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Ponnusamy T, Kundra P, Rudingwa P, Gopalakrishnan S. Comparison of laryngeal morbidities with modified reinforced silicone tube intubation guided over a bougie vs. a guidewire: novel assessment with voice analysis. Anaesthesia 2018; 73:730-737. [PMID: 29411359 DOI: 10.1111/anae.14236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
Semi-rigid flexible introducer-guided tracheal intubation is associated with pharyngolaryngeal morbidities. We compared the practice of railroading a newly described modified reinforced silicone tracheal tube with a built-in guide channel in its wall over a non-kinking guidewire with railroading the same tube over a disposable bougie, with respect to pharyngolaryngeal morbidities. One hundred and twenty-four ASA 1 and 2 adults were randomly assigned to undergo bougie-guided (n = 62) or wire-guided (n = 62) intubation under general anaesthesia. All patients were assessed for postoperative pharyngolaryngeal complaints. In addition, voice parameters (fundamental frequency, shimmer, jitter and harmonic noise ratio) with vowels 'a' and 'i' were analysed pre-operatively and 24 h postoperatively. The success of first-attempt intubation and the associated haemodynamic response were also recorded. A higher incidence of pharyngolaryngeal complaints was seen in the bougie group, 48.3%, 95%CI (35.9-60.9%) when compared with wire-guided group 28.3%, 95%CI (18.0-40.6%), p = 0.01. Postoperatively, all the voice parameters were significantly more affected when compared with their pre-operative value in the bougie-guided group (p < 0.05) but not in the wire-guided group. The success of first-attempt intubation was similar in both groups. Wire-guided orotracheal intubation was associated with a lower incidence of pharyngolaryngeal complaints and effect on voice when compared with bougie-guided intubation.
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Affiliation(s)
- T Ponnusamy
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - P Kundra
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - P Rudingwa
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Gopalakrishnan
- Department of Ear Nose Throat Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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2
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van den Heever A, Scribante J, Perrie H, Lowman W. Microbial contamination and labelling of self-prepared, multi-dose phenylephrine solutions used at a teaching hospital. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1251062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Grape S, Schoettker P. The role of tracheal tube introducers and stylets in current airway management. J Clin Monit Comput 2016; 31:531-537. [DOI: 10.1007/s10877-016-9879-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/12/2016] [Indexed: 12/15/2022]
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4
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Dexheimer Neto FL, de Andrade JMS, Raupp ACT, da Silva Townsend R, Neres FS, Cremonese RV. Use of a homemade introducer guide (bougie) for intubation in emergency situation in patients who present with difficult airway: a case series. Braz J Anesthesiol 2016; 66:204-7. [PMID: 26952232 DOI: 10.1016/j.bjane.2013.06.019] [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: 03/13/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS The use of the handmade introducer guide can be a useful option for the management of difficult airways.
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Affiliation(s)
| | | | | | | | - Fernanda Santos Neres
- Unidade de Terapia Intensiva Adulto, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
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5
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Dexheimer Neto FL, Andrade JMSD, Raupp ACT, Townsend RDS, Neres FS, Cremonese RV. [Use of a homemade introducer guide (bougie) for intubation in emergency situation in patients who present with difficult airway: a case series]. Rev Bras Anestesiol 2014; 66:204-7. [PMID: 26546210 DOI: 10.1016/j.bjan.2013.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/10/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS The use of the handmade introducer guide can be a useful option for the management of difficult airways.
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Affiliation(s)
| | | | | | | | - Fernanda Santos Neres
- Unidade de Terapia Intensiva Adulto, Hospital Ernesto Dornelles, Porto Alegre, RS, Brasil
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Affiliation(s)
- M R Rai
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
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Paul A, Gibson AA, Robinson ODG, Koch J. The traffic light bougie: a study of a novel safety modification. Anaesthesia 2014; 69:214-8. [DOI: 10.1111/anae.12522] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 12/17/2022]
Affiliation(s)
- A. Paul
- Royal Infirmary of Edinburgh; Edinburgh UK
| | | | | | - J. Koch
- Royal Infirmary of Edinburgh; Edinburgh UK
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8
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Cummings IM, Howell V, Thoppil A, Flaxman E, Sharma S, Blunt MC, Young PJ. Chlorhexidine cleaning of re-usable bougies. Anaesthesia 2013; 68:830-4. [DOI: 10.1111/anae.12269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - V. Howell
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - A. Thoppil
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - E. Flaxman
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - S. Sharma
- Queen Elizabeth Hospital; Kings Lynn; UK
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9
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Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe RG, O'Meara P, Hamilton L. Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation. Anaesthesia 2012; 67:371-6. [PMID: 22288931 DOI: 10.1111/j.1365-2044.2011.06999.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
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Braude D, Ronan D, Weiss S, Boivin M, Gerstein N. Comparison of available gum-elastic bougies. Am J Emerg Med 2009; 27:266-70. [DOI: 10.1016/j.ajem.2008.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 02/12/2008] [Accepted: 02/14/2008] [Indexed: 10/21/2022] Open
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Arndt GA, Cambray AJ, Tomasson J. Intubation bougie dissection of tracheal mucosa and intratracheal airway obstruction. Anesth Analg 2008; 107:603-4. [PMID: 18633039 DOI: 10.1213/ane.0b013e318176fe36] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intubation bougies are commonly used to aid in intubation when an optimal view of the larynx is not obtained. We describe a case of tracheal perforation using a disposable intubation bougie resulting in a complete intratracheal airway obstruction relieved by cricothyrotomy. Disposable intubation bougies may have mechanical properties that differ from their nondisposable counterparts making complications more likely.
