Efecto de la maniobra de fijación en línea en la clasificación de Cormack-Lehane / Effect of the in-line fixation maneuver on Cormack-Lehane classification

Resumen: Introducción: El manejo correcto de la vía aérea en los pacientes politraumatizados es crucial, ya que es necesario tener una vía aérea segura y proveer adecuada ventilación sin emperorar una probable lesión medular. Objetivo: Determinar el efecto de la maniobra de fijación en línea (MILS del inglés Manual In-Line Stabilisation) en la clasificación de Cormack-Lehane (CL), así como la correlación con el índice de masa corporal (IMC). Material y métodos: En un estudio descriptivo en el Centro Hospitalario del Estado Mayor Presidencial en la Ciudad de México se incluyeron 56 pacientes con estado físico ASA I a IV. El anestesiólogo realizó la laringoscopía directa bajo MILS y valoró el grado de CL. Inmediatamente después se reposicionó al paciente en posición de olfateo, se efectuó nueva laringoscopía directa y se revaloró de nuevo el grado de CL. Resultados: Los grados del CL fueron significativamente diferentes entre la posición MILS versus olfateo. Los grados de CL fueron en su mayoría altos cuando se posicionó al paciente en MILS (75% de los pacientes clasificados entre III y IV) y disminuyeron significativamente al ser cambiados a posición de olfateo. Conclusión: Se observa mejoría del CL cuando se cambia de posición MILS a olfateo.

Abstract: Introduction: Correct airway management of polytraumatized patients is crucial because of the necessity of securing the airway and providing adequate ventilation without worsening a probable spinal cord injury. Objective: Determine the effect of manual inline stabilization (MILS) on Cormack-Lehane classification and if there is any correlation with body mass index (BMI). Material and methods: In a descriptive study at the Centro Hospitalario del Estado Mayor Presidencial in Mexico City, we included 56 patients with ASA physical status I to IV. The anesthesiologist performed direct laryngoscopy while MILS was performed and observed the CL grade. Immediately after, the patient was repositioned into the sniffing position, direct laryngoscopy was performed, and the CL grade was observed again. Results: The CL grades observed were significantly different between MILS vs. Sniffing position. CL grades were mainly high when positioned in MILS (75% classified as grades III and IV) and diminished significantly when changed to the sniffing position. Conclusion: Improvement of CL grade was observed when changing from MILS to sniffing position.

Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19 / Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice

Manejo anestésico de resección de quiste de vallécula en neonato. A propósito de un caso / Anesthetic management of vallecular cyst resection in neonate. A case report

Difficult airway management is one of the most important challenges an anesthesiologist faces. It is due to the high morbidity and mortality that it entails. The challenge is even greater if the patient is a newborn. For this reason, we should have different strategies that allow us to anticipate and treat possible complications derived from the procedure. In this case, we present a newborn with vallecular cyst and respiratory distress who is admitted for cyst resection. The gold-standard in anticipated difficult airway management is the fibrobronchoscope. We decided to perform an alternative management by means of orotracheal intubation with videolaryngoscope (Glydescope®) in spontaneous ventilation

El manejo de una vía aérea difícil es uno de los retos más importantes a los que puede enfrentarse un anestesiólogo debido a la elevada morbimortalidad que conlleva. El reto aún es mayor si el paciente es un neonato. Por este motivo, debemos contar con diferentes estrategias que permitan anticipar y poder tratar las posibles complicaciones derivadas del procedimiento. En este caso, presentamos un neonato con quiste de vallécula con clínica de trabajo respiratorio que es admitido para cirugía de exéresis del quiste. El gold standard en el manejo de una vía aérea difícil conocida es el fibrobroncoscopio. Nosotros decidimos realizar un manejo anestésico alternativo mediante intubación orotraqueal con videolaringoscopio (Glydescope®) en ventilación espontánea.

