Elective Endotracheal Intubation Research Articles

Stroboscopy and acoustic analysis of voice following endotracheal intubation in otological surgeries

BackgroundStroboscopy is an endoscopy that is performed with intermittent light at a frequency that approximates the frequency of a moving object so that it appears in slow motion or motionless. It is used to analyze the structure and motion of the vocal fold.Aim and objectiveTo compare the stroboscopic findings of various vocal parameters such as symmetry, amplitude, periodicity, mucosal wave of vocal folds, and glottis closure before and after elective endotracheal intubation and to compare acoustic analysis of voice using fundamental frequency, intensity, maximum phonation time, and dysphonia severity index in patients before and after elective intubation, who were undergoing otological surgeries. It also assesses the correlation between changes in these vocal and acoustic parameters and the size of the endotracheal tube, duration of intubation, and number of attempts made during intubation. This study creates awareness and provides insights to avoid intubation-related vocal fold injury.MethodsThis was a prospective cohort study involving 31 patients done in a Tertiary Care Centre. All patients who underwent otological surgeries by elective endotracheal intubation were included. All of them underwent stroboscopic and acoustic evaluation preoperatively, 24 h, and 7 days postoperatively.ResultsStatistically significant changes in mucosal wave pattern score were observed in the 1st postoperative day that reverted to normal by the end of 7th postoperative day and in GRBAS which was significant at the end of both 1st and 7th POD. Other parameters like fundamental frequency, intensity, DSI, MPT, amplitude, symmetry, periodicity, and glottis closure remain unaltered. There was a moderate positive correlation between the duration of intubation (minutes) and mucosal wave 1st POD (P-value: 0.003).ConclusionThe majority of the patients (61%) had normal laryngeal structures. A total of 39% had evidence of injury, the most common being right vocal fold hemorrhage improved by the end of 7th postoperative day and became normal.

Main steps for closing a 3.5 cm post intubation tracheal laceration in a 63-year-old woman after elective single-lumen endotracheal intubation for vocal cords polyp surgery.

Main steps for closing a 3.5 cm post intubation tracheal laceration in a 63-year-old woman after elective single-lumen endotracheal intubation for vocal cords polyp surgery.

Time to desaturation in preterm infants undergoing endotracheal intubation

BackgroundNeonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited...

Different Effects of Two Protocols for Pre-Procedural Analgosedation on Vital Signs in Neonates during and after Endotracheal Intubation.

Analgosedation is often used for endotracheal intubation in neonates, but no consensus exists on the optimal pre-procedural medication. To compare the time to intubation and vital signs during and after intubation in 2 NICUs using different premedication protocols. Prospective observational study in 2 tertiary NICUs, comparing fentanyl and optional vecuronium for elective neonatal endotracheal intubation (NICU-1) with atropine, morphine, midazolam and optional pancuronium (NICU-2). Primary endpoints were: time to intubate and number of intubation attempts; secondary endpoints were: deviations of heart rate, oxygen saturation and blood pressure from baseline until 20 min post intubation. 45 and 30 intubations were analyzed in NICU-1 and NICU-2. Time to intubation was longer in NICU-1 (7 min) than in NICU-2 (4 min; p=0.029), but the mean number of intubation attempts did not differ significantly. Bradycardias (34 vs. 1, p<0.001) and hypoxemias (136 vs. 48, p<0.001) were more frequent in NICU-1, and tachycardias (59 vs. 72, p<0.001) more frequent in NICU-2. Mean arterial blood pressure (MAP) increased in NICU-1 (+6.18 mmHg) and decreased in NICU-2 (-5.83 mmHg), whereas mean heart rates (HR) decreased in NICU-1 (-19.29 bpm) and increased in NICU-2 (+15.93 bpm). MAP and HR returned to baseline 6-10 min after intubation in NICU-1 and after 11-15 min and 16-20 min in NICU-2, respectively. The two protocols yielded significant differences in the time to intubation and in the extent and duration of physiologic changes during and post-intubation. Short acting drugs should be preferred and vital signs should be closely monitored at least 20 min post intubation. More studies are required to identify analgosedation protocols that minimize potentially harmful events during endotracheal intubation.

