RESUMO
Abstract Introduction: In the management of the anticipated difficult airway (DA), awake intubation is the strategy of choice. In this context, flexible fibroscopy is the tool most widely used as the first choice. However, there is always the rare case where it may fail. Important findings: Six successful rescue cases using videolaryngoscopy following failed fibroscopy in patients with anticipated DA, and 1 case of rescued extubation of an airway previously secured with fiberoptic bronchoscopy. Conclusion: Videolaringoscopy may be an adequate tool to use as a backup plan for the management of an anticipated DA.
Resumen Introducción: En el manejo de vía aérea difícil anticipada la estrategia de elección es la intubación con el paciente despierto. En este contexto, la fibroscopia flexible es la herramienta más utilizada como plan A; sin embargo, en raras ocasiones puede fallar. Hallazgos importantes: Se presentan seis casos de rescates exitosos con videolaringoscopia luego de fibroscopia fallida en pacientes con vía aérea difícil anticipada, y un caso de rescate de extubación de vía aérea asegurada previamente con fibrobroncoscopio. Conclusión: La videolaringoscopia puede ser una adecuada herramienta como plan B para el manejo de la vía aérea difícil anticipada.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Manuseio das Vias Aéreas , Falha da Terapia de Resgate , Intubação Intratraqueal , Laringoscopia , Técnicas de Diagnóstico do Sistema Respiratório , Fibras ÓpticasRESUMO
Objective To evaluate the effect of single operation video intubationscope assisted by disposable mouthpiece in orotracheal intubation. Methods 100 patients undergoing general anesthesia were randomly divided into two groups with 50 cases in each: mouthpiece group (group M): single operation video intubationscope assisted by disposable mouthpiece in orotracheal intubation was performed; control group (group C): Video intubationscope oral intubation assisted by helper were applied. The BP, MAP, HR and SpO2 in the two groups were recorded during intubation. The success rate of intubation, duration of glottis exposure, duration of intubation and complications were recorded. Results Oral-tracheal intubation with video intubationscope were successfully completed for all 100 pa-tients, SpO2 during intubation in two groups was maintained above 95.0%, there was no significant hemodynamic changes in two groups. There were no significant difference in the one-time success rate of intubation, duration of glottis exposure and duration of intubation between group M and group C [92.0%vs 88.0%, (13.0 ±7.0) vs (14.0 ±8.0), (20.0 ± 10.0) vs (21.0 ± 11.0), > 0.05]. No significant complications were reported. Conclusion Compared with video intubationscope oral intubation assisted by helper, single operation video intubationscope assisted by dis-posable mouthpiece in orotracheal intubation also is feasible and effective without needing assistant, it is a simple and convenient technology worthy of application.
RESUMO
Objective To study the use of fiberoptic bronchoscope in the positioning of double-lumen endobronchial tube in Chinese patients. Methods Ninety ASA Ⅰ - Ⅱ patients (60 male and 30 female) undergoing thoracic surgery requiring one-lung ventilation were enrolled in the study. Age ranged from 14-79 years (mean age 56 ?16) and the average height was 169? 6 cm (male) and 158?6 cm (female) respectively. Anesthesia was induced with fentanyl, propofol and vecuronium. Double-lumen endobronchial tube (Broncho-Cath, Mallincrodt Medical) was inserted following conventional procedure. Proper position of double-lumen tube(DLT) was determined by auscultation. Fiberoptic bronchoscope was made if needed. The fiberoptic bronchoscopy was repeated after lateral decubitus positioning of the patient. The depth of the tube inserted was recorded. Results The fiberoptic bronchoscopy revealed that the incidence of malpositioning of the left-sided DLT was 68% and of right-sided DLT was 62% . The most common malposition was that the tube was placed too deep. The dislodgement of DLT in lateral decubitus positioning of the patient occurred in 24% patients and in most cases the DLT was moved upward. The depth of insertion did not correlate with the patient' s height. Conclusion Fiberoptic bronchoscopy is a reliable technique for correct positioning of DLT and should be used routinely.