Prevailing practices in airway management: a prospective single-centre observational study of endotracheal intubation

<p><b>INTRODUCTION</b>Airway management during anaesthesia has potential difficulties and risks. We aimed to investigate the utility of routine airway assessment for predicting difficult tracheal intubation, review the prevailing practice of videolaryngoscope use amongst anaesthetists in a teaching hospital and determine the incidence of intraoperative and postoperative airway-related complications.</p><p><b>METHODS</b>A prospective observational study of 1,654 patients undergoing general anaesthesia with endotracheal intubation over a seven-month period was performed. Data regarding airway and anaesthetic management was collected and analysed.</p><p><b>RESULTS</b>Videolaryngoscopes were used as the first-choice equipment in 60.5% of the cohort. The incidence of difficult intubation was 2.1%, of which 45.7% of cases were unanticipated. The sensitivity of airway assessment was 54.3%, with a positive predictive value of 8.1%. When difficult intubation was anticipated, more videolaryngoscopes were used as the first equipment of choice compared to the Macintosh laryngoscope (p < 0.001). In the Macintosh group, more patients required a change of airway equipment (p = 0.015), but the number of intubation attempts was similar (p = 0.293). The incidence of intraoperative (p = 0.920) and postoperative complications (p = 0.380) were similar in both groups.</p><p><b>CONCLUSION</b>Using the current predictors of difficult intubation, half of the difficult airways we encountered were unanticipated. Videolaryngoscopes were preferred when difficulty was anticipated and were also used in routine tracheal intubation.</p>

Comparison of application of videolaryngoscope and Macintosh laryngoscope in double-lumen endobronchial intubation / 临床麻醉学杂志

Objective To explore the application value of videolaryngoscope and Macintosh la ryngoscope in double-lumen endobronchial intubation.Methods Eighty patients (50 males,30 females,aged 18-70 years,ASA grade Ⅰ-Ⅲ) of both sexes,scheduled for thoracic surgery and double lumen endobronchial intubation were randomly divided into two groups using a random number table:videolaryngoscope group and Macintosh laryngoscope group.The intubation time,the success rate of intubation,the views of glottis,the hemodynamics during the first 4 minutes of intubation,the number of positive responses to intubation and the incidence of pharyngalgia at 24 h after the operation were observed and compared between the two groups,the condition of oral hemorrhage and the injury of the tracheal walls were recorded as well.Results Compared with videolaryngoscope group,the C-L grade and the success rate of the first intubation of Macintosh laryngoscope group was significantly higher,the intubation time of Macintosh laryngoscope group was significantly shor ter (P＜0.05).In addition,the positive cases of responses to intubation and the incidence of pharyngalgia at 24 h after the operation of Macintosh laryngoscope group were obviously less than those of videolaryngoscope group (P＜0.05).There was no significant difference between the two groups of oral injury bleeding and the injury of tracheal wall and protuberance.At T2,T3,the two groups of MAP were significantly lower than that of T1,and the MAP of videolaryngoscope group was significantly lower than that of t Macintosh laryngoscope group at T2,T3 (P ＜ 0.05).Conclusion Compared with videolaryngoscope,Macintosh laryngoscope is more suitable for the doublelumen endobronchial intubation in patients predicted without difficulty in intubating.

Comparing insertion characteristics on nasogastric tube placement by using GlideScopeTM visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados

