Maintenance Of Airway Patency Research Articles

Evaluation of First Aid Skills at the Station "Basic Cardiopulmonary Resuscitation of Adults and Maintenance of Airway Patency" During Primary Specialized Accreditation in the Specialty Neonatology

The publication presents the results of an assessment of first aid skills at the station "Basic cardiopulmonary resuscitation of adults and maintenance of airway patency" during the primary specialized accreditation in the specialty of neonatology in 2023. The assessment of demonstration of practical skills showed a high level of training of specialists who have mastered the residency program, and also revealed some errors and inaccuracies that need to be paid attention to when preparing for accreditation.

Anaesthetic Management of Non-intubated Video-assisted Thoracic Surgery

Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate.This article discusses disadvantages of intubated anaesthetic approaches and advantages of non-intubated thoracic surgery as well as the anaesthetic management. This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications.Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.

Correlation between predictors of difficult mask ventilation and its grading using a risk score

Background: Maintenance of airway patency and oxygenation are the main objectives of face mask ventilation. Preoperative prediction can reduce the incidence of unanticipated difficult mask ventilation (DMV). Aim of Study: The aim of this study was to evaluate the correlation between predictors of DMV and its grading using a risk score. Study Setting and Design: This was an observational study approved by the Institutional Ethics Committee in a tertiary care hospital between 2020 and 2021. Patients and Methods: A total of 110 adult patients scheduled for elective surgery under general anaesthesia were studied. A detailed preoperative airway assessment was done to identify and risk score for seven standard predictors of DMV (male gender, age >55 years, body mass index ≥30 kg/m2, obstructive sleep apnoea [STOP-BANG score], edentulous state, modified Mallampati class and presence of beard). The risk score was correlated with the grading of mask ventilation in the operation theatre performed using the four-point scale as described by Han et al. Results: A statistically significant association was found with standard predictors such as male gender, obstructive sleep apnoea (STOP-BANG score) and the total preoperative risk score with the grading of mask ventilation (P < 0.05 for all). Additional risk factors found statistically significant were interincisor distance, thyromental distance, neck circumference, receding mandible, mandibular jaw protrusion, restricted neck movements, buck teeth and submucosal fibrosis. Conclusion: Prediction of DMV with preoperative risk score can lead to better anticipation of difficult airway management. Appropriate anticipatory airway management could potentially decrease the incidence of failed ventilation and resultant hypoxia.

Short-Term Preclinical Application of Functional Human Induced Pluripotent Stem Cell-Derived Airway Epithelial Patches.

Airway pathologies including cancer, trauma, and stenosis lack effective treatments, meanwhile airway transplantation and available tissue engineering approaches fail due to epithelial dysfunction. Autologous progenitors do not meet the clinical need for regeneration due to their insufficient expansion and differentiation, for which human induced pluripotent stem cells (hiPSCs) are promising alternatives. Airway epithelial patches are engineered by differentiating hiPSC-derived airway progenitors into physiological proportions of ciliated (73.9 ± 5.5%) and goblet (2.1 ± 1.4%) cells on a silk fibroin-collagen vitrigel membrane (SF-CVM) composite biomaterial for transplantation in porcine tracheal defects ex vivo and in vivo. Evaluation of ex vivo tracheal repair using hiPSC-derived SF-CVM patches demonstrate native-like tracheal epithelial metabolism and maintenance of mucociliary epithelium to day 3. In vivo studies demonstrate SF-CVM integration and maintenance of airway patency, showing 80.8 ± 3.6% graft coverage with an hiPSC-derived pseudostratified epithelium and 70.7 ± 2.3% coverage with viable cells, 3 days postoperatively. The utility of bioengineered, hiPSC-derived epithelial patches for airway repair is demonstrated in a short-term preclinical survival model, providing a significant leap for airway reconstruction approaches.

To tube or not to tube: a skeptic's guide to nonintubated thoracic surgery.

