Manual laryngeal fixation facilitates tracheal intubation during chest compression: A randomized crossover manikin study.

PURPOSE: We compared the effectiveness of external manual laryngeal fixation (MLF) for tracheal intubation during chest compression using three laryngoscopes, the Macintosh laryngoscope (McL), McGRATH® MAC (McGRGTH), and Pentax-AWS Airwayscope® (AWS) on an adult manikin. METHODS: Sixteen novice doctors and 15 experienced anesthesiologists performed tracheal intubation during chest compression on an adult manikin using the McL, McGRATH, and AWS with or without MLF. Tracheal intubation time and intubation success rate were measured. RESULTS: In the AWS trial, all novice and experienced doctors successfully secured the airway with or without MLF during chest compression. In McL and McGRATH trials, MLF significantly improved the rate of successful intubation during chest compression compared to without MLF for novice doctors. While intubation time did not significantly differ with or without MLF in the AWS trial, MLF significantly shortened intubation time in McL and McGRATH trials for both novice and experienced doctors. CONCLUSION: These findings suggest that MLF facilitates tracheal intubation with the McL and McGRATH during chest compression.

Comparison of polyvinyl chloride and elastic stannum stylet extraction forces with various lubricants: a simulation study.

BACKGROUND: Stylets are the most frequently used devices for tracheal intubation, but can be a source of postoperative pharyngeal pain or hoarseness. In this study, we evaluated extraction forces between polyvinyl chloride (PVC) and stannum (Sn) stylets with various lubricants. FINDINGS: Using a manikin, we compared extraction forces between PVC and Sn stylets under four different conditions: without lubricant, 3 ml of water (water), three sprays of 8 % lidocaine (lidocaine), and olive oil. A force measuring device was used to accurately measure the extraction force for stylet removal. The extraction force was significantly smaller with the Sn stylet compared to the PVC stylet, regardless of the lubricant used for all three tracheal tubes with different diameters tested (P < 0.05). In comparisons by lubricant, lidocaine and olive oil resulted in significantly lower extraction forces than with no lubricant or water with the PVC stylet for all tracheal tubes tested. In contrast, there were no significant differences in extraction force by lubricant for the Sn stylet across all tracheal tubes tested. CONCLUSIONS: The Sn stylet required less extraction force compared to the PVC stylet, regardless of the lubricant used.

[Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 µg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium.

[Anesthetic Management of Simultaneous Right Lobectomy and Esophagectomy with a Double-lumen Tracheal Tube and Bronchial Blocker].

Anesthestic management with prolonged one-lung ventilation is difficult, especially when the patient continues smoking habit. Here, we report a successful one-lung ventilation and protection with combined use of double-lumen endotracheal tube and bronchial blocker. A 68-year-old man (height 153 cm; weight, 45 kg) was scheduled for simultaneous surgery of right lobectomy and esophagectomy. He kept smoking to the operation day. To protect the ventilated lung, we guided the bronchial lumen of the DLT to the left bronchus under fiberoptic bronchoscope (FOB) guide and inflated the bronchial cuff. Next, we inserted the bronchial blocker from the tracheal lumen of the DLT and inflated the cuff in the left bronchus under FOB guidance. We performed continuous suctioning of the right trachea via the inner lumen of BB. During the operation, non-negligible amount of blood and sputum was aspirated from the inner lumen of the BB. Furthermore, there was no visible blood inflow in the left bronchus. We could protect the ventilated lung with double cuff, i. e. bronchial cuff of DLT in the left bronchus and BB cuff in the right bronchus. Simultaneous operation was uneventfully performed and no oxygenation or ventilation trouble was observed during the operation.