Endotracheal intubation in patients undergoing open abdominal surgery in the lateral position: a comparison between the intubating video stylet and fiberoptic intubating bronchoscopy.

BackgroundSome situations compel anesthetists to execute endotracheal intubation in the lateral position. We compared elective endotracheal intubation in the lateral decubitus position using the video stylet (VS) device with the fiberoptic (FO) bronchoscope device in patients undergoing abdominal surgery.MethodsOverall, 50 patients were enrolled in this prospective, randomized study. They were randomly classified into the VS intubation or FO intubating bronchoscope group. After anesthesia induction, patients were placed in the lateral decubitus position, and a single investigator well-versed with the use of the VS and FO bronchoscope performed the intubation. The primary outcome was the time taken for intubation. Secondary outcomes included the intubation success rate, hemodynamic response at specific time points and perioperative complications.ResultsThe average time taken for intubation was significantly lesser in the VS group than in the FO group, with values of 39.5 ± 10.0 and 75.6 ± 16.2 s, respectively (P < 0.001). Incidences of a successful first attempt of intubation in the VS and FO groups were 88% and 100%, respectively, showing no significant difference. There was a negligible difference in complications between the groups, except sore throat, which showed a higher incidence in the VS group than in the FO group (P = 0.002).ConclusionsIn laterally positioned patients, elective endotracheal intubation with VS provides less intubation time; however, its use is accompanied by a significant increase in the hemodynamic response after intubation and an increased incidence of sore throat.

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Elective short-term nasotracheal intubation for postthyroidectomy tracheomalacia due to a long-standing large goiter: An experience at tertiary care center

Long-standing large goiters impose possibility of various complications. Tracheomalacia is one such feared problem. The presence of bilateral mobile vocal folds and extubation failure after surgery affirms diagnosis. Methods to deal with tracheomalacia include silicon tracheal stent grafts, tracheostomy, and prolonged intubation. We share our experience of the successful management of tracheomalacia with elective short-term endotracheal intubation. A 36-year-old female presented with a massive neck swelling, for the past 9 years along with slight change in voice and breathing difficulty. We performed near total thyroidectomy for colloid goiter. Intra-operative assessment suggested tracheomalacia. We kept patient on nasotracheal intubation for 1 week, and then extubated successfully. Postthyroidectomy tracheomalacia is a rare but significant complication. We advocate trial of our successful method of elective short-term intubation for its management. This can prove an easy and cost-effective alternative in comparison with tracheostomy or tracheal stent grafts.

Remifentanil versus Fentanyl for pain control during elective endotracheal intubation for surfactant administration in preterm infants

Introduction: Today, the reality of pain in neonates is an undisputed fact, but pain management in clinical practice remains a challenging issue. All neonatal units should have a pain management protocol. The aim of this study was to compare the effectiveness of Remifentanil versus Fentanyl in pain control during elective endotracheal intubation for surfactant administration in preterm infants. Materials and methods: Preterm infants with gestational age between 28 weeks and 34 weeks + 6 days with Respiratory Distress Syndrome (RDS) who needed surfactant administration were divided into two groups using a random sampling method. Neonates in the first group received 2 μg/kg intravenous Fentanyl infusion and neonates in group 2 received 1 μg/kg intravenous Remifentanil before elective endotracheal intubation for surfactant therapy. The vital signs, including heart rate, oxygen saturation, mean arterial blood pressure and change in facial grimace were documented in an unnamed Premature Infant Pain Profile-Revised (PIPP-R) scoring sheet individually. Video recording was performed in both groups before, during and after the endotracheal intubation. All videos and data were interpreted and scored by two Newborn Individualized Developmental Care and Assessment Program (NIDCAP) professionals. Results: The mean PIPP-R score in the Fentanyl-treated group was 13.06 ± 3.55 and in the Remifentanil-treated group was 10.75 ± 2.93, with no statistically significant difference (p = 0.054). There was less need for Naloxone use in the Remifentanil group (p < 0.001). Incidence of apnea, severe drop in oxygen saturation, Intra-Ventricular Hemorrhage (IVH) and chest rigidity were not significantly different between the two groups. Conclusion: Although the difference was not statistically significant, Remifentanil reduced the pain score more than Fentanyl during elective endotracheal intubation in preterm infants. We recommend conducting further studies with larger study populations to determine the better drug and the optimal dosage of these drugs in neonates.