Abstract Background and objective: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScopeTM visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Methods: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. Results: The results showed success rates of 74.5% in the GlideScopeTM Group as compared to 58.3% in the MacIntosh Group (p = 0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2 ± 9.3 s as compared to Group B, with a duration of 18.9 ± 13.0 s (p = 0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p = 0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. Conclusion: This study showed that using the GlideScopeTM to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Resumo Justificativa e objetivo: Este foi um estudo clínico prospectivo e randômico para comparar a taxa de sucesso da inserção de sonda nasogástrica (NG) com as técnicas de visibilização guiada pelo laringoscópio GlideScope® versus guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Métodos: Foram recrutados 96, ASA I ou II, entre 18-70 anos, e divididos randomicamente em dois grupos, com uma ou outra técnica. Foi calculado o tempo transcorrido desde a inserção da sonda NG, da narina até a inserção do comprimento calculado da sonda. A taxa de sucesso de inserção da sonda NG foi avaliada quanto à inserção bem-sucedida na primeira tentativa. As complicações associadas às técnicas de inserção foram registradas. Resultados: Os resultados mostraram taxas de sucesso de 74,5% para o grupo GlideScope® em comparação com 58,3% para o grupo MacIntosh (p = 0,10). Para as tentativas que falharam, a sonda NG foi inserida com sucesso em todos os casos, com as técnicas de resgate. A duração da primeira tentativa para ambas as técnicas não foi estatisticamente significativa: 17,2 ± 9,3 segundos no Grupo A e 18,9 ± 13,0 segundos no Grupo B (p = 0,57). No total, 33 pacientes desenvolveram complicações durante a inserção da sonda NG: 39,4% no Grupo A e 60,6% no Grupo B (p = 0,15). As complicações mais comuns ocorridas foram enrolamento, seguido de sangramento e dobradura. Conclusão: Este estudo mostrou que o uso do GlideScope® para facilitar a inserção de sonda nasogástrica foi comparável ao uso do laringoscópio MacIntosh quanto à taxa de sucesso de inserção e às complicações.

Comparison of McGrath-5 video-laryngoscope and McCoy laryngoscope guided double-lumen tube intubation in patients with difficult airway / 中国内镜杂志

Objective To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method:McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.

Bilateral Vocal Cord Palsy after Thyroidectomy Detected by McGrath Videolaryngoscope / 대한내분비외과학회지

Bilateral vocal cord palsy (BVCP) is a rare complication of thyroid surgery, and it is confusing and frustrating for both patients and medical staff. We found postoperative vocal cord dysfunction using a McGrath videolaryngoscope from a patient with stridor and dyspnea after thyroidectomy performed with intraoperative recurrent laryngeal nerve monitoring. Soon after, the patient was diagnosed with BVCP by an ENT otolaryngologist using a laryngeal fiberscope. The patient underwent exploration and received a permanent tracheostoma. The possibility of false negative findings from intraoperative nerve monitoring should considered if there is suspicion of BVCP in a high risk patient after thyroidectomy. The McGrath video-laryngoscope can be useful for early discovery of postoperative vocal cord dysfunction.

Intubation training by video-laryngoscope among novice residents:digital video versus intubation model simulator / 基础医学与临床

Objective To compare the effectiveness of training with a digital video disc ( DVD)-based instruction ver-sus intubation model simulator in placement of endotracheal tube by video -laryngoscope .Methods Sixty patients un-dergoing elective gynecology surgeries and twenty residents of Dept .of anesthesiology were randomized to place a en-dotracheal tube by video-laryngoscope .Results Compared with intubation model simulator , intubation time [ (68 ± 14)s vs (69 ±7)s], score of performance (8.24 ±0.64 vs 8.31 ±0.58), failure rate (3 times/11 vs 1time/9 resi-dents), and instruction rate (5times/11 vs 4times/9 residents) were no statistic difference .Conclusions Digital video disc ( DVD)-based instruction is an alternative way to intubation model simulator in training .

Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury-a manikin study / Comparação do C-MAC convencional e C-MAC D-blade com laringoscópios diretos em simulação de lesão da coluna cervical-estudo em modelo / Comparação do C-MAC convencional e C-MAC D-blade com laringoscópios diretos em simulação de lesão da coluna cervical-estudo em modelo / Comparación del C-MAC convencional y C-MAC D-blade con laringoscopios directos en simulación de lesión de la columna cervical (estudio en modelo)

