Laryngoscopy For Tracheal Intubation Research Articles

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

Laryngoscopy for tracheal intubation has been developed for many decades. Among various conventional laryngoscopes, videolaryngoscopes (VLs) have been applied in different patient populations, including difficult airways. The safety and effectiveness of VLs have been repeatedly studied in both normal and difficult airways. The superiority of VLs then has been observed and is advocated as the standard of care. In contrast to laryngoscopy, the development of video-assisted intubating stylet (VS, also named as styletubation) was noticed two decades ago. Since then, sporadic clinical experiences of use have appeared in the literature. In this review article, we presented our vast use experiences of the styletubation (more than 55,000 patients since 2016). We found this technique to be swift (the time to intubate from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction and fast learning curve for the novice trainees) in both normal and difficult airway scenarios. We, therefore, propose that the styletubation technique can be feasibly applied as universal routine use for tracheal intubation.

Abstract 136: Does End-Tidal Carbon Dioxide Measured at the Facial Mask Predict Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest?

Introduction: High value of end-tidal carbon dioxide (EtCO2), measured at the end of a tracheal tube, is closely associated with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) resuscitation. The aim of this study was to evaluate whether EtCO2 measured at the face mask (FM) before an intubation procedure, may also predict ROSC in OHCA. Material and Methods: This was a prospective non-interventional study. Between May 1 st 2022 and January 30 th 2023, all patients ≥ 18 years with an OHCA on EMS arrival and for whom a laryngoscopy for tracheal intubation was considered, were included. An EtCO2 sensor was directly placed between the valve of the bag-valve-mask and the FM while cardiopulmonary resuscitation was continued. Age, gender, initial rhythm, ROSC on scene and last EtCO2 at the FM (FM-EtCO2) value before laryngoscopy were collected. Patients were assigned to 3 groups: FM-EtCO2 < 10 mmHg ; 10 mmHg < FM-EtCO2 < 30 mmHg and FM-EtCO2 > 30 mmHg. Results: Twenty-three patients were included. Mean age was 64.9 ± 12.2 years and sex ratio was 3.6. Initial rhythm was asystole for 16 (69.6 %) patients, ventricular fibrillation for 5 (21.7 %) and pulseless rhythm for 2 (8.7%). Eight (34.8 %) patients had a ROSC on scene. Five (21,8 %) patients had a FM-EtCO2 < 10 mmHg ; 7 (30,4%) a 10 mmHg < FM-EtCO2 < 30 mmHg and 11 (47,8 %) a FM-EtCO2 > 30 mmHg. Among those with a ROSC, 2 had a FM-EtCO2 < 10 mmHg and 6 a FM-EtCO2 > 30 mmHg (p=0,038). Conclusion: A high value of EtCO2 measured at the face mask (above 30mmHg) was significantly associated with ROSC. This survey proposes a method that would facilitate the knowledge of an EtCO2 value, well known to predict ROSC in OHCA, earlier than with the reference method. Further studies are needed to validate these results.

Effects of Nalbuphine with Morphine on Mean Systolic and Mean Diastolic Blood Pressures after Laryngoscopic Tracheal Intubation in Elective Coronary Artery Bypass Grafting

Background: The raise in mean blood pressure and heart rate associated with intubation and laryngoscopy is harmful for patients of ischemic heart disease, hypertension, raised intracranial and intraocular pressure. To counter this problem nalbuphine began to be used. Nalbuphine is an opioidagonist antagonist which acts on ê receptor as agonist and on μ receptors as antagonist. We chose to study its haemodynamic response to orotracheal intubation. Aim: To compare the mean systolic and diastolic blood pressure with nalbuphine with morphine after laryngoscopic tracheal intubation in elective coronary artery bypass grafting. Methods: The study was a randomized controlled trial. 100 patients fulfilling selection criteria were included in the study from Operation theatre of Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. Patients were randomly divided in two equal groups by using lottery method. In group A, morphine was administered and in group B, Nalbuphine were administered during induction of general anaesthesia. History was taken from patients. Demographic information like age, gender and co-morbid. Patients were followed for results of the study. All information of was noted and entered in the Proforma. Results: One hundred patients fulfilling selection criteria were included in the study. In group A, morphine was administered and in group B, Nalbuphine were administered during induction of general anaesthesia. Comparison of SBP and DBP has been done between both of the study groups mean and SD of SBP in morphine group was 113.16 and 9.15(p-value=0.007), in nalbuphine group 120.90 and 11.46(p-value=0.03), respectively. Conclusion: It had been considered that morphine offers better analgesic conditions, but it also cause hemodynamic instability. nalbuphine can help in preventing anaesthesia complications, and cause less hemodynamic instability which results in less requirement of maintenance drugs for attenuation. This study to confirmed that nalbuphine can help in less fluctuation in hemodynamic conditions of the patients as compared to morphine. Keywords: Coronary artery bypass grafting, systolic blood pressure, diastolic blood pressure, nalbuphine, morphine

Hemodynamic Responses during Insertion of Laryngeal Mask Airway versus Conventional Intubation

Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity,

High-flow nasal oxygenation for anesthetic management

High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital.

