Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Introduction The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilítate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60° angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective To compare the ease of oral intubation with the use of the C-MAC stylet (60° angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Method Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60° angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions The 60° angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

Introducción: El videolaringoscopio C-MAC D-blade se diseñó para los casos de intubación de la vía aérea difícil. Para facilitar una intubación más rápida y sencilla en la paradoja de la laringoscopía se prefiere un introductor. Por tanto, decidimos realizar un estudio para comparar el estilete de 60° C-MAC y el bougie elástico de goma como ayudas para la intubación utilizando el laringoscopio C-MAC D-blade en una situación simulada de vía aérea difícil. Objetivo: Comparar la facilidad de intubación oral mediante el uso del estilete del C-MAC (estilete angulado de 60°) con la intubación realizada sobre un bougie insertado con la guía del C-MAC D0-blade en pacientes con restricción simulada de la movilidad cervical. Métodos: Estudio prospectivo, aleatorizado y controlado realizado en un solo centro. Se realizó intubación utilizando el laringoscopio C-MAC D-blade D en 48 pacientes quirúrgicos asignados aleatoriamente a 2 grupos de 24 cada uno: grupo de estilete, grupo S (con el estilete angulado de 60°) y el grupo de bougie o grupo B (con bougie) después de establecer una estabilización manual del eje para restringir la movilidad cervical. Se aplicaron las pruebas U de Mann-Whitney U y de Chi cuadrado según correspondiera. Resultados: Con el estilete fue más fácil (Grupo S 75% vs. Grupo B 16.7%) y más rápida (Grupo S 26.83 ± 8.61s vs. Grupo B 47.18 ± 16.46s) la intubación, requiriéndose un menor número de intentos en comparación con el Grupo B. Los dos grupos experimentaron un estrés hemodinámico similar en respuesta a la intubación. Conclusiones: El estilete angulado de 60° C-MAC es una ayuda más efectiva y ahorra más tiempo con el C-MAC D-blade en comparación con el bougie.

A comparison of tracheal intubation guided by Lightwand,Shikani optical stylet or Macintosh / 实用医学杂志

Objective To compare of the application of tracheal intubation guided by Lightwand,Shikani optical stylet,or Macintosh. Methods Ninety ASA Ⅰ~Ⅱ patients undergoing elective general anesthesia were randomly divided into three groups(n = 30):Macintosh group(group M),Lightwand group(group L)and Shi-kani optical stylet group(group S). MAP and HR were recorded at the time of entering the operating room(T1), before intubation(T2),at the immediate time of intubation(T3),3 mins(T4)and 5 mins after intubation(T5). The intubation duration,the first intubation success rate,the number of intubation,and the incidence of complications including sore throat were observed. Results As compared with T1,MAP and HR decreased significantly at T2in the three groups(P<0.05). As compared with T2,HR increased in group L and MAP and HR increased in group S at T3(P<0.05). As compared with group M,MAP and HR at T4and T5were lower in groups L and S(P<0.05). The first intubation time was obviously shorter in group L than in other groups(P<0.05). The incidence of compli-cations was lower in group S(P < 0.05). The first success rate of intubation,the intubation times and the inci-dence of airway complications did not differ significantly among the three groups.(P > 0.05). Conclusions As compared with Macintosh,Lightwand and Shikani optical stylet have less influence on hemodynamic parameters. Lightwand needs shorter intubation time,Shikani optical stylet has the lowest rate of sore throat.

Comparison of different stylets used for intubation with the C-MAC D-Blade® Videolaryngoscope: a randomized controlled study / Comparação de diferentes estiletes usados para intubação com o videolaringoscópio C-MAC D-Blade®: um estudo randômico e controlado

