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Lan CH, Luk HN, Qu JZ, Shikani A. An Approach to Improve the Effectiveness of the Video-Assisted Intubating Stylet Technique for Tracheal Intubation: A Case Series Report. Healthcare (Basel) 2023; 11:healthcare11060891. [PMID: 36981548 PMCID: PMC10048425 DOI: 10.3390/healthcare11060891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Direct laryngoscopy and videolaryngoscopy are currently the dominant tools for endotracheal intubation. However, the video-assisted intubating stylet, a type of videolaryngoscopy, has been shown to offer some advantages over these tools, such as rapid intubation time, high first-attempt success rates, less airway stimulation, and high subjective satisfaction. On the other hand, this optical intubating technique also has some technical limitations that need to be addressed, including camera lens fogging, airway path disorientation, and obscured visibility due to secretions. In this clinical report, we describe an approach that improves the visibility of the glottis by introducing a suctioning catheter into the nasopharyngeal airway to enhance the efficiency and accuracy of using the intubating stylet technique for tracheal intubation.
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Affiliation(s)
- Cing-Hong Lan
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
- Bio-Math Laboratory, Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alan Shikani
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, MD 21218, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
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2
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A Randomized Study of Rigid Video Stylet versus Macintosh Laryngoscope for Double-Lumen Endobronchial Tube Intubation Assistance in Thoracoscopic Pulmonary Surgery. J Clin Med 2023; 12:jcm12020540. [PMID: 36675468 PMCID: PMC9865992 DOI: 10.3390/jcm12020540] [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] [Received: 11/08/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Double-lumen endobronchial tube (DLT) intubation is more challenging than single-lumen tube intubation is, and the rigid video stylet (RVS) is one of the tools that has emerged to deal with this demanding intubation procedure. We evaluated whether the UE® RVS can shorten the DLT intubation time and improve the first-attempt intubation success rate compared with that of Macintosh laryngoscope (ML). A total of 130 participants scheduled to undergo thoracoscopic pulmonary surgeries were enrolled. They were randomized to receive either ML- or RVS-assisted DLT intubation. The primary outcomes were the intubation time and first-attempt intubation success rate. The secondary outcomes were the overall intubation success rate, mean arterial pressure, postoperative sore throat (POST), and postoperative hoarseness at 1 h and 24 h. Compared with the ML group, the intubation time was significantly shorter in the RVS group (p < 0.001; 30.82 ± 10.61 vs. 39.62 ± 6.54 s), however, the first-attempt success rate was significantly lower (p = 0.048; 83.08% vs. 95.16%). The POST at 1 h was less severe in the RVS group (p = 0.021). No significant differences were found for the other indicators. Among the patients with normal airways, the UE® RVS can achieve faster DLT intubation and decrease the severity of a POST at 1 h, although it was associated with a lower first-attempt intubation success rate.
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3
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Kang TW, Wang JD, Tsai YS, Lin CR, Tseng CCA. Intubation difficulty scale contributors and time delay in clinical practice. Medicine (Baltimore) 2022; 101:e28724. [PMID: 35089244 PMCID: PMC8797472 DOI: 10.1097/md.0000000000028724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/07/2022] [Indexed: 01/05/2023] Open
Abstract
The intubation difficulty scale (IDS) includes 7 contributors that provide a comprehensive assessment of difficult intubation. However, the effect of each contributor is unclear, and the scale has not been revalidated recently and has not been validated in orient. This study determined the duration of successful intubation (DSI) for each of these 7 contributors.The patients were intubated by attending anesthesiologists. The duration and other data were recorded by 2 research assistants. Anaesthesiologists reported the IDS and their perceptions. A linear mixed-effects model with a DSI was constructed using IDS factors.In total, 1095 patients were enrolled. The average DSI was 23.9 ± 21.8 seconds (37.1% IDS = 0). All 7 factors were independently associated with duration, with the exception of vocal cord adduction. The best model was as follows: DSI (in seconds) = 15.2 + 31.1 (number of additional attempts) + 26.2 (number of additional operators) + 11.4 (number of alternative techniques) + 7.9 (increased lift force) + 4.9 (external laryngeal pressure) + 3.5 (Cormack grade 1). The mixed models were similar except for the regression coefficient for the number of alternative techniques that decreased from 11.4 to 6.9 seconds.We confirmed that each IDS contributor affects the DSI and validated a prediction model with 6 IDS contributors. This prediction model may facilitate the development of strategic plans for critical airway management. Furthermore, it could improve simulations and monitor learning progress and help provide valuable feedback.
