Intubation In Group Research Articles

Robotic‐assisted cardiac surgery without lung isolation utilizing single‐lumen endotracheal tube intubation

This study assessed the feasibility and outcomes of performing robotic cardiac surgery without lung isolation using single-lumen (SL) endotracheal tube intubation. Between 2013 and 2017, 132 patients underwent robotically-assisted atrial septal defect closure. A retrospective analysis was performed of 23 patients (11 males, mean age 30.9 ± 5 years) who underwent robotic surgery with double-lumen (DL) endotracheal tube intubation (group 1) compared with 109 patients (57 males, mean age 32.4 ± 7.5 years) undergoing the same procedure with SL endotracheal intubation (group 2). The patient groups were compared in terms of demographic characteristics, operative data, and complications. The technical feasibility of the robotic procedure without lung isolation was evaluated. There were no mortality, intraoperative complication, and conversion. Mean total anesthesia time was significantly decreased in the SL intubation group (238.3 ± 22.4 vs 227.2 ± 21.2 minutes; P = .025). First-pass intubation success was significantly higher in the SL intubation group (17 [73.9%] vs 98 [89.9%] patients; P = .032). Mean ventilation time (10.9 ± 5.3 hours), intensive care unit stay (16.8 ± 10.1 hours), and the length of hospital stay (3.8 ± 1.2 days) was significantly decreased in patients with SL tube (P < .05). Unilateral reexpansion pulmonary edema was observed in five (21.7%) patients with DL tube, whereas no patient with SL tube had this complication. SL endotracheal tube intubation without lung isolation is a feasible and safe airway alternative in robotic cardiac procedures. This approach resulted in shorter anesthesia time, ventilation time and the length of hospital stay. Port placement and robotic set-up can be uneventfully performed without lung isolation.

Outcomes After Prehospital Endotracheal Intubation in Suburban/Rural Pediatric Trauma

BackgroundTrauma is the leading cause of death in pediatric patients over 1 y of age. Controversy exists regarding prehospital airway management for these patients, with some studies suggesting that endotracheal intubation in the field or at a referring hospital is associated with increased mortality and complication rate. These studies were largely performed at urban centers, and it is unclear whether the results apply to suburban/rural networks with longer transport times and more stops at referring hospitals. The purpose of this study is to evaluate differential outcomes in pediatric trauma patients who underwent endotracheal intubation at the scene of injury, referring hospital, or pediatric trauma center in a predominantly rural/suburban setting. Materials and methodsA retrospective review was performed evaluating trauma patients age 18 y or younger at a single institution over 10 y (2004-2014). Patients were selected who underwent endotracheal intubation and were classified based on location of intubation (scene, referring hospital, or trauma center). Fischer's exact test and t-tests were performed for comparison. Univariate and multivariate regression analyses were performed. Results288 patients were identified. 155 (53.8%) were intubated at the scene of injury, 55 (19.1%) at a referring hospital, and 72 (25%) at the trauma center. Overall mortality was 21.9%, which was highest in the scene intubation group (29.7%) compared with the referring hospital (20%) and trauma center (5.6%) groups (P < 0.01). Patients intubated at the scene had higher Injury Severity Scores and lower Glasgow Coma Scale scores (P < 0.01). Duration of intubation was lowest in the trauma center group (P < 0.01). Complication rate was highest in the referring hospital group (P < 0.05). Multivariate analysis revealed that age, injury severity, and neurologic status were the key drivers of mortality rather than location of intubation. ConclusionsMortality and duration of intubation were lowest in trauma patients intubated at a pediatric trauma center. However, location of intubation was not a significant independent predictor of mortality or complications on multivariate analysis, suggesting that age, injury severity, and neurologic status are the main indicators of prognosis in severe pediatric trauma.

Secretory IgA in Mucosa of Pharynx and Larynx Plays an Important Role against Influenza A Virus Infection in Kidney Yang Deficiency Syndrome Model.