Abstract Objective The angle of the C-MAC D-Blade® videolaryngoscope, which is used for difficult airway interventions, is not compatible with routinely used endotracheal tubes. Methods A prospective randomized crossover study was performed comparing five intubation methods for use with standardized airways, including using different stylets or no stylet: Group HS, hockey-stick stylet; Group DS, D-blade type stylet; Group CS, CoPilot® videolaryngoscope rigid stylet®; Group GEB, gum elastic bougie; and Group NS, no stylet. A manikin was used to simulate difficult intubation with a Storz C-MAC D-Blade® videolaryngoscope. The duration of each intubation stage was evaluated. Results Participants in this study (33 anesthesiology residents and 20 anesthesiology experts) completed a total of 265 intubations. The number of attempts made using no stylet was significantly greater than those made for the other groups (p < 0.05 for group NS- group GEB, group NS- group DS, group NS- group CS and group NS- group HS). The duration to pass the vocal cords significantly differed among all groups (p < 0.001). The total intubation duration was shortest when using D-blade stylet, CoPilot stylet and hockey stick stylet. Although no difference was observed between stylet groups, a significant difference was found between each of these three and no stylet and gum elastic bougie (p < 0.05 and p < 0.001, respectively). Conclusion Use of the correct stylet leads to a more efficient use of the Storz C-MAC D-Blade®. In our study, the use of the D-blade stylet, the CoPilot stylet and the hockey stick stylet provided quicker intubation, allowed easier passage of the vocal cords, and decreased the total intubation duration. To confirm the findings of our study, randomized controlled human studies are needed.

Resumo Objetivo O ângulo do videolaringoscópio C-D-MAC Blade®, usado para intervenções em via aérea difícil, não é compatível com os tubos endotraqueais rotineiramente usados. Métodos Um estudo prospectivo, randômico e cruzado foi conduzido para comparar cinco métodos de intubação em modelo de via aérea, com o uso de diferentes estiletes em cinco grupos: taco de Hockey; D-blade; CoPilot VL® rígido; Gum Elastic Bougie e controle (sem estilete). Um manequim foi utilizado para simular intubação difícil com o laringoscópio Storz C-MAC D-Blade®. Foi avaliada a duração de cada fase de intubação. Resultados Os participantes deste estudo (33 residentes de anestesiologia e 20 especialistas em anestesiologia) concluíram 265 intubações no total. O número de tentativas realizadas sem estilete foi significativamente maior que o dos outros grupos (p < 0,05 para SE-GEB, SE-DB, SE-CP e SE-HS). O tempo para passar pelas cordas vocais foi significativamente diferente entre todos os grupos (p < 0,001). O tempo total de intubação foi menor com o uso de D-blade, CoPilot VL® rígido e taco de Hockey. Embora não tenha havido diferença entre D-blade, CoPilot VL® rígido e taco de Hockey, uma diferença significativa foi observada entre cada um desses três e os grupos sem estilete e Gum Elastic Bougie (p < 0,05 e p < 0,001, respectivamente). Conclusão A escolha do estilete certo leva ao uso mais eficiente do videolaringoscópio Storz C-MAC D-Blade®. Em nosso estudo, o uso do D-blade, CoPilot VL® rígido e taco de Hockey proporcionou intubação mais rápida, facilitou a passagem pelas cordas vocais e diminuiu o tempo total de intubação. Para confirmar os resultados de nosso estudo, estudos controlados e randômicos com humanos são necessários.

Is endobronchial ultrasound-guided transbronchial needle aspiration with a stylet necessary for lymph node screening in lung cancer patients?

During endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), a needle is commonly used with a stylet, although recently the stylet has been omitted. This prospective study aimed to compare the quality of specimens obtained by EBUS-TBNA performed with and without a stylet. Between November 2013 and November 2014, 131 patients with lung cancer underwent EBUS-TBNA, with a total of 148 mediastinal or hilar lymph nodes sampled both with and without an inner-stylet, yielding 296 cytological specimens. Specimens were scored cytologically using five parameters: background blood or clot, amount of cellular material, degree of cellular degeneration, degree of cellular trauma, and retention of appropriate architecture. The procedure with a stylet required significantly longer operation time than without a stylet (14.5±0.8 vs 12.7±1.1 min, P<0.001). Excellent specimens were obtained in 261/296 and 260/296 samples in the procedures with and without a stylet, respectively (P=0.9), while the remaining 35 and 36 samples, respectively, were adequate. The diagnosing and staging of lung cancer using EBUS-TBNA did not differ significantly between the groups. In conclusion, specimen collection by EBUS-TBNA without a stylet is easier and faster than the procedure using a stylet and absence of a stylet did not alter specimen quality or diagnostic accuracy.

