The clinical application of homemade airway exchange catheter on extubation of patients with difficult tracheal intubation in intensive care unit / 中国中西医结合急救杂志

Objective To discuss the clinical application of homemade airway exchange catheter on the extubation of patients with difficult tracheal intubation in intensive care unit(ICU). Methods Sixty-two patients with difficult tracheal intubation who failed their initial extubation trial were randomly divided into conventional group (31 cases)and observation group(31 cases). The patients in the conventional group received routine extubation process,while the patients in the observation group were extubated under the guidance over a homemade airway exchange catheter. The changes in heart rate(HR),blood pressure,respiratory rate(RR)and pulse blood oxygen saturation(SpO2)were compared at 12 hours after extubation,so as the re-intubation rate,intubation success rate at first attempt and re-intubation time in two groups,and the tolerance and complications after extubation were observed. Results After extubation,the HR,blood pressure and RR were increased significantly(all P<0.05), and the SpO2 was much lower in conventional group(P<0.05),while those parameters were changed little and basically in the normal ranges in the observation group. At 12 hours after extubation,the re-intubation rate was much lower(6.45%vs. 25.81%,P<0.05)in the observation group,with shorter re-intubation time(seconds:27±14 vs. 49±28,P<0.01),higher intubation success rate at first attempt(90.32%vs. 54.84%,P<0.01)and better tolerance (77.4% vs. 61.3%,P<0.05)compared with those in the conventional group. There was no severe complication in the observation group,and there were 1 cases of glottic edema with cricothyroid membrane puncture,2 cases of broncheal mucous membrane bleeding and 2 cases of bucking in the conventional group. Conclusion Compared with conventional extubation process,the extubation over homemade airway exchange catheter can increase the rate of extubation,reduce re-intubation rate and the re-intubation time,with favorable tolerance and no occurrence of serious complications,and is one of the safe and effective extubation strategies in patients with difficult tracheal intubation in ICU.

Anesthesiologic considerations in a pediatric patient with cornelia de lange syndrome: A case report / 대한마취과학회지

Cornelia de Lange syndrome (CdLS) is a relatively uncommon, multiple malformation syndrome involving neurodevelopmental, craniofacial, cardiac, musculoskeletal and gastrointestinal systems. Anesthetic management of a patient with CdLS may pose a serious problem mainly from difficult tracheal intubation, aspiration complications and cardiac malformation. We report our successful experience in anesthetic management of a 15-month-old male patient with CdLS who underwent orchiopexy for bilateral cryptochidism.

Retropharyngeal Abscess after an Unexpected Difficult Tracheal Intubation: A case report / 대한마취과학회지

A retropharyngeal abscess is a rare complication of tracheal intubation.A case of retropharyngeal abscess after unexpected difficult tracheal intubation is presented with a review of the medical literature.A 45-year-old female patient underwent excision and biopsy of the left false vocal cord mass under general anesthesia with tracheal intubation.There was unexpected difficulty of the tracheal intubation and several trials of intubations were performed.The patient complained of pain on the left side of the neck, a sore throat, dysphagia, and chest discomfort one day postoperatively.The patient had fever of 38.7degrees C.Flexible laryngoscopy, neck X-ray, neck computed tomography, and pharyngoesophagographic studies were performed, which revealed a retropharyngeal abscess.The patient was treated with antibiotics, nil per os, nasogastric tube feeding and underwent surgery for incision and drainage of the retropharyngeal abscess under local anesthesia.The patient recovered without complications, and the patient was discharged 12 days postoperatively.

Emergency Airway Management using a Laryngeal Mask Airway (LMA) Following Extubation in an Infant with a Congenital Facial Anomaly: A case report / 대한마취과학회지

A female infant (4 months-old) with Goldenhar syndrome was scheduled for cheiloplasty to treat a transverse facial cleft and congenital macrostomia. There was no past history of difficulty during feeding or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional oro-tracheal intubation was possible. However, following extubation of the endotracheal tube she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #1 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. Here we describe the use of a LMA for emergency airway management in an infant.

The Clinical Effectiveness of the Bonfils Intubation Fibrescope in Difficult Tracheal Intubation / 영남의대학술지

BACKGROUND: This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for cases of difficult tracheal intubation. MATERIALS AND METHODS: For patients with an ASA physical status 1 or 2 betwen the ages of 20-90, direct laryngoscopy was performed and the layngoscopic view graded according to the Cormack and Lehane classification. Forty patients with Cormack and Lehane grade 3 or 4 were intubated using the Bonfils intubation fibrescope. During intubation, the success rates for tracheal intubation, overall time to intubation, number of attempts and adverse effects were recorded. The Thyromental and sternomental distances were recorded after the orotracheal intubation. RESULTS: The success rates were significantly higher in Cormack and Lehane grade 3 (96.9%) patients compared to grade 4 (50%) (P<0.01). The time to intubation was significantly faster in patients with grade 3 compared to grade 4 (20 (10-49[7-300]) sec vs. 180 (31-300[10-300]) sec, P=0.01). The number of cases with a SpO2<90% was significantly lower in patients with grade 3 (3.1%) compared to grade 4 (50%) (P<0.01). CONCLUSION: In patients with Cormack and Lehane grade 3, tracheal intubation using the Bonfils intubation fibrescope appears to be an effective technique for the management of a difficult intubation. However, the Bonfils intubation fibrescope can not always be used for the management of a difficult intubation in grade 4 patients; for these patients other effective instruments should be considered for difficult intubations.

Anesthetic Experience in a Patient with Goldenhar Syndrome: A case report / 대한마취과학회지

Goldenhar syndrome is a rare congenital disorder of hemicraniofacial and vertebral defects related to the abnormal development of the first and second branchial arches. In some infants, congenital heart disease, and pulmonary and renal defects are also present. Goldenhar syndrome commonly involves an airway which is difficult to manage. Tracheal intubation may be difficult due to a combination of retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral abnormities. We experienced the anesthetic management of an 8-month-old boy with Goldenhar syndrome who received excision and biopsy for conjunctival dermoid and ureteral reimplantation for vesicoureteral reflux under general anesthesia. Airway management, with thiopental, rocuronium and sevoflurane, and tracheal intubation were accomplished successfully in the patient. Surgery was performed uneventfully and the patient was discharged without complication.

Clinical analysis on 362 cases of difficult tracheal intubation solved by tube changer / 重庆医科大学学报

Objective:To discuss the effect of tube changer in relieving difficult tracheal intubation.Methods:Three hundred and sixty-two patients with difficult tracheal intubation were selected to be aided with tube changer in the study.Electrocardiogram,blood pressure and oxygen saturation were observed.Results:The incidence of successful intubation was 93.9%(340/362).Twenty-two failing cases were treated by tracheotomy.Conclusion:Tube changer is a well assisting equipment in treating difficult tracheal intubation.By using tube changer,the intubation time in the patients with difficult intubations decreased and the incidence of successful intubation increases.It is recommended to adjust intubation on the basis of monitoring result.