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Kumar A, Gupta N, Bhargava T, Gupta A, Kumar V, Bharti SJ, Garg R, Mishra S, Bhatnagar S, Malhotra RK. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC ® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anaesth 2024; 71:503-510. [PMID: 38243098 DOI: 10.1007/s12630-023-02687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.
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Affiliation(s)
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
- Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India.
| | - Tanvi Bhargava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev K Malhotra
- Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India
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Talbot NC, Luther PM, Spillers NJ, Alexander SJ, Saus AJ, Jeha GM, Rogers LN, Varrassi G, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AD. Experimental Analysis of the Efficiency and Usability of Tylke Versus Magill Forceps. Cureus 2023; 15:e48857. [PMID: 38106711 PMCID: PMC10722340 DOI: 10.7759/cureus.48857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION The procedure of nasotracheal intubation (NI) has long been performed utilizing the Magill forceps as developed by Sir Ivan Magill in the 1920s. While used for nearly a century, several serious patient safety concerns remain including torn tube cuffs, vocal cord trauma, and inefficient tube placement. The Tylke forceps have been developed as a modification to the largely unchanged form of Magill forceps. METHODS In the present investigation we compared the efficacy, number of clasps, and muscle activation involved in NI using the Tylke forceps versus the Magill forceps in previously untrained individuals. RESULTS Tylke forceps showed faster successful NI over the standard Magill forceps at an average intubation time of 6.54s vs. 13.73s, respectively. Tylke forceps also had fewer clasps per intubation over the Magill. The trapezius, deltoid, and brachioradialis muscle activation was also compared in Tylke vs Magill forceps intubation trials. Tylke forceps required less lower muscle activation in the brachioradialis and trapezius over the Magill forceps with Tylke forceps resulting in higher deltoid muscle activation. CONCLUSION Tylke forceps were more efficacious and reduced the number of clasps over the Magill forceps when used in successful NI with different muscle activation patterns.
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Affiliation(s)
- Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Patrick M Luther
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Noah J Spillers
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Steven J Alexander
- Physiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Arthur J Saus
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - George M Jeha
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Laine N Rogers
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Elyse M Cornett
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Mora A, Hamidullah A, Samaranayake S, Elnagar I. Life-Threatening Airway Obstruction and Septic Shock Due to Submandibular Space Infection: A Case Report. Cureus 2023; 15:e47181. [PMID: 38021865 PMCID: PMC10652231 DOI: 10.7759/cureus.47181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Submandibular space infection, a rare and aggressive form of cellulitis, affects the floor of the mouth and neck, potentially leading to life-threatening complications. Although commonly associated with oral trauma and contiguous abscesses, the severity of these odontogenic infections often escalates due to underlying comorbidities. This report presents a unique case of a 74-year-old man who developed severe complications following an outpatient oral procedure. The patient exhibited fever and mouth swelling within a short time, which quickly advanced to impending airway compromise and septic shock. Diagnostic imaging revealed extensive swelling from the left submandibular region extending to the anterior neck and parapharyngeal space, effacing the airway. This necessitated immediate nasotracheal intubation and mechanical ventilation. Medical management comprised emergent antibiotic administration, airway protection, and admittance to the intensive care unit. This case underscores the potential severity of complications arising from an odontogenic infection in the presence of multiple comorbidities following an oral procedure. It emphasizes the need for prompt symptom recognition, emergency airway management, and the initiation of antibiotic therapy. Furthermore, this case illustrates the critical role of various imaging modalities and the choice of intubation technique in patients with an anticipated difficult airway. Despite the severity of submandibular space infection, a timely, effective, and multidisciplinary approach can mitigate fatal outcomes and improve patient prognosis.
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Affiliation(s)
- Annalee Mora
- Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Oak Hill Hospital, Brooksville, USA
| | - Alisher Hamidullah
- Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Oak Hill Hospital, Brooksville, USA
| | - Sophia Samaranayake
- Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Oak Hill Hospital, Brooksville, USA
| | - Islaam Elnagar
- Anesthesiology, HCA Healthcare/USF Morsani College of Medicine GME: Oak Hill Hospital, Brooksville, USA
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Kim J, Jang EA, Kang D, Moon S, Bae HB. Comparison of the Nasal Cavity Guidance Methods' Effects during Nasotracheal Intubation Using a Preformed Nasotracheal Tube: A Prospective Randomized Controlled Trial. Int J Environ Res Public Health 2023; 20:4503. [PMID: 36901515 PMCID: PMC10002088 DOI: 10.3390/ijerph20054503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Nasotracheal intubation is mainly performed to provide a safe airway during maxillofacial surgeries. Several guiding devices are suggested to facilitate nasotracheal intubation and reduce complications. We attempted to compare intubation conditions during nasotracheal intubation using a nasogastric tube and a suction catheter, which are readily available in operating rooms. In this study, 114 patients undergoing maxillofacial surgery were randomly divided into the nasogastric tube guidance group (NG group) and the suction catheter guidance group (SC group). The primary outcome was the total intubation time. Moreover, the incidence and degree of epistaxis, the position of the tube in the nasal cavity after intubation, and the number of manipulations during intubation in the nasal cavity were investigated. The insertion time from the nostril to the oral cavity and the total intubation time were significantly shorter in the SC group than in the NG group (p < 0.001). The incidence of epistaxis was lower at 35.1% in the NG group and 43.9% in the SC group than the previously reported 60-80%, but there was no statistical difference between the two groups. The use of a suction catheter aid during nasotracheal intubation can be used effectively because it shortens the intubation time and does not increase complications.
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Affiliation(s)
- Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
| | - Eun-A Jang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Dongho Kang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea
| | - Seonho Moon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
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Hashimoto M, Sato (Boku) A, Sento Y, Kamimura Y, Kako E, Okuda M, Tachi N, Okumura Y, Kuroda I, Hoshijima H, Ito H, Sobue K. 3M microfoam™ surgical tape prevents nasal pressure injury associated with nasotracheal intubation: A randomized double-blind trial. Medicine (Baltimore) 2023; 102:e32679. [PMID: 36637954 PMCID: PMC9839254 DOI: 10.1097/md.0000000000032679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND 3M microfoam™ surgical tape (3ST: 3M Japan Limited) is used for pressure wound control of medical equipment. It is cushioned and can be fitted to any body part. Here we investigated whether 3ST prevents nasal pressure injury associated with nasotracheal intubation (NTI). METHODS We conducted a prospective, randomized double-blind study, enrolling 63 patients aged 20 to 70 years, who underwent general anesthesia with NTI. They were divided into 2 groups; those treated with 3ST (group S; n = 31) and control (group C; n = 31). After NTI and before securing the nasotracheal tube, a 35 × 25 mm 3ST was used to protect the nasal wing in group S, and the nasotracheal tube was fixed in place after NTI without protection in group C. The primary outcome was the presence or absence of nasal pressure injury after extubation. The Chi-Square test was used to assess the association between the 2 categorical variables. RESULTS Nasal pressure injury was observed in 7 and 19 patients from groups S and C, respectively, representing a significant difference between the 2 groups (24.1% vs 67.8%, P = .001). Remarkably, none of the patients developed ulcers. CONCLUSION 3ST prevents nasal pressure injury associated with NTI.