BACKGROUND: CMAC videolaryngoscope has recently been introduced for videoscope guided intubation. The aim of our study was to compare and evaluate the efficacy of the conventional blade and the angulated D blade of the CMAC videolaryngoscope with the direct laryngoscopes in simulated cervical spine injury patients on the airway manikin. MATERIALS AND METHODS: Following power analysis, 33 resident doctors were enrolled to perform endotracheal intubation using all the 4 different laryngoscopes namely the Macintosh laryngoscope, McCoy laryngoscope, conventional CMAC videolaryngoscope and the D blade of the CMAC videolaryngoscopes on the airway manikin in simulated cervical spine injury. The demographic variables of the resident doctors were recorded. The outcomes measured included vocal cord visualization (Cormack-Lehane grading), time taken to intubate, number of attempts for successful intubation and optimizing maneuvers required. RESULTS: The use of indirect videolaryngoscopes resulted in better glottic visualization in comparison to the direct laryngoscopes (CL-I) in 20/33 (60.6%) in the Macintosh group, 24/33 (72.7%) in McCoy group, 30/33 in (90.9%) in Vlc group and 32/33 (96.9%) in Vld group. The time taken to intubate averaged to 15.54 ± 2.6 in Macintosh group, 18.90 ± 4.47 in McCoy group, 20.21 ± 7.9 in Vlc group and 27.42 ± 9.09 in Vld group. The 1st attempt intubation success rate was 84.8% (Macintosh), 72.7% (McCoy), 90.9% (Vlc) and, 78.7% (Vld). CONCLUSIONS: The overall performance of the conventional CMAC blade proved to be the best when compared with the D-blade CMAC, Macintosh blade and the McCoy blade for intubation in simulated cervical spine patients by anesthesia residents. .

JUSTIFICATIVA E OBJETIVO: o videolaringoscópio C-MAC foi recentemente introduzido para orientar a intubação. O objetivo deste estudo foi comparar e avaliar a eficácia do laringoscópio C-MAC de lâmina convencional e C-MAC de lâmina angulada (D-blade) com laringoscópios diretos em simulação de pacientes com lesão de coluna cervical usando modelo de vias aéreas. MATERIAIS E MÉTODOS: após a análise do poder do estudo, 33 médicos residentes foram inscritos para realizar intubações endotraqueais, usando todos os quatro laringoscópios diferentes: laringoscópio Macintosh, laringoscópio McCoy, videolaringoscópios C-MAC convencional e C-MAC D-blade em modelos de vias aéreas com simulação de lesão da coluna cervical. As variáveis demográficas dos médicos residentes foram registradas. Os resultados avaliados incluíram visualização das pregas vocais (classificação de Cormack-Lehane), tempo necessário para intubar, número de tentativas para intubação bem-sucedida e manobras de otimização necessárias. RESULTADOS: o uso de laringoscópios indiretos resultou em melhor visualização da glote em comparação com os laringoscópios diretos (CL-I) em 20/33 (60,6%) no grupo Macintosh, 24/33 (72,7%) no grupo McCoy, 30/33 (90,9%) no grupo Vlc e 32/33 (96,9%) no grupo Vld. A média do tempo necessário para entubar foi de 15,54 ± 2,6 no grupo Macintosh, 18,90 ± 4,47 no grupo McCoy, 20.21 ± 7,9 no grupo Vlc e 27,42 ± 9,09 no grupo Vld. A taxa para a primeira tentativa de intubação bem-sucedida foi de 84,8% (Macintosh), 72,7% (McCoy), 90,9% (Vlc) e 78,7% (Vld). CONCLUSÃO: o desempenho geral da lâmina do C-MAC convencional mostrou ser melhor quando comparado com o das lâminas ...