Objective Influenza virus poses a major threat to human health and has serious morbidity and mortality which commonly occurs in high-risk populations. Pharynx and larynx of the upper respiratory tract mucosa is the first defense line against influenza virus infection. However, the ability of the pharynx and larynx organ to eliminate the influenza pathogen is still not clear under different host conditions. Methods In this study, a mouse model of kidney yang deficiency syndrome (KYDS) was used to mimic high-risk peoples. Two different methods of influenza A (H1N1) virus infection by nasal dropping or tracheal intubation were applied to these mice, which were divided into four groups: normal intubation (NI) group, normal nasal dropping (ND) group, model intubation (MI) group, and model nasal dropping (MD) group. The normal control (NC) group was used as a negative control. Body weight, rectal temperature, and survival rate were observed every day. Histopathologic changes, visceral index, gene expressions of H1N1, cytokine expressions, secretory IgA (SIgA) antibodies of tracheal lavage fluids in the upper respiratory tract, and bronchoalveolar lavage fluids were analyzed by ELISA. Results The MD group had an earlier serious morbidity and mortality than the others. MI and NI groups became severe only in the 6th to 7th day after infection. The index of the lung increased significantly in NI, MI, and MD groups. Conversely, indices of the thymus and spleen increased significantly in NC and ND groups. H&E staining showed severe tissue lesions in MD, MI, and NI groups. H1N1 gene expressions were higher in the MD group compared with the MI group on the 3rd day; however, the MD group decreased significantly on the 7th day. IL-6 levels increased remarkably, and SIgA expressions decreased significantly in the MD group compared with the NC group. Conclusions SIgA secretions are influenced directly by different conditions of the host in the pharynx and larynx in the upper respiratory tract mucosa. In the KYDS virus disease mode, SIgA expressions could be inhibited severely, which leads to serious morbidity and mortality after influenza A virus infection. The SIgA expressions of the pharynx and larynx would be an important target in high-risk populations against the influenza A virus for vaccine or antiviral drugs research.

Comparison of the C-MAC D-Blade videolaryngoscope and direct laryngoscope in pediatric patients: Randomized controlled trial.

Endotracheal intubation is a key skill for clinicians and may be challenging in some patients due to various reasons. Nowadays, various kinds of videolaryngoscopes are available and usually used as a rescue device when direct laryngoscopy failed. Pediatric airway has some differences when compared with adults and may be challenging. This study aims to compare and evaluate C Mac D-Blade and commonly used Macintosh laryngoscope in pediatric patients. In this study, 56 pediatric patients, 5-10 years old (10-40 kgs) who had undergone elective surgery and need endotracheal intubation were included after obtaining ethical board approval and informed consent from parents. The patients were randomized into two equal groups for laryngoscopy and intubation by either with Macintosh laryngoscope or C Mac D-Blade videolaryngoscope. Glottic view, number of attempts, intubation time, any complications and hemodynamic variables were recorded. A value of p<0.05 was considered significant. In pediatric patients with unanticipated difficult airway, the mean intubation time was significantly shorter with C Mac D-Blade (21±9 and 41±7 seconds, respectively (p<0.001). The results of the two groups were similar concerning the remaining parameters. C Mac D-Blade videolaryngoscope shortened intubation time about twice when compared to Macintosh blade C Mac D-Blade videolaryngoscope, Videolaryngoscopes may be a good alternative for routine intubation, education and a rescue device for difficult intubation.

Assessment of Psychomotor Skill using Mentally Guided Imagery and Physical Practice in Medical Interns- An Interventional Study

Introduction: Mentally Guided Imagery (MGI) has successfully been applied in sports for skill acquisition and performance enhancement. Despite the fact that athletes often use mental imagery as a part of their preparation, it has not been extensively explored as a learning technique in medical education. Few studies had highlighted mental imagery as a way to review and practice surgical skills efficiently. The present study aimed to assess the efficiency of intubation skills acquired through mental imagery in medical interns. Aim: To assess and compare the effect of Guided mental imagery and physical practice using mannequins on intubation technique among 40 medical Interns after seven days of training. Materials and Methods: The study was conducted in the Department of Emergency Medicine, Velammal Medical College and Hospital, Madurai over a period of seven days. Forty house surgeons were randomly divided into two groups. Group A (n=20) practiced MGI on intubation technique and Group B (n=20) practiced on mannequins one hour everyday for seven days. The performance of the students was assessed using a graded Objective Structured Clinical Examination (OSCE). Results: Results of Group A and Group B were analysed and compared statistically using paired and unpaired t-test. Though there was significant difference between the pre and post values in the MGI group (p&lt;0.001), there was no statistically significant difference (p=0.216) in the post-intervention scores between the Mentally Guided Imagery (MGI) and physical practice group. Conclusion: Guided mental imagery was as effective as additional physical practice for medical students learning to perform intubation.