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Affiliation(s)
- George A Arndt
- Department of Anesthesiology, B6/319 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3272, USA.
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13
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Wilkes AR, Hodzovic I, Latto IP. Introducing new anaesthetic equipment into clinical practice. Anaesthesia 2008; 63:571-5. [DOI: 10.1111/j.1365-2044.2008.05583.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Greenland KB, Liu G, Tan H, Edwards M, Irwin MG. Comparison of the Levitan FPS Scope and the single-use bougie for simulated difficult intubation in anaesthetised patients. Anaesthesia 2007; 62:509-15. [PMID: 17448065 DOI: 10.1111/j.1365-2044.2007.05003.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A randomised cross-over study was performed in 34 patients with no evidence of airway difficulties, following induction of general anaesthesia, to compare the efficacy of the Levitan FPS scope (LFPS) and the single-use bougie for tracheal intubation during simulated grade IIIa laryngoscopy. Success rates for intratracheal placement of the device, and the time required for insertion and tracheal intubation were recorded. Both devices were equally successful (31/34 for the LFPS vs 29/34 for the bougie) for insertion into the glottis. The mean insertion time for the LFPS was statistically longer than that for the bougie (4.4-12.5 s) but this difference was not clinically relevant. Intubation times were similar between the two devices. Major problems hindering successful intubation using the LFPS were the presence of a narrow epiglottic-pharyngeal wall space and copious secretions. An inability to maintain the desired shape was the principal cause of failure with the bougie.
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Affiliation(s)
- K B Greenland
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane & Women's Hospital, and Anaesthesiology and Critical Care - School of Medicine, University of Queensland, Brisbane, Australia.
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15
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Rowley E, Dingwall R. The use of single-use devices in anaesthesia: balancing the risks to patient safety. Anaesthesia 2007; 62:569-74. [PMID: 17506734 DOI: 10.1111/j.1365-2044.2007.04995.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Single-use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. Single-use devices, manufactured at a lower cost to justify their disposal, are perceived to have a lesser efficacy, which may threaten patient safety through iatrogenic harm. There is, in addition, growing scepticism about the actual risk of contracting variant Creutzfeldt-Jakob disease and other blood-borne diseases from reused surgical instruments. Interview data suggests that when choosing to use a single-use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single-use devices used on themselves and their family if they were patients.
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Affiliation(s)
- E Rowley
- Institute for Science and Society, West Wing, Law and Social Sciences Building, University Park, University of Nottingham NG7 2RD, UK.
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16
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A comparison of the use of Trachlight® and Eschmann multiple-use introducer in simulated difficult intubation. Eur J Anaesthesiol 2007. [DOI: 10.1097/00003643-200701000-00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harvey K, Davies R, Evans A, Latto IP, Hall JE. A comparison of the use of Trachlight and Eschmann multiple-use introducer in simulated difficult intubation. Eur J Anaesthesiol 2006; 24:76-81. [PMID: 16938152 DOI: 10.1017/s0265021506001177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The Eschmann multiple-use introducer is widely used in the management of difficult intubations. Transillumination of the neck is less commonly used. We conducted a randomized crossover study comparing the Trachlight lightwand and Eschmann multiple-use introducer in simulated difficult intubation. METHODS Sixty-four healthy patients were studied using a standard anaesthetic and full muscle relaxation assessed by train of four. A Macintosh laryngoscope was then inserted and then lowered to simulate a Grade 3 view. Tracheal placement was attempted with both Trachlight lightwand and Eschmann multiple-use introducer in a randomized order. Anaesthetists placing the devices had extensive experience with the Eschmann multiple-use introducer, but only 15 previous uses of the Trachlight. Success rates and time for tracheal placement were recorded. RESULTS The Eschmann multiple-use introducer and Trachlight were successfully placed in 96.8% and 93.7%, respectively (n.s.). Mean (SD) time to intubation for Eschmann multiple-use introducer and Trachlight were 15(6) and *21(13), respectively (*P < 0.001). CONCLUSION The Trachlight is a potentially useful alternative to the Eschmann multiple-use introducer in difficult intubation.
