Intubation For Airway Management Research Articles

Pediatric Laryngeal Coccidioidomycosis: A Case Series in an Endemic Region.

Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted this study to review the characteristics of laryngeal coccidioidomycosis in children. We performed a retrospective review of patients ≤21 years of age with laryngeal coccidioidomycosis who were treated from January 2010 to December 2017. We collected demographic data, clinical and laboratory studies and patient outcomes. Five cases of pediatric laryngeal coccidioidomycosis were reviewed. All children were Hispanic and 3 were female. The median age was 1.8 years and the median duration of symptoms before diagnosis was 24 days. The most common symptoms included fever (100%), stridor (60%), cough (100%) and vocal changes (40%). Airway obstruction requiring tracheostomy and/or intubation for airway management was present in 80%. The most frequent location of lesions was the subglottic area. Coccidioidomycosis complement fixation titers were frequently low and culture/histopathology of laryngeal tissue was necessary to make a definitive diagnosis. All patients required surgical debridement and were treated with antifungal agents. None of the patients had recurrence during the follow-up period. This study suggests that laryngeal coccidioidomycosis in children presents with refractory stridor or dysphonia and severe airway obstruction. Favorable outcomes can be achieved with a comprehensive diagnostic work-up and aggressive surgical and medical management. With the rise in cases of coccidioidomycosis, physicians should have a heightened awareness regarding the possibility of laryngeal coccidioidomycosis when encountering children who have visited or reside in endemic areas with stridor or dysphonia.

Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children

BackgroundsTo preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children.MethodsOne hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation.ResultsThe first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04–1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03–1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia.ConclusionThe SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management.Trial registrationThis study was approved by the University’s Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn. Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Comparison of SaCoVLM™ video laryngeal mask-guided intubation and i-gel combined with flexible bronchoscopy-guided intubation in airway management during general anesthesia: a non-inferiority study

BackgroundWhen a difficult airway is unanticipatedly encountered and the initial laryngoscopic intubation fails, a supraglottic airway device (SAD) may be placed to aid ventilation and oxygenation, and act as a conduit for intubation. SaCoVLM™, as new SAD, can offer a direct vision to guide intubation. However, no study has evaluated the performance of SaCoVLM™ video laryngeal mask (VLM) intubation and i-gel combined with flexible bronchoscopy (FB)-guided intubation in airway management during general anesthesia.MethodsA total of 120 adult patients were randomly allocated into the SaCoVLM™ group (Group S) and i-gel group (Group I). After induction of general anesthesia, guided tracheal intubation under direct vision of the SaCoVLM™ was conducted in Group S, while Group I received FB-guided tracheal intubation using the i-gel. The success rate of SAD placement, first-pass success rate of guided tracheal tube placement, and total success rate in both groups were recorded. The time for SAD placement, time for guided tracheal intubation, total intubation time (time for SAD placement and intubation), glottic exposure grading and postoperative intubation complications (i.e., dysphagia, hoarseness, pharyngalgia, etc.) of both groups were also compared.ResultsThe first-time success rate of SAD placement was 98% in two groups. The first-pass success rate of guided endotracheal intubation was 92% in Group S and 93% in Group I (P = 0.74 > 0.05). The total intubation time was 30.8(± 9.7) s and 57.4(± 16.6) s (95% CI = -31.5 to -21.7) in Group S and Group I, respectively (P < 0.01). The total complication rate was 8% in Group S and 22% in Group I (P < 0.05). The laryngeal inlet could be observed in the S group through the visual system of SaCoVLM™. No dysphagia or hoarseness was reported.ConclusionSaCoVLM™ can reveal the position of laryngeal inlet, thus providing direct vision for tracheal intubation. SaCoVLM™ -guided intubation is faster, and does not rely on FB, compared to i-gel combined with FB-guided intubation. Besides, SaCoVLM™ has a lower post-intubation complication rate.Trial registrationChinese Clinical Trials Registry (ChiCTR2100043443); Date of registration: 18/02/2021.

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

Fibreoptic intubation in airway management: a review article.