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Affiliation(s)
- Ting-Wei Kang
- Department of Anaesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Seng Tsai
- Department of Anaesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chung-Ren Lin
- Department of Anaesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chih Alex Tseng
- Department of Anaesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Karczewska K, Bialka S, Smereka J, Cyran M, Nowak-Starz G, Chmielewski J, Pruc M, Wieczorek P, Peacock FW, Ladny JR, Szarpak L. Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10235524. [PMID: 34884226 PMCID: PMC8658072 DOI: 10.3390/jcm10235524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.
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Affiliation(s)
- Katarzyna Karczewska
- Department of Anesthesiology, Masovian Specialist Hospital, 26-617 Radom, Poland;
| | - Szymon Bialka
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Maciej Cyran
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | | | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Polonia University, 42-200 Czestochowa, Poland
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Bialystok Medical University, 15-295 Bialystok, Poland;
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-500-186-225
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [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: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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Wahdan AS, El-Refai NAR, Omar SH, Abdel Moneem SA, Mohamed MM, Hussien MM. Endotracheal intubation in patients undergoing open abdominal surgery in the lateral position: a comparison between the intubating video stylet and fiberoptic intubating bronchoscopy. Korean J Anesthesiol 2020; 74:234-241. [PMID: 33070582 PMCID: PMC8175876 DOI: 10.4097/kja.20384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some situations compel anesthetists to execute endotracheal intubation in the lateral position. We compared elective endotracheal intubation in the lateral decubitus position using the video stylet (VS) device with the fiberoptic (FO) bronchoscope device in patients undergoing abdominal surgery. METHODS Overall, 50 patients were enrolled in this prospective, randomized study. They were randomly classified into the VS intubation or FO intubating bronchoscope group. After anesthesia induction, patients were placed in the lateral decubitus position, and a single investigator well-versed with the use of the VS and FO bronchoscope performed the intubation. The primary outcome was the time taken for intubation. Secondary outcomes included the intubation success rate, hemodynamic response at specific time points and perioperative complications. RESULTS The average time taken for intubation was significantly lesser in the VS group than in the FO group, with values of 39.5 ± 10.0 and 75.6 ± 16.2 s, respectively (P < 0.001). Incidences of a successful first attempt of intubation in the VS and FO groups were 88% and 100%, respectively, showing no significant difference. There was a negligible difference in complications between the groups, except sore throat, which showed a higher incidence in the VS group than in the FO group (P = 0.002). CONCLUSIONS In laterally positioned patients, elective endotracheal intubation with VS provides less intubation time; however, its use is accompanied by a significant increase in the hemodynamic response after intubation and an increased incidence of sore throat.