Comparison between shikani optical stylet and Mc coy laryngoscope on elder patients with intratracheal intubation anesthesia / 中国内镜杂志

Objective To compare shikani optical stylet and Mc coy laryngoscope on elder patients with intratracheal intubation anesthesia.Methods 112 cases of elder patients with intratracheal intubation anesthesia were enrolled as study objects, all patients were divided into shikani optical stylet group (52 cases), Mc coy laryngoscope group (60 cases) according to different intubation way. Then detect the hemodynamic parameters, stress-related indicators, EEG relevant indicators of the two groups.Results One time success rate and total success rate in Shikani visual laryngoscope group was higher than Mc Coy visual laryngoscope group, while many times intubation rate was lower (P < 0.05); T1, T2 MAP, HR levels were lower in Shikani optical stylet group than Mc Coy laryngoscope group patients (P < 0.05); Plasma levels of epinephrine, norepinephrine, and glucose on T1, T2 in Shikani optical stylet group was lower than that in Mc Coy laryngoscope group (P < 0.05); T1, T2 BIS, ECoG grading, αβ% values in Shikani optical stylet group was lower than that in Mc coy laryngoscope group (P < 0.05).Conclusions Elderly patients with intratracheal intubation anesthesia received shikani optical stylet can enhance the success rate of intubation and effectively stabilize patients circulatory system, reduce excessive physical stress caused by various system dysfunction, which shows positive significance.

Comparison of intubation of Shikani optical stylet and Clarus Video Stylet in patients with cervical spine immobilization / 实用医学杂志

Objective To compare the application of Shikani optical stylet(SOS)and Clarus Video Sty-let(Tracway)in patient with cervical spine immobilization in tracheal intubation. Method Sixty patients,ASAⅠ~Ⅱ,undergoing cervical internal fixation operation,were randomly divided into Shikani optical stylet group (Group S,n = 30)and Clarus Video Stylet group(Group T,n = 30). MAP,HR and RPP(The rate-pressure product)were recorded at the point before induction of anesthesia(T1),before intubation(T2),at the immediate time of intubation(T3)and 1 min(T4),3 mins(T5),and 5 mins after intubation(T6).The intubation time,one-time success rate of intubation,the number of intubation times and the incidence of sore throat and other complica-tions were observed. Results The one-time intubation time in group S was obviously shorter than that in group T (P<0.05).The incidence of mild sore throat and intubation throat injury rate were lower in group S than those in group T(P<0.05).Compared with those at T1,MAP and RPP decreased significantly at point of T2~T6in both of two groups(P<0.05).There was no significantly difference in MAP,HR and RPP at any points of time between the two groups. The one-time success rate of intubation,the number of intubation times and the incidence of air-way complications in two groups(P>0.05)were no significantly different. Conclusions Compared with Clarus Video Stylet(Tracway),Shikani optical stylet can shorten the intubation time in patients with cervical spine immo-bilization,but no difference was found in regard to the hemodynamic influence on intubation,success rate of intu-bation,the intubation times,the sore throat and the other related complications.

Preliminary Clinical Application of a Novel Locking Stylet in Cardiac Lead Extraction / 中国循环杂志

Objective: To explore the safety and efficacy of a novel lead locking device (LLD) in the procedure of cardiac lead extraction for heart rhythm implants. Methods: A total of 6 patients using LLD for cardiac lead extraction in our hospital were retrospectively reviewed. Clinical parameters, the reason of cardiac lead extraction, lead locking stylet condition, outcome of lead extraction and operative complications were summarized. Results: There were 6 patients including 1 female with the median age at 62.5 years. LLD was used and 13 cardiac leads were extracted including 1 scrap electrode wire and 12 functional electrode wire. Among those, LLD was successfully inserted and locked on the top of 11/13 (85%) leads for whole procedure and 2 (15%) leads were not locked for whole procedure; 12 (92 %) leads were completely removed and 1 (8%) lead was partially removed. No severe complications occurred. Conclusion: The novel LLD may safely and effectively extract electrode lead which is beneficial for complete cardiac lead extraction.