Retrospective evaluation of anesthesia and surgery methods in proximal hypospadias cases

Aim: The appropriate anesthetic technique to be used in cases of proximal hypospadias in children is a subject of debate. Local or regional anesthesia as well as intubation can be used. In this study, it was aimed to evaluate retrospectively the different anesthesia and surgery techniques used and their perioperative outcomes in the cases of proximal hypospadias consulting our hospital.Materials and Methods: The hospital files of 30 cases operated on for proximal hypospadias were scanned retrospectively to evaluate the different methods of anesthesia and repair surgery implemented. The patients operated under general anesthesia were grouped on the basis of the airway equipment used for anesthesia as Laryngeal mask airway (Group 1) and endotracheal intubation (Group 2). Routine penile block implementation, effectiveness of anesthesia, side effects, hemodynamic changes and complications in all patients were recorded. Results: A total of 56 sessions of operations on 28 patients were carried out. In 26 of the session’s laryngeal mask and in 30 sessions endotracheal intubation were used. When the data of Group 1 and Group 2 were compared, the groups did not differ significantly with respect to age, anesthesia methods and duration, hypospadias repair methods, duration and sessions, intraoperative parameters, hospital stay and complications (all p>0.05). The two groups differed on the ASA physical status classification values with Group 2 values being significantly higher (p0.05).Conclusion: Effectiveness of anesthesia by using LMA or endotracheal intubation were perioperatively equivalent during repair of proximal hypospadias with different methods of surgery.

Postoperative Complications, Patient Safety, and Comfort of the Oral Fiberoptic Bronchoscopy-guided Intubation Compared with the Oral laryngoscope Intubation

Introduction: Postoperative sore throat (POST) and hoarseness is an on-going worldwide challenge after general anaesthesia. In this study, we hypothesised that patients intubated with the fiberoptic bronchoscope–guided intubation device differs in POST and hoarseness from other patients intubated with the oral Macintosh laryngoscope–guided intubation device. If this could be confirmed, the guideline of peri anaesthesia may need to be different. Objective: This study aimed to investigate whether fiberoptic intubation can provide increased patient safety and comfort compared to standard laryngoscope intubation performed by nurse anaesthetists. Methods: Within this single-blinded, consecutively controlled clinical trial two hundred and nine patients scheduled for elective neurosurgical treatment requiring intratracheal intubation, were randomly divided into intervention and control group. The intervention group received fiberoptic bronchoscopy–guided intubation during anaesthesia as well as nursing and postoperative treatment based on conventional drug therapy after neurosurgical treatment. The control group received intubation during anaesthesia, as usual, using Macintosh laryngoscope intubation, and postoperative treatment based on conventional drug therapy after neurosurgical treatment. Data regarding the patient safety were obtained during peri anaesthesia, and data concerning the patient comfort were collected on the first postoperative day. Statistical analyses were performed using SPSS version 22. Results: Seven patients were excluded (3.3%); thus, the final population consisted of two hundred and two patients: 62.4% women, the mean age of 52 years (20 to 86 years), 106 (52.5%) patients in the fiberoptic intubation group. A statistically significant difference was found between groups according to patient safety, measured by the number of anaesthetists involved P=0.024 in favour of the fiberoptic intubation device. A trend was pointing to increased pain in the mouth and throat P=0.053, when intubated with the laryngoscope. Other patient safety and comfort measurements showed no statistically significant differences between groups. Conclusions: The study directs attention to some possible benefits of using the fiberoptic intubation device, which may improve patient safety and comfort when compared to standard laryngoscope intubation.

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

BackgroundThere is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients.MethodsThis is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE).ResultsThe maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups.ConclusionCompared to general anesthesia with intubation and combined spinal-epidural anesthesia, general anesthesia with LMA and nerve block had better postoperative analgesic effect and less disturbances on intraoperative hemodynamics and postoperative cognition for elderly patients undergoing intertrochanteric fracture surgeries.