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Affiliation(s)
- Amr Samir Wahdan
- Department of Anesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Sohaila Hussien Omar
- Department of Anesthesia, Surgical ICU and Pain Management, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Shady Amr Abdel Moneem
- Department of Anesthesia, Surgical ICU and Pain Management, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Mennatallah Magdi Mohamed
- Department of Anesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mahmoud Hussien
- Department of Anesthesia, Surgical ICU and Pain Management, Theodor Bilharz Research Institute, Cairo, Egypt
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7
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Kim YS, Song J, Lim BG, Lee IO, Won YJ. Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis. PLoS One 2020; 15:e0238060. [PMID: 32857788 PMCID: PMC7455027 DOI: 10.1371/journal.pone.0238060] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Double-lumen tube is commonly used in thoracic surgeries that need one-lung ventilation, but its big size and stiff structure make it harder to perform intubation than a conventional tracheal intubation tube. Objectives To investigate the effectiveness and safety of videoscopes for double-lumen tube insertion. The primary outcome was the success rate of first attempt intubation. Secondary outcomes were intubation time, malposition, oral mucosal damage, sore throat, and external manipulation. Design Systematic review and network meta-analysis Data sources Databases (Pubmed, Embase, Cochrane, Kmbase, Web of science, Scopus) up to June 23, 2020 were searched. Eligibility Randomized controlled trials comparing different videoscopes for double-lumen tube intubation were included in this study. Methods We classified and lumped the videoscope devices into the following groups: standard (non-channeled) videolaryngoscope, channeled videolaryngoscope, videostylet, and direct laryngoscope. After assessing the quality of evidence, we statistically analyzed and chose the best device based on the surface under the cumulative ranking curve (SUCRA) by using STATA software (version 16). Results We included 23 studies (2012 patients). Based on the success rate of the first attempt, a rankogram suggested that the standard videolaryngoscope (76.4 of SUCRA) was the best choice, followed by videostylet (65.5), channeled videolaryngoscope (36.1), and direct laryngoscope (22.1), respectively. However, with regard to reducing the intubation time, the best choice was videostylet, followed by a direct laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope, respectively. Direct laryngoscope showed the lowest incidence of malposition but required external manipulation the most. Channeled videolaryngoscope showed the highest incidence of oral mucosal damage, but showed the lower incidence of sore throat than standard videolaryngoscope or direct laryngoscope. Conclusion Most videoscopes improved the success rate of double-lumen tube intubation; however, they were time-consuming (except videostylet) and had a higher malposition rate than the direct laryngoscope.
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Affiliation(s)
- Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jihyun Song
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Il Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
- * E-mail:
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8
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Collins SR, Titus BJ, Campos JH, Blank RS. Lung Isolation in the Patient With a Difficult Airway. Anesth Analg 2019; 126:1968-1978. [PMID: 29189274 DOI: 10.1213/ane.0000000000002637] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One-lung ventilation is routinely used to facilitate exposure for thoracic surgical procedures and can be achieved via several lung isolation techniques. The optimal method for lung isolation depends on a number of factors that include (1) the indication for lung isolation, (2) anatomic features of the upper and lower airway, (3) availability of equipment and devices, and (4) the anesthesiologist's proficiency and preferences. Though double-lumen endobronchial tubes (DLTs) are most commonly utilized to achieve lung isolation, the use of endobronchial blockers offer advantages in patients with challenging airway anatomy. Anesthesiologists should be familiar with existing alternatives to the DLT for lung isolation and alternative techniques for DLT placement in the patient with a difficult airway. Newer technologies such as videolaryngoscopy with or without adjunctive fiberoptic bronchoscopy may facilitate intubation and lung isolation in difficult airway management.
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Affiliation(s)
- Stephen R Collins
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Brian J Titus
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Javier H Campos
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Randal S Blank
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
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9
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The Clarus Video System (Trachway) and direct laryngoscope for endotracheal intubation with cricoid pressure in simulated rapid sequence induction intubation: a prospective randomized controlled trial. BMC Anesthesiol 2019; 19:33. [PMID: 30832590 PMCID: PMC6399974 DOI: 10.1186/s12871-019-0703-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background During an emergency endotracheal intubation, rapid sequence induction intubation (RSII) with cricoid pressure (CP) is frequently implemented to prevent aspiration pneumonia. We evaluated the CVS in endotracheal intubation in RSII with CP, in comparison with a direct laryngoscope (DL). Methods One hundred fifty patients were randomly assigned to one of three groups: the CVS as a video stylet (CVS-V) group, the CVS as a lightwand (CVS-L) group and DL group. Primary outcomes were to assess the power of the CVS, compared with DL, regarding the first attempt success rate and intubation time in simulated RSII with CP. Secondary outcomes were to examine hemodynamic stress response and the incidence of complications. Results The first attempt success rates within 30 s and within 60 s were higher in CVS-V and DL group than those in CVS-L group (p = 0.006 and 0.037, respectively). The intergroup difference for intubation success rate within 30 s was nonsignificant and almost all the patients were successfully intubated within 60 s (98% for CVS-L and DL group, 96% for CVS-L group). Kaplan-Meier estimator demonstrated the median intubation time was 10.6 s [95% CI, 7.5 to 13.7] in CVS-V group, 14.6 s [95% CI, 11.1 to 18.0] in CVS-L group and 16.5 s [95% CI, 15.7 to 17.3] in DL group (p = 0.023 by the log-rank test). However, the difference was nonsignificant after Sidak’s adjustment. The intergroup differences for hemodynamic stress response, sore throat and mucosa injury incidence were also nonsignificant. Conclusions The CVS-D and DL provide a higher first attempt intubation success rate within 30 and 60 s in intubation with CP; the intubation time for the CVS-V was nonsignificantly shorter than that for the other two intubation methods. Almost all the patients can be successfully intubated with any of the three intubation methods within 60 s. Trial registration ClinicalTrials.gov identifier: NCT03841890, registered on February 15, 2019 (retrospectively registered).