Successful Tracheal Intubation Using Rigid Video-Stylet in a Ptiaent with Tracheobronchopathia Osteochondroplastica / 계명의대학술지

Tracheobronchopathia osteochondroplastica (TO) is a rare dysplastic disease of the trachea characterized by cartilaginous or bony nodules in the tracheobronchial lumen. Rigid video-stylet is an intubating device that provides favorable conditions even in the difficult cases. In this report, we describe a successful airway management using the rigid video-stylet in a 62-year-old man with unanticipated difficult intubation later diagnosed for TO. He was planned for elective percutaneous nephrolithotomy under general anesthesia. He was healthy without any airway symptoms. With the rigid video-stylet, we not only performed successful tracheal intubation but also examined endotracheal lumen simultaneously. Using the rigid video-stylet, we noticed multiple whitish projecting nodules in the trachea, which were the typical findings for TO.

Impact of orotracheal intubation by Macintosh laryngoscopy versus Shikani optical stylet on blood pressure and heart rate / 实用医学杂志

Objective To compare the hemodynamic response to orotracheal intubation by Macintosh laryngoscopy (MAC) with Shikani optical stylet (SOS). Methods Forty neurosurgical patients, ASA physical status Ⅰ~Ⅲ, were prospectively randomized to MAC group (n = 20) and SOS group (n = 20) according to the method of orotracheal intubation. Heart rate (HR) and invasive systolic blood pressure (SBP) were recorded at pre- and post-intubation. Results The intubation time was significantly longer in SOS group than in MAC group [(22 ± 8) s vs. (17 ± 8) s, P < 0.05]. SBP in both groups decreased significantly after induction (P < 0.05) and increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ at 3, 4 and 5 min. HR in both groups did not differ significantly between the SBP after induction. HR in both groups increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ markedly at 3, 4 and 5 min after induction. There were no significant differences in the peak SBP and HR between the two groups. Conclusion MAC and SOS cause similar hemodynamic responses to orotracheal intubation.

Comparison of Shikani optical stylet and Macintosh laryngoscope for double-lumen endotracheal tube intubation / 北京大学学报(医学版)

Objective:To compare the efficacy and safety of Shikani ( S) optical stylet and Macintosh (M) laryngoscope for double-lumen endotracheal tube intubation .Methods:In the study, 60 patients undergoing elective thoracic surgery were randomly allocated to group S ( n=30 ) and group M ( n=30 ) . After general anesthesia induction , the patients in group S and group M were intubated double-lumen en-dotracheal tube ( DLT) by Shikani optical stylet ( SOS) and macintosh laryngoscope respectively .Intuba-tion time, intubation attempts , cuff broken and oral mucosal or dental injury were recorded;Blood pres-sure and heart rate at baseline ( T0 ) , at the time of intubaiton onset ( T1 ) , 1 minute after intubaiton (T2), 3 minutes after intubation (T3) and 5 minutes after intubation (T3) were also recorded;Hoarse-ness and throat sore of the patients 24 hours after surgery were evaluated .Results:The intubaiton time with the SOS was faster than with the Macintosh [(37.4 ±9.7) s vs.(43.9 ±13.7) s, P=0.039] and the first attempt success rate (87%vs.80%, P=0.488) did not differ between the groups; No tube cuff broke in both the groups;Group S had fewer patients who suffered oral mucosal or dental injury than group M (8 vs.2, P=0.038);The blood pressure and heart rate at T0,T1,T2,T3 and T4 did not differ between the groups;Throat sore(7 vs.10, P=0.390) and hoarseness (5 vs.7, P=0.519) incidence did not differ between the groups .Conclusion:By comparison of the Macintosh laryngoscope , the SOS provides faster DLT intubation and causes less oral Mucosal or dental injury .