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

A prospective, randomized comparative study for use of proseal laryngeal mask airway as an alternative to endotracheal intubation for airway management in children under general anesthesia

Introduction: Proseal laryngeal mask airway (PLMA) which is an upgraded modification of classic LMA, incorporating a gastric drainage tube lateral to the main airway tube which permits the regurgitated liquid gastric contents to bypass the glottis and prevents pulmonary aspiration. A prospective randomized interventional comparative study was performed to compare the efficiency of PLMA with a tracheal tube (TT) in pediatric patients with respect to number of attempts to placement of devices, hemodynamic responses and perioperative complications. Material and Methods: Sixty children, ASA physical status I and II weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective infraumblical surgeries of 30-60 minutes duration, randomly divided into two group of 30 patients each. All patients were premedicated with IV midazolam and glycopyrrolate. General anesthesia with caudal epidural analgesia was given in all cases. IV propofal and sevoflurane was used for inducing general anesthesia. PLMA was inserted in group I and tracheal tube (TT) in patients of group II. In all cases after PLMA / TT insertion; caudal epidural analgesia was given and general anesthesia (GA) was maintained with O2, N2O and sevoflurane. Results: Ease of insertion was comparable in both the groups. There were no significant differences in mean oxygen saturation SpO2 (%) and end tidal carbon dioxide (ETCO2)) levels recorded at different time intervals between the two groups. However, highly significant changes in hemodynamic parameters were observed in the TT group. Complications such as nausea and vomiting (3.33%), sore throat (2%) and coughing (26.66%) were observed in the TT group. Conclusion: We concluded that PLMA could be used as an effective and safe airway device in children alternative to TT undergoing general anesthesia. Keywords: General anesthesia, Hemodynamic response, Paediatric, Proseal laryngeal mask airway, Tracheal tube

Tracheal Opening Discrimination During Intubation Using Acoustic Features and Gaussian Mixture Model

Correct identification of glottic opening is crucial during endotracheal tube intubation for airway management. Direct glottis visualization by the physician is considered best standard practice, but it is dependent on conditions, skill, and experience. This study proposes an improved oxygen insufflation system that applies an acoustic modeling approach to discriminate glottic and non-glottic areas utilizing the acoustic response from a steady directional airflow at the hypopharynx. An electric stethoscope is placed at the suprasternal notch to record sound produced by insufflation during intubation. The Gaussian mixture model with mel-frequency cepstral coefficients (MFCCs) is used to determine differences between glottic and non-glottic areas. A dataset containing 56.567 seconds of non-glottic sound and 46.472 seconds of glottic sound was recorded from 8 anesthetized adults receiving intubation. Short-time analysis and several objective evaluations were performed to investigate system performance. The evaluation results show that the system achieved a high classification accuracy of 93.24%. The proposed approach outperformed a baseline linear discriminant analysis method with various configurations of linear prediction coding coefficients and MFCCs, and shows potential in improving glottic identification during endotracheal tube intubation.

Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: a comparison between laryngeal tube and endotracheal tube

In 2005 the European Resuscitation Council published new guidelines for advanced life support. One of the issues was to reduce the "no flow time", which is defined as the time without chest compression in the first period of cardiac arrest. In a manikin study, we evaluated whether using the laryngeal tube instead of endotracheal intubation for airway management during cardiac arrest could reduce the "no flow time". The study was prospective and included 50 volunteers who performed standardized management of simulated cardiac arrest in a manikin. All participants had completed an obligatory course in emergency medicine but had not been specifically trained in endotracheal intubation; they were therefore designated as unfamiliar in using the endotracheal tube to secure the airway, in accordance with the definition of the European Resuscitation Council. We defined two groups for the study: the LT group, who used the laryngeal tube to secure the airway; and the ET group, who used the endotracheal tube and bag-mask ventilation to ventilate the manikin. The participants were initially randomly assigned to one of the groups and thereafter completed the other scenario. Study endpoints were the total "no flow time" and adherence to guidelines of the European Resuscitation Council. Use of the laryngeal tube during cardiac arrest in the manikin significantly reduced the "no flow time" when compared with endotracheal intubation (109.3 s vs. 190.4 s; P < 0.01). The laryngeal tube was inserted significantly faster than the endotracheal tube (13 s vs. 52 s; P < 0.01) and was correctly positioned by 98% of the participants at the first attempt, compared with 72% using the endotracheal tube. With regard to the guidelines of the European Resuscitation Council, we are convinced that during cardiac arrest supraglottic airway devices should be used by emergency personnel unfamiliar with endotracheal intubation.

