1
|
Taboada M, Cariñena A, Estany-Gestal A, Iglesias-Álvarez D, Veiras S, Martínez A, Eiras M, De Miguel M, Selas S, Martínez-Monzonis A, Pereira P, Bastos-Fernández M, González-Salvado V, Álvarez-Barrado M, Ferreiroa E, Caruezo V, Costa J, Naveira A, Otero P, Adrio B, Martínez-Cereijo JM, Fernández Á, González-Juanatey JR, Álvarez J, Seoane-Pillado T. Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial. Anaesth Crit Care Pain Med 2024; 43:101346. [PMID: 38278357 DOI: 10.1016/j.accpm.2024.101346] [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: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique. METHODS In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications. RESULTS A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%-48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%-40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%-55%; p < 0.001). CONCLUSIONS Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04980976.
Collapse
Affiliation(s)
- Manuel Taboada
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain.
| | - Agustín Cariñena
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ana Estany-Gestal
- Research Methodology Unit, Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | | | - Sonia Veiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Adrián Martínez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - María Eiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Manuela De Miguel
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Salomé Selas
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Pedro Pereira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | | | | | - Esteban Ferreiroa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Valentín Caruezo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Costa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Alberto Naveira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Pablo Otero
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Belén Adrio
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Manuel Martínez-Cereijo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ángel Fernández
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Julián Álvarez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
| |
Collapse
|
2
|
Kumar N, Falkson S, Yi Y, Iyer MH, Essandoh M. Video Laryngoscopy-Guided Transesophageal Echocardiography Probe Insertion: A Worthy Approach to Consider. J Cardiothorac Vasc Anesth 2023; 37:496-497. [PMID: 36543664 DOI: 10.1053/j.jvca.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolas Kumar
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Samuel Falkson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yangtian Yi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
3
|
Borde D, C K, Jasapara A, Shetty V, Juvekar N, Desurkar V, Gaidu J, Joshi P, Asegaonkar B, Kp U, V V, Joshi S, Koshy T. Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study. J Cardiothorac Vasc Anesth 2022; 36:4289-4295. [PMID: 36038439 DOI: 10.1053/j.jvca.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. DESIGN A multicenter randomized control study. SETTING At 5 tertiary care level hospitals. PARTICIPANTS Three hundred sixty-three adult patients undergoing elective cardiac surgery. INTERVENTIONS The patients were randomized into 2 groups-the conventional group (C group; n = 177) and the VL group (n = 186) for TEE probe insertion. MEASUREMENTS AND MAIN RESULTS The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n = 26; 14.7%) compared to the VL group (n = 14; 7.5%; p = 0.029). The number of attempts for probe insertion was significantly lower in the VL group (p = 0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n = 88; 47%), followed by posterior (n = 77; 41%) and lateral (n = 21;12%). CONCLUSION The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
Collapse
Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar C
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Nilesh Juvekar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Vinayak Desurkar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Jyoti Gaidu
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unnikrihnan Kp
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vipinraj V
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Thomas Koshy
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
4
|
Bansal N, Magoon R, Shri I, Walian A, Kashav RC. Innovative Troubleshooting of Difficult TEE Probe Insertion: Letter To Editor Response. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1750210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Noopur Bansal
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Iti Shri
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ashish Walian
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ramesh Chand Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
5
|
Patel KM, Desai RG, Trivedi K, Neuburger PJ, Krishnan S, Potestio CP. Complications of Transesophageal Echocardiography – A Review of Injuries, Risk Factors and Management. J Cardiothorac Vasc Anesth 2022; 36:3292-3302. [DOI: 10.1053/j.jvca.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/09/2023]
|
6
|
[Intraoperative transesophageal echocardiography as monitoring procedure in noncardiac surgery patients]. Anaesthesist 2021; 70:1059-1072. [PMID: 34762164 DOI: 10.1007/s00101-021-01035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/27/2022]
Abstract
Transesophageal echocardiography (TEE) is firmly established in cardiac surgery for diagnostics, hemodynamic monitoring and as a guiding tool. Dynamic and (patho)physiological processes of the heart can be immediately depicted. Ideally, therapeutic changes can be derived. For this reason, TEE is increasingly used in high-risk non-cardiac surgery interventions and in the interventional setting. In the first part of this advanced training series, general aspects regarding TEE examinations as well as indications and contraindications are presented. Clinical fields of application, where TEE can play a role in hemodynamic monitoring are outlined. The second part focusses on an emergency examination pathway and differential diagnoses, which can be made in the event of intraoperative hemodynamic instability or unexplained hypoxemia using TEE. The article concludes with an outlook on the use of computer-aided evaluation of TEE images.