Awake endotracheal intubation using a video-assisted intubating stylet in a patient with a large supraglottic mass: A case report

A 70-year-old man was scheduled for laryngeal microsurgery for supraglottic tumor. A preoperative indirect laryngoscopy demonstrated a large tumor obstructing the most of glottic opening. To prevent damage to the tumor during advancement of the endotracheal tube (ETT), an awake intubation assisted by Clarus Video System (CVS), was planned. Ten percent lidocaine spray was applied to the oropharynx. After sufficient preoxygenation, the patient was lightly sedated with continuous remifentanil and propofol infusion. The CVS, loaded with an ETT (inner diameter of 5.5 mm), was inserted orally by the anesthesiologist. The tube was carefully slid off the stylet into the glottic opening under direct vision. The anesthesiologist also confirmed that there was no damage to the tumor during intubation.

Alternativas a la intubación orotraqueal ANTE UNA VÍA Aérea difícil en nuestro medio / Alternatives for the orotracheal intubation in case of a difficult airway in our environment

Introducción: El control de la vía aérea en el quirófano es una responsabilidad del anestesiólogo, por lo que al finalizar su formación debe haber desarrollado las habilidades necesarias para atender esta exigencia. El control adecuado de la vía aérea para garantizar una correcta ventilación y oxigenación no sólo es indispensable en muchos procedimientos anestésico-quirúrgicos sino también en todas aquellas situaciones en las que la función respiratoria está comprometida. En los últimos años se ha producido una proliferación de nuevos dispositivos y se han mejorado las técnicas antiguas de intubación y ventilación proporcionándonos una gran ayuda en el manejo de la vía aérea difícil. Objetivo: Evaluar el empleo de nuevos instrumentales para la intubación difícil. Desarrollo: Se realizó una revisión bibliográfica sobre los nuevos instrumentos para intubación difícil recién llegados a nuestro hospital como estilete luminoso, guía de Eschmann o gum elastic bougie, combitubo, con el fin de adquirir los elementos teóricos para aplicarlo en la práctica clínica. Conclusiones. De acuerdo a la experiencia con estos instrumentos y la literatura revisada, la primera opción es la utilización del combitubo, la guía de Eschmann o gum elastic bougie en segundo lugar y el estilete luminoso en tercer lugar.

The anesthesiologist is responsible for the control of the airway in the operating theatre who ending its training must to have developed the skills necessary to manage this demand. The appropriate control of the airway to guarantee a proper ventilation and oxygenation not only is essential in many anesthetic-surgical procedures but also in all those situations where the respiratory function is involved. In past years there has been appeared new devices and an improvement in past techniques of intubation and ventilation allowing us a great help in the management of this difficult airway. Objective: To assess the use of new tools for a difficult intubation. Development: A bibliographic review was carried out on the new tools for a difficult intubation now available in our hospital including a bright stylet, Eschmann's guide or gum elastic bougie, combitube to acquire the theoretical elements to be applied in the clinical practice. Conclusions: According to experience with these tools and the reviewed literature, the first option is the use of the combitube, the Eschmann guide or gum elastic bougie in the second place, and the bright stylet in the third one.

Duration of feeding and superficial and in-depth damage to soybean seed by selected species of stink bugs (Heteroptera: Pentatomidae)

Laboratory studies were conducted to compare duration of feeding and superficial and in-depth damage to soybean (Glycine max) seeds by the Southern green stink bug, Nezara viridula (L.), the Neotropical brown stink bug, Euschistus heros (F.), the red-banded stink bug, Piezodorus guildinii (Westwood), and the green-belly stink bug, Dichelops melacanthus (Dallas). Results indicated that feeding time was significantly longer for N. viridula (≈ 133 min) compared to E. heros and D. melacanthus (≈ 70 min), but not different from P. guildinii (≈ 103 min). There was a positive correlation between feeding time and the resulting damage for E. heros, N. viridula and P. guildinii (R² > 0.80, P < 0.0001), but not for D. melacanthus (R² = 0.1011, P = 0.1493). The deepest seed damage (2.0 mm) was made by P. guildinii and the shallowest (0.5 mm) by D. melacanthus. The depth of the seed damage by E. heros and N. viridula (0.8, 1.2 mm, respectively) was intermediate in comparison to the other species studied. Feeding damage to the seed endosperm caused variable cell disruption and protein body dissolution, particularly when P. guildinii fed on seeds, suggesting that the deleterious action of salivary enzymes was greater for this bug compared to the others.