The aim of this review is to provide an overview of the rationale and evidence for nonintubated thoracic surgery and guide clinicians, considering the implementation of nonintubated thoracic surgery, to find an anesthetic approach suitable for their department. Based on physiologic considerations alone, nonintubated thoracic surgery would be expected to be an advantageous concept in thoracic anesthesia, especially in patients at high risk for pulmonary complications. Currently existing evidence, however, does not support these claims. Although the feasibility and safety have been repeatedly demonstrated, high-quality evidence showing a significant benefit regarding clinically relevant patient-centered outcomes is not available.Anesthetic approaches to nonintubated thoracic surgery differ significantly; however, they usually concentrate on six main aspects: maintenance of airway patency, respiratory support, analgesia, patient comfort, cough suppression, and conversion techniques. Given the lack of high-quality studies comparing different techniques, evidence-based guidance of clinical decision-making is currently not possible. Until further evidence is available, anesthetic management will depend mostly on local availability and expertise. In select patients and with experienced teams, nonintubated thoracic surgery can be a suitable alternative to intubated thoracic surgery. Until more evidence is available, however, a general change in anesthetic management in thoracic surgery is not justified.

Tracheostomy management

Tracheostomy management

Evaluation of bronchoscopic placement of tracheobronchial silicone stents: an Ain Shams University Hospital experience

Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicone stents is a well-established procedure in the management of malignant and benign tracheobronchial stenosis. However, there is limited experience with this technique in Egypt. This study aimed to retrospectively evaluate the results of our experience with bronchoscopic placement of tracheobronchial silicone stents. Between January 2007 and December 2011, 44 Dumon stents were inserted in the central airways of 40 patients using rigid bronchoscopy under general anesthesia. Data related to stent application were collected from patient’s records. Of the 40 patients with either benign (20) or malignant (20) tracheal stenosis, stents were indicated in stabilizing airway patency after tumor debulking, counteracting extrinsic compression, sealing malignant fistulas, and treating complex-type benign strictures in 22.5, 27.5, 7.5, and 42.5% of patients, respectively. One stent was placed in 36 (90%) patients and two stents in four (10%) patients. Four (10%) patients required two stent procedures for adequate airway stabilization. Procedural complication in the form of trivial perforation of the bronchial wall occurred in one (2.5%) patient. Stent migration occurred in 10% of the patients, granuloma formation in 17.5%, tumor ingrowth in 7.5%, and stent obstruction by mucus secretions in 7.5% during the first 3 months after stent insertion, with an overall complication rate of 45%. All complications were non-life-threatening and all were reversibly managed. There was no mortality resulting from stent placement recorded during the first 3 months after stent insertion. This study showed that bronchoscopic placement of Dumon silicone tracheobronchial stent is easily applied and effective in the maintenance of airway patency in malignant and benign tracheobronchial stenosis. Non-life-threatening stent-related complications occur but are easily managed. Egypt J Broncho 2014 8:38–43

Pediatric Acute External Laryngeal Trauma

Larynx and adjacent anatomical structures have complicated physiological functions and mechanical features. Traffic accidents, penetrating stab wounds and shot wounds, sports matches, and occupational accidents cause external laryngeal trauma. In the management of laryngeal trauma, maintenance of airway patency has priority. In this case report, we will mention of a 15-year-old male patient with a blunt laryngeal trauma and also the approach to laryngeal traumas.