Collapse
|
7
|
Kumamoto T, Tashima K, Hiraoka C, Ikuta Y, Yamamoto T. McGRATH MAC video laryngoscope assistance during transesophageal echocardiography may reduce the risk of complications: a manikin study. BMC Anesthesiol 2021; 21:14. [PMID: 33430768 PMCID: PMC7798285 DOI: 10.1186/s12871-020-01231-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. METHODS Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. RESULTS The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. CONCLUSIONS These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician's experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.
Collapse
Affiliation(s)
- Taisuke Kumamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan.
| | - Koichiro Tashima
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Chieko Hiraoka
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Yoshihiro Ikuta
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Tatsuo Yamamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| |
Collapse
|
8
|
Furutani K, Watanabe T, Matsuda K, Kamiya Y, Baba H. SUZYTM forceps facilitate nasogastric tube insertion under McGRATHTM MAC videolaryngoscopic guidance: A randomized, controlled trial. Medicine (Baltimore) 2020; 99:e22545. [PMID: 33031298 PMCID: PMC10545345 DOI: 10.1097/md.0000000000022545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nasogastric tubes can be easily inserted in patients under general anesthesia. However, for difficult cases, insertion techniques that can be used in routine clinical practice are limited. SUZY forceps are designed for the removal of pharyngolaryngeal foreign bodies under guidance of a McGrath videolaryngoscope. We hypothesized that using SUZY forceps under McGrath videolaryngoscopic guidance may facilitate nasogastric tube insertion and tested this in a randomized controlled trial. METHODS Adult patients who underwent gastrointestinal or hepato-pancreato-biliary surgery were randomly allocated to 2 groups; the SUZY group and the Magill group. Patients, nurses, and all clinical staff except for the attending anesthesiologist were blinded to group assignment throughout the study. After anesthesia induction, insertion of the nasogastric tube was performed by skilled anesthesiologists with either SUZY or Magill forceps according to group allocation under McGrath videolaryngoscopic guidance. The primary endpoint was insertion time which was defined as the time required to advance the nasogastric tube by 55 cm from the nostril. Secondary endpoints were the success rates of the nasogastric tube insertion, which were defined as a 55-cm advancement from the nostril at the 1st, 2nd, and 3rd attempt, proper insertion rate, the severity of pharyngolaryngeal complications, and hemodynamic parameters during nasogastric tube insertion. RESULTS Sixty patients were randomized and none of these patients were excluded from the final analysis. The median [interquartile range] insertion time was 25 [18-33] seconds in the SUZY group, and 33 [21-54] seconds in the Magill group (P = .02). Success rates were not different between the groups (97% and 80% in the SUZY and Magill group at 1st attempt, respectively, P = .10). Both, the severity score of the mucosal injury and the severity of sore throat were higher in the Magill than in the SUZY group, whereas the degree of hoarseness did not differ between the 2 groups. Hemodynamic parameters were not significantly different between the groups. CONCLUSION Using SUZY forceps under McGrath videolaryngoscopic guidance reduced the time required to insert a nasogastric tube and the severity of pharyngolaryngeal complications, when compared to using Magill forceps.