Introduction The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design A facility-based cross-sectional study design was used. Result In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.

Comparison of Oral Gabapentin Versus Control on Hemodynamic Response to Direct Laryngoscopy for Tracheal Intubation in Patients Undergoing Elective Surgery

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Success in Difficult Airway Managements with Video Laryngoscope After Two Failures in Intubation with Macintosh and McCoy Laryngoscope: A Case Report

Introduction: Currently, creating a secure airway for general anesthesia is an integral part of the process of anesthesia. The difficulty of this process effects morbidity and mortality rates. In order to achieve further success in these patients, it is advised to use video laryngoscope. Case Presentation: The patient was a 45-year-old female, who was a candidate for cholecystectomy along with laparoscopic surgery, and had referred to Peimaniyeh hospital of Jahrom, Iran, during September 2016. In the initial assessment, the patient seemed to be in a difficult airway class, while in her surgery documents from 5 and 10 years ago and in her previous records no history of this problem was mentioned. After the administration of drugs before surgery and anesthesia induction, tracheal intubation had failed by use of routine laryngoscope and McCoy laryngoscope in two stages. Finally, the use of video laryngoscope for tracheal intubation was successful. During the intubation attempts, the patient was ventilated with 100% oxygen mask and her arterial blood oxygen saturation had not decreased. Conclusions: Therefore, it is recommended for the patient to be investigated carefully in terms of airway management. In addition, in case of difficult intubation, selecting video laryngoscope to facilitate intubation may be appropriate. The mere absence of a difficult airway management is not a reason that the problem will not occur in the future.

The novel video‐assisted intubating laryngeal mask Totaltrack compared to the intubating laryngeal mask Fastrach – a controlled randomized manikin study

The novel Totaltrack combines a supraglottic airway device with video laryngoscopic tracheal intubation. The intubation laryngeal mask Fastrach is an established device without visual control of intubation. We hypothesized that supraglottic ventilation success with Totaltrack would be similar to Fastrach, but intubation would be performed faster due to visual control of the procedure. Fifty-five anaesthesiologists were randomized into one of two study arms: Fastrach Totaltrack. After a standardized introduction, six consecutive attempts of supraglottic ventilation and intubation attempts with each of one of the devices were performed on an airway manikin. The combined primary outcome was: time to supraglottic ventilation and time to ventilation after intubation. Additionally, success rate and learning curves were evaluated. Supraglottic time to ventilation was shorter when using the Fastrach compared to the Totaltrack (median: 7.8s [confidence interval [CI]: 7.0-8.6s] vs. 11s [CI: 7.8-14.2s], P<0.001). Intubation was faster using the Fastrach compared to Totaltrack (median: 12.5s, [CI: 10.1-14.9s] vs. 23.3s [CI: 21.5-25.1s], P<0.001). Success rate for supraglottic ventilation was comparable between Fastrach and Totaltrack (86-96%). Successful intubation via the device was 100% in Fastrach and ranged from 61% to 93% in Totaltrack, with a higher probability of successful intubation after four applications. In this manikin-based study the novel Totaltrack did not prove superior to Fastrach despite a similar design. Video laryngoscopic control of supraglottic ventilation and endotracheal intubation was prolonged using the Totaltrack. Clinical trials are mandatory to evaluate the role of the Totaltrack in airway management.

The reflective intubation manoeuvre increases success rate in moderately difficult direct laryngoscopy: A prospective case-control study.

Reflective intubation is a recently described technique to facilitate tracheal intubation. The aim of the study was to assess success rate of reflective intubation in patients undergoing tracheal intubation and to correlate its application with laryngeal visibility. A prospective case-control study. Operating theatre suite of a university hospital. One hundred randomly selected patients undergoing elective surgery who required tracheal intubation as part of standard anaesthesia care. All patients underwent an initial intubation attempt using conventional direct laryngoscopy. Successfully intubated patients formed group E (easy), and the remaining patients underwent a single reflective intubation attempt. Patients with successful reflective intubation formed group M (moderate). The remaining patients underwent tracheal intubation using a suitable alternative intubation technique (group D, difficult). Primary outcomes were the success rate and time to successful intubation. Laryngeal visibility scores, changes in arterial oxygen saturation and incidence of sore throat were secondary outcomes. Forty-six patients underwent successful tracheal intubation using conventional laryngoscopy (group E), 42 patients presented moderate difficulty (group M) and 12 patients required alternative intubation techniques (group D). Reflective intubation was successful in 78% of patients in the 'noneasy' subgroup, but was unsuccessful in 22%. Intubation times were 9 ± 3 (group E), 15 ± 9 (group M) and 46 ± 38 s (group D). Oxygen saturation was comparable in all patients. Sore throat occurred significantly more often in group D. Reflective intubation proved to be successful in moderately difficult intubation conditions (Cormack and Lehane classes 2 and 3a). Reflective intubation represents a very useful first-line methodological extension of direct laryngoscopic tracheal intubation.