Estudo comparativo entre o uso de laringoscópio e estilete luminoso para intubação traqueal / A comparative study between the laryngoscope and lighted stylet in tracheal intubation / Estudio comparativo entre el uso de laringoscopio y estilete luminoso para la intubación traqueal

JUSTIFICATIVA E OBJETIVOS: A abordagem das vias aéreas como uso do laringoscópio pode causar diversos tipos de traumatismos. Este estudo teve como objetivo tentar esclarecer se o método de intubação que utiliza o estilete luminoso pode ser uma alternativa menos traumática para o paciente em comparação ao método por laringoscopia direta. MÉTODO: O presente estudo envolveu 98 pacientes de 16 a 88 anos, estado físico ASA I e II. Os pacientes foram divididos em dois grupos: Grupo L, submetido à intubação com laringoscópio, com 54 pacientes, e Grupo E, intubado com estilete luminoso, com 44 pacientes. Foram avaliados o número de tentativas para intubação, tempo de intubação, variação de pressão arterial e frequência cardíaca, dor de garganta (odinofagia), disfagia e rouquidão pós-operatória. RESULTADOS: Os dados demográficos e os parâmetros hemodinâmicos foram semelhantes entre os grupos. Não houve diferença estatística significativa na pesquisa de dor de garganta e disfagia entre os dois grupos. A rouquidão foi o único dado estudado em que se observou diferença estatística significativa, mais predominante no grupo E (p = 0,05). CONCLUSÕES: Ambas as técnicas de intubação são semelhantes em relação ao comportamento hemodinâmico dos dois grupos. No entanto, o grupo com estilete luminoso apresentou maior frequência do sintoma rouquidão.

BACKGROUND AND OBJECTIVES: Approaching the airways with a laryngoscope can cause different types of injuries. The objective of the present study was to determine whether lighted stylet tracheal intubation can be a less traumatic alternative for patients when compared to direct laryngoscopy. METHODS: Ninety-eight patients between 16 and 88 years and physical status ASA I and II participated in the present study. Patients were separated into two groups: Group L, 54 patients who were intubated with a laryngoscope, and Group E, 44 patients who were intubated with a lighted stylet. The number of attempts, time until intubation, variation in blood pressure and heart rate, and postoperative sore throat (odynophagia), dysphagia, and hoarseness were evaluated. RESULTS: Demographic data and hemodynamic parameters were similar in both groups. Statistically significant differences in the incidence of sore throat and dysphagia were not observed. Hoarseness was the only data that showed statistically significant differences, being more predominant in Group E (p = 0.05). CONCLUSIONS: The intubation techniques are similar regarding the hemodynamic behavior in both groups. However, hoarseness was more common in group with lighted stylet.

JUSTIFICATIVA Y OBJETIVOS: El abordaje de las vías aéreas con el uso del Laringoscopio puede causar diversos tipos de traumatismos. Este estudio tuvo el objetivo de intentar aclarar si el método de intubación que utiliza el estilete luminoso puede ser una alternativa menos traumática para el paciente en comparación con el método por laringoscopia directa. MÉTODOS: El presente estudio captó 98 pacientes de 16 a 88 años, estado físico ASA I y II. Los pacientes fueron divididos en dos grupos: Grupo L, sometido a la intubación con Laringoscopio, con 54 pacientes, y el Grupo E, intubado con estilete luminoso, que contó con 44 pacientes. Se evaluó el número de intentos para la intubación, el tiempo de intubación, la variación de la presión arterial y la frecuencia cardíaca, dolor de garganta (odinofagia), disfagia y ronquera postoperatoria. RESULTADOS: Los datos demográficos y los parámetros hemodinámicos fueron similares entre los grupos. No hubo diferencia estadística significativa en la investigación del dolor de garganta y disfagia entre los dos grupos. La ronquera fue el único dato estudiado en que se observó diferencia estadística significativa, lo que predominó más en el grupo E (p = 0,05). CONCLUSIONES: Se observó que las dos técnicas de intubación son similares con relación al comportamiento hemodinámico de los dos grupos. Sin embargo, el grupo E presentó una frecuencia más elevada del síntoma de la ronquera.