JUSTIFICACIÓN Y OBJETIVO: el videolaringoscopio C-MAC fue recientemente introducido para orientar la intubación. El objetivo de este estudio fue comparar y evaluar la eficacia del laringoscopio C-MAC de lámina convencional y C-MAC de lámina angulada (D-blade) con laringoscopios directos en una simulación de pacientes con lesión de la columna cervical usando modelo de vías aéreas. MATERIALES Y MÉTODOS: después del análisis del poder del estudio, 33 médicos residentes fueron inscritos para realizar intubaciones endotraqueales, usando 4 laringoscopios diferentes: laringoscopio Macintosh, laringoscopio McCoy, videolaringoscopios C-MAC convencional (Vlc) y C-MAC D-blade (Vld) en modelos de vías aéreas con simulación de lesión de la columna cervical. Las variables demográficas de los médicos residentes fueron registradas. Los resultados evaluados incluyeron la visualización de las cuerdas vocales (clasificación de Cormack-Lehane), tiempo necesario para intubar, número de intentos para intubación exitosa y maniobras de optimización necesarias. RESULTADOS: el uso de laringoscopios indirectos trajo como resultado una mejor visualización de la glotis en comparación con los laringoscopios directos (CL-I) en 20/33 (60,6%) en el grupo Macintosh, 24/33 (72,7%) en el grupo McCoy, 30/33 (90,9%) en el grupo Vlc y 32/33 (96,9%) en el grupo Vld. El tiempo medio necesario para intubar fue de 15,54 ± 2,6 en el grupo Macintosh; 18,90 ± 4,47 en el grupo McCoy; 20,21 ± 7,9 en el grupo Vlc; y 27,42 ± 9,09 en el grupo Vld. La tasa para el primer intento de intubación exitoso fue de un 84,8% (Macintosh), un 72,7% (McCoy), un 90,9% (Vlc) y un 78,7% (Vld). CONCLUSIÓN: el rendimiento global de la lámina del C-MAC convencional mostró ser mejor cuando se le comparó con el de las láminas ...

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R) / 대한구급학회지

BACKGROUND: The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening. METHODS: Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time. RESULTS: The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001). CONCLUSIONS: Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

Intubación nasotraqueal con ‘videolaringoscopio artesanal’ en paciente con vía aérea dificultosa prevista

RESUMEN El objetivo de este trabajo fue analizar un caso de vía aérea dificultosa prevista que requirió intubación nasotraqueal (INT) para cirugía maxilofacial, y se resolvió con un laringoscopio convencional modificado mediante el agregado de una mini cámara. Paciente de sexo femenino de 68 años, coordinada para osteosíntesis de maxilar inferior y órbita con INT. Antecedentes: neoplasma de mama operado. Fumadora intensa. Traumatismo encéfalocraneano 3 semanas antes, con fractura de peñasco y sin lesiones parenquimatosas. Parálisis facial periférica secundaria al trauma. Del examen se destaca: desviación de rasgos a izquierda, parálisis de Bell, apertura bucal disminuida (2,5 cm), Mallampati IV, flexo-extensión de cuello limitada, distancias conservadas. Se preparó la narina derecha con solución de adrenalina aplicada con torundas. Premedicación con Fentanil 2 mg/kg, preoxigenación al 100%, inducción con propofol. Se comprobó una buena permeabilidad de la narina derecha digitalmente, por lo que se pasó una sonda endotraqueal (SET) 7.0 hasta atravesar los cornetes; laringoscopía con pala curva número 3 preparada con una cámara de 7 mm (7 mm USB Endoscope, Welsky Technologies Limited) pegada en el extremo distal, conectada a una notebook en la cual se visualizaron las estructuras. No se administró relajante muscular hasta lograr la intubación. Al visualizar las cuerdas vocales en la pantalla, se progresó la SET en la vía aérea sin necesidad de utilizar pinza de Magill. Conclusión: el laringoscopio modificado con el agregado de una cámara y bajo visión en una pantalla fue efectivo para realizar la INT y resolver esta situación de vía aérea dificultosa prevista.

