1
|
Raven SA, Montgomery NT, Chen AS, Nourmohammadi Z, Plott J, Shih A, Koppera P, Zopf DA. Effects of saline submersion at body temperature on airway supportive devices including a novel nasopharyngeal device produced using 3D-printing. Am J Otolaryngol 2024; 45:104366. [PMID: 38729016 DOI: 10.1016/j.amjoto.2024.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE This study investigated dimension changes of various nasopharyngeal airways, including a novel self-supporting device, after saline submersion at body temperature to simulate in-vivo use. Dimension changes over time may reduce efficacy during long-term use and require sizing adjustments or limits on duration of use. MATERIALS AND METHODS Cuffless Covidien endotracheal tubes, pediatric Rusch fixed flange polyvinyl chloride nasal airway tubes, pediatric Rusch Robertazzi style Mediprene nasal airway tubes, and novel silicone elastomer self-supporting nasopharyngeal airways were fully submerged in 0.9 % normal saline solution incubated at 37 degrees Celsius for 15 days. All devices had tube length and wall thickness measured after 0, 1, 2, 3, 4, 5, 10, and 15 days. The 95 % confidence intervals of tube dimensions at each date were compared with the 95 % confidence intervals at day 0. RESULTS The Covidien ET tube, Rusch PVC NPA, and ssNPA tube lengths and wall thicknesses did not change significantly over 15 days. The Rusch Mediprene NPAs had a statistically significant increase in length starting at day 1 and wall thickness at day 2. CONCLUSIONS The novel ssNPA did not expand in the in-vitro environment, supporting its safety for extended use. The PVC NPA and ET tube dimensions also remained stable. However, the Rusch Mediprene NPAs had significant length expansion after 1 day of submersion, indicating a considerable risk of expansion during extended use with potential implications for patient care. Silicone and PVC NPA dimensions remained stable when saturated, indicating these materials may be more appropriate for extended use.
Collapse
Affiliation(s)
- Sarah A Raven
- University of Michigan Medical School, Michigan Medicine, University of Michigan, 1301 Catherine Street, Ann Arbor, MI 49109, USA; Department of Otolaryngology - Head and Neck Surgery, Wayne State University, 5E UHC, 4201 St Antoine, Detroit, MI 48201, USA
| | - Nathan T Montgomery
- Department of Mechanical Engineering, College of Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, College of Engineering, University of Michigan, 2200 Bonisteel Boulevard, Ann Arbor, MI 48109, USA
| | - Alyssa S Chen
- University of Michigan Medical School, Michigan Medicine, University of Michigan, 1301 Catherine Street, Ann Arbor, MI 49109, USA; Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Mass General Brigham, 243 Charles Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Zahra Nourmohammadi
- Department of Biomedical Engineering, College of Engineering, University of Michigan, 2200 Bonisteel Boulevard, Ann Arbor, MI 48109, USA
| | - Jeffrey Plott
- Department of Biomedical Engineering, College of Engineering, University of Michigan, 2200 Bonisteel Boulevard, Ann Arbor, MI 48109, USA
| | - Albert Shih
- Department of Mechanical Engineering, College of Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, College of Engineering, University of Michigan, 2200 Bonisteel Boulevard, Ann Arbor, MI 48109, USA
| | - Prabhat Koppera
- Department of Anesthesiology, Michigan Medicine, University of Michigan, 1540 E Hospital Drive, Ann Arbor, MI 48109, USA
| | - David A Zopf
- Department of Biomedical Engineering, College of Engineering, University of Michigan, 2200 Bonisteel Boulevard, Ann Arbor, MI 48109, USA; Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, University of Michigan, 1540 E Hospital Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
2
|
Khan MU, Khalid W, Latif N, Hussain T. Nasopharyngeal Airway in the Trachea: A Case Report. Cureus 2024; 16:e60149. [PMID: 38864059 PMCID: PMC11166376 DOI: 10.7759/cureus.60149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.
Collapse
Affiliation(s)
- Muhammad Usman Khan
- Anesthesiology and Critical Care, National Hospital & Medical Center, Lahore, PAK
| | - Waqar Khalid
- Anesthesiology and Critical Care, National Hospital & Medical Center, Lahore, PAK
| | - Naveed Latif
- Anesthesiology and Critical Care, National Hospital & Medical Center, Lahore, PAK
| | - Tanvir Hussain
- Anesthesiology and Critical Care, National Hospital & Medical Center, Lahore, PAK
| |
Collapse
|
3
|
Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery. Anesthesiol Res Pract 2018; 2018:8567516. [PMID: 29755518 PMCID: PMC5884407 DOI: 10.1155/2018/8567516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/28/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.
Collapse
|
5
|
Comparison of Nasopharyngeal Airway Device and Nasal Oxygen Tube in Obese Patients Undergoing Intravenous Anesthesia for Gastroscopy: A Prospective and Randomized Study. Gastroenterol Res Pract 2016; 2016:2641257. [PMID: 26997951 PMCID: PMC4779835 DOI: 10.1155/2016/2641257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/29/2015] [Accepted: 01/10/2016] [Indexed: 12/14/2022] Open
Abstract
Objective. This prospective and randomized study evaluated the efficacy and safety of the nasopharyngeal airway relative to the nasal oxygen tube in obese patients undergoing painless gastroscopy. Materials and Methods. Obese patients (BMI ≥ 28 kg/m2; n = 260) were randomly and equally apportioned to the nasopharyngeal airway (Group A) or nasal oxygen tube (Group B) group. Three patients were excluded due to failure of insertion of the nasopharyngeal airway. The duration of endoscopy, anesthetic dose, recovery time, and adverse events were recorded. The satisfaction of the anesthetist, physicians, and patient was scored. Results. The SpO2 reduction was significantly less in Group A than in Group B. Use of a respirator for assisted ventilation occurred significantly less in Group A. The groups were similar regarding mean arterial pressure, heart rate, anesthetic dose, duration of gastroscopy, recovery time, and adverse events. Satisfaction of the physician and anesthetist was greater in Group A; the groups were similar in patient satisfaction. Conclusions. Use of the nasopharyngeal airway for obese patients during painless gastroscopy resulted in less SpO2 reduction relative to the nasal oxygen tube. Altogether, it is a safe and effective device for obese patients undergoing painless gastroscopy.
Collapse
|
6
|
Nasopharyngeal airway stenting devices for obstructive sleep apnoea: a systematic review and meta-analysis. The Journal of Laryngology & Otology 2014; 129:2-10. [PMID: 25544266 DOI: 10.1017/s0022215114003119] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices. METHODS Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea-hypopnoea index, and sleep quality were collected. RESULTS Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Polysomnography data for patients treated with nasal trumpets as an isolated therapy were pooled for meta-analysis. The mean apnoea index ± standard deviation, for 53 patients, decreased from 32.4 ± 15.9 to 9.0 ± 7.2 episodes per hour (p < 0.00001). The mean apnoea-hypopnoea index, for 193 patients, decreased from 44.1 ± 18.9 to 22.7 ± 19.3 episodes per hour (p < 0.00001). The mean lowest oxygen saturation, for 193 patients, increased from 66.5 ± 14.2 to 75.5 ± 13.9 per cent (p < 0.00001). CONCLUSION Some studies have demonstrated limited effectiveness and low tolerability of nasopharyngeal airway stenting devices, while other studies have shown a significant benefit in treating obstructive sleep apnoea, with a high level of patient acceptance. Nasal trumpets have been successful in decreasing airway obstruction in the short term.
Collapse
|