Collapse
Affiliation(s)
- Kenta Furutani
- Department of Anesthesiology, Niigata University Medical and Dental Hospital
| | - Tatsunori Watanabe
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Keiichiro Matsuda
- Department of Anesthesiology, Niigata University Medical and Dental Hospital
| | - Yoshinori Kamiya
- Department of Anesthesiology, Niigata University Medical and Dental Hospital
| | - Hiroshi Baba
- Department of Anesthesiology, Niigata University Medical and Dental Hospital
| |
Collapse
|
9
|
Namekawa M, Tsujimoto Y, Banno M, Kataoka Y, Tsujimoto H, Inaba Y, Fujiwara T. Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2020; 34:453-463. [PMID: 32219541 DOI: 10.1007/s00540-020-02759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] - 0.60; 95% confidence interval [CI] - 0.73, - 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD - 8.57; 95% CI - 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.
Collapse
Affiliation(s)
- Motoki Namekawa
- Department of Critical Care Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan.
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan
| | - Masahiro Banno
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yu Inaba
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| |
Collapse
|
10
|
Ramalingam G, Choi S, Agarwal S, Kunst G, Gill R, Fletcher SN, Klein AA, Shashidaran P, Waghmare K, Kadayam R, Flynn F, Gavin N, Mairead‐Machugh U, Bell M, Hawthorn A, Sajgalik P, Burri N, Meraglia A. Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care. Anaesthesia 2019; 75:21-26. [DOI: 10.1111/anae.14734] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
Affiliation(s)
- G. Ramalingam
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
| | - S.‐W. Choi
- Department of Anaesthesiology Faculty of Medicine The University of Hong Kong HongKongHKSAR
| | - S. Agarwal
- Department of Cardiothoracic Anaesthesia Manchester Royal Infirmary ManchesterUK
| | - G. Kunst
- Department of Cardiothoracic Anaesthesia Kings College Hospital LondonUK
| | - R. Gill
- Department of Cardiothoracic Anaesthesia University Hospital Southampton UK
| | - S. N. Fletcher
- Department of Cardiothoracic Anaesthesia St Georges University Hospitals London UK
| | - A. A. Klein
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Difficult TEE Probe Placement: The Evidence, Troubleshooting Techniques, and a Guide to Alternative Monitoring Options for Intraoperative Physicians. Semin Cardiothorac Vasc Anesth 2019; 23:369-378. [DOI: 10.1177/1089253219842836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transesophageal echocardiography (TEE) imaging has become an essential component of many open and interventional cardiac procedures and has increasing use in monitoring for noncardiac procedures, partly because of an aging population. Whether expected or not, encountering difficulty when inserting the TEE probe presents the anesthesiologist with a conundrum. Repeated insertion attempts increase the risk of a serious complication; however, proceeding without TEE may be unacceptable to the proceduralist or surgeon. The aim of this review is to present the spectrum of complications possible with TEE, propose several evidence-based insertion tips, examine potential alternative cardiac imaging options, and finally, propose a roadmap for providers who encounter difficulty when placing a TEE probe.