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10
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Chen PT, Ting CK, Lee MY, Cheng HW, Chan KH, Chang WK. A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope ® with conventional blind placement. Anaesthesia 2019; 72:1097-1106. [PMID: 28804889 DOI: 10.1111/anae.13984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/27/2022]
Abstract
Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.
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Affiliation(s)
- P T Chen
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,School of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - C K Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - M Y Lee
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - H W Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - K H Chan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - W K Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, Republic of China
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11
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Liu HH, Dong F, Liu JY, Wei JQ, Huang YK, Wang Y, Zhou T, Ma WH. The use of ETView endotracheal tube for surveillance after tube positioning in patients undergoing lobectomy, randomized trial. Medicine (Baltimore) 2018; 97:e13170. [PMID: 30544376 PMCID: PMC6310589 DOI: 10.1097/md.0000000000013170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The ETView tracheoscopic ventilation tube (TVT) is a tracheal tube (TT) incorporating a video camera and a light source in its tip. The view from the tip appears continuously on a portable monitor in the anesthesia area. We evaluated the effectiveness and usefulness of the single/double ETView TVT in monitoring the tracheal tube position during general anesthesia undergoing video-assisted thoracoscopic lobectomy.Eighty-three patients with pulmonary bullae (American Society of Anesthesiologists (ASA) I-III) undergoing lobectomy, with general anaesthesia, were included. Patients were randomly assigned to 3 groups, based on the tube ETView double-lumen tube (VDT), ETView single-lumen tube (VST), or traditional double lumen tube (DT).All 83 patients' intubations were successful to achieve 1-lung ventilation: 74 patients at the first attempt (22/26 in VDT, 26/28 in VST, 26/29 in DT group) and 9 patients at the second attempt. The time to achieve 1-lung ventilation with the VDT was 58.5 ± 21.5 (mean ± SD) seconds, the VST was 38.2 ± 10.1 (mean ± SD) seconds, and the DT group was 195.5 ± 40.3 (mean ± SD) seconds. During operations, the ETView tubes provided continuous airway visualization in all patients; a good view was obtained in 24/25 patients in VDT/VST, moderate in 4/12 patients in VDT/VST, and poor in 1/1 patients in VDT/VST. When the patient left the postanesthesia care unit, all had sore throat and 26/15/25 patients in VDT/VST/DT group had hoarseness. All had good outcomes of the surgical operations.We found the ETView tube to be helpful in the endotracheal intubation and continuous surveillance of tube position in patients with video-assisted thoracoscopic lobectomy. The ETView single lumen endotracheal tube had fewer associated complications and is superior to the 2 double-lumen tubes.