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Affiliation(s)
- Mayumi Hashimoto
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
| | - Aiji Sato (Boku)
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
- * Correspondence: Aiji Sato (Boku), Department of Anesthesilogy, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, Aichi 464-8651, Japan (e-mail: )
| | - Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Eisuke Kako
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Masahiro Okuda
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
| | - Naoko Tachi
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
| | - Yoko Okumura
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
| | - Izumi Kuroda
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi, Japan
| | - Hiroshi Hoshijima
- Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry 4-1 Seiryomachi, Aoba, Sendai, Miyagi, Japan
| | - Hidekazu Ito
- Department of Anesthesiology, Toyokawa City Hospital, 23 Yahatacho Noji, Toyokawa-city, Aichi, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
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Hashemi SJ, Shetabi H, Talakoub R, Aminizad A. Comparison of Success Rate and Safety of Nasotracheal Intubation by Conventional and Finger-Guided Method in Patients Undergoing Maxillofacial Surgery. Adv Biomed Res 2023; 12:35. [PMID: 37057229 PMCID: PMC10086639 DOI: 10.4103/abr.abr_255_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/29/2021] [Accepted: 01/31/2022] [Indexed: 04/15/2023] Open
Abstract
Background Different techniques have been introduced to reduce the complications of nasotracheal intubation. The aim of this study was to compare the incidence of nasotracheal intubation complications in finger-guided and conventional methods. Materials and Methods In this double-blind randomized trial study, 70 patients who were candidates for oral and maxillofacial surgery who required nasal intubation were included in the study finally of which 33 patients with conventional method and 35 patients with finger-guided tubes in the nasopharynx were analyzed at the end of the study. Variables such as success rate, hemodynamic response, and complications of intubation were compared between the two groups. Results There was no significant difference between the two groups in terms of hemodynamic response to intubation (P > 0.05). There was a significant difference between the two groups in terms of success in tracheal intubation (P < 0.05). There was a significant difference between the two groups in terms of epistaxis immediately after intubation (P < 0.05). There was no significant difference between the two groups in terms of nasal turbine fractures (P > 0.05). However, the frequency of submucosal intubation in the conventional method was significantly higher than the other group (P = 0.02). Conclusion Nasotracheal intubation using the finger guiding technique in the nasopharynx is associated with a higher success rate and less complications after intubation such as epistaxis and submucosal intubation compared to the conventional method.
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Affiliation(s)
- Seyed Jalal Hashemi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shetabi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Hamidreza Shetabi, Alzahra Hospital, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Reihanak Talakoub
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Avishan Aminizad
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Xing J, Zhang Y, Guan J, Cai J, Wu B, Hei Z. Use of a urinary catheter as a guidewire to facilitate safe nasotracheal intubation following iatrogenic retropharyngeal perforation. Anaesth Rep 2022; 10:e12197. [PMID: 36504729 PMCID: PMC9722399 DOI: 10.1002/anr3.12197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Nasotracheal intubation facilitates adequate access for surgical procedures in the oral cavity, is not limited by mouth opening and can be better tolerated by patients in intensive care. Complications of nasotracheal intubation can include epistaxis, turbinate injury and sinusitis. Retropharyngeal submucosal perforation by the tracheal tube has also been infrequently reported. Here, we report a case of difficult nasotracheal intubation resulting in retropharyngeal submucosal perforation in a patient with a history of obstructive sleep apnoea listed for uvulopalatopharyngoplasty. To facilitate successful tracheal re-intubation, we used a soft urinary catheter via the other nostril. In this report, we discuss the reasons why this complication may have occurred, how submucosal perforation could be avoided, and reflect on our management of this rare complication. Difficult nasotracheal intubation can present unique challenges, and airway management plans should be made accordingly.
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Affiliation(s)
- J. Xing
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Y. Zhang
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - J. Guan
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - J. Cai
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - B. Wu
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Z. Hei
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
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Lin CH, Tseng KY, Su MP, Chuang WM, Hu PY, Cheng KI. Cuff inflation technique is better than Magill forceps technique to facilitate nasotracheal intubation guiding by GlideScope® video laryngoscope. Kaohsiung J Med Sci 2022; 38:796-803. [PMID: 35652136 DOI: 10.1002/kjm2.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022] Open
Abstract
Video laryngoscopy is often selected to assist nasotracheal intubation in allowing better laryngeal visualization, although there is no comparative study evaluating the effectiveness between auxiliary techniques by using Magill forceps and inflated cuff in GlideScope video laryngoscopy for nasotracheal intubation. Fifty-one of 100 patients in a Magill forceps group and 47 of 100 patients in a cuff inflation group were included in the final analysis in this randomized, single-blind, parallel, clinical trial study. Induction agents were routinely administered according to body weight, while intubation time spent, attempts, and related side effects were recorded. Compared to the Magill forceps group, the cuff inflation technique shortened the total intubation time (70.0 ± 24.5 s vs. 87.0 ± 25.0 s, p = 0.001) and the time of advancing the nasotracheal tube from oropharyngeal space into the trachea (25.9 ± 16.4 s vs. 42.3 ± 21.2 s, p < 0.001). However, the number of intubation attempts was not significantly different between groups. During tube advancement, the tube was rotated to accommodate the glottis and trachea more frequently in the cuff inflation group (p = 0.009), but the blade of the laryngoscope shifted and was adjusted to the proper position more frequently in the Magill forceps group (p < 0.001). In the Magill forceps group, the tube cuff might be clipped incidentally and the intubator might shift their gaze away from the screen during intubation, although there was no significant difference in intubation-related side effects between groups. Unlike the conventional approach, nasotracheal intubation with the GlideScope® video laryngoscope using the auxiliary technique of cuff inflation could be more suited than using Magill forceps.
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Affiliation(s)
- Chia-Heng Lin
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Miao-Pei Su
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Ming Chuang
- Department of Anesthesiology, Qishan Hospital of the Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Ping-Yang Hu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Sengel N, Toprak ME, Selmi NH, Atac MS. Using of panoramic and posteroanterior cephalometric radiographs to identify the optimal nasal passage for nasotracheal intubation. Niger J Clin Pract 2022; 25:647-652. [PMID: 35593608 DOI: 10.4103/njcp.njcp_1739_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aim Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. Materials and Methods The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Results There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. Conclusion The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.
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Affiliation(s)
- N Sengel
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
| | - M E Toprak
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
| | - N H Selmi
- Department of Anesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Onkoloji Eğitim ve Araştırma Hastanesi, Yenimahalle, Ankara, Turkey
| | - M S Atac
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
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Sengel N, Karabulut G, Kavuncuoğlu D, Selmi NH, Sivgin V, Toprak ME. Nasotracheal intubation performance with the mcgrath videolaryngoscope versus macintosh laryngoscope in oral and maxillofacial surgery- An observational study. Niger J Clin Pract 2022; 25:683-689. [PMID: 35593613 DOI: 10.4103/njcp.njcp_1923_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aim Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and glottis visualization of McGrath video laryngoscope with the Macintosh laryngoscope for routine nasotracheal intubation. Materials and Methods Records of seventy-one ASA (American Society of Anesthesiologists) I-II patients were evaluated and allocated into two groups (McGrath video laryngoscope (VL) and Macintosh groups). Intubation times, modified intubation difficulty scale (MIDS) scores, and hemodynamic parameters (heart rate and mean arterial pressure) were compared after the anesthesia induction and the intubation. Results Mean intubation time in the McGrath group (24.9 ± 5.9 seconds) was significantly lower than that of the Macintosh group (28 ± 6.2 seconds; P = 0.037). Magill forceps were needed less in the McGrath group compared to the Macintosh group (13.89% vs. 42.86%; P = 0.009). Total MIDS scores were similar (P = 0.778). There was no significant difference in the hemodynamic parameters between the groups. Conclusion The McGrath VL significantly reduced the intubation time and the use of Magill forceps compared with Macintosh direct laryngoscope and can be utilised effectively for routine nasotracheal intubation.