Randomized Comparison of the Pentax AirWay Scope and Macintosh Laryngoscope for Tracheal Intubation in Patients With Obstructive Sleep Apnoea

Abstract Background Patients with obstructive sleep apnoea (OSA) can often present difficulties in intubation. This study aimed to compare the efficacy of the Pentax AirWay Scope (AWS) with that of the Macintosh laryngoscope for tracheal intubation in patients with OSA. Methods Forty-six patients undergoing uvulopalatopharyngoplasty were randomly allocated to tracheal intubation with either the Macintosh laryngoscope or the Pentax AWS. In all patients, intubation was performed by one of two anaesthetists experienced with both devices. The primary and secondary endpoints of this study were the intubation difficulty scale (IDS) score and success/failure and duration of the first successful intubation attempt. Results With the Pentax AWS, tracheal intubation was successful on the first attempt in all patients whereas four patients required repeated attempts at intubation with the Macintosh laryngoscope. The IDS score was significantly lower using the Pentax AWS and glottic exposure was better (the Cormack and Lehane grade 1 in all patients vs grade 2 or higher in all patients, P Conclusions In this study of patients with OSA, tracheal intubation by experienced anaesthetists was facilitated using the Pentax AWS compared with the Macintosh laryngoscope.

Downfolding of the epiglottis during laryngoscopic tracheal intubation.

Downfolding of the epiglottis during laryngoscopic tracheal intubation.

Angiographic catheter as airway exchange device through laryngeal airway mask in unanticipated difficult airway in emergency department

Sir, Angiographic catheter (AC) is commonly used in intervention cardiology, but its application outside cardiac catheterization laboratory (CCL) is seldom reported. AC has been used for nasogastric tube insertion.[1] We used AC as an airway exchange catheter through ProSeal laryngeal airway mask (PLMA) in an unanticipated difficult airway in emergency department (ED). A 42-year-old man admitted at midnight to our ED with diagnosis of severe acute pancreatitis with respiratory failure with apparent normal airway. After preoxygenation rapid sequence intubation was tried with cricoid pressure but unable to intubate even after removal of cricoid pressure for a moment. Immediately airway was secured with size 4 PLMA. The patient needs definite airway for prolonged mechanical ventilation. But we did not have sophisticated airway gadgets in our resuscitation kit. Then we used a 9 Fr sterile AC (Medtronic, Minnesota, USA) with guide wire [Figure 1] lubricated with lignocaine 2% gelly as airway exchange catheter in airway port of PLMA [Figure 2] keeping suction catheter in gastric port. It passed smoothly into trachea and a tactile sensation was felt by keeping the palm on trachea. After 35 cm of insertion, PLMA was removed. Apnea oxygenation was supplied to the patient through the angiographic catheter after removing guide wire and an 8 mm internal diameter endotracheal tube (ET) was exchanged. ET confirmed with capnometry and 5-point chest auscultation. Figure 1 Angiographic catheter with guidewire Figure 2 Angiography catheter inside ProSeal laryngeal airway mask Repeated attempts of laryngoscopy for tracheal intubation in difficult airway are associated with decreased success, increase complications, and morbidities. Alternative airway devices like gum elastic bougies, rigid or flexible fiberoptic bronchoscope, intubating laryngeal mask airway (LMA), video laryngoscope, light wand, and cricothyroidotomy are very effective in this situation.[2]. Airway management in ED is often more difficult than operation theater due to unavailability of difficult airway gadgets, improper environment, and untrained medical stuff. As an intubation conduit LMA is used in different way like blind ET passage after proper LMA placement, using a premounted ET in LMA, bougie-aided intubation via LMA, light wand-aided intubation through LMA, fiberscope aided intubation via LMA, and so on. PLMA having narrower airway tube will not allow to pass larger ET, but absence of aperture bar allow smooth passage of AC. Above all, PLMAs have gastric drainage tube to reduced incidence of aspiration, prevent gastric insufflation, and allow ventilation with higher pressure as it was required in our patient. People used fiberoptic aided intubation through the LMA-Supreme using an Aintree Intubating Catheter (AIC) in manikin.[3] Cook et al.,[4] reported seven case of difficult intubation via PLMA using AIC. AIC are long length, atraumatic, ability to oxygenate, and ventilate during exchange process. But the guidewire in it is too thin and soft for support. We used sterilized AC with atramatic guide wire which have same function as AIC but minimum cost and easily available from CCL. This AC was previously used for angiography but sterilized with 2% glutaraldehyde for 10 min before use in this patient.[5] In conclusion, emergency resuscitation and airway kit must contain classic LMA and LMA for rescue ventilation and oxygenation, while a resterilized AC can also be a useful gadget in difficult airway situation with limited resource.