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Affiliation(s)
- Hui-Hui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Fang Dong
- Graduate School of GuangZhou University of Chinese Medicine
| | - Jia-Yi Liu
- Department of Anesthesiology, Guangzhou Sun Yat-sen Memorial Hospital Sun Yun-sen University
| | - Jian-Qi Wei
- Department of Anesthesiology, GuangDong 999 Brain Hospital, Guangzhou, Guangdong
| | - Yan-Kui Huang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Tao Zhou
- Department of Otolaryngology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Wu-Hua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
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12
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Cho EA, Hwang SH, Lee SH, Ryu KH, Kim YH. Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e11834. [PMID: 30095660 PMCID: PMC6133530 DOI: 10.1097/md.0000000000011834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A rigid video-stylet intubation device provides safe and accurate access to the trachea by enabling visualization of the airway structures during tracheal intubation. The primary purpose of this study was to examine the effects of glycopyrrolate premedication on tracheal intubation with a rigid video-stylet. METHODS In this prospective, randomized, double-blinded study, 78 patients were randomly assigned to the control group (n = 39; no glycopyrrolate administration) or the glycopyrrolate group (n = 39; 0.005 mg/kg glycopyrrolate, intramuscular injection). A rigid video-stylet was used for tracheal intubation. The degree of oral secretion observed through the video-stylet monitor was assessed using the OptiScope laryngeal view and graded on a 4-point scale (1, excellent; 2, good; 3, poor; and 4, unacceptable). The time to intubation and hemodynamic variables at baseline and 1, 3, and 5 minutes after intubation were recorded. RESULTS The OptiScope laryngeal view grades of the glycopyrrolate group (grade 1 = 16 [41.0%], 2 = 17 [43.6%], 3 = 6 [15.4%], and 4 = 0 [0%]) were significantly higher than those of the control group (grade 1 = 9 [23.1%], 2 = 11 [28.2%], 3 = 18 [46.2%], and 4 = 1 [2.6%]; P = .02). The intubation time was shorter in the glycopyrrolate group (18.5 seconds [15.0-22.0]) than the control group (22.0 seconds [17.9-26.4], P = .02). There was no significant difference in the hemodynamic variables between groups. CONCLUSION Glycopyrrolate facilitated tracheal intubation with a rigid video-stylet by decreasing oral secretions and providing better visualization and faster intubation with hemodynamic stability. TRIAL REGISTRY www.clinicaltrials.gov; Identifier: NCT03050242.
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Affiliation(s)
- Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Sung-Ha Hwang
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Yun-Hong Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea
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13
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Yoo JY, Park SY, Kim JY, Kim M, Haam SJ, Kim DH. Comparison of the McGrath videolaryngoscope and the Macintosh laryngoscope for double lumen endobronchial tube intubation in patients with manual in-line stabilization: A randomized controlled trial. Medicine (Baltimore) 2018. [PMID: 29517671 PMCID: PMC5882448 DOI: 10.1097/md.0000000000010081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Double lumen endobronchial tube (DLT) intubation is commonly used for one-lung ventilation in thoracic surgery. However, because of its large size and shape, it is difficult to perform intubation compared with a single lumen tube. The aim of this randomized controlled trial was to determine whether the McGrath videolaryngoscope has any advantage over the direct Macintosh laryngoscope for DLT intubation in patients with a simulated difficult airway. METHODS Forty-four patients (19-60 years of age); scheduled to undergo general anesthesia with one-lung ventilation were assigned to 1 of 2 groups: DLT intubation with the McGrath videolaryngoscope (ML group [n = 22]); or conventional Macintosh laryngoscope (DL group [n = 22]). After manual in-line stabilization was applied as a way of simulating a difficult airway, the time required for intubation and the quality of glottic view were evaluated. RESULTS The time to successful intubation was not different between the 2 groups (ML group, 45 s [interquartile range, 38-52 s] versus DL group, 54 s [45-59 s]; P = .089). The McGrath videolaryngoscope, however, provided a significantly better glottic view. Modified Cormack and Lehane grade was better (P < .001), and the percentage of glottis opening score was higher in the ML group (P < .001). Overall intubation difficulty scale score was lower in the ML group (1 [0-2]) versus the DL group (3 [2-4]) (P < .001). CONCLUSION The McGrath videolaryngoscope improved glottic view and resulted in lower overall intubation difficulty scale score in patients with in-line stabilization.