SUMMARY The objective of this work was to analyze a case of expected difficult airway that required nasotracheal intubation (INT) for maxillofacial surgery, which was resolved with a traditional laryngoscope modified by the addition of a mini-camera. Female patient, 68 years of age, scheduled for osteosynthesis of jaw and orbit with INT. History: operation of breast cancer. Heavy smoker. Traumatic brain injury 3 weeks before, with petrous bone fracture and no parenchymal injuries. Peripheral facial paralysis secondary to trauma. Examination shows: features deviation to the left, Bell's palsy, reduced mouth opening (2.5 cm), Mallampati IV, limited flexion and extension of the neck, distances are preserved. Right nostril was prepared with adrenaline solution applied with swabs. Premedication with Fentanyl 2 g/kg, preoxygenation at 100%, induction with propofol. Good permeability of right nostril was confirmed by digital examination, allowing to insert a 7.0 endotracheal tube (ETT) until passing through the turbinate bones; laryngoscopy with #3 curved blade equipped with a 7 mm camera (7 mm USB Endoscope, Welsky Technologies Limited) at the distal tip, connected to a notebook wherein structures were visualized. No muscle relaxant was administered until intubation was completed. ETT was introduced after visualizing the vocal cords on the screen; Magill forceps were not used. Conclusion: the laryngoscope modified by the addition of a camera for visualization on a monitor screen was effective to carry out INT and manage this expected difficult airway situation.

RESUMO O objetivo deste trabalho foi analisar um caso de previsão de via aérea difícil que requereu intubacão nasotraqueal (INT) para cirurgia maxilofacial, que foi solucionado com um laringoscópio convencional modificado mediante o acoplamento de uma câmera. Paciente do sexo feminino de 68 anos, marcada para realizar osteossintese do maxilar inferior e orbita com INT. Antecedentes. Operada de neoplasia de mama. Tabagista intensa. Traumatismo encefalocrãniano há 3 semanas, com fratura de rochedo e sem lesões parenquimatosas. Paralisia facial periférica secundaria ao trauma. Do exame destaca-se : desvio de simetria facial a esquerda, paralisia de Bell, abertura bucal diminuída (2.5 cm) Mallampatti IV, flexo-extensão do pescoço limitada, distancias conservadas. Preparou-se a narina direita com solução de adrenalina aplicada em torundas. Premedicação com Fentanil 2 µg /kg, pré-oxigenacão a 100%, indução com Propofol. Comprovou-se boa permeabilidade da narina direita digitalmente, pela qual se introduziu uma sonda endotraqueal (SET) 7.0 até atravessar os cornetos , laringoscopia com lamina curva numero 3 preparada com uma câmera de 7 mm (7 mm USB Endoscope , Welsky Technologies Limited) acoplada ao extremo distal, conectada a um notebook no qual se visualizaram as estruturas. Não se administrou relaxante muscular ate que houve-se sucesso na intubação. Ao visualizar as cordas vocais na tela, se progrediu a SET na via aérea sem necessidade de utilização de pinça de Magill. Conclusão: o laringoscópio modificado com uma câmera acoplada e visualização numa tela foi efetivo para realizar a INT e resolver essa situação de previsão de via aérea difícil.

The clinical application of video-laryngoscope in spontaneous respiration tracheal intubation / 中华急诊医学杂志

ObjectiveTo assess the safety and clinical values of video-laryngoscope in spontaneous respiration tracheal intubation for emergency patients. Methods Seventy-nine patients,who needed the endotracheal intubation,were recruited in our department between January 2010 and December 2010,and were randomly ( random number) divided into two groups according to consultative sequence.Forty patients (group A ) were operated with traditional laryngoscope and thirty-nine patients (group B ) with videolaryngoscope.The operative time and success rate of tracheal intubation,Cormack-Lehane classification,as well as adverse events,were recorded.The heart rate ( HR ),mean arterial blood pressure ( MAP),respiratory rate ( RR ),and saturation of pulse oxygen ( SpO2 ) were observed pre-operation,during operation and 2 min post-operation.Results( 1 ) The Cormack-Lehane classification in group A were significantly lower than in group B. (2) The operative time of tracheal intubation in group B was significantly less than that in group A [(35.6+12.7) svs. (58.3 ± 13.5) s; P＜0.05] ; and one-time success rate of tracheal intubation in group B was higher than that in group A ( 84.6％ vs.52.5％ ; P ＜0.05).(3) Compared to group B,the HR and MAP in Group A were significantly increased at t2 and t3 ( P ＜ 0.05 ). ( 4 ) The adverse events,including restlessness,bucking and injury,were significantly decreased in group B than those in group A ( P ＜ 0.05 ).ConclusionsThe video-laryngoscope used in spontaneous respiration tracheal intubation,could improve Cormack-Lehane classification,short operative time,enhance one-time success rate and reduce adverse evevnts.

