Experimental Study to Develop a Method for Improving Sample Collection to Monitor Laryngoscopes after Reprocessing

BACKGROUND/AIMS: The microbiological surveillance of endoscopes and automated flexible endoscope reprocessing have been proven to be two of the most difficult and controversial areas of infection control in endoscopy. The purpose of this study was to standardize a sampling method for assessing the effectiveness of standard reprocessing operating procedures for flexible fiberoptic laryngoscopes (FFLs). METHODS: First, the sampling devices were directly inoculated with Bacillus atrophaeus spores; second, tissue non tissue (TNT) wipes were tested on artificially contaminated surfaces and on FFLs. RESULTS: Comparison of the sponges, cellulose, and TNT wipes indicated that the TNT wipes were more effective in releasing spores (93%) than the sponges (49%) and cellulose wipes (52%). The developed protocol provides a high efficiency for both collection and extraction from the stainless steel surface (87% of the spores were removed and released) and from the FFL (85% of the spores were removed and released), with relatively low standard deviations for recovery efficiency, particularly for the analysis of the FFL. CONCLUSIONS: TNT wipes are more efficient for sampling surface areas, thereby aiding in the accuracy and reproducibility of environmental surveillance.

Comparison of Preoperative Screening for Patients with Obstructive Sleep Apnea Hypopnea Syndrome by Cinema Magnetic Resonance and Fiber Optic Laryngoscope / 听力学及言语疾病杂志

Objective To localize the upper airway obstruction of patients with obstructive sleep apnea hypopnea syndrome (OSAHS)with the Cinema Magnetic Resonance(Cine-MR) and fiber optic laryngoscope with Müller maneuver(FLMM)before operation and discuss the clinical application values.Methods Before operation, FLMM and Cine-MR were applied to 22 patients diagnosed as OSAHS by Polysomnography(PSG).Medical examinations conducted in this study from September 2015 to April 2016 to examine the obstruction of the soft palate region, the lingual region and epiglottis.Results There were complete agreements between the Cine-MR and FLMM at locating obstruction sites of the soft palate (n=22/n=22),and there were moderate agreements between the Cine-MR and FLMM in locating obstruction sites of the retroglottal region(n=13/n=6),epiglottal region (n=4/n=2)and multiple level(n=13/n=6), respectively.Conclusion For those moderate and severe OSAHS patients with multiple sites obstruction , the preoperative application of the Cine-MR and FLMM together will be better in locating the obstruction sites.

Kinked J-tip guidewire within the tracheal lumen during retrograde intubation: A case report

Retrograde intubation is an alternative option for gaining airway access for patients with a difficult airway.We report a successful management of a kinked J-tip guidewire within a tracheal lumen with flexible fiberoptic laryngoscope in a patient with type II odontoid fracture.It is helpful to adjusting the depth of angiocatheter and handling of J-tip guidewire if J-tip guidewire does not come out into the oral cavity at the expected length during retrograde intubation.

Fiberoptic Laryngoscopic View of the Laryngeal Mask Airway Placed in the Hypopharynx / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) should be correctly placed into the hypopharynx for adequate ventilation. The purpose of this study was to evaluate a LMA position relation to the laryngeal skeleton and narrowing degree of a LMA lumen by the epiglottis. METHODS: The LMA (# 3 or # 4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberoptic laryngoscopic findings through the lumen of LMA were recorded at ten minutes after LMA placements. The position of the LMA was estimated in relation to its distal aperture to the laryngeal skeleton as central, posterior, right and left lateral position. The narrowing degree of the LMA by the epiglottis was estimated as 0%, 1~25%, 26~50%, 51~75%, or 76~100%. RESULTS: The fiberoptic laryngoscope showed central positions in 70.1%, lateral deviations to the left or right in 21.2% and posterior positions in 9%. The most frequent incidence (84/231, 36.4%) of narrowing by the epiglottis is 76~100% but ventilating problems were not developed. However, ventilation was impossible immediately after LMA placement in one patient, so the LMA was removed and the trachea was intubated. Esophageal enterance was visible in one patient without regurgitation of the stomach content. CONCLUSIONS: These findings show that LMA provides a reliable and safe airway management technique, although inadequate positioning and narrowing of LMA lumen by the epiglottis may frequently occur.

An Anthropometric Measurements of the Upper Airway Using Fiberoptic Laryngoscope in Korean Adults / 대한구급학회지

Introduction: An anthropometric distance is crucial for an easy endotracheal intubation and correct placement of endotracheal tube in the trachea. There may be a racial difference of the anthropometric measurement. So we measured the anthropometric distances of the upper airway in Korean adult patients. METHODS: A standard anesthetic induction and maintenance was performed in 100 adult patients following endotracheal intubation. Various anthropometric measurements were determined while the patients head were in a neutral position. Thyromental and sternomental distance were measured. A distance from upper central incisor to carina or cricoid cartilage was directly measured using fiberoptic laryngoscope. However, the length from upper central incisor to midtrachea & the cricoid cartilage-carina distance were indirectly calculated from the above measured distances. Correlation analyses were also performed between age, height, or weight and the above measured anthropometric distances. RESULTS: The mean distances from upper central incisor to carina, cricoid cartilage or midtrachea were 25.5+/-1.8, 13.9+/-1.9, or 19.8+/-1.8cm respectively. The mean distance from cricoid cartilage to carina was 11.6+/-1.4cm. Thyromental and thyrosternal distance were 6.6+/-0.9 and 15.7+/-1.5cm respectively. All mean anthropometric distances of male were longer than those of female patients. Thirty-eight patients (38%) had the thyromental distance < or = 6cm while one patient (1%) had thyrosternal distance < or = 12.5cm. A good correlation (r< or =0.6) was observed between height and upper central incisor-carina distance. CONCLUSIONS: This study suggests that these measured anthropometric data are useful for an easy endotracheal intubation and accurate endotracheal placement in the trachea.

Difficult Intubation in Post-Orthognathic Surgical Patient / 대한마취과학회지

This 17 year-old male patient had an experience of a difficult intubation problem on miniplate removal operation after orthognathic surgery, but he didn't have the same problem on a previous orthognathic surgery 1 year before. He suffers from mental retardation and speaking disability due to congenital brain damage. I think difficult exposure of the larynx was caused by the imbalance of neck muscle force and jaw instability, as result from surgery. The preoperative airway evaluation is very important because findings may dictate choice of intubation technique. A flexible fiberoptic laryngoscope may be the most useful aid to awake intubation in the patient with a known difficult airway.

Use of the flexible fiberoptic laryngoscope to change endotracheal tube / 대한마취과학회지

The fiberscope is no longer an experimental instrument, and it is a state-of-the-art technique for airway management in the operating room, recovery room, and intensive care unit. Changing the oral tube to a nasal one is often necessary if the trachea is to be intubated for a long period. A nasal tube is better tolerated by the patient, is easier to secure when the patient is moved, and is easier to attach to the respiratory care equipment. We describe three cases report changing the oral tube to a nasal one in neurosurgical pa- tient post operatively under flexible fiberoptic laryngoscope, while the interruption of venti- lation is minimized.