Video 1 edited the main steps for closing a 3 cm tracheal fistula in a 57-year old woman after elective single-lumen endotracheal intubation for breast surgery

Video 1 edited the main steps for closing a 3 cm tracheal fistula in a 57-year old woman after elective single-lumen endotracheal intubation for breast surgery

Video 2 edited the main steps for closing a 3 cm tracheal fistula in a 71-year old man after elective single-lumen endotracheal intubation for lumbar disc surgery

Video 2 edited the main steps for closing a 3 cm tracheal fistula in a 71-year old man after elective single-lumen endotracheal intubation for lumbar disc surgery

Abstract No. 110 - “Avoiding tracheostomy”: percutaneous sclerotherapy of low-flow vascular malformations involving the airway with elective prolonged endotracheal intubation

Abstract No. 110 - “Avoiding tracheostomy”: percutaneous sclerotherapy of low-flow vascular malformations involving the airway with elective prolonged endotracheal intubation

Propofol Dose-Finding to Reach Optimal Effect for (Semi-)Elective Intubation in Neonates

To define the effective dose for 50% of patients (ED50) of propofol for successful intubation and to determine the rate of successful extubation in those patients with planned intubation, surfactant administration, and immediate extubation (INSURE procedure). In addition, pharmacodynamic effects were assessed. Neonates (n = 50) treated with propofol for (semi-)elective endotracheal intubation were stratified in 8 strata by postmenstrual and postnatal age. The first patient in each stratum received an intravenous bolus of 1 mg/kg propofol. Dosing for the next patient was determined using the up-and-down method. A propofol ED50 dose was calculated in each stratum with an effective sample size of at least 6, via the Dixon-Masey method, with simultaneous assessment of clinical scores and continuous vital sign monitoring. Propofol ED50 values for preterm neonates <10 days of age varied between 0.713 and 1.350 mg/kg. Clinical recovery was not attained at the end of the 21-minute scoring period. Mean arterial blood pressure showed a median decrease between 28.5% and 39.1% from baseline with a brief decrease in peripheral and regional cerebral oxygen saturation. Variability in mean arterial blood pressure area under the curve could not be explained by weight or age. Low propofol doses were sufficient to sedate neonates for intubation. Clinical recovery was accompanied by permissive hypotension (no clinical shock and no treatment). The propofol ED50 doses can be administered at induction, with subsequent up-titration if needed, while monitoring blood pressure. They can be used for further dosing optimalization and validation studies. ClinicalTrials.gov: NCT01621373; EudraCT: 2012-002648-26.

A pilot randomized clinical trial assessing the effect of cricoid pressure on risk of aspiration.

Patients at risk for microaspiration during elective intubation often receive cricoid pressure in the hopes of mitigating such risk. However, there is scarce evidence to either support or reject this practice. The objective of this investigation was to assess the effect of cricoid pressure on microaspiration and to inform the potential feasibility of conducting a larger, more definitive clinical trial. This was a pilot randomized clinical trial set in the operating rooms of a tertiary referral hospital between August and October of 2014. Patients with risk factors for microaspiration (obesity, gastroesophageal reflux disease, or diabetes) were enrolled. The patients were randomized to either cricoid pressure or no cricoid pressure during induction of anesthesia with endotracheal intubation. Immediately after intubation, a sample of lower airway secretions was collected and analyzed for pepsin A. A total of 95 patients were evaluated, randomized and completed the study protocol. 46 were randomized to cricoid pressure and 49 to no cricoid pressure. Seven patients crossed-over treatment arms. A total of 18 (19.6%) patients met the pre-defined criteria for microaspiration. In both the intention-to-treat and per-protocol analyses, there were no statistically significant differences in the rate of microaspiration [OR (95% CI)] = 1.39 (0.49-3.92) and 1.30 (0.44-3.86), respectively. Utilizing pepsin A as a biomarker of aspiration, this pilot clinical trial did not find evidence for a reduced rate of aspiration or adverse clinical events with the administration of cricoid pressure during elective endotracheal intubation of patients with risk factors for microaspiration.