Dental Treatment of a Patient with Cerebral Palsy under General Anesthesia

Dental Treatment of a Patient with Cerebral Palsy under General Anesthesia Jun-Min Chung, D.D.S., Kwang-Suk Seo, M.D., Young-Eun Yi, D.D.S., Hee-Jung Han*, R.N., Jin-Hee Han*, R.N., Hye-Jung Kim*, R.N., Teo-Jeon Shin, M.D., Hyun-Jeong Kim, M.D., Kwang-Won Yum, M.D., and Juhe Chang, D.D.S. Department of Dental Anesthesiology, Seoul National University, School of Dentistry, *Department of Dental Anesthesiology, † Clinic for Persons with Disabilities, Seoul National University Dental Hospital, Seoul, Korea Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was 174 ± 56 min and staying time at PACU was 88 ± 39 min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety. (JKDSA 2008; 8: 22~28) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Airway management with the laryngeal tube in rabbits

The rabbit's oropharyngeal anatomy complicates the use of endotracheal intubation for airway management during surgical procedures. To determine if the laryngeal tube is useful for airway management in rabbits, the authors applied the device and evaluated its efficacy to ventilate the lungs. The laryngeal tube was inserted blindly and without difficulty in six healthy male New Zealand White rabbits; all of the rabbits were ventilated adequately with and without neuromuscular blockade. The authors conclude that the laryngeal tube can be used as an alternative means of airway management in rabbits.

Clinical competence in the performance of fiberopt laryngoscopy and endotracheal intubation: A study of resident instruction

Anesthesiologists must be competent in the technique of fiberoptic laryngoscopy and intubation in airway management. The goal of this study was to test the hypothesis that an acceptable level of technical expertise in fiberoptic laryngoscopy and intubation may be acquired within 10 intubations while maintaining patient safety. The learning objectives were an intubation time of 2 minutes or less and greater than 90% success on the first intubation attempt. Ninety-one ASA physical status I–II patients with normal laryngeal anatomy had general anesthesia and were intubated orally with an Olympus LF-1 fiberoptic scope; the mean (± SD) time for intubation was 1.92 ± 1.45 minutes. Four residents with no prior experience with fiberoptic laryngoscopy intubated at least 15 patients each. A learning curve was generated using logarithmic analysis of the mean (± SD) time for intubation of patients 1 to 15 for all residents combined. The curve showed that the mean (±SD) intubation time decreased from 4.00 ± 2.91 to 1.53 ± 0.76 minutes within the first 10 intubations. After the tenth intubation, the mean time was 1.53 minutes and the percent success on the first attempt at intubation was greater than 95%. There were no clinically important changes in 0 2 saturation, mean arterial pressure (MAP), or heart rate (HR) as a consequence of fiberoptic intubation. The results suggest that an acceptable level of technical expertise in fiberoptic intubation can be obtained (as defined by the learning objectives) by the tenth intubation, and patient safety is maintained. Directors of anesthesia residency training should consider these data in determining training protocols for teaching fiberoptic laryngoscopy and intubation.

The Esophageal Obturator Airway

The esophageal obturator airway (EOA) has been considered a beneficial ventilatory technique for use in cardiopulmonary resuscitation (CPR). At present, seven studies in the literature compare the EOA with other means of ventilation in humans; only one is an actual field study of its effectiveness. We reviewed the available literature dealing with the device to define clearly its role in the ventilatory treatment of patients who require CPR. There appears to be no current evidence of the EOA's effectiveness for ventilation in prehospital cardiac arrest, and fatal complications have been reported with its use. The use of the EOA to replace endotracheal intubation in airway management is not substantiated in the literature.