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Affiliation(s)
- N Sengel
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - G Karabulut
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - D Kavuncuoğlu
- Department of Public Health, Samandağ Health Directorate, Hatay, Turkey
| | - N H Selmi
- Intensive Care Department, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - V Sivgin
- Department of Anesthesiology and Reanimation, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - M E Toprak
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey
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Piper N, Lacey J, Konstantatos A. Unilateral dilated pupil following nasotracheal intubation. Anaesth Rep 2021; 9:e12142. [PMID: 34881365 DOI: 10.1002/anr3.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- N Piper
- Department of Anaesthesiology Alfred Hospital Melbourne Victoria Australia
| | - J Lacey
- Department of Anaesthesiology Alfred Hospital Melbourne Victoria Australia
| | - A Konstantatos
- Department of Anaesthesiology Alfred Hospital Melbourne Victoria Australia
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Kasaudhan S, Gupta M, Singh K, Khan A. A comparison of intubating conditions for nasotracheal intubation with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope employing cuff inflation technique in adult patients. Indian J Anaesth 2021; 65:S104-S109. [PMID: 34703054 PMCID: PMC8500197 DOI: 10.4103/ija.ija_236_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/28/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: While performing laryngoscopy during nasotracheal intubation (NTI), the tip of the advancing endotracheal tube (ETT) generally lies along the posterior pharyngeal wall. The inflation of the ETT cuff brings it anterior towards the glottis. The present study was planned to compare the intubating conditions for NTI with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope (VL) employing ETT cuff inflation technique. Methods: This prospective randomised study was carried out on 50 patients, American Society of Anesthesiologists physical status I–II, age 18–60 years of either sex with an indication for NTI under general anaesthesia. They were randomly divided into two groups: group VL (n = 25): C-MAC® VL and group ML (n = 25): Macintosh laryngoscope. The primary outcome was to compare the total duration of NTI (T), while the secondary outcomes were to compare the need for cuff inflation or assistance with Magill forceps for successful NTI, the total number of attempts to achieve successful NTI, haemodynamic effects and complications. Results: T was significantly higher in group ML than group VL (P < 0.001). The intubation was successful with cuff inflation in all the patients in group VL, however, six patients of group ML required assistance with Magill forceps (P = 0.022). The haemodynamic parameters were all significantly higher at 3 min in group ML in comparison to group VL. Conclusion: The cuff inflation technique when used along with C-MAC® VL had more success rate, required lesser time and had minimal postoperative complications in comparison to the Macintosh laryngoscope.
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Affiliation(s)
- Sonia Kasaudhan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Madhu Gupta
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Kriti Singh
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Anas Khan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
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Kumar A, Gupta N, Kumar V, Bharti SJ, Garg R, Kumar R, Bhatnagar S. Comparative evaluation of glidescope videolaryngosocope and conventional macintosh laryngoscope for nasotracheal intubation in patients undergoing oropharyngeal cancer surgeries: A prospective randomized study. J Anaesthesiol Clin Pharmacol 2021; 37:542-547. [PMID: 35340943 PMCID: PMC8944373 DOI: 10.4103/joacp.joacp_30_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/09/2020] [Accepted: 04/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Nasotracheal intubation in oropharyngeal cancer patients is challenging owing to anatomical alterations. Various videolaryngoscopes have been compared to conventional laryngoscope and also amongst each other in different clinical scenarios; the supremacy of videolaryngoscopes over conventional laryngoscope in oropharyngeal cancer patients is yet to be established. We compared the efficacy of glidescope videolaryngoscopes and Macintosh laryngoscope for nasotracheal intubation in patients posted for routine oropharyngeal cancer. MATERIAL AND METHODS 120 ASA I and II oropharyngeal cancer patients scheduled for elective surgery were randomized to undergo nasotracheal intubation after induction of general anesthesia with glide scope video laryngoscope (Group GVL, N = 60) or Macintosh laryngoscope (Group L, N = 60) as per group allocation. Time to glottic view, total intubation time (primary objective), hemodynamic fluctuations, and additional manoeuvres to aid intubation were recorded. RESULTS Time to visualize the glottic opening (9.20 ± 4.6 sec vs 14.8 ± 6.3 sec) (P = 0.000) and the total intubation time was significantly less in group GVL (35.6 ± 9.57 sec vs 42.2 ± 11 sec) (P = 0.001). Glidescope videolaryngosocpe provided better glottic views and resulted in significantly fewer manoeuvres to facilitate NTI (P = 0.009). The median numeric rating scale (NRS), hemodynamic parameters and complications were similar in both the groups. CONCLUSION Glidescope videolaryngosocpe is better than conventional Macintosh laryngoscope for intubation times and need of manoeuvres to facilitate intubation and should be a preferred device for NTI in patients with oropharyngeal cancer.
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Affiliation(s)
- Abhishek Kumar
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
- Address for correspondence: Dr. Nishkarsh Gupta, Home Address: 437, Pocket A, Sarita Vihar, New Delhi - 110 076, India. E-mail:
| | - Vinod Kumar
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Rajeev Kumar
- Scientist (Statistician), BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India
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Wang L, Liu Q, Xiaoming D, Wang Y, Xiang G, Wei L, Yang D. Ephedrine pretreatment for nasotracheal intubation-related epistaxis in maxillofacial surgery with sufficient lubrication: A randomized clinical trial. J Clin Pharm Ther 2021; 46:1680-1686. [PMID: 34409620 DOI: 10.1111/jcpt.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Prior to nasotracheal intubation (NTI), topical nasal vasoconstrictors are used to prevent NTI-related epistaxis (NTIRE). Since we learned that there is no significant increase in NTIRE among hypertensive patients undergoing NTI with adequate lubrication but without vasoconstrictors, we initiated this randomized controlled study to assess the necessity of vasoconstrictor use in reducing NTIRE. METHODS Patients with the American Society of Anesthesiologists Physical Status Classification 1 and normal coagulation function, planned to undergo maxillofacial surgery with NTI were enrolled. Patients were randomly (1:1) assigned to each of the treatment groups: nasal treatment using pure oxybuprocaine gel with adequate lubrication (group G) or 1% ephedrine in addition to oxybuprocaine gel with adequate lubrication (group EG). In addition, the incidence and severity of NTIRE and intubation adjustments were studied. RESULTS A total of 844 patients, 429 and 415 (groups G and EG, respectively), were included in the analysis. No significant differences were observed in the NTIRE incidence rates in groups G (28%) and EG (27%; p = 0.75, relative risk [RR] = 0.95, 95% confidence interval [CI] 0.70-1.29). No significant differences in the NTIRE incidence rates between the two nostrils were observed in both groups (group G: left, 27.9% vs. right, 28% [p = 0.98, RR = 1.01, 95% CI 0.67-1.51]; group EG: left, 25.8% vs. right, 27.9% [p = 0.63, RR = 1.12, 95% CI 0.72-1.73]. No significant difference was observed in the severity of NTIRE (p = 0.74). In case of difficult advancement of the endotracheal tube, NTIRE incidence was 71% vs. 12% with smooth intubation (p < 0.01, RR = 18.33, 95% CI 12.55-26.77). WHAT IS NEW AND CONCLUSION Well-lubricated nasotracheal intubation does not require pretreatment with ephedrine to reduce NTIRE.