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Affiliation(s)
| | | | | | | | - Seok Jin Haam
- Department of Cardiovascular and Thoracic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dae Hee Kim
- Department of Anesthesiology and Pain Medicine
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14
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Liu TT, Li L, Wan L, Zhang CH, Yao WL. Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube intubation in thoracic surgery: a systematic review and meta-analysis. Anaesthesia 2018; 73:997-1007. [PMID: 29405258 DOI: 10.1111/anae.14226] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 01/02/2023]
Abstract
Double-lumen intubation is more difficult than single-lumen tracheal intubation. Videolaryngoscopes have many advantages in airway management. However, the advantages of videolaryngoscopy for intubation with a double-lumen tube remain controversial compared with traditional Macintosh laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library and the Web of Science for randomised controlled trials comparing videolaryngoscopy with Macintosh laryngoscopy for double-lumen tube intubation. We found that videolaryngoscopy provided a higher success rate at first attempt for double-lumen tube intubation, with an odds ratio (95%CI) of 2.77 (1.92-4.00) (12 studies, 1215 patients, moderate-quality evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or dental injuries during double-lumen tube intubation, odds ratio (95%CI) 0.36 (0.15-0.85) (11 studies, 1145 patients, low-quality evidence, p = 0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54 (0.36-0.81) (7 studies, 561 patients, moderate-quality evidence, p = 0.003), compared with Macintosh laryngoscopy. There were no significant differences in intubation time, with a standardised mean difference (95%CI) of -0.10 (-0.62 to 0.42) (14 studies, 1310 patients, very low-quality evidence, p = 0.71); and the incidence of postoperative voice change, odds ratio (95%CI) 0.53 (0.21-1.31) (7 studies, 535 patients, low-quality evidence, p = 0.17). Videolaryngoscopy led to a higher incidence of malpositioned double-lumen tube, with an odds ratio (95%CI) of 2.23 (1.10-4.52) (six studies, 487 patients, moderate-quality evidence, p = 0.03).
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Affiliation(s)
- T T Liu
- Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - L Li
- Department of Physiology, Hubei University of Chinese Medicine, Wuhan, China
| | - L Wan
- Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C H Zhang
- Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - W L Yao
- Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Wan L, Liao M, Li L, Qian W, Hu R, Chen K, Zhang C, Yao W. McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation: A randomized trial. Medicine (Baltimore) 2016; 95:e5739. [PMID: 28002347 PMCID: PMC5181831 DOI: 10.1097/md.0000000000005739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. METHODS Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. RESULTS The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05). CONCLUSIONS When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty.
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Affiliation(s)
- Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Mingfeng Liao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Li Li
- Department of Physiology, Hubei University of Chinese Medicine, Wuhan, China
| | - Wei Qian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Rong Hu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Kun Chen
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Chuanhan Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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16
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El-Tahan MR. Videolaryngoscopes for placement of double lumen tubes: Is it time to say goodbye to direct view? Saudi J Anaesth 2016; 10:218-27. [PMID: 27051377 PMCID: PMC4799618 DOI: 10.4103/1658-354x.168804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The advances in thoracic procedures require optimum lung separation to provide adequate room for surgical access. This can be achieved using either a double-lumen tube (DLT) or a bronchial blocker (BB). Most thoracic anesthesiologists prefer the use of DLT. However, lung separation in patients with potential difficult airway can be achieved using either BB through a single lumen tube or placement of a DLT over a tube exchanger or a fiberoptic bronchoscope. Numerous videolaryngoscopes (VL) have been introduced offering both optical and video options to visualize the glottis. Many studies reported improved glottis visualization and easier DLT intubation in patients with normal and potential difficult airway. However, these studies have a wide diversity of outcomes, which may be attributed to the differences in their designs and the prior experience of the operators in using the different devices. In the present review, we present the main outcomes of the available publications, which have addressed the use of VL-guided DLT intubation. Currently, there is enough evidence supporting using VL for DLT intubation in patients with predicted and unanticipated difficult airway. In conclusion, the use of VL could offer an effective method of DLT placement for lung separation in patients with the potential difficult airway.