单切口胸膜腔镜检查术的护理

【目的】探讨不明原因胸腔积液患者在不需要麻醉科医师监护和特殊供氧条件下，应用传统局部麻醉方式基础上和小剂量咪达唑仑–芬太尼静脉复合麻醉行单切口胸膜腔镜检查护理要点。【方法】对50例患者检查前由责任护士做好健康宣教、心理护理，协助患者备好常规检查、备药；人工气胸等；术前30 min常规2%利多卡因5~8 ml + 0.1%肾上腺素0.2~0.3 ml浸润局部麻醉，在此基础上依据患者年龄、体重、基础疾病遵医嘱应用小剂量咪达唑仑2~3 mg、芬太尼1 ug/kg静脉注射镇静镇痛；术中给予吸氧、生命体征、血氧饱和度监测，保持呼吸道通畅；术后胸腔闭式引流护理，加强复张性肺水肿、疼痛、发热、胸腔出血、胸腔漏气及皮下气肿等并发症的观察及护理。【结果】50例患者均一次成功完成单切口胸膜腔镜检查，无严重并发症病例，确诊恶性肿瘤30例、慢性炎症12例，结核5例，未明确诊断3例，术后恢复良好。【结论】对不明原因胸腔积液患者应用传统局部浸润麻醉方式和小剂量咪达唑仑–芬太尼静脉复合麻醉行单切口胸膜腔镜检查安全、检查阳性率高，护理上检查前做好患者健康宣教及心理护理，术中严密观察患者神志、心率、呼吸、血氧饱和度，及时清理呼吸道分泌物，保持清理呼吸道通畅，术后做好胸腔闭式引流护理及疼痛、发热、皮下气肿、复张性肺水肿等等并发症的观察与护理，全程精心护理与单切口胸膜腔镜检查成功密切相关。[Objective] To investigate unexplained pleural effusion in patients without the need for anes- thesiologists care and domiciliary oxygen; to apply traditional methods based on local anesthesia and a small dose of midazolam-fentanyl intravenous injection for primary surgical pleuroscopy. [Methods] 50 patients were examined by nurses for routine aspect of health education, psychological counseling, patient preparation, maintenance drug and pleuroscopy set. 30 minutes prior to the pleuroscopy, local anesthesia was provided with 2% lidocaine (5 - 8 ml) + 0.1% adrenaline solution (0.2 - 0.3 ml); based on the patient’s age, weight and underlying disease a small dose of midazolam 2 - 3 mg, fentanyl 1 ug/kg intravenous injection was given as analgesia. Thoracic drainage care, prevention of re-expansion pulmonary edema, pain, fever, pleural hemorrhage, pleural air leaks, subcutaneous emphysema and other possible complications were taken care of intra-operatively; oxygen supplementation, monitoring of vital signs and oxygen saturation, maintenance of airway patency was continuously done. [Results] 50 patients suc- cessfully underwent primary surgical pleuroscopy, 30 cases were diagnosed with malignancy, 12 cases of chronic inflammation, 5 cases of tuberculosis, and 3 cases with uncertain diagnosis. None of the patients had post pleuroscopy complication. [Conclusion] Patients with unexplained pleural effusion should undergo primary surgical pleuroscopy using the traditional methods of local anesthesia and a small dose of midazolam-fentanyl intravenous injection. The aspect of nursing includes health education, psychological counseling, patient preparation; maintenance drug and pleuroscopy set check. Intra-operative monitoring of heart rate, respiratory rate, oxygen satura- tion, suction of respiratory secretions, maintaining airway patency followed by good postopera- tive care and thoracic drainage reduces the complications of pain, fever, subcutaneous emphy- sema, swelling, re-expansion pulmonary edema. Proper nursing care and the outcome of primary surgical pleuroscopy are closely related.

Hemodynamic Response to Dynamic Changes in Upper Airway Impedance?A Volunteer Study

Introduction: Intermittent airway obstruction may occurring both intubated and non-intubated critically ill patients due to endotracheal tube obstruction or kinking in the former and loss of oropharyngeal tone particularly during sedation in the latter patient group. Spontaneous breathing efforts against high airway resistance invoke shifts in intrathoracic pressure, which could potentially negatively affect cardiac performance. Previous studies utilized the Mueller Maneuver as a model for pathophysiologic changes during these episodes. However, this model only accounts for the state of maximum inspiration. To study progressive airway obstruction of various degrees, we devised an experimental setup allowing for a dynamic simulation and identification of associated short-term effects of breathing against discretely increasing airway resistance. Material and methods: 14 healthy volunteers (9 female, 5 male; mean age 27.8 ± 4.1 years, mean body mass index 26.1 ± 3.6 kg/m2) were asked to breathe through a set of endotracheal tubeswith decreasing internal diameter, while cardiovascular and hemodynamic parameters were recorded.StrokeVolume (SV) and Cardiac Index (CI) were recorded using thoracic bioreactance. Heart Rate (HR), non-invasive arterial blood pressure, oxygen saturation and spirometry parameters were also recorded. Results: Baseline SV, HR and CI averaged 99.8 ml, 69.5/min and 4.01 l/min/m2. During respiration through tubes with decreasing diameters, SV, HR and CI decreased significantly. At maximum airway resistance, SV, HR and CI averaged 90.7 ml, 65.0/min and 3.38 l/min/m2, representing mean percent changes from baseline of -9.1% (p=0.0041), -6.5% (p<0.0001) and -15.7% (p<0.0001). Strong inverse Pearson correlations were detectible between calculated additional airway resistance (Hagen-Poiseuille) and SV (R=-0.143, p=0.013), and CI (R=-0.147, p=0.011), respectively. Blood pressure, arterial oxygen saturation and spirometry parameters did not differ significantly. Conclusions: Increases in airway resistance were dynamically associated with significant hemodynamic deterioration. Ensuring the maintenance of airway patency is therefore an important factor to consider in hemodynamically unstable patients.