Site-directed topical lidocaine spray attenuates perioperative respiratory adverse events in children undergoing elective surgery

BackgroundPerioperative respiratory adverse events (PRAEs) are a major cause of morbidity and mortality associated with pediatric anesthesia. Topical lidocaine administration reduces risk of PRAE in children undergoing elective endotracheal intubation. However, definitive evidence of its efficacy remains elusive, due, in part, to the wide variability in the methodology for spraying topical lidocaine. In this randomized controlled double-blind clinical trial, we sought to evaluate the effect of site-directed topical airway lidocaine, sprayed directly onto supraglottic, glottis, and subglottic areas, on the incidence of PRAE. MethodsThe study population consisted of 322 children (age range, 6 mo-12 y), who were scheduled for an elective surgical procedure under general anesthesia with endotracheal intubation. Patients were randomly assigned to receive topical spray of lidocaine (group L) or saline (group S) over the supraglottic, glottis and subglottic areas under direct vision before tracheal intubation. Incidence of PRAE and time to extubation was recorded. ResultsThere were no statistically significant intergroup differences with regard to baseline demographics, patient characteristics, and surgical parameters. Group L was associated with a significantly lower incidence of PRAE as compared with group S (12.80% versus 38.13%, respectively; P < 0.001). Similarly, the incidence of laryngospasm (1.7% versus 8.1%; P = 0.01), excessive coughing (4.3% versus 13.2%; P = 0.005), and oxygen desaturation <95% (6.8% versus 16.9%; P = 0.005), respectively, was significantly lower in group L. However, time to extubation was longer in group L as compared with that in group S (18.6 ± 7.7 min versus 21.3 ± 8.9 min; P = 0.03). ConclusionsSite-directed topical spray of lidocaine over supraglottic, glottis, and subglottic areas before tracheal intubation significantly reduced the incidence of PRAE and a prolongation of extubation time in children.

McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

IntroductionCritically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation...

Su1514 Adverse Events Associated With Endoscopy for Food Bolus Impaction in Patients Receiving Conscious Sedation vs. Anesthesia Support With Elective Endotracheal Intubation

Su1514 Adverse Events Associated With Endoscopy for Food Bolus Impaction in Patients Receiving Conscious Sedation vs. Anesthesia Support With Elective Endotracheal Intubation

Hypoplastic Left Heart Syndrome and Obstructive Total Anomalous Pulmonary Venous Connection: A Rare and Severe Association

First gestation of a 21 years-old woman referred for fetal echocardiography because of HLHS identified during the second trimester screening ultrasound. A fetal echocardiogram performed in the 31st gestational week confirmed the diagnosis; however, it was associated with supracardiac obstructive TAPVC, with a high velocity flow observed at the level of the vertical vein (1.14 m/s Figure 1). Elective caesarean section was performed in the 38th gestational week in a hospital with a well-developed pediatric cardiology program, and the catheterization laboratory was ready to receive the baby shortly after birth. The Apgar score was of 6/7/8 and birth weight 3,295 kg. Elective endotracheal intubation at the ICU and catheterization of the umbilical vein and artery were performed. Continuous infusion of prostaglandin was initiated. In the first hours of life, oxygen saturation ranged from 30% to 40% and the chest x-ray revealed severe pulmonary edema (Figure 2-A). Postnatal echocardiography confirmed the diagnosis and identified diminutive left atrium (Figure 3). The Newborn (NB) was immediately taken to the catheterization laboratory for obstruction relief of the vertical vein. Two stents were deployed next to the connection of the vertical vein with the common pulmonary vein (Figure 4). After the procedure, oxygen saturation rose to 80% and there was a significant improvement of pulmonary congestion (Figure 2-B), hemodynamic and metabolic status. In the third day of life the baby underwent a hybrid procedure (selective pulmonary artery banding and ductal stenting). She had a good post-operative course and was transferred to the ward on the eighth day.