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Affiliation(s)
- Lei Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quanle Liu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Deng Xiaoming
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ye Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guihua Xiang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingxin Wei
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dong Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Prashant HT, Kerai S, Saxena KN, Wadhwa B, Gaba P. Comparison of cuff inflation method with curvature control modification in thermosoftened endotracheal tubes during nasotracheal intubation - A prospective randomised controlled study. Indian J Anaesth 2021; 65:369-376. [PMID: 34211194 PMCID: PMC8202803 DOI: 10.4103/ija.ija_1393_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/27/2021] [Accepted: 03/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Thermosoftening of endotracheal tube (ETT) is a simple method which reduces risk of epistaxis during nasotracheal intubation (NTI). This method, however, decreases the stiffness of ETT and necessitates frequent manipulation with Magill forceps. Cuff inflation technique has been found effective for navigating ETTs during NTI. Another method is using an ETT, modified with a silk thread which can be used to control its curvature. We conducted the present study to compare the ease of navigation of thermosoftened ETT using curvature control modificationwiththe cuff inflation technique. Methods: Depending on the method used for navigating thermosoftened ETT to glottis, 70 patients undergoing general anaesthesia with NTI were randomly divided into two groups. The primary outcome was ease of navigation of thermosoftened ETT. Secondary outcomes were time taken for moving tube from oropharynx to glottis and incidence of epistaxis during NTI. Results: Both techniques resulted in successful navigation of thermosoftened ETT in all patients with majority of cases resulting in smooth engagement to glottic inlet. The difference in ease of navigation between the groups was 7% [95% CI (−9.21% to 23.28%)] and it was not found to be statistically significant (P = 0.395). Cuff inflation method resulted in faster alignment to glottis compared to use of modified tube (12. 39 ± 7 Vs 18.73 ± 11.5 sec; P = 0.003). Conclusion: For thermosoftened ETT, both cuff inflation method and the technique of curvature controlled modified ETT can be used for navigation of tube to glottis with ease.
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Affiliation(s)
- H T Prashant
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Kirti Nath Saxena
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Bharti Wadhwa
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Prachi Gaba
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Ambulkar R, Ranganathan P, Savarkar S, Divatia JV. A randomized controlled trial comparing McGRATH series 5 videolaryngoscope with the Macintosh laryngoscope for nasotracheal intubation. J Anaesthesiol Clin Pharmacol 2021; 36:477-482. [PMID: 33840927 PMCID: PMC8022068 DOI: 10.4103/joacp.joacp_1_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 11/09/2022] Open
Abstract
Background and Aims: The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries. Material and Methods: We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). The secondary objectives included success rates, number of attempts, need for optimization maneuvers, Cormack and Lehane (CL) grade, and percentage of difficult intubations. Results: The mean TTI in the VL group was 43 (±10.6) versus 75 (±38.0) s in the Macintosh group (99% CI: 12.5; –51.6 s; P < 0.001). The overall intubation success rate was 100% in both groups. All 29 (100%) patients in the VL group were intubated in the first attempt versus 26 (86%) patients in the Macintosh group (99% CI –5; 33%; P = 0.11). In the Macintosh group, 20 (66%) patients needed optimization maneuver versus none in the VL group (99% CI 40; 91%; P < 0.001). In the VL group, 28 (96%) patients had a CL grade 1 view versus 9 (31%) in Macintosh group (99% CI 38; 92%; P < 0.001). There were no difficult intubations in the VL group versus 3 (10%) in the Macintosh group (99% CI: 7; 28%; P = 0.237). There was no trauma to oropharyngeal structures in either group. Conclusion: The McGRATH series 5 VL has faster TTI, better glottic visualization, and less need for optimization maneuvers than the Macintosh laryngoscope for NTI in patients with unanticipated difficult airways, when performed by experienced anesthetists.
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Affiliation(s)
- Reshma Ambulkar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Priya Ranganathan
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Sukhada Savarkar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
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Kumar V, Angurana SK, Baranwal AK, Nallasamy K. Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial. Front Pediatr 2021; 9:713516. [PMID: 34604139 PMCID: PMC8481700 DOI: 10.3389/fped.2021.713516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The data on long-term nasotracheal intubation among mechanically ventilated critically ill children is limited. The purpose of this study was to compare the rate of post-extubation airway obstruction (PEAO) with nasotracheal and orotracheal intubation. Methods: This open-label randomized controlled trial was conducted in PICU of a tertiary care and teaching hospital in North India from January-December 2020 involving intubated children aged 3 months-12 years. After written informed consent, children were randomized into nasotracheal and orotracheal intubation groups. Post-extubation, modified Westley's croup score (mWCS) was used at 10-timepoints (0-min, 30 min, 1, 2, 3, 6, 12, 24, 36, and 48-h after extubation) to monitor for PEAO. The primary outcome was the rate of PEAO; and secondary outcomes were time taken for intubation, number of intubation attempts, complications during intubation, unplanned extubation, repeated intubations, tube malposition/displacement, endotracheal tube blockade, ventilator associated pneumonia, skin trauma, extubation failure/re-intubation, duration of PICU stay, and mortality. Results: Seventy children were randomized into nasotracheal (n = 30) and orotracheal (n = 40) groups. Both the groups were similar in baseline characteristics. The rate of PEAO was similar between nasotracheal and orotracheal groups (10 vs. 20%, p = 0.14). The maximum mWCS and mWCS at 10-timepoints were similar in two groups. The time taken for intubation was significantly longer (85 vs. 48 s, p < 0.001) in nasotracheal group, whereas other secondary outcomes were similar in two groups. Conclusion: The rate of PEAO was not different between nasotracheal and orotracheal groups. Clinical Trial Registration:http://ctri.nic.in, Identifier: CTRI/2020/01/022988.