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Affiliation(s)
- M R El-Tahan
- Department of Anesthesiology, University of Dammam, Dammam, Al Khubar 31952, Saudi Arabia
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17
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Szarpak L, Kurowski A, Zaśko P, Karczewska K, Czyzewski L, Bogdanski L, Adamczyk P, Truszewski Z. Double-lumen tube tracheal intubation in a manikin model using the VivaSight Double Lumen: a randomized controlled comparison with the Macintosh laryngoscope. Am J Emerg Med 2016; 34:103-4. [DOI: 10.1016/j.ajem.2015.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/02/2015] [Indexed: 11/29/2022] Open
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18
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Lee MC, Tseng KY, Shen YC, Lin CH, Hsu CW, Hsu HJ, Lu IC, Cheng KI. Nasotracheal intubation in patients with limited mouth opening: a comparison between fibreoptic intubation and the Trachway®. Anaesthesia 2015; 71:31-8. [DOI: 10.1111/anae.13232] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M. C. Lee
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - K. Y. Tseng
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Y. C. Shen
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - C. H. Lin
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - C. W. Hsu
- Division of Oral Maxillofacial Surgery; Department of Dentistry; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - H. J. Hsu
- Division of Oral Maxillofacial Surgery; Department of Dentistry; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - I. C. Lu
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - K. I. Cheng
- Department of Anesthesiology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Anesthesiology; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
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19
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A suction pipe segment as an alternative to a tube stop when carrying out tracheal intubation with a Trachway intubating stylet with a longer shaft. Tzu Chi Med J 2015. [DOI: 10.1016/j.tcmj.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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21
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Koopman EM, Barak M, Weber E, Valk MJA, de Schepper RTI, Bouwman RA, Huitink JM. Evaluation of a new double-lumen endobronchial tube with an integrated camera (VivaSight-DL™): a prospective multicentre observational study. Anaesthesia 2015; 70:962-8. [DOI: 10.1111/anae.13068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 12/01/2022]
Affiliation(s)
- E. M. Koopman
- Department of Anesthesiology; VU University Medical Center; Amsterdam The Netherlands
| | - M. Barak
- Department of Anesthesiology; Rambam Health Care Campus; Haifa Israel
| | - E. Weber
- Department of Anesthesiology; Catharina Hospital; Eindhoven The Netherlands
| | - M. J. A. Valk
- Department of Anesthesiology; VU University Medical Center; Amsterdam The Netherlands
| | | | - R. A. Bouwman
- Department of Anesthesiology; Catharina Hospital; Eindhoven The Netherlands
| | - J. M. Huitink
- Department of Anesthesiology; VU University Medical Center; Amsterdam The Netherlands
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22
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Yao WL, Wan L, Xu H, Qian W, Wang XR, Tian YK, Zhang CH. A comparison of the McGrath®Series 5 videolaryngoscope and Macintosh laryngoscope for double-lumen tracheal tube placement in patients with a good glottic view at direct laryngoscopy. Anaesthesia 2015; 70:810-7. [PMID: 25721326 DOI: 10.1111/anae.13040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- W. L. Yao
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - L. Wan
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - H. Xu
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - W. Qian
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - X. R. Wang
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Y. K. Tian
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - C. H. Zhang
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Hsu HT, Chou SH, Chou CY, Tseng KY, Kuo YW, Chen MC, Cheng KI. A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube. BMC Anesthesiol 2014; 14:72. [PMID: 25206313 PMCID: PMC4158352 DOI: 10.1186/1471-2253-14-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 08/13/2014] [Indexed: 11/23/2022] Open
Abstract
Background The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. Methods We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. Results Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups. Conclusion When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications. Trial registration ClinicalTrials.gov Identifier: NCT01605591.
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Affiliation(s)
- Hung-Te Hsu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, Republic of China
| | - Shah-Hwa Chou
- Department of Chest Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, Republic of China ; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, Republic of China
| | - Chun-Yen Chou
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, Republic of China
| | - Yi-Wei Kuo
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China
| | - Mei-Chun Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin District, Kaohsiung 807, Taiwan, Republic of China ; Faculty of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, Republic of China
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Yao WL, Wang XR, Xu H, Zhang Y, Zhang CH. McGrath®series 5 videolaryngoscope evaluation for double-lumen tube intubation. Anaesthesia 2014; 69:646-7. [PMID: 24813140 DOI: 10.1111/anae.12720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- W. L. Yao
- Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - X. R. Wang
- Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - H. Xu
- Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Y. Zhang
- Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - C. H. Zhang
- Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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25
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Affiliation(s)
| | - S W Wu
- Kaohsiung Medical University, Kaohsiung, Taiwan
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