Clinical assessment and related intervention of neonatal upper airway obstruction

Objective:To discuss the diagnosis and evaluation of upper airway obstruction in neonates, classify the possible causes of neonatal upper airway obstruction, establish a standardized diagnosis and treatment procedure to improve the of treatment efficacy. Method:Clinical data of 71 cases with upper airway obstruction history were retrospective analyzed, 38 cases were treated by combined medical and surgical treatment, 17 cases underwent medical treatment, 16 cases abandonment the treatment. The effectiveness of fibrolaryngoscope, CT, neck ultrasound, MRI and other results was evaluated, and to analyze the prognosis of the treatment, the outcomes and risk factors were also analysed, to evaluate risk factors associated with upper airway obstruction. Result:Fifty-five cases were cured or improved. The mortality rate of 16 children who gave up treatment and left hospital automatically was 81.25%（13/16）. The accuracy rate of flexible laryngoscope in detecting the level of upper airway obstruction was 100%, the coincidence rate of B-ultrasound for upper airway cystic occupation was 100%. Etiological order from high to low was congenital space-occupying lesions, congenital upper airway malformation, vocal cord paralysis, Pierre-Robin syndrome. The site of obstruction has a significant influence on the severity of upper airway obstruction（P<0.05）. The cure rate of the non-endotracheal intubation group was higher than that of the endotracheal intubation group（P<0.05）. Conclusion:The obstruction site of upper airway significantly affects the outcome and the severity of the disease. Upper airway space occupying lesions are the primary causes of upper airway obstruction in neonates. Early assessment and timely treatment can improve the cure rate and improve the prognosis. Internal medicine combined with surgical treatment is effective in relieving upper airway obstruction.

The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P&lt;0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P&lt;0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P&lt;0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):289-294.

A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures

BackgroundAirway management is challenging in children with Robin sequence (RS) requiring mandibular distraction osteogenesis (MDO). We derived and validated a prediction rule to identify difficult intubation before MDO for children with RS based on craniofacial computed tomography (CT) images.MethodThis was a retrospective study of 69 children with RS requiring MDO from November 2016 to June 2018. Multiple CT imaging parameters and baseline characteristic (sex, age, gestational age, body mass index [BMI]) were compared between children with normal and difficult intubation according to Cormack−Lehane classification. A clinical prediction rule was established to identify difficult intubation using group differences in CT parameters (eleven distances, six angles, one section cross-sectional area, and three segment volumes) and clinicodemographic characteristics. Predictive accuracy was evaluated by receiver operating characteristic (ROC) curve analysis.ResultsThe overall incidence of difficult intubation was 56.52%, and there was no significant difference in sex ratio, age, weight, height, BMI, or gestational age between groups. The distance between the root of the tongue and posterior pharyngeal wall was significantly shorter, the bilateral mandibular angle shallower, and the cross-sectional area at the epiglottis tip smaller in the difficult intubation group. A clinical prediction rule based on airway cross-sectional area at the tip of the epiglottis was established. Area > 36.97 mm2 predicted difficult intubation while area < 36.97 mm2 predicted normal intubation with 100% sensitivity, 62.5% specificity, 78.6% positive predictive value, and 100% negative predictive value (area under the ROC curve = 0.8125).ConclusionComputed tomography measures can objectively evaluate upper airway morphology in patients with RS for prediction of difficult intubation. If validated in a larger series, the measures identified could be incorporated into airway assessment tools to guide treatment decisions.This was a retrospective study and was granted permission to access and use these medical records by the ethics committee of Guangzhou Women and Children’s Medical Center.Trials registrationRegistration No. ChiCTR1800018252, NaZhang, Sept 7 2018.

Comparison of intravenous and transtracheal lidocaine on hemodynamic changes in patients with hypertension following tracheal intubation: A double blind clinical trial

BackgroundHemodynamic changes following intubation can be reduced by lidocaine at the time of induction of anesthesia and during laryngoscopy to prevent complications such as myocardial ischemia, infarction and brain damage. The aim of this study was to compare the effects of intravenous lidocaine and transtracheal lidocaine on hemodynamic changes in patients with hypertension under medical treatment following tracheal intubation. Materials and methodsIn this prospective double-blind randomized clinical study, patients aged 40–70 years with hypertension who were candidates for general anesthetic surgery were randomly divided into three groups: A (intravenous lidocaine), B (transtracheal lidocaine) and C (placebo). Blood pressure and heart rate were record at 30 s after induction of anesthesia, 30 s after intubation and 3, 6 and 9 min after intubation. ResultsThe results showed that the mean systolic blood pressure varied significantly between 3 groups at 30 s after induction (group A: 127.08 ± 10.08, group B: 134 ± 9.77 and group C: 123 ± 1.55 mmHg) (P = 0.007) and 30 s after intubation (group A: 154.42 ± 15.75, group B: 142.58 ± 8.63, group C: 158 ± 17.37 mmHg) (P = 0.001). The mean diastolic blood pressure was significantly different between 3 groups in 30 s after intubation (group A: 93.23 ± 13.7, group B: 87.92 ± 4.22 and group C: 98.09 ± 9.29 mmHg) (P = 0.003). The mean heart rate was significantly different between 3 groups in 30 s after intubation (group A: 81.65 ± 8.06, group B: 74.65 ± 6.22 and group C: 82.5 ± 7.16 bit/minutes) (P < 0.001). ConclusionOur results showed that use of lidocaine in hypertensive patients following tracheal intubation can results in a more stable systolic and diastolic blood pressure as well as heart rate. It should be noted that the use of lidocaine for the presence or absence of cardiac dysrhythmias showed no difference among the study groups.

Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

PurposeIn acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do.MethodsWe retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed.ResultsThe cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097).ConclusionTracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients.Level of evidence2b

Early Intubation vs. Supportive Care in Management of Severe Blunt Chest Trauma; a Randomized Trial Study.

Early intubation is one of the critical issues in patients with chest trauma. This study aimed to examine the effect of early intubation on outcomes of patients with severe blunt chest trauma. This clinical trial was performed on patients with blunt chest trauma referring to emergency department. Patients were randomly divided to intervention (early intubation) and control (supportive care) groups and the duration of hospitalization, complete recovery rate, laboratory changes, and in hospital mortality were compared between the two groups. 64 cases were divided into two equal groups of early intubation and control. There were no significant differences between two groups regarding age (p=0.36), sex (p=0.26), type of trauma (p>0.05), and comorbid diseases (p>0.05). The duration of hospitalization in the early intubation group was significantly lower than that of the control group (p = 0.01). 90.6% of those in early intubation group and 68.8% of those in the control group showed complete recovery (p = 0.03). There was no case of mortality in either group. There was a significant difference in venous blood pH between the groups at 6, 12, 18 and 24 hours after intubation (p < 0.05). Also, there was a significant difference in the HCO3 level at 6 and 12 hours after intubation (p <0.05). Early intubation is better than supportive treatment in patients with severe chest trauma because of a better complete recovery rate, lower duration of hospitalization, and better acid/base situation.

Substance use and inhalation injury in adult\xa0burn patients: retrospective study of the impact on outcomes

BackgroundSubstance use, alcohol use, and smoking use have all been associated with burn injury. Few studies have investigated associations with substances, alcohol, smoking, inhalational only burns, and patient outcomes. The purpose of the study was to identify risk factors for pulmonary failure in patients suffering inhalation injury, focusing on the impact of substance, alcohol, and cigarette use.MethodsThis is a single-center retrospective analysis of 115 patients admitted to the Johns Hopkins Bayview Burn Center with inhalational injury from January 1, 2010, through September 30, 2018. Patients were excluded if they were under the age of 18 years or had burn involvement of the skin > 5%. Primary outcome variables measured were if patients were intubated, length of total time intubated, substance use, alcohol use, and smoking use. Secondary outcome variables measured were types of substances used (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, codeine/morphine), total number of substances used, intensive care unit (ICU) length of stay (LOS), hospital LOS, secondary complications, and patient mortality. Analysis was performed with Fisher’s exact test and the Mann-Whitney U test. A sub-group analysis for each substance, alcohol, smoking, and control sub-group was compared to its respective sub-group without substance, alcohol, smoking, and control within the no intubation and intubation group. A sub-group analysis of substance use, alcohol use, smoking use, and control was further analyzed with binomial logistic regression within the intubation group.ResultsFollowing inhalation injury, 50/115 (43%) patients required intubation. Forty-two of the 50 (84%) patients intubated had substance use (p < 0.001). Thirty-one of the 50 (62%) patients intubated had history of smoking (p = 0.038). Among the specific substances used, 26/50 (52%) patients intubated were using benzodiazepines (p < 0.001) and 7/50 (14%) patients were using cocaine (p = 0.022). The lengths of intubation, ICU LOS, and hospital LOS with no substance use were shorter than with substance use (p < 0.001). Following the adjusted sub-group analysis, patients with substance use (odds ratio (OR) 6.4, 95% confidence interval (CI) [2.5–16.3]; p < 0.001) and smoking use (OR 2.5, 95% CI [1.2–5.1]; p = 0.013) were more likely to be intubated on admission than those without substance or smoking use.ConclusionsIn patients admitted with an inhalational injury with less than or equal to 5% external burns, the presence of a substance and smoking use on admission provides a further risk of intubation and respiratory compromise. Substance use on admission poses a greater risk of longer intubation, ICU LOS, and hospital LOS. A higher potential for substance use should be suspected in this patient population with prompt treatment.