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Affiliation(s)
- Vijay Kumar
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dhakate VR, Singam AP, Bharadwaj HS. Evaluation of Nasopharyngeal Airway to Facilitate Nasotracheal Intubation. Ann Maxillofac Surg 2020; 10:57-60. [PMID: 32855916 PMCID: PMC7433945 DOI: 10.4103/ams.ams_190_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/18/2019] [Accepted: 01/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Nasotracheal intubation is the most common method of airway management in oral and maxillofacial surgery patients. However, many times, it is associated with bleeding resulting from trauma to nasopharyngeal mucosa. We conducted this study to determine the effectiveness of nasopharyngeal airway (NPA) to easily facilitate the nasopharyngeal insertion and to reduce the trauma during nasotracheal intubation. Methods: A total of 120 patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly divided into two groups of 60 each, after preparation with xylometazoline drops intranasally, lubrication with lignocaine jelly, and thermosoftening of the tip of the endotracheal tube (ETT). In group NPA, dilatation of the nasal cavity was done with NPA before nasotracheal intubation and in Group C, nasotracheal intubation was done without dilatation of the nasal cavity. The smoothness of insertion of ETT was graded on a 4‑point rating scale. Assessment of bleeding into nasopharynx was confirmed during laryngoscopy and was also graded with 4‑point scale. Results: In the NPA group, all the 60 (100%) patients had smooth or relatively smooth (Grade 0 or 1) insertion compared to 51 (85%) patients in the control group (P < 0.0001). Eighteen (30%) patients had mild (Grade 1) bleeding and one (1.67%) patient had moderate bleeding (Grade 2) in the control group, whereas only four (6.67%) patients in the NPA group had mild (Grade 1) bleeding (P = 0.0005). Conclusion: Dilatation of nasal cavity with NPA significantly eases the insertion of ETT into the nasopharynx and also significantly decreases the incidence and severity of trauma and bleeding during nasotracheal intubation.
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Affiliation(s)
- Vinay R Dhakate
- Department of Anaesthesia, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Amol Prakash Singam
- Department of Anaesthesia, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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19
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Arslan ZI. Reply to Letter to the Editor. Turk J Med Sci 2020; 50:279. [PMID: 31655527 PMCID: PMC7080346 DOI: 10.3906/sag-1909-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zehra Ipek Arslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Abstract
Objective Nasotracheal (NT) intubation is commonly applied during head and neck surgery. However, improper tube size and depth may cause complications. In the current study, we investigated whether NT tubes are being appropriately used in terms of size and depth in adult patients. Methods Nares were sized in 40 patients using standard nasopharyngeal airways (6.0–8.0) before elective surgery under general anesthesia. The largest sized airway that passed easily into the nasopharynx without resistance was considered as a proper size. Using a fiberoptic scope, the distances from the nares to the vocal cords and the nares to the carina were measured. Rates of proper NT tube positioning were calculated with regard to the cuff and distal tip. Results The most frequent sizes of properly fitted NT tubes were 6.5 and 6.0 in male and female patients, respectively. Positioning of the cuff and distal tip was only appropriate when using a properly sized tube in 26% and 47% of male and female patients, respectively. Conclusion Care should be taken to determine the insertion depth after placing an NT tube that has been sized to fit the nostril. Moreover, NT tubes of the same diameter may be required in various lengths. Trial registration: Registered at ClinicalTrial.gov; https://clinicaltrials.gov/ct2/show/NCT02876913; Registration number NCT02876913
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Soon Young Yun
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Soojeong Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
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Abstract
Background The aim of our study was to compare the hemodynamic responses and adverse events associated with nasotracheal intubation (NTI) using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS) in children undergoing general anesthesia for outpatient dental surgery. Methods Eighty children (aged 5-15 years) were scheduled to undergo outpatient dental surgery under general anesthesia and of these children those who required NTI were included. Results NTI was significantly longer in the FOB group (P = 0.03). In both groups, systolic blood pressure (SBP) and heart rate (HR) significantly decreased after the induction of anesthesia when compared with the baseline values. SBP was significantly higher in both groups at intubation and 1 and 3 min after intubation when compared with postinduction. SBP significantly increased in the DLS group compared with the FOB group at intubation and 1 min after intubation. HR was significantly increased at intubation and 1 min after intubation in the DLS group compared with the FOB group. Nose bleeding after intubation was significantly more frequent in the DLS group (30%) than in the FOB group (7.5%) (P = 0.034). The incidence of sore throat 24 h after surgery was 20% (8/40) in the DLS group and 2.5% (1/40) in the FOB group (P = 0.014). Conclusions There are fewer hemodynamic responses and adverse events in the FOB group than in the DLS group; therefore, FOB can be safely used for NTI in children undergoing outpatient dental surgery, and FOB may be more successful than DLS for NTI.
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Affiliation(s)
- A S Ozkan
- Faculty of Medicine, Inonu University, Malatya, Turkey
| | - S Akbas
- Faculty of Medicine, Inonu University, Malatya, Turkey
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Lee YJ, Megwalu U, Melara E, Divi V, Fernandes VT, Sirjani D. Jaw Opening Decreases Window to the Deep Parotid Lobe. Otolaryngol Head Neck Surg 2018; 159:439-441. [PMID: 29609515 DOI: 10.1177/0194599818766317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To describe the relationship between jaw opening and access to the deep parotid window, we identified the following distances in 10 human skulls: symphysis to angle of mandible, mastoid tip to angle of mandible, angle of mandible to condylar process, and mastoid tip to condylar process. With the jaw closed and open, these distances were measured with 1 to 3 wooden blocks, each measuring 1 cm, between the upper and lower incisors. The triangular deep parotid area formed by the last 3 distances was calculated. A repeated measures analysis of variance showed a significant decrease in the deep parotid area with increasing interincisal distance ( P < .01). A generalized estimating equation model demonstrated a statistically significant decreasing area of the deep parotid window with increasing interincisal distance. These results suggest that nasal intubation may improve access to the parotid window.
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Affiliation(s)
- Yu-Jin Lee
- 1 Stanford University School of Medicine, Stanford, California, USA
| | - Uchechukwu Megwalu
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Erick Melara
- 3 Division of Clinical Anatomy, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Vasu Divi
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Vinay T Fernandes
- 4 Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Davud Sirjani
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,5 Department of Otolaryngology-Head and Neck Surgery, Palo Alto Veterans Affairs, Palo Alto, California, USA
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Mishra G, Philip VM, Kumar VRH, Sivashanmugam T. Suitability of Nasotracheal Intubation using King Vision and Truview PCD Video Laryngoscopes: A Randomized Clinical Trial. Anesth Essays Res 2018; 12:581-585. [PMID: 29962638 PMCID: PMC6020610 DOI: 10.4103/aer.aer_68_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Several video laryngoscopes had demonstrated their superiority over conventional oral and nasal intubation techniques. King Vision video laryngoscope has fewer studies supporting its suitability for oral intubations. However, its suitability as a nasal intubating device has not been yet evaluated. We evaluated the suitability of King Vision video laryngoscope for nasotracheal intubation comparing with TruviewPCD. METHODS Eighty American Society of Anesthesiologists Grade I and II elective surgical patients were studied. After meeting the inclusion criteria, 80 study subjects were randomized into two groups. Group T were intubated using TruviewPCD and Group K were intubated with the nonchanneled King Vision video laryngoscope. Our primary outcome was single successful nasotracheal intubation without use of any additional maneuvers. The time taken for intubation, use of additional maneuverers, Cormack-Lehane grading, and hemodynamics were also analyzed. RESULTS Seventy-one patients (88.75%) were successfully intubated in a single attempt, i.e. 35 patients (90%) in Group K and 36 patients (87.5%) in Group T. Intubation time (mean ± standard deviation) was 67.9 ± 24.1 s in Group T and 64.9 ± 20.0 s in Group K where comparison was not statistically significant (P = 0.5). The additional maneuvers (P = 0.2) and hemodynamic changes were not clinically significant. There were no associated serious complications. CONCLUSION King Vision video laryngoscope is just as effective as TruviewPCD video laryngoscope for successful nasotracheal intubation.