PO-0272 Evaluation Of Propofol For Sedation In Neonatal Endotracheal Intubation

<h3>Background</h3> Propofol is increasingly used as a rapid and short acting induction agent. Concerns about cardiovascular side effects have limited its use in neonates. In our level III NICU and prehospital paediatric medical team, propofol is the first drug of choice for all intubations in hemodynamically stable newborns. <h3>Aim</h3> To evaluate efficacy and tolerance of propofol in neonates. <h3>Methods</h3> Monocentric prospective observational study, conducted between June 2012 and March 2014 including neonates needing elective endotracheal intubation. Patients received a starting dose of 1 mg/kg of propofol. Additional doses of 0.5 mg/kg were repeated until sufficient sedation was obtained. Haemodynamic parameters were recorded before, during and after propofol injection. The level of sedation, intubation conditions, and side effects were recorded. <h3>Results</h3> Propofol was used in 89 intubations in 83 patients with a median gestational age of 31 wk + 5 d (25 wk +6 d to 41 wk +3 d), postnatal age was 4 h (17 min to 67 days), and weight was 1530 g (610–4820 g). A propofol starting dose was sufficient in 34% of patients. A total dose of 2 mg/kg was efficient in the 73% of patients. Physicians were satisfied about the intubation conditions in 75%. Short and moderate hypotension occurred in 32% of patients independently of doses and gestational ages (91% before 12 h of age). No patients required neither fluids nor vasopressor. The following side effects were also noted: apnea (35%), bradycardia (&lt;10%). <h3>Conclusion</h3> Propofol offered good intubation conditions without significant side effects. Doses needed to obtain sufficient sedation varied widely.

PO-0727 Predictors Of Difficult Endotracheal Intubation Of Infants In Nicu-kamc, Riyadh, Ksa

Background and aim Intubation in NICU is a daily procedure, that may be associated with serious complications. We studied the effect of different factors that may contribute to the difficulty and success of semi elective endotracheal intubation of sick infants managed at NICU of KAMC-Riyadh. Methods A retrospective review of prospectively collected data of infants that had semi elective endotracheal intubation from 1/1/2010 till 1/7/2011. The studied factors were : experience of intubating physician, body weight and post conceptional age (PCA) of the infants, premedication. Success of intubation was assessed by number of trials, pain score, and occurrence of bradycardia and or desaturation. Results 180 infants had semi elective intubation. Birth weight (490–4995 gms), PCA (25 to 53 weeks). Premedication was used in 108 infants; Fentanyl:66, Midazolam : 33 infants, and both medications: 9 infants. Univariate analysis showed that difficult intubation (need for ≥3 trials of intubation) positively correlates with junior intubating physicians (p Multilogestic Regression analysis showed independent correlation between difficulty of intubation and total number of attempts of intubation with the junior (RI, and R2 & Service physicians of less than 12 months experience) intubating physician (p 0.001 and 0.01). Using premedication had no contribution to success of intubation, number of attempts of intubation and occurrence of Bradycardia and/ or desaturation. Conclusion The only predictor of difficult intubation of infants in NICU in our study was having intubation by junior physician, while premedication did not contribute to the success of intubation.

Tu1370 Elective Endotracheal Intubation Prior to Emergent EGD in Patients With Suspected Variceal Hemorrhage: an Evaluation of Outcome and Complications

Variceal hemorrhage is a lethal complication of portal hypertension with reported mortality of 15-50% and a rebleeding risk of 70-80%. EGD therapy is the definitive treatment of choice. Large volume of blood located in the stomach is considered as the potential risk of aspiration during emergent EGD. Elective intubation is more commonly adopted in nowadays to prevent aspiration. However, despite widely in utilization, there is limited evidence that reveals prophylactic intubation improves patient outcomes.