Awake Glidescope(R) intubation in a patient with a huge and fixed supraglottic mass: A case report / 대한마취과학회지

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.

The successful intubation using Shikani Optical Stylet(TM) on difficult intubation patients: A report of 2 cases

The Shikani Optical Stylet(TM) (SOS, Clarus Medical, USA) is another tool to facilitate tracheal intubation. It combines the benefits of a lightwand and a fiberoptic bronchoscope. We report the application of SOS in facilitating the tracheal intubation of two-person with history of difficult airway management. A 25-year-old woman with micrognathia was scheduled to undergo an exploratory laparotomy. Intubation attemps failed with a direct laryngoscope because of difficulty in her mouth opening. Although airway management was re-attempted by a laryngeal mask airway, it also failed for the same reason. Airway management was successfully performed using the SOS instead of a laryngeal mask airway. The second case was a 38-year-old woman with ankylosing spondylitis, scheduled for spinal fusion. She had difficulty in extending her neck. Intubation was successfully performed via the SOS. We believe that intubation by the SOS is a useful and readily available alternative technique for patients with difficult airways.

Application of Shikani optical stylet to orotracheal intubation in critically conscious patients / 中华急诊医学杂志

Objective To investigate the practical value of Shikani optical stylet used for orotracheal intubation in critically conscious patients and to evaluate the successful rate. Method A total of 48 conscious patients with severe respiratory failure were selected from January 2008 to June 2009. Of them, there were 31 males and 17 females,aging 21-86 years old with an average of 57 years old. All enrolled patients needed endotracheal intubation for mechanical ventilation support, and they were assigned to Shikani group (group S, n = 25) and Macintosh group (group M, n = 23) according to the odd and even number of date of admission to this study. The time consumed for intubation, the number of failure in intubation, the adverse effects or complications such as hemodynam-ic changes, injury to the pharyngo-oral cavity, choking and breath-hold were observed and recorded. The rank test and chi-square test were used for statistical analysis. Results The ratio of the successful intubation at first attempt was much higher in group S (96.0%) than that in group M (60.9%) (P <0.01). Compared with group M, the time consumed for intubation was significantly shortened, the cardiovascular reactions were much mild, and the incidence of injury to pharyngo-oral cavity, choking and breath-hold were less in the group S ( P < 0.01 all). Conclusions For the acute and critical patients, especially the conscious ones, orotracheal intubation with the Shikani optical stylet is rapid, successful, safe and less injurious, resulting in mild cardiovascular reactions.

Iatrogenic Aspiration of a Broken Stylet Detected by Cough / 대한마취과학회지

Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.

Iatrogenic Aspiration of a Broken Metallic Stylet: A case report / 대한마취과학회지

Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.

Surgical Patch Treatment of SVC Syndrome Caused by Transvenous Pacemaker Lead / 日本心臓血管外科学会雑誌

A 56-year-old male had complained of serious facial edema 2 years after transvenous pacemaker implantation. Venography at admission showed complete occlusion of the left innominate vein and severe stenosis of the SVC. A 20mmHg pressure gradient was recognized between bilateral internal jugular veins and SVC. Various conservative therapeutic approaches had been ineffective, then surgical treatment was recommended. A median sternotomy was made, removing the pacing lead by a Locking Stylet easily and safely. The stenotic section was dilated, resecting the fibrous tissue in the thickened venous wall, and enlarged with a shaped pericardial patch. Symptoms diminished postoperatively. Histological findings revealed phlebosclerosis of the stenotic venous wall. This type of surgical approach is effective for lesions with irreversible occlusion or severe stenosis causing SVC syndrome and which do not respond to conservative therapy.