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Affiliation(s)
- K Harvey
- University Hospital of Wales, Cardiff University, Cardiff, UK
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18
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Hodzovic I, Latto IP, Wilkes AR, Hall JE, Mapleson WW. Evaluation of Frova, single-use intubation introducer, in a manikin. Comparison with Eschmann multiple-use introducer and Portex single-use introducer. Anaesthesia 2004; 59:811-6. [PMID: 15270974 DOI: 10.1111/j.1365-2044.2004.03809.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In a randomised cross-over study, 48 anaesthetists attempted to place a Frova single-use introducer, an Eschmann multiple-use introducer and a Portex single-use introducer in the trachea of a manikin set up to simulate a grade 3 laryngoscopic view. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). Successful placement (proportion, 95% confidence interval) of either the Frova introducer (65%, 50-77%) or the Eschmann introducer (60%, 46-73%) was significantly more likely than with the Portex introducer (8%, 3-20%). There were no significant differences between the success rates for the Frova and the Eschmann introducers. A separate experiment revealed that the peak force exerted by the Frova and Portex introducers was two to three times greater than that which could be exerted by the Eschmann introducer, p < 0.0001, indicating that the single-use introducers are more likely to cause tissue trauma during placement.
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Affiliation(s)
- I Hodzovic
- Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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Hodzovic I, Wilkes AR, Latto IP. Bougie-assisted difficult airway management in a manikin ? the effect of position held on placement and force exerted by the tip. Anaesthesia 2004; 59:38-43. [PMID: 14687097 DOI: 10.1111/j.1365-2044.2004.03448.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In a randomised cross-over study, 50 anaesthetists attempted to place a multiple-use bougie in the trachea of a manikin, when holding it at either 20 cm or 30 cm from the tip. A grade 3 laryngoscopic view was simulated. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). The success rates when held at 20 and 30 cm distance from the tip were 68 and 62%, respectively (p = 0.55). In a separate experiment, multiple and single-use bougies were held at four different positions and pressed onto a disc attached to a force transducer. The peak force exerted by the single-use bougies was two to three times greater than that which could be exerted by the multiple-use bougies (p < 0.0001). Holding the bougie at either 20 or 30 cm distance from the tip is unlikely to influence bougie placement. The single-use bougie is much more likely to cause trauma to tissue during placement, particularly if held close to the tip.
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Affiliation(s)
- I Hodzovic
- University Hospital of Wales College of Medicine, Heath Park, Cardiff, UK University Hospital of Wales, Heath Park, Cardiff, UK.
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20
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Rasic NF, Friesen RM, Anderson B, Hoban SA, Olson N, Kress J. Prepared endotracheal tubes: are they a potential source for pathogenic microorganisms? Anesth Analg 2003; 97:1133-1136. [PMID: 14500170 DOI: 10.1213/01.ane.0000082241.56353.97] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Prepared endotracheal tubes (PETTs) are frequently used for unanticipated difficult intubation, but their storage time is highly variable and institution-dependent. We sought to determine first, if open, unused PETTs are a potential source of pathogenic microorganisms, and second, if PETTs can provide a medium for bacterial survival after deliberate contamination. A stylet was inserted into a 7-mm ETT, and this system was ethylene oxide sterilized. The PETTs were placed in 20 different locations and sampled 8 times in a 4-wk period. Growth was determined after 48-h incubation, and the microorganism was identified. In Phase 2, the PETT (n = 40) was swabbed with a fresh suspension of H. influenzae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium, or a negative control. Nonvirulent bacteria were cultured from 13 of 160 (8.1%) samples and from 15 of 320 (4.7%) samples in Phases 1 and 2, respectively. No PETT grew the same bacteria more than once. In Phase 2, after 24 h, only E. faecium was recovered. Based on this study, the pathogenic potential of PETTs is very small, and they can be safely used for up to 1 mo. This practice could translate to significant cost reduction for operating room budgets. IMPLICATIONS Prepared endotracheal tubes (PETTs) are back-up airway equipment to be used in the case of a difficult intubation. A short PETT shelf life because of unknown safe storage time results in significant budget costs. This blinded, controlled study examined the pathogenic potential of PETTs in the operating room environment.