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Affiliation(s)
- Gayatri Mishra
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be- University), Puducherry, India
| | - Varghese Mammen Philip
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be- University), Puducherry, India
| | - Vadlamudi Reddy Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be- University), Puducherry, India
| | - Thiyagarajan Sivashanmugam
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be- University), Puducherry, India
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Amin DP, Cooper MN, Newton KI. Traumatic Lingual Hematoma Resulting in Bilateral Temporal Mandibular Joint Dislocations. J Emerg Med 2018; 54:e101-e103. [PMID: 29452722 DOI: 10.1016/j.jemermed.2017.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction. CASE REPORT Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously undiagnosed thrombocytopenia. Airway stabilization was rapidly established via nasotracheal intubation after standard intubation techniques were deemed unfeasible. Despite correction of the coagulopathy, the LH continued to expand, resulting in bilateral tympanomandibular joint (TMJ) dislocations. To our knowledge, this complication has not been previously reported as a complication of LH. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite being a relatively uncommon condition, LH has the potential to result in life-threatening airway obstruction with limited airway options. Prompt airway stabilization should be the first priority upon diagnosis. A rapidly evolving LH can limit standard orotracheal rapid sequence intubation options, and may require alternative airway procedures. Additionally, ongoing lingual swelling after airway stabilization has now been shown in our case to result in bilateral TMJ dislocations. Concurrent management of reversible coagulopathy may help prevent this complication or reduce its severity.
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Affiliation(s)
- Dhara P Amin
- Department of Emergency Medicine, Cook County (Stroger) Hospital, Rush Medical College, Chicago, Illinois
| | | | - Kim I Newton
- Department of Emergency Medicine, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine at University of Southern California, Los Angeles, California
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Christensen LK, Armstead VE, Bilyeu DP, Johnson KE, Friesen RH. Hemodynamic responses and plasma phenylephrine concentrations associated with intranasal phenylephrine in children. Paediatr Anaesth 2017; 27:768-773. [PMID: 28504321 DOI: 10.1111/pan.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intranasal phenylephrine, an alpha-1 adrenergic agonist, causes vasoconstriction of the nasal mucosa and is used to reduce bleeding associated with nasotracheal intubation or endoscopic sinus surgery. The purpose of this study was to describe the hemodynamic effects associated with plasma phenylephrine concentrations following topical intranasal administration of 0.25% and 0.5% phenylephrine in children. METHODS After Institutional Review Board and parental approval, 77 children between the ages of 2 and 12 years were studied in a prospective, double-blind manner and randomized into three groups. Group 1 received intranasal saline, while groups 2 and 3 received 0.1 mL/kg of 0.25% or 0.5% phenylephrine, respectively. All received the same anesthetic of halothane, N2 O, O2 , and vecuronium. After inhalation induction, endtidal halothane and PaCO2 were maintained at 1.5% and 35 mm Hg, respectively. Heart rate and rhythm, systolic, diastolic, and mean, noninvasive arterial blood pressures were recorded and venous blood was obtained for measurement of plasma phenylephrine concentration by high-performance liquid chromatography at baseline and at 2, 5, 10, and 20 minutes following intranasal spray application of the study drug. Nasotracheal intubation was performed immediately following the 5-minute measurements, and the presence of bleeding was assessed. Hemodynamic data were compared by analysis of variance for repeated measures. Bleeding and arrhythmia incidence among groups were analyzed using chi-squared tests. Phenylephrine levels were correlated with hemodynamic values via regression analysis. RESULTS Fifty-two patients received intranasal phenylephrine. Increases in blood pressure correlated with increasing plasma phenylephrine concentration. Systolic blood pressure increased 8%, and mean blood pressure increased 14%, which were statistically significant but clinically insignificant. Heart rate did not change, and the incidence of arrhythmia was low and similar among groups. Bleeding following nasotracheal intubation was less frequent in Group 3 (11/27 subjects) than in Group 1 (17/25). Peak plasma phenylephrine concentrations were observed by 14±7 minutes following intranasal administration, and were highly variable among individuals (37.8±39.7 and 49.6±93.9 ng/mL [mean±SD] in Groups 2 and 3). DISCUSSION Administration of intranasal phenylephrine, 0.25% and 0.50%, results in rapid but highly variable systemic absorption that is associated with mild increases of blood pressure that are clinically insignificant. Bleeding associated with nasotracheal intubation was less following administration of 0.5% intranasal phenylephrine than following intranasal saline.
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Affiliation(s)
- Lisa K Christensen
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Valerie E Armstead
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - David P Bilyeu
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Kenneth E Johnson
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Robert H Friesen
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
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Jo YY, Kim HS, Lee KC, Chang YJ, Shin Y, Kwak HJ. CONSORT the effect of intraoperative dexmedetomidine on hemodynamic responses during emergence from nasotracheal intubation after oral surgery. Medicine (Baltimore) 2017; 96:e6661. [PMID: 28422874 PMCID: PMC5406090 DOI: 10.1097/md.0000000000006661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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 Dexmedetomidine provides smooth emergence with reduced agitation. The authors hypothesized low-dose dexmedetomidine infusion might contribute to hemodynamic stability during and after nasotracheal tube extubation. METHODS Ninety-three adult patients scheduled for oral and maxillofacial surgery were enrolled in this prospective study. Patients were randomly assigned to receive normal saline (control group, n = 31), dexmedetomidine at 0.2 μg/kg/h (DEX0.2 group, n = 31), or dexmedetomidine at 0.4 μg/kg/h (DEX0.4 group, n = 31). Mean arterial pressure (MAP), heart rate (HR), and response entropy (RE) and state entropy (SE) were recorded during emergence from anesthesia. RESULTS Extubation times were similar in the 3 groups. Mean MAP was significantly lower at eye opening (T3) and immediately after extubation (T4) in the DEX0.2 (P = .013 and .003, respectively) and DEX0.4 group (P = .003 and .027, respectively) than in the control group. At T3 and T4, mean HR was significantly higher in the control group than in the DEX0.2 (P = .014 and .022, respectively) or DEX0.4 groups (P = .003 and <.001, respectively). In the postanesthetic care unit, mean MAP and HR were significantly lower in the DEX0.2 (P = .03 and .022, respectively) and DEX0.4 groups (P = .027 and <.001, respectively) than in the control group. CONCLUSION Intraoperative dexmedetomidine infusion at rates of 0.2 or 0.4 μg/kg/h during oral and maxillofacial surgery could provide stable hemodynamic profiles during anesthetic emergence from nasotracheal intubation without delaying extubation times.
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Patil VV, Subramanya BH, Kiranchand N, Bhaskar SB, Dammur S. Does C-MAC ® video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries? Indian J Anaesth 2016; 60:732-736. [PMID: 27761036 PMCID: PMC5064697 DOI: 10.4103/0019-5049.191676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS C-MAC® video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC® VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC® VL for NTI. METHODS Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8-18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC® VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups. RESULTS C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1-M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%). CONCLUSION The overall performance of C-MAC® VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres.