Performance of Retrograde Light-guided Laryngoscopy for Tracheal Intubation

Performance of Retrograde Light-guided Laryngoscopy for Tracheal Intubation

Shedding New Light on an Old Technique

Shedding New Light on an Old Technique

Intubation au vidéolaryngoscope sous-sédation

We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation.

Comparison of Pentax-AWS Airwayscope, Airtraq and Miller laryngoscope for tracheal intubation by novice doctors during infant cardiopulmonary resuscitation simulation: a randomized crossover trial

Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airway Scope (AWS) with an infant-sized Intlock (AWS-I), Airtraq laryngoscope (ATQ) and Miller laryngoscope during chest compressions on an infant manikin. Twenty-three novice doctors performed tracheal intubation on an infant manikin using the AWS-I, ATQ and Miller laryngoscope, with or without chest compressions. In Miller laryngoscope trials, one participant failed to secure the airway without chest compressions, while nine failed with compressions (P < 0.05). In ATQ trials, none of the participants failed without compressions, while six failed with compressions (P < 0.05). In AWS-I trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the Miller laryngoscope and ATQ, but not with the AWS-I. The AWS-I is an effective device for endotracheal intubation during chest compressions in infant simulations managed by novice doctors.

Awake Fiberoptic or Awake Laryngoscopic Tracheal Intubation in Patients With Anticipated Difficult Airway Management

Rosenstock, Charlotte V.*; Thøgersen, Bente†; Afshari, Arash‡; Christensen, Anne-Lise*; Eriksen, Claus*; Gätke, Mona M.† Author Information

Observation of the effect of TruviewTM EVO2 laryngoscope for emergency endotracheal intubation

Objective To evaluate the value of TruviewTM EVO2 optical laryngoscope for emergency endotracheal intubation in the clinical application. Methods Forty-four patients in need for emergency endotracheal intubation were randomly （ random number） divided into two groups： the observation group （TruviewTM EVO2 optical laryngoscope for tracheal intubation, n = 22 ） and the control group （ordinary laryngoscope for tracheal intubation, n = 22 ）. Parameters recordered included C/L （Cormack-Lehane） grade, the time taken for successful intubation, tracheal intubation times, lowerest SpO2 during the intubation and the incidences of complications after intubation. IDS （ intubation difficulty scale ） scores were calculated and the total effective rates were compared. Results The data showed that there were no significant differences in the duration of the successful endotracheal intubation attempts between the two groups, respectively （24.04 ± 6.56） s and （21.97 ± 8.92） s, P 〉 0.05. The C/L grade with the observation group was 10： 9： 3：0 （ Ⅰ ： Ⅱ ： Ⅲ ： Ⅳ ）, which was significantly better than that with the control group （ 3： 7： 9： 3, P 〈 0.01 ）. The tracheal intubation times of the observation group was 17： 5：0 （ one time： two times： three times）, which was significantly better than that of the control group （ 9： 8： 5, P 〈 0, 01 ）. The. minimum of Sp02 in the observatign ,grqup （97. 3l ± 1.64） % was significantly higher than that in the control group （92.03 ± 5.39） % , （P 〈 0. 01 ）. The incidence of complications after intubation was lower in the observation group. The IDS score in the observation group （0. 68 ±0. 38） was much lower than those in the control group （ 2. 54 ±1.49）, （ P 〈 0. 01 ）. In addition, the total effective rate of the observation group （86. 36% ） was significantly higer than that in the control group （45.45%）, （P 〈 0. 01 ）. Conclusions Using optical laryngoscope for emergency endotracheal intubation could facilitate the glottis exposure and reduce C/L grade effectively. It could lead to lower the incidence of complications andincrease the success rate of tracheal intubation. Key words: TruviewTMEV02 laryngoscope ; Ordinary laryngoscope ; Emergency tracheal intubation ; C/L grade; IDS grade

173 A Comparison of the GlideScope® Video Laryngoscope to the C-MAC® Video Laryngoscope for Tracheal Intubation in the Emergency Department

173 A Comparison of the GlideScope® Video Laryngoscope to the C-MAC® Video Laryngoscope for Tracheal Intubation in the Emergency Department