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Affiliation(s)
- Nivez F Rasic
- Department of Anesthesia, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
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21
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Marfin AG, Pandit JJ, Hames KC, Popat MT, Yentis SM. Use of the bougie in simulated difficult intubation. 2. Comparison of single-use bougie with multiple-use bougie. Anaesthesia 2003; 58:852-5. [PMID: 12911356 DOI: 10.1046/j.1365-2044.2003.03289.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied the success rates for tracheal intubation in 32 healthy, anaesthetised patients during simulated grade IIIa laryngoscopy, randomised to either the multiple-use or the single-use bougie. Success rates (primary end-point) and times taken (secondary end-point) to achieve tracheal intubation were recorded. The multiple-use bougie was more successful than the single-use one (15/16 successful intubations vs. 9/16; p = 0.03). With either device, median [range] total tracheal intubation times for successful attempts were < 54 [24-84] s and there were no clinically important differences between these times. We conclude that the multiple-use bougie is a more reliable aid to tracheal intubation than the single-use introducer in grade IIIa laryngoscopy.
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Affiliation(s)
- A G Marfin
- Nuffield Department of Anaesthesia, The John Radcliffe Hospital, Oxford, OX3 9 DU
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22
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Francon D, Estèbe JP, Ecoffey C. [Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22 Suppl 1:28s-40s. [PMID: 12943860 DOI: 10.1016/s0750-7658(03)00124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management.
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Affiliation(s)
- D Francon
- Service d'anesthésie-réanimation, institut Paoli-Calmettes, Marseille, France
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Annamaneni R, Hodzovic I, Wilkes AR, Latto IP. A comparison of simulated difficult intubation with multiple-use and single-use bougies in a manikin. Anaesthesia 2003; 58:45-9. [PMID: 12492669 DOI: 10.1046/j.1365-2044.2003.02871.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a randomised cross-over study, 20 anaesthetists attempted to place a multiple- or single-use bougie in the trachea of a manikin, in which a grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists made two attempts at placement with each bougie and were blinded to success (tracheal placement) or failure (oesophageal placement). The success rates for the first attempts with the multiple- and single-use bougies were 85 and 15%, respectively [mean (95% CI) difference between the two bougies 70% (40-84%); p < 0.001]. The success rates for the second attempts were similar to those for the first attempts with both bougies. There is an increased risk of failure to intubate the trachea when using a single-use bougie, and this must be weighed against the unquantified risk of cross-infection from prions when using a multiple-use bougie.
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Affiliation(s)
- R Annamaneni
- University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
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25
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Dyson E, Smith GB. Common faults in resuscitation equipment--guidelines for checking equipment and drugs used in adult cardiopulmonary resuscitation. Resuscitation 2002; 55:137-49. [PMID: 12413751 DOI: 10.1016/s0300-9572(02)00169-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Successful advanced life support relies, in part, upon the availability and correct functioning of resuscitation equipment. However, numerous publications report deficiencies and defects in key items of resuscitation equipment, particularly those relating to airway management and defibrillation. Some of these are generic and relate to basic device failure (e.g. intrinsic design faults, manufacturing errors, random component failure), external factors (e.g. power failure, gas supply failure, electromagnetic interference) and human error (notably, inadequate knowledge, lack of experience and training, inadequate checking, insufficient maintenance). However, others are device specific. This paper identifies the common, generic faults that lead to equipment malfunction and recommends the resuscitation equipment essential for successful cardiopulmonary resuscitation. It also describes examples of specific equipment malfunction and makes suggestions for the nature and frequency of resuscitation equipment and drug checks, using a structured, and easy-to-recall list.
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Affiliation(s)
- Elsbeth Dyson
- Department of Intensive Care Medicine, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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27
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Abstract
Hospital risk management demands the development of broad and inclusive infection control policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infection control teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infection control policies despite the widespread use of anaesthetic equipment in many clinical areas outside the theatre complex. This article offers practical guidance when preparing an infection control policy for anaesthetic equipment. The cost effectiveness of single patient use items versus reprocessing equipment is discussed. The importance of a multi-disciplinary approach, especially where the evidence base is weak, is highlighted.
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Affiliation(s)
- T A King
- Department of Anaesthesia, District General Hospital, Eastbourne, East Sussex, UK
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