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Affiliation(s)
- Vinuta V Patil
- Department of Anaesthesiology, DM WIMS Medical College and Hospital, Wayanad, Kerala, India
| | - Bala H Subramanya
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India
| | - N Kiranchand
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India
| | - Srinivasalu Dammur
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India
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Abstract
Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure.
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Affiliation(s)
- Varun Chauhan
- Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Gaurav Acharya
- Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
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Hunyady AI, Otto RK, Christensen A, Jonmarker C. Nares-to-carina distance in children: does a 'modified Morgan formula' give useful guidance during nasal intubation? Paediatr Anaesth 2015; 25:936-42. [PMID: 26033678 DOI: 10.1111/pan.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge of the normal nares-to-carina (NC) distance might prevent accidental bronchial intubation and be helpful when designing preformed endotracheal tubes (ETT). OBJECTIVE The aim was to measure NC distance and to examine whether a height/length-based 'modified Morgan formula' would give useful guidance for nasotracheal ETT depth positioning. METHODS Two groups were studied. A younger group consisted of nasally intubated postoperative patients. In these, NC distance was obtained as the sum of ETT length and the distance from the ETT tip to the carina, as measured from an anteroposterior chest X-ray. An older group consisted of children who had undergone computerized tomography (CT) examination including head, neck, and chest. In these, NC was measured directly from the CT image. The modified Morgan formula was derived from the NC vs height/length relationship. RESULTS Nares-to-carina distance was best predicted by a linear equation based on patient height. The equation in the younger group (1 day-8 years, n = 57) was: NC (cm) = 0.14 × height + 5.8, R(2) = 0.90, and in the older group (2.1-20 years, n = 45): NC (cm) = 0.15 × height + 3.4, R(2) = 0.93. The equation for the groups combined (n = 102) was: NC (cm) = 0.14 × height + 6.2, R(2) = 0.97. Based on the latter equation, a modified Morgan formula was identified as: ETT position at nares in cm = 0.12 × height + 5. If the ETT had been placed as calculated by this formula, the ETT tip would have been at 85 + 5% (mean ± sd) of NC distance, and the ETT tip-to-carina distance would have been 3.1 ± 1.1 cm (range 0-6.6). Bronchial intubation would not have occurred in any child, but a comparison to tracheal length measurements indicates that ETT tip position could be too proximal in some children. CONCLUSION The study confirms previous reports: NC distance can be well predicted from height/length. A modified Morgan formula might decrease the risk for accidental endobronchial intubation in infants and children, but ETT position need to be confirmed by auscultation or other verification.
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Affiliation(s)
- Agnes I Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexis Christensen
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA, USA
| | - Christer Jonmarker
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Foreman PM, Harrigan MR, Griessenauer CJ, Loukas M, Tubbs RS. Access to the carotid artery bifurcation: Cadaveric study with application to nasotracheal intubation as a technique to improve access to a high carotid artery bifurcation. Br J Neurosurg 2015; 29:865-7. [PMID: 26312946 DOI: 10.3109/02688697.2015.1071331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Carotid endarterectomy (CEA) is a common and efficacious surgical procedure for the prevention of ischemic stroke due to atherosclerosis of the internal carotid artery (ICA). A high common carotid artery bifurcation can make CEA technically difficult due to limited carotid artery exposure. A cadaveric study was performed to evaluate the efficacy of nasotracheal intubation for improving access to a high carotid artery bifurcation. Based on this study, nasotracheal intubation does not improve access to a high carotid artery bifurcation as compared with orotracheal intubation.
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Affiliation(s)
- Paul M Foreman
- a Department of Neurological Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mark R Harrigan
- a Department of Neurological Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Christoph J Griessenauer
- a Department of Neurological Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Marios Loukas
- b Department of Anatomical Sciences , St. George's University , Grenada
| | - R Shane Tubbs
- c Pediatric Neurosurgery, Children's Hospital , Birmingham , AL , USA
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Abstract
Background and Aims: MacGrath videolaryngoscope is one of the recent videolaryngoscopes, which can be used to facilitate nasotracheal intubations using Scroeder directional stylet. Material and Methods: 15 patients, American Society of Anesthesiologists Grades I-II, undergoing tonsillectomy, requiring nasotracheal intubation were included. All patients were intubated with MacGrath videolaryngoscope and Schroeder stylet. Primary outcome measures were duration and ease of intubation. Overall success rate, number of attempts, modified Cormack-Lehane (C-L) grading, and complications were also recorded. Results: All 15 intubations were successful during first laryngoscopy attempt. C-L Grade I views were obtained in 14 patients (93%) and Grade II view in one patient (7%). The time required to obtain the best C-L view was 9.4 ± 1.5 s. The time taken to complete tracheal intubation was 34.27 ± 3.38 s. Average numerical rating scale for tracheal intubation was 8.7 ± 0.9. Minor complications occurred in four patients (26.7%). Conclusions: MacGrath videolaryngoscope produces excellent laryngoscopic views in patients with normal airways. Impaction of tracheal tube on posterior nasopharyngeal wall can be overcome by Schroeder stylet.
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Affiliation(s)
- Bikramjit Das
- Department of Anaesthesiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology, J.N. Medical College, A.M.U., Aligarh, Uttar Pradesh, India
| | - Nadeem Raza
- Department of Anaesthesiology, J.N. Medical College, A.M.U., Aligarh, Uttar Pradesh, India
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Abstract
Background: A double-blinded, prospective, and randomized study was designed to determine the efficacy and tolerability of intravenous (IV) magnesium sulfate (MgSO4) to facilitate fiberoptic bronchoscopic (FOB) nasotracheal intubations. Patients and Methods: A total of 120 patients scheduled to undergo elective awake fiberoptic nasotracheal intubation, while they were anesthetized for elective surgery were randomly allocated to one of three groups: The control Group S (n = 40) received 100 ml (50 ml 0.9% saline + 50 ml paracetamol) was infused in 10 min and direct IV 5 ml 0.9% normal saline, Group MD (n = 40): Received midazolam IV in a dose of 0.07 mg/kg in 5 ml 0.9% normal saline and 100 ml 0.9% was infused in 10 min and Group MS (n = 40): IV 45 mg/kg MgSO4 10 min in 100 ml of 0.9% normal saline through 10 min and direct IV 5 ml 0.9% normal saline. Results: Time required for nasotracheal intubation was significantly less in group Groups MD and MS, as compared with the control group, but not significant between the two groups. (Group MD: 9.05 + 1.95 min, Group MS 3.75 + 0.75 min and Group S 16.85 + 1.7 min). However, the number of fiberoptic intubation was significantly more in the MD and MS groups, as compared with the control group. Easy intubation (control group: 0, Group MD: 25 and Group MS: 35), moderate difficulty (control group: 5, Group MD: 12 and Group MS: 4) and difficult (control group: 35, Group MD: 3 and Group MS: 1). Procedure adverse events were significantly lower in Group MS. None of the patients in Group MS had procedure hypoxia, but it occurred in 10 patients of Group MD and 20 patients in Group S. Six patients in Group S and two in Group MD had procedure apnea whereas, none of the patients in the MS group experienced this. After medication and just before intubation heart rate and mean arterial pressure were significantly less in Groups MD and MS, as compared to the control group (Group MD: 77 + 7.7 beat/min, Group MS: 70 + 5.6 beat/min and Group S: 80 + 7.8 beat/min) (Group MD: 90 + 8.5 mmHg, Group MS: 80 + 8.1 mmHg and Group S: 105 + 10.5 mmHg). This difference however, significant between Group MD and Group MS. Conclusion: Intravenous MgSO4 improved awaken FOB intubation without adverse hemodynamic or respiratory effects.