A comparison of the Glidescope(R) to the McGrath(R) videolaryngoscope in patients / 대한마취과학회지

BACKGROUND: The Glidescope(R) videolaryngoscope is a new device for tracheal intubation that provides an improved view of the larynx. This study was performed to compare the Glidescope with the McGrath videolaryngoscope in terms of time to intubation (TTI) and number of attempts. METHODS: Patients were randomly allocated to one of two groups, Glidescope or McGrath group, by using computer-generated numbers. Tracheal intubation was attempted by an anesthesiologist with extensive experience using these two devices. The operator recorded ease of visualization of glottic structures based on the classification described by Cormack and Lehane. Number of failures, number of attempts and their duration, total intubation time, and events during the whole procedure were recorded. The duration of one attempt was defined as the time elapsed between picking up the endotracheal tube and verification of tracheal intubation with visualization of three expiratory carbon dioxide waveforms. TTI was defined as the sum of the duration of all intubation attempts (as many as three), excluding preoxygenation procedures. RESULTS: TTI was significantly shorter for the Glidescope(R) compared to the McGrath(R) laryngoscope (40.5 vs. 53.3 s, respectively, P < 0.05). However, glottic views obtained at intubation were similar between the two groups. Number of intubation attempts was not significantly different between the two groups (1.03 +/- 0.19 vs 1.10 +/- 0.32, respectively) (mean +/- SD). CONCLUSIONS: Study results demonstrated that the Glidescope reduced total intubation time in comparison with the McGrath, in terms of TTI in patients with normal airways.

The use of Pentax-Aws(R) for difficult intubation due to postburn contracture: Two cases report / 대한마취과학회지

The causes of difficult intubation associated with post-burn contracture from the face to the upper torso include the limitations of neck movement and opening the mouth. Fiberoptic oral intubation can be the final alternative technique that overcomes those difficulties. However, a small inter-incisor gap about 2 cm, a fixed head or neck position and the large tongue in these cases makes fiberoptic intubation difficult. The Pentax-AWS video display unit (Pentax-AWS(R), Pentax, Japan) (Pentax-AWS) allows indirect visualization of the glottis without a straightened line of orophalyngolaryngeal axis and its attached tracheal tube and this makes the intubation easier. We experienced rapid, easy intubation with Pentax-AWS following multiple attempts of fiberoptic intubation or confirming a bad glottic view with a Macintosh laryngoscope. Further study is needed on the availibility of Pentax-AWS and comparing it with fiberoptic intubation for the management of a difficult airway.

Application of Glidescope Video-Laryngoscope in Children Undergoing General Anesthesia / 实用儿科临床杂志

0.05).The Cormack and Lehane laryngeal exposure grades obtained by the Macintosh laryngoscope with and without ELM were significantly different(Z=3.55 P0.05).Of all 33 pediatric patients,successful orotracheal intubation using the GSLV was completed by one attempt in 31 patients and by 2 attempts in 2 cases.The time required to achieve successful tracheal intubation was 20-51(30.0? 7.9) s.Conclusions GSLV is as useful as Macintosh laryngoscope for laryngeal exposure and orotracheal intubation in children.When the orotracheal intubation is done using the GSLV in children,the distal end of a styletted endotracheal tube should be bent anteriorly to an angle of 70-80 degrees and ELM is routinely used.