Nasotracheal intubation in patients with limited mouth opening: a comparison between fibreoptic intubation and the Trachway®

In patients with limited mouth opening, traditional laryngoscopy and videolaryngoscopes are not useful when performing nasotracheal intubation. Eighty patients with limited mouth opening who required nasotracheal intubation were randomly assigned to either fibreoptic intubation (n = 40) or the Trachway^® (n = 40). Using the modified nasal intubation difficulty scale, 22 (55%) patients who received fibreoptic intubation were categorised as no difficulty compared with 40 (100%) patients in the Trachway group (p < 0.001). Mean (SD) total intubation time was 71.8 (23.3) s in patients who received fibreoptic intubation compared with 35.4 (9.8) s in the Trachway group (p < 0.001). We conclude that the Trachway technique for nasotracheal intubation is quicker and easier compared with fibreoptic intubation in patients with limited mouth opening.     

Precise localization of a recurrent tracheo-oesophageal fistula using retrograde guide wire placement

A 4-month-old-infant was presented with a presumptive diagnosis of a recurrent tracheo-oesophageal fistula. Preoperative bronchoscopy failed to reveal any defects on the tracheal lumen; however, combined oesophagoscopy and bronchoscopy successfully identified the tracheal orifice of the fistula, which facilitated surgical identification of the recurrent fistula and proper placement of the tracheal tube.     

新净界应用于经口气管插管行机械通气患者口腔护理的效果观察

目的:观察新净界应用于经口气管插管行机械通气患者口腔护理的效果.方法:将90例经口气管插管行机械通气患者随机分为试验组和对照组各45例,对照组采用常规擦洗+冲洗法进行口腔护理,试验组在对照组方法的基础上,最后用新净界进行口腔喷涂.观察两组患者口腔清洁度及各种并发症的发生率.结果:试验组和对照组比较,患者口腔清洁度明显改善(P＜0.05),口腔溃疡、霉菌感染率、牙菌斑及VAP发生率明显降低(P＜0.05).结论:经口气管插管行机械通气患者在进行口腔护理后应用新净界进行喷涂能改善患者的口腔清洁度,并能有效的降低口腔溃疡、霉菌感染、牙菌斑及VAP的发生率.     

A new retrograde transillumination technique for videolaryngoscopic tracheal intubation

This single‐centre, prospective trial was designed to assess the efficacy of a new retrograde transillumination device called the ‘Infrared Red Intubation System’ (IRRIS) to aid videolaryngoscopic tracheal intubation. We included 40 adult patients, who were undergoing elective urological surgery under general anaesthesia. We assessed the ability to differentiate the transilluminated glottis from other structures and found a median (IQR [range]) larynx recognition time of 8 (5–14 [3–28]) s. The difference in laryngeal visibility on the screen between the deactivated vs. activated device expressed on a visual analogue scale was significant (6 (4–7 [2–10]) vs. 10 (8–10 [4–10]); p < 0.001). The number of laryngoscope insertions was 1 (1–2 [1–3]) and the device showed high values on a visual analogue scale ranging from 0 (lowest score) to 10 (highest score) for helpfulness (6 (5–7 [2–10])), credibility (10 (8–10 [5–10])) and ease of use (10 (9–10 [8–10])). Tracheal intubation with the system lasted 26 (16–32 [6–89]) s. No alternative technique of securing the airway was necessary. The lowest SpO₂ during intubation was 98 (97–99 [91–100])%. We conclude that this method of retrograde transillumination can assist videolaryngoscopy.     

Management of difficult airway by retrograde tracheal intubation

A case of difficult intubation is presented in a patient of adenoid cystic carcinoma with a large right-sided facial defect. She was managed with radiotherapy and a myocutaneous flap reconstruction was done with retrograde tracheal intubation     

Wire-guided endobronchial blockade in a patient with a limited mouth opening

PURPOSE: We report the use of wire-guided endobronchial blockade, a new method of achieving one-lung ventilation, in a patient requiring awake, nasal, fibreoptic intubation for resection of a lung carcinoma. CLINICAL REPORT: A 43-yr-old woman with limited mouth opening, from severe TMJ dysfunction, required a right thoracotomy for right upper lobe wedge resection. One-lung ventilation was accomplished using a new type of wire-guided endobronchial blocker. The device was placed coaxially through the endotracheal tube using a pediatric bronchoscope through a special bronchoscopy port. CONCLUSION: Effective one-lung ventilation was achieved using this system. The system may prove advantageous in clinical situations where placement of double lumen endotracheal tubes or Univent tubes is technically impractical or impossible.     