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Affiliation(s)
- Ahmed Said Elgebaly
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt
| | - Ahmed Ali Eldabaa
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt
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Olmez G, Ali Ozyilmaz M, Menekse A. Comparison of the effects of remifentanil andalfentanil on cardiovascular response to nasotracheal intubation: A prospective, randomized, double-blind study. Curr Ther Res Clin Exp 2005; 66:385-93. [PMID: 24672137 DOI: 10.1016/j.curtheres.2005.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2005] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nasotracheal intubation is often necessary in patients undergoingelective or emergency maxillofacial surgery. Previous studies have suggested that the increase in blood pressure after nasotracheal intubation is significantly greater than the increase after orotracheal intubation. Many drugs, including narcotic analgesics, are effective in modifying cardiovascular responses to orotracheal intubation. OBJECTIVE The effects of remifentanil and alfentanil on the cardiovascularresponses to nasotracheal intubation were compared in healthy patients scheduled to undergo surgery. METHODS This prospective, randomized, double-blind study was conductedat the Department of Anesthesiology and Reanimation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. Patients aged 16 to 65 years scheduled to undergo elective maxillofacial surgery and who were American Society of Anesthesiologists status I or 11 were randomly assigned to receive remifentanil 1 μg/kg in 10 mL saline over 30 seconds followed by an infusion of 0.5 μg/kg · min, or alfentanil 10 μg/kg in 10 mL saline over 30 seconds followed by an infusion of saline. Anesthesia was then induced with propofol, cisatracurium, and 1% isoflurane with 66% nitrous oxide in oxygen. Heart rate (HR) and systolic and diastolic arterial pressures (SAP and DAP, respectively) were measured noninvasively at 2 minutes before general anesthesia induction (baseline); 2 minutes after induction; and 1, 3, and 5 minutes after nasotracheal intubation. Patients were monitored for cardiac changes using electrocardiography. RESULTS Forty consecutive patients were enrolled in the study. Twenty patients (11 males, 9 females; mean [SD] age, 27.7 [12.6] years) received remifentanil, and 20 patients (12 males, 8 females; mean [SD] age, 31.5 [17.2] years) received alfentanil. Two minutes after anesthesia induction, mean (SD) arterial pressures decreased significantly from baseline in the remifentanil group (changes, 22 [8]/11 [6] mm Hg) and the alfentanil group (changes, 10 [9]/12 [8] mm Hg) (both, P < 0.05). Changes in SAP and DAP followed a similar pattern in both groups, but SAP was significantly lower in the remifentanil group compared with that in the alfentanil group throughout the study period (all, P < 0.05). After 1 minute of intubation, DAP was significantly lower in the remifentanil group compared with that in the alfentanil group (66 [9] mm Hg vs. 73 [20] mm Hg; P < 0.05). Compared with baseline, HR was decreased significantly in both groups throughout the study (all, P < 0.05). Except SAP in the alfentanil group, SAP, DAP, and HR were increased 1 minute after intubation compared with preintubation values. However, SAP, DAP, and HR remained significantly lower compared with baseline values throughout the study period in both groups (all, P < 0.05) except DAP at 1 minute after incubation in the alfentanil group. Five patients in the remifentanil group and 2 patients in the alfentanil group required treatment of hypotension. None of the patients in either group required treatment of bradycardia. CONCLUSIONS In this study in healthy surgical patients aged 16 to 65 years, remifentanil 1 μg/kg given over 30 seconds, followed by a remifentanil infusion of 0.5 μg/kg · min, was similarly effective compared with alfentanil 10 μg/kg in attenuating the pressor response to nasotracheal intubation, but the incidence of hypotension in patients administered remifentanil was high.
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Wang SY, Mei Y, Sheng H, Li Y, Han R, Quan CX, Hu ZH, Ouyang W, Liu ZQ, Duan KM. Tramadol combined with fentanyl in awake endotracheal intubation. J Thorac Dis 2013; 5:270-7. [PMID: 23825758 DOI: 10.3978/j.issn.2072-1439.2013.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/26/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore the feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation. METHODS Using Dixon's up-and-down sequential design, the study enrolled patients from each of the 20-49, 50-60 and 70-and-above age groups scheduled for elective surgery under general anesthesia. The feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation, guided by fiberoptic bronchoscopy, were verified. RESULTS After intravenous injection with fentanyl 2.2 μg/kg and tramadol 2.0 mg/kg in the 20-49 age group, fentanyl 1.6 μg/kg and tramadol 1.9 mg/kg in the 50-69 age group and fentanyl 1 μg/kg and tramadol 1.8 mg/kg in those at the age of 70 or above, the patients achieved conscious sedation without obvious respiratory depression. Meanwhile, under these dosages, the patients could easily tolerate the thyrocricocentesis airway surface anesthesia and fiberoptic bronchoscope guided tracheal intubation. Postoperative follow-up showed that most patients had memory of the intubation process but without significant discomfort. No awake endotracheal intubation-related side effect was noted. CONCLUSIONS Fiberoptic bronchoscope guided nasotracheal intubation can be successfully completed with background administration of fentanyl and tramadol. However, the specific dosages need to be tailored in different age of patients.
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Affiliation(s)
- Sai-Ying Wang
- Institution of Pharmacology, Central South University, China; ; Department of Anesthesiology, the 3rd Xiangya Hospital of Central South University, China
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Abstract
A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation.
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Affiliation(s)
- H K Baddoo
- Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra.
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Abstract
Background: The Truview™ EVO2 laryngoscope, with its unique optical lens system and blade tip angulation, has proved its usefulness in providing adequate laryngeal exposure and intubation via the oral route. However, the same has not been evaluated for nasotracheal intubation. Aim: We evaluated the suitability of the Truview™ EVO2 laryngoscope for nasotracheal intubation. Methods: Fifty ASA grade I and II elective surgical patients were studied. Patients aged below 15 years or having difficult airway were excluded. Under standard anesthesia protocol, nasotracheal intubation was performed using a Truview™ EVO2 laryngoscope and, in cases of inability to complete intubation in three attempts, the Macintosh laryngoscope was used. Time taken for intubation, use of Magill's forceps and need for optimization maneuvers were noted. The primary outcome was percentage of successful intubation, while hemodynamic changes and duration of intubation were taken as secondary outcomes. Results: Majority (94%) could be intubated successfully with the Truview™ EVO2 laryngoscope. Average time taken for intubation was 50.1 s. The hemodynamic changes were not clinically significant. Regression analysis revealed lack of association between duration of intubation and hemodynamic changes. There were no serious complications. Conclusion: The Truview™ EVO2 laryngoscope is a useful tool in performing nasotracheal intubation, ensuring a high level of success rate among patients with normal airway anatomy.
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Affiliation(s)
- U S Raveendra
- Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka, India
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