Percutaneous tracheotomy: forceps vs. cone dilatation techniques

Percutanoeous tracheotomy [PT] is a minimal invasive procedure alternative to surgical tracheotomy. PT offers an added advantage of enormous decrease of time interval between decision of doing tracheotomy and actually doing it. Moreover hazards of patient transport can be avoided as it can be safely performed at the bedside. We started doing PT in 2003 and performed 100 cases using forceps dilatation. Later we switched over to cone dilatation where we performed 215 cases. This study aims to compare two techniques of forceps vs. cone dilatation methods for PT. A total of 100 cases of PT were performed starting from December 2003 to August 2005 using the forceps dilatation method [group A]. Further 215 cases were conducted [group B] from September 2003 to July 2008 using the cone dilatation method. Time of performing both procedures was recorded. Also incidence of complications was also recorded in both groups. The incidence of minor bleeding in group A was 9%, whereas in group B was 5.58%. Major bleeding occurred in two patients in group B. Both cases suffered of pneumothorax and emphysema. One patient developed life-threatening tension pneumothorax and required cardio pulmonary resuscitation. This was one case in this series, in which the procedure has contributed to patient's morbidity. Guide wire-related technical difficulties were seen in 2% of the cases in group A, and 3.7% of cases in group B. forceps dilatation PT is superior to the cone dilatation technique in terms of safety. Further studies are needed to confirm our results

'best fit' endotracheal tube in children - comparison of four formulae

Uncuffed endotracheal tubes are still being recommended by most pediatric anesthetists at our institutes. Different algorithms and formulae have been proposed to choose the best-fitting size of the tracheal tube. The most widely accepted is related to the age of the child [inner diameter [ID] in mm= [age in yr/4] +4; the second is a body, length-related formula [ID in mm=2 + height in cm/30]; the third, a multivariate formula [ID in mm=2.44 + age in yr x 0.1 + height in cm x 0.02 + weight in kg x 0.016] [5]; the fourth, the width of the 5[th] fingernail is used for ID prediction of the ETT [ID in mm = maximum width of the 5[th] fingernail]. The primary endpoint of this prospective study was to compare the size of the 'best fit' tracheal tube with the size predicted using each of the above mentioned formulae. With Institutional Ethics Committee approval and parental consent, 27 boys, 23 girls, ASA I-III, 2-10 years, scheduled for different surgical procedures requiring general anesthesia and endotracheal intubation, were enrolled in the study. The size of 'best fit' endotracheal tubes in those children were compared. The internal diameter considered the 'best fit' by the attending pediatric anesthesiologist was compared to age-based, length-based, multivariate-based and 5[th] fingernail width-based formulae. For all test, P<0.05 was considered to be statistically significant. The mean [SD] IDs for the 'best fit', age-based, length-based, multivariate and 5[th] fingernail techniques were 5.31 [0.691], 5.54 [0.622], 5.82 [0.572], 5.71 [0.67] and 5.43 [0.821] mm, respectively. The age-based and 5[th] fingernail width-based predictions of ETT size are more accurate than length-based and multivariate-based formulae in terms of mean value and case matching