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Kuo YM, Lai HY, Tan ECH, Li YS, Chiang TY, Huang SS, Huang WC, Chu YC. Cervical spine immobilization does not interfere with nasotracheal intubation performed using GlideScope videolaryngoscopy: a randomized equivalence trial. Sci Rep 2022; 12:4041. [PMID: 35260735 PMCID: PMC8904815 DOI: 10.1038/s41598-022-08035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
GlideScope-assisted nasotracheal intubation (NTI) has been proposed as an alternative to difficult orotracheal intubation for critical patients or those under cervical immobilization. We evaluated the difficulty of performing NTI using GlideScope under cervical orthosis. A total of 170 patients scheduled for elective cervical spinal surgery that required NTI were randomized to receive cervical immobilization using a cervical collar (collar group) or no cervical immobilization at all (control group) before anesthetic induction (group assignment at 1:1 ratio). All NTI during anesthetic induction were performed using the GlideScope. The primary outcome was time to intubation. The secondary outcomes were ease of intubation, including the necessity of auxiliary manipulations to assist intubation, and the nasotracheal intubation difficulty scale (nasoIDS). An exploratory analysis identified morphometric parameters as predictors of time to intubation, the necessity of auxiliary manipulations, and a nasoIDS score ≥ 4. For time to intubation, the mean difference (collar group-control) was - 4.19 s, with a 95% confidence interval (CI) of - 13.9 to 5.52 that lay within our defined equivalence margin of 16 s. Multivariate regressions precluded the association of cervical immobilization with a necessity for auxiliary manipulations (adjusted odds ratio [aOR] 0.53, 95% CI [0.26-1.09], P = 0.083) and a nasoIDS ≥ 4 (aOR 0.94 [0.84-1.05], P = 0.280). Among all morphometric parameters, the upper lip bite test class was predictive of a longer time to intubation (all analyses relative to class 1, 14 s longer for class 2, P = 0.032; 24 s longer for class 3, P = 0.070), increased necessity for auxiliary manipulation (aOR 2.29 [1.06-4.94], P = 0.036 for class 2; aOR 6.12 [1.04-39.94], P = 0.045 for class 3), and nasoIDS ≥ 4 (aOR 1.46 [1.14-1.89], P = 0.003 for class 3).The present study demonstrated that GlideScope achieved NTI in patients with or without cervical immobilization equivalently with respect to intubation time and ease.
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Affiliation(s)
- Yi-Min Kuo
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Hsien-Yung Lai
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, 970, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, 11217, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Ting-Yun Chiang
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
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Park DH, Lee CA, Jeong CY, Yang HS. Nasotracheal intubation for airway management during anesthesia. Anesth Pain Med (Seoul) 2021; 16:232-247. [PMID: 34352965 PMCID: PMC8342817 DOI: 10.17085/apm.21040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022] Open
Abstract
Nasotracheal intubation is used as a basic method for airway management, along with orotracheal intubation under anesthesia and intensive care. It has become an effective alternative method to orotracheal intubation with increased benefits of offering better mobility and surgical field in oral and maxillofacial surgery and possibly in trauma and critically ill patients. Nasotracheal intubation is performed through a relatively narrow nasal cavity; therefore, additional precautions are needed. Accordingly, nasotracheal intubation methods have evolved over the years with accumulated clinical experience and improved instruments to facilitate safe intubation with reduced complications. Therefore, in this review article, we summarize the basic anatomy of the nasal airways to clarify the precautions, delineate the history and development of various methods and instruments, and describe the indications, contraindications, complications, and preventive methods of nasotracheal intubation.
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Affiliation(s)
- Dong Ho Park
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji University Medical Center, Eulji University, School of Medicine, Daejeon, Korea
| | - Chia An Lee
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji University Medical Center, Eulji University, School of Medicine, Daejeon, Korea
| | - Chang Young Jeong
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji University Medical Center, Eulji University, School of Medicine, Daejeon, Korea
| | - Hong-Seuk Yang
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji University Medical Center, Eulji University, School of Medicine, Daejeon, Korea
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Kim J, Im KS, Lee JM, Ro J, Yoo KY, Kim JB. Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients. J Int Med Res 2015; 44:136-46. [PMID: 26647074 PMCID: PMC5536577 DOI: 10.1177/0300060515594193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia. Methods Mallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented. Results Of 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time. Conclusions Ease of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.
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Affiliation(s)
- Joungmin Kim
- Department of Anaesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyong Shil Im
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Myeong Lee
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaehun Ro
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Yeon Yoo
- Department of Anaesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jong Bun Kim
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Manabe Y, Iwamoto S, Seto M, Sugiyama K. Appropriate head position for nasotracheal intubation by using lightwand device (Trachlight). Anesth Prog 2014; 61:47-52. [PMID: 24932977 DOI: 10.2344/0003-3006-61.2.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of "unsuccessful" cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis.
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Affiliation(s)
- Yozo Manabe
- Department of Systemic Management for Dentistry, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
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