The GSVL is an effective device for nasotracheal intubation and may be incorporated easily into routine clinical practice. Compared with the Macintosh laryngoscope, the GSVL can provide an improved laryngeal view in the patient with difficult airway.     

GlideScope视频喉镜技术在不同困难气道的应用效果评估

目的应用GlideScope视频喉镜对术前预计为困难气道的患者进行识别,探讨其临床应用价值。方法术前评估为困难气道的成年患者30例,ASAⅠ～Ⅱ级,年龄18～65岁,体重45～90kg,在全身麻醉诱导后分别应用Macintosh直接喉镜和GlideScope视频喉镜进行气道评估,记录Cormach～Lehane分级。结果 Macintosh直接喉镜和GlideScope视频喉镜暴露下的Cormach～Lehane分级差异有统计学意义(P<0.005)。结论对于非小口及张口受限类型的困难气道,应用GlideScope视频喉镜能提高困难气道插管成功率。     

视频喉镜和头部可控气管导管用于困难气道经口气管插管的临床研究

目的:评价在视频喉镜下使用头部可控气管导管在困难气道经口气管插管中的应用,观察其可操作性和临床应用价值。方法:术前评估为困难气道择期外科手术患者33例,ASAⅠ或Ⅱ级,随机分为3组:M组、G1组和G2组,每组各11例,常规麻醉诱导后,M组用Macintosh直接喉镜和普通气管导管,G1组采用Glidescope视频喉镜和普通气管导管,G2组采用Glidescope视频喉镜和头部可控气管导管,实施经口气管插管。分别记录采用Macintosh直接喉镜和Glidescope视频喉镜喉部显露Cormark-Lehane分级、气管插管操作时间和插管成功率和一次成功率。结果:与M组相比,G1组和G2组Cormark-Lehane分级中Ⅰ和Ⅱ级的例数显著增多(P<0.05);G1组和G2组插管时间明显缩短(P<0.05),其中G2组插管时间明显缩短于G1组(P<0.05);G1组和G2组插管成功率显著增加(P<0.05),插管一次成功率G2组明显高于G1组(P<0.05)。结论:采用Glidescope视频喉镜实施经口气管插管具有喉部显露清晰、损伤小和降低气管插管难度等优点,配合使用头部可控导管使操作更容易。