Comparison of two techniques for retrograde tracheal intubation in human fresh cadavers

BACKGROUND: During retrograde tracheal intubation, the short distance existing between the cricothyroid membrane and vocal cords may be responsible for accidental extubation. The insertion of a catheter into the trachea before the removal of the guide wire may help to cope with this problem. This work was conducted to study the impact of such a modification on the success rate and the duration of the procedure. METHODS: Procedures of retrograde tracheal intubation following the classic and modified techniques were randomly performed in cadavers (n = 70). The duration of the procedure from the puncture of the cricothyroid membrane to the inflation of the balloon of the endotracheal tube was measured, and, at the end of the procedure, the position of the endotracheal tube was checked under laryngoscopy. The procedure was considered to have failed if it had taken more than 5 min or when the endotracheal tube was not positioned in the trachea. RESULTS: The mean time to achieve tracheal intubation was similar in both groups (123 +/- 51 vs. 127 +/- 41 s; not significant), but intubation failed significantly more frequently with the classic technique (22 vs. 8 failures; P < 0.05). All failures were related to incorrect positioning of the endotracheal tube. In four cases, both techniques failed. CONCLUSIONS: This efficient, simple modification of the technique significantly increases the success rate of the procedure, without prolonging its duration. These data should be confirmed in clinical conditions but may encourage a larger use of the retrograde technique in cases of difficult intubation.     

Fibreoptic tracheal intubation after placement of the laryngeal tube

Background. The laryngeal tube is a new alternative for securingthe airway. After adequate oxygenation, insertion of a trachealtube is still required in many situations. In such circumstances,fibreoptic placement of a tube exchange catheter after placementof the laryngeal tube is possible before tracheal intubation.Throughout the procedure, oxygen administration can continuevia the laryngeal tube, the tube exchange catheter and the trachealtube. Methods. The feasibility of this technique was tested in 10patients scheduled for elective surgery. Results. The laryngeal tube was placed at the first attemptwith adequate ventilation in all patients. The tube exchangemanoeuvre was performed successfully in all but one patient. Conclusion. This technique is an important alternative for airwaymanagement and provides a significant degree of patient safety. Br J Anaesth 2002; 89: 733–8     

The Glidescope for tracheal intubation in patients with ankylosing spondylitis

Editor—After reading the article on use of Glidescope^®for tracheal intubation in patients with ankylosing spondylitis(AS),¹ we had an opportunity of using this in a patient withAS with predicted difficult intubation on preoperative evaluation. A 43-yr-old male patient (weight 40 kg and     

Submandibular approach for tracheal intubation in patients with panfacial fractures

Background: The oral route for tracheal intubation can interfere with somemaxillofacial surgical procedures. At the same time, the nasalroute can be contraindicated or impossible. Tracheostomy isthe usual solution in these circumstances, but it carries ahigh incidence of complications. We tested the submandibularroute for tracheal intubation as an alternative to tracheostomyin such situations. Methods: The procedure was performed in 13 patients suffering from panfacialfractures associated with a fracture of skull base or a displacednasal fracture, and in one patient with post-caustic burn scaraffecting most of the face including the nose and requiringa full thickness skin flap surrounding the mouth. Results: The technique was found easy and satisfactory for both the surgeonand the anaesthetist. It allowed uninterrupted surgical techniquesand a secure airway. In six of the 13 patients, the submandibulartracheal tube was left in place for up to 44 h in the intensivecare unit after the operation without complications or difficulties.Accidental dislodgement of the tube to the right main bronchusoccurred in two patients while carrying out the procedure; itwas rapidly detected and corrected. In another two patients,postoperative superficial infection occurred that respondedwell to local treatment. No other complications were encountered. Conclusions: Submandibular tracheal intubation is a simple and effectivetechnique for upper airway management in some maxillofacialsurgical patients when both oral and nasal tracheal intubationsare not convenient.     

逆行钢丝顺行换管器引导困难气管插管技术的临床应用

目的评估逆行钢丝和顺行换管器引导困难气管插管技术的临床应用价值。方法术前预测属困难气道者34例,其中经Mallampati困难气道评估Ⅲ级者10例,Ⅳ级者24例。其中,28例直接经环甲膜或环甲膜下1、2或2、3气管环间隙穿刺,逆行钢丝和顺行换管器引导气管插管,其中6例患者经纤支镜插管失败后改用该技术,并获得插管成功。另有18例患者全麻诱导后经口明视喉镜插管失败,改用该技术插管成功。结果本组逆行钢丝和顺行换管器引导气管插管成功率100%,术后无一例出现并发症。结论逆行钢丝和顺行换管器引导气管插管技术操作快捷简便,损伤较小,成功率高。