Collapse
|
12
|
Furutani K, Watanabe T, Kamiya Y, Baba H. Comparison of a curved forceps with a conventional straight forceps for nasogastric tube insertion under videolaryngoscopic guidance: A randomized, crossover manikin study. Medicine (Baltimore) 2017; 96:e7983. [PMID: 28858136 PMCID: PMC5585530 DOI: 10.1097/md.0000000000007983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nasogastric tube (NGT) insertion is an easy procedure that can be routinely performed under general anesthesia. However, for difficult cases, there are limited insertion techniques available in routine clinical practice, considering the flexibility of NGTs. The SUZY curved forceps are designed for the removal of pharyngolaryngeal foreign bodies under guidance of the McGRATH MAC (McG) videolaryngoscope. Because McG enables clear visualization of the esophageal inlet, we hypothesized that the SUZY forceps can facilitate easier NGT insertion compared with the conventional Magill forceps under McG guidance and designed a randomized, crossover manikin study to test this hypothesis. MATERIALS AND METHODS Ten anesthesiologists participated in this study. Each participant was instructed to insert an NGT using either the SUZY or the Magill forceps under McG guidance. Both types of forceps were used by each participant in a computer-generated random order. The primary outcome measure was the number of "strokes" (1 stroke was defined by a specific sequence of participant actions) required to advance the NGT 30 cm from the starting point. Data are expressed as medians (interquartile ranges [ranges]). RESULTS The number of strokes required for NGT insertion was fewer in the SUZY group than in the Magill group {7 [7.0-12.5 (5-14)] vs 16.5 [13.5-20.3 (7-22)]; P <.05}. The time required for NGT insertion was also lesser in the SUZY group than in the Magill group {15.4 [13.7-20.0 (7.0-38.3)] seconds vs 30.3 [22.0-42.3 (12.8-47.5) seconds]; P <.05}. CONCLUSIONS The SUZY curved forceps facilitated NGT insertion more effectively than the Magill straight forceps under McG guidance. Our results suggest that NGT insertion using the SUZY forceps under McG guidance is a secure and easy procedure.
Collapse
Affiliation(s)
- Kenta Furutani
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma
| | - Tatsunori Watanabe
- Division of Anesthesiology, Niigata University Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Yoshinori Kamiya
- Division of Anesthesiology, Niigata University Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Hiroshi Baba
- Division of Anesthesiology, Niigata University Medical and Dental Sciences, Niigata City, Niigata, Japan
| |
Collapse
|
13
|
Kavrut Ozturk N, Kavakli AS. Use of McGrath MAC Videolaryngoscope to Assist Transesophageal Echocardiography Probe Insertion in Intubated Patients. J Cardiothorac Vasc Anesth 2016; 31:191-196. [PMID: 27498268 DOI: 10.1053/j.jvca.2016.03.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Transesophageal echocardiography (TEE) probe insertion with the conventional blind insertion technique may be difficult in anesthetized and intubated patients. The use of a videolaryngoscope may facilitate the insertion of the TEE probe. The aim of this study was to compare the conventional technique with the use of the McGrath MAC videolaryngoscope for TEE probe insertion in terms of success rate, duration of insertion, and complications in patients undergoing cardiovascular surgery. DESIGN A prospective, randomized study. SETTING Training and research hospital. PARTICIPANTS Eighty-six adult patients undergoing cardiovascular surgery were included. INTERVENTIONS Eighty-six adult patients were randomized into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope group (n = 43). Success rates, duration of insertion, complications, and hemodynamic changes during insertion were recorded. MEASUREMENTS AND MAIN RESULTS The success rate of TEE probe insertion at the first attempt was higher in the McGrath videolaryngoscope group (90.5%) than in the conventional group (43.9%) (p = 0.012). The mean duration for successful insertion of the TEE probe at the first attempt was longer in the McGrath videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for successful insertion of the TEE probe was similar in both groups. Pharyngeal injuries were observed more frequently in the conventional group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe tip in the conventional group was higher than in the McGrath group (21.9% v 4.8%). There were no statistical differences between the 2 groups in systolic blood pressure, mean arterial pressure, diastolic blood pressure, and heart rate before and after TEE insertion. CONCLUSIONS The use of the McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery patients increases the success rate and reduces pharyngeal injuries compared to the conventional technique. The use of the McGrath MAC videolaryngoscope for TEE insertion causes similar hemodynamic changes as in the conventional blind insertion technique.
Collapse
Affiliation(s)
- Nilgun Kavrut Ozturk
- Department of Anesthesiology and Reanimation, Antalya Education and Research Hospital, Antalya, Turkey.
| | - Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Antalya Education and Research Hospital, Antalya, Turkey
| |
Collapse
|