Do Intubation Devices Affect Middle Ear Pressure Dynamics?

Our study aimed to investigate the effects of different intubation devices on middle ear pressure (MEP) dynamics by evaluating MEP during stages of anesthesia.Sixty-one consecutive patients were randomly assigned to 2 groups: the classical endotracheal intubation group and the Baska Mask (a new laryngeal mask [LMA]) group. All patients received the same anesthesia protocol. The right and left MEP values of the patients were measured and recorded preoperatively, during the induction of anesthesia, at the time of intubation and at 5th minute of anesthesia.In group 1, the pressure values measured in the right ear during anesthesia induction, at the time of intubation and at 5th minute of anesthesia were 10.97 ± 27.06, 16.77 ± 29.40, and 21.64 ± 90.31, respectively, compared to left ear values of 8.61 ± 26.39, 18.77 ± 37.84, and 38.61 ± 56.96 daPa, respectively. In group 2, MEP values measured in the right ear during anesthesia induction, at the time of intubation, and at 5th minute of anesthesia were 9.53 ± 20.43, 22.30 ± 41.50, and 20.60 ± 46.85 daPa, respectively, compared to left ear values of -4.26 ± 25.17, 6.20 ± 26.56, and 30.30 ± 65.17 daPa, respectively. MEP was statistically significantly increased in the classical endotracheal intubation group compared to the LMA group.We found that the increase in pressure is lower in patients receiving LMA compared to classical endotracheal intubation. The Baska Mask LMA is recommended in selected patients to prevent complications of MEP elevation.

Submental intubation versus tracheostomy in maxillofacial fractures.

To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated. This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Patients who had unstable cervical vertebra, laryngeal trauma, urgent tracheostomy, and patients with expected prolonged postoperative ventilation were excluded from the study. Patients were randomly assigned to elective tracheostomy and submental intubation groups. The patients were evaluated according to the time required to do elective tracheostomy or submental intubation, the operation comorbidity and complications, and the postoperative scar. The average time required to do submental intubation was 8.35min versus 30.75min required to do elective tracheostomy with significant difference (p < 0.0001). No complication was reported with submental intubation while in elective tracheostomy group, surgical emphysema was registered in two patients. The submental scar was acceptable in all patients while the tracheostomy scar needs scar revision in four cases (p = 0.0325). Submental endotracheal intubation appeared to be a simple, safe, and significantly faster reliable alternative to tracheostomy during surgical reconstruction of selected cases of maxillofacial fractures without indication for prolonged postoperative ventilation support with significantly lower morbidity.

Efficacy of nasotracheal intubation for airway management in neonates with Pierre Robin sequence undergoing surgery with general anesthesia

Objective To evaluate the efficacy of nasotracheal intubation for airway management in neonates with Pierre Robin sequence undergoing surgery with general anesthesia. Methods Sixty full-term neonates of both sexes with Pierre Robin Sequence, aged 2-28 days, weighing 2.4-3.8 kg, scheduled for elective mandibular distraction osteogenesis, were divided into 2 groups (n=30 each) using a random number table method: nasotracheal intubation group (group N) and orotracheal intubation group (group O). Combined intravenous-inhalational anesthesia was used during surgery.The success rate of intubation, intubation time, heart rate, mean arterial pressure and SpO2 during intubation, and occurrence of complications during intubation were recorded, and the time of extubation and occurrence of complications after extubation were also recorded. Results Compared with group O, the intubation time was significantly shortened, the first-time intubation success rate was increased, the heart rate and mean arterial pressure were decreased at 2 min after intubation, the lowest SpO2 was increased during intubation, and the incidence of pharyngeal soft tissue injury during intubation and hoarseness after extubation was decreased in group N (P<0.05). Conclusion Nasotracheal intubation can be used for airway management in neonates with Pierre Robin sequence undergoing surgery under general anesthesia, and the efficacy is superior to that of orotracheal intubation. Key words: Intubation, intratracheal; Pierre Robin syndrome; Infant, newborn

A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement: A CONSORT-compliant article.

Background:The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method.Methods:Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative.Results:In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05).Conclusion:The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.

Erratum to clinical efficacy of high-flow oxygen therapy through nasal cannula in patients with acute heart failure.

[This corrects the article DOI: 10.21037/jtd.2019.01.51.].