Evolution of Airway Devices

Maintenance of patent airway is essential for adequate oxygenation and ventilation. Failure, even for a short period can be life-threatening. So expertise in airway management is essential in every medical speciality. Management of the airway has come a long way since the endotracheal intubation done by Macewan (1880) to present day use of modern and sophisticated devices. The wide variety of airway armamentarium is available today. Since, time available to secure airway is short one has to be optimally prepared with proper selection of equipment, technique and participation of personnel experienced in doing it. This is a brief review of evolution of airway devices.

Comparative Life Cycle Assessment of Disposable and Reusable Laryngeal Mask Airways

Growing awareness of the negative impacts from the practice of health care on the environment and public health calls for the routine inclusion of life cycle criteria into the decision-making process of device selection. Here we present a life cycle assessment of 2 laryngeal mask airways (LMAs), a one-time-use disposable Unique™ LMA and a 40-time-use reusable Classic™ LMA. In life cycle assessment, the basis of comparison is called the "functional unit." For this report, the functional unit of the disposable and reusable LMAs was taken to be maintenance of airway patency by 40 disposable LMAs or 40 uses of 1 reusable LMA. This was a cradle-to-grave study that included inputs and outputs for the manufacture, transport, use, and waste phases of the LMAs. The environmental impacts of the 2 LMAs were estimated using SimaPro life cycle assessment software and the Building for Environmental and Economic Sustainability impact assessment method. Sensitivity and simple life cycle cost analyses were conducted to aid in interpretation of the results. The reusable LMA was found to have a more favorable environmental profile than the disposable LMA as used at Yale New Haven Hospital. The most important sources of impacts for the disposable LMA were the production of polymers, packaging, and waste management, whereas for the reusable LMA, washing and sterilization dominated for most impact categories. The differences in environmental impacts between these devices strongly favor reusable devices. These benefits must be weighed against concerns regarding transmission of infection. Health care facilities can decrease their environmental impacts by using reusable LMAs, to a lesser extent by selecting disposable LMA models that are not made of certain plastics, and by ordering in bulk from local distributors. Certain practices would further reduce the environmental impacts of reusable LMAs, such as increasing the number of devices autoclaved in a single cycle to 10 (-25% GHG emissions) and improving the energy efficiency of the autoclaving machines by 10% (-8% GHG emissions). For both environmental and cost considerations, management and operating procedures should be put in place to ensure that reusable LMAs are not discarded prematurely.

Single motor unit recordings in human geniohyoid reveal minimal respiratory activity during quiet breathing

Maintenance of airway patency during breathing involves complex interactions between pharyngeal dilator muscles. The few previous studies of geniohyoid activity using multiunit electromyography (EMG) have suggested that geniohyoid shows predominantly inspiratory phasic activity. This study aimed to quantify geniohyoid respiration-related activity with single motor unit (SMU) EMG recordings. Six healthy subjects of normal body mass index were studied. Intramuscular EMG recordings of geniohyoid activity were made with a monopolar needle with subjects in supine and seated positions. The depth of the geniohyoid was identified by ultrasound, and the electrode position was confirmed with maneuvers to isolate activity in geniohyoid and genioglossus. Activity was recorded at 85 sites in the geniohyoid during quiet breathing (45 supine and 40 seated). When subjects were supine, 33 sites (73%) showed no activity during breathing and 10 (22%) showed tonic activity. In addition, one site showed a tonic SMU with increased expiratory discharge, and one site in another subject had one unit with expiratory phasic activity. When subjects were seated, 27 sites (68%) in the geniohyoid showed no activity, 12 sites (30%) showed tonic activity that was not respiration related, and one unit at one site showed phasic expiratory activity. The average peak discharge frequency of geniohyoid motor units was 16.2 ± 3.1 impulses/s during the "geniohyoid maneuver," which was the first part of a swallow. In contrast to previous findings, the geniohyoid shows some tonic activity but minimal respiration-related activity in healthy subjects in quiet breathing. The geniohyoid has little active role in airway stability under these conditions.

Common Synaptic Input to the Human Hypoglossal Motor Nucleus

The tongue plays a key role in various volitional and automatic functions such as swallowing, maintenance of airway patency, and speech. Precisely how hypoglossal motor neurons, which control the tongue, receive and process their often concurrent input drives is a subject of ongoing research. We investigated common synaptic input to the hypoglossal motor nucleus by measuring the coordination of spike timing, firing rate, and oscillatory activity across motor units recorded from unilateral (i.e., within a belly) or bilateral (i.e., across both bellies) locations within the genioglossus (GG), the primary protruder muscle of the tongue. Simultaneously recorded pairs of motor units were obtained from 14 healthy adult volunteers using tungsten microelectrodes inserted percutaneously into the GG while the subjects were engaged in volitional tongue protrusion or rest breathing. Bilateral motor unit pairs showed concurrent low frequency alterations in firing rate (common drive) with no significant difference between tasks. Unilateral motor unit pairs showed significantly stronger common drive in the protrusion task compared with rest breathing, as well as higher indices of synchronous spiking (short-term synchrony). Common oscillatory input was assessed using coherence analysis and was observed in all conditions for frequencies up to ∼ 5 Hz. Coherence at frequencies up to ∼ 10 Hz was strongest in motor unit pairs recorded from the same GG belly in tongue protrusion. Taken together, our results suggest that cortical drive increases motor unit coordination within but not across GG bellies, while input drive during rest breathing is distributed uniformly to both bellies of the muscle.

Discharge Patterns of Human Genioglossus Motor Units During Sleep Onset

Multiunit electromyogram recordings of genioglossus have demonstrated an abrupt reduction in the muscle's activity at sleep onset. Recent evidence from single motor unit recordings indicates that the human genioglossus muscle consists of motor units with a variety of discharge patterns. The aim of the present study was to determine the effect of sleep onset on the activity of individual motor units as a function of their particular discharge pattern. Genioglossus activity was assessed using intramuscular fine-wire electrodes via a percutaneous approach. Sleep onsets (alpha-to-theta transitions) were identified and the genioglossus electromyogram recordings analyzed for single motor unit activity. Sleep research laboratory. Sleep and respiratory data were collected in 8 healthy subjects (6 men). One hundred twenty-seven motor units were identified: 23% inspiratory phasic, 45% inspiratory tonic, 4% expiratory phasic, 9% expiratory tonic, 16% tonic, and 3% other. Approximately 50% of inspiratory units (phasic and tonic) ceased activity entirely at sleep onset, whereas those inspiratory units that continued to be active showed a reduction in the proportion of each breath over which they were active. However, the rate of discharge of inspiratory units during the period they did fire was not altered. In contrast, tonic and expiratory units were unaffected by sleep onset, maintaining their discharge pattern over the alpha-to-theta transition. Central control of inspiratory motoneuron output differs from that of tonic and expiratory units during sleep onset, suggesting that the maintenance of airway patency during sleep may become more reliant on the stiffening properties of tonic and expiratory modulated motor units.

Biochemistry of Anterior, Medial, and Posterior Genioglossus Muscle in the Rat

The tongue plays a vital role in swallowing actions. However, tongue muscles have been understudied, and it is unclear if tongue muscles are homogeneous with respect to muscle fiber-type distribution. We examined myosin heavy chain (MHC) composition of anterior, medial, and posterior sections of the genioglossus muscle (GG) using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in ten adult (9 months old) male Fischer 344/Brown Norway hybrid rats. We found that Type IIx MHC predominated in the anterior, medial, and posterior regions of the GG muscle (p=0.002), followed by IIa, then IIb. The anterior GG contained a significantly greater (p=0.004) proportion of Type IIa than did the medial or posterior regions, while the posterior GG contained a significantly greater (p=0.002) proportion of Type IIb MHC than did the medial or anterior GG. Accordingly, we found variable expression of MHC isoforms across anterior, medial, and posterior portions of the GG muscle, with more fast-contracting isoforms found posteriorly. Because motor control of the tongue requires precise and rapid movements for bolus manipulation and airway protection, variable expression of MHC isoforms along the anteroposterior axis of the GG muscle may be required to efficiently achieve deglutition and maintenance of airway patency.

Bench-to-bedside review: Early tracheostomy in critically ill trauma patients

A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy.

Obstructive sleep apnoea and anaesthesia

Upper airway obstruction is common during both anaesthesia and sleep, as a result of loss of muscle tone present during wakefulness. Patients with obstructive sleep apnoea (OSA) are vulnerable during anaesthesia and sedation as the effects of loss of wakefulness are compounded by drug-induced depression of muscle activity and of arousal responses, so that they cannot respond to asphyxia. Conversely, those with 'difficult' airways during anaesthesia, either because of problems with maintenance of airway patency without tracheal intubation or because intubation itself is problematic, are at increased risk of OSA. These relationships have clinical importance. On the one hand identification of patients with OSA forewarns the anaesthetist of potential difficulty with airway maintenance intra- and postoperatively, influencing choice of anaesthetic technique and postoperative nursing environment. On the other hand difficulty with airway maintenance during anaesthesia should prompt further investigation for the possibility of OSA.

Endobronchial metallic stent placement for airway complications after lung transplantation: Longitudinal results

Background In lung transplant recipients, bronchial stenosis (SB) and bronchomalacia (MB) result in obstructive airway disease and allograft dysfunction due to pulmonary infection. We hypothesized that endobronchial metallic stent placement for SB and MB would result in long-term improvement in respiratory function and rates of pulmonary infection. Methods We studied symptomatic lung transplant recipients with bronchoscopic evidence of proximal airway complications (SB or MB) and a synchronous decline in forced expiratory volume in 1 second (FEV 1) of at least 10% in the 6-month period before intervention. Stent placement was the primary intervention for SB and all focal MB lesions and for recurrent or refractory SB lesions failing a single initial attempt at balloon dilation. FEV 1 and rates of pulmonary infection were assessed in the 12-month interval before and after stent placement. Spirometric evaluation was performed at 3-month intervals and compared with spirometry at the time of stent placement. The rates of pulmonary infection, determined by the number of antibiotics prescribed, was determined before and after endobronchial correction. Results Thirty recipients underwent a total of 75 procedures (50 stent insertions and 25 balloon dilations). FEV 1 improved significantly after stent placement compared with base line (1.29 ± 0.43 L) as follows: 3 months, 1.45 ± 0.50 L, p = 0.014; 6 months, 1.59 ± 0.57 L, p = 0.002; 12 months 1.59 ± 0.53 L, p = 0.006. The infection rate decreased from the 12-month period preceding stent insertion to the corresponding period after stent insertion (6.97/100 days ± 6.33 versus 5.74/100 days ± 7.76, p = 0.018). Recurrent SB occurred in 17.3%. No life-threatening complications occurred after stent placement and no deaths were attributed to stent malfunction or malposition. Conclusions In lung transplant recipients with SB and MB, maintenance of airway patency by stent placement is safe and resulted in improvements in lung function and reduced pulmonary infection rates for up to 1 year after their insertion.

New Jaw Support Device and Awake Fiberoptic Intubation

To the Editor: The jaw support device (JSD), designed to support the bilateral angle of the patient’s jaw, facilitates exposure of the larynx and maintenance of airway patency without the need for an assistant during fiberoptic intubation in anesthetized, paralyzed patients (1). The first prototype of this device, however, can be used only with the Maquet Operating Table System (MAQUET, Rastatt, Germany) and requires the manipulation of six screws (three on each side) for adjustment. To overcome these problems, we have developed a new prototype of the JSD (Arizono Orthopedic Supplies Company Ltd., Kitakyushu, Japan). This new device is attached to a stainless board, which enables it to be used on any operating table, and it is easily and quickly adjustable to fit the jaw by using the easy locking mechanism and levers (Figure 1).Figure 1: A new jaw support device supporting the bilateral angle of the jaw. The device maintains jaw thrust and head extension. Bilateral heads (A) attached to the easy-locking poles are adjustable to the desired height and direction by simply pulling up. Bilateral universal arms (B) attached to a stainless board can be fixed only by pushing the levers (C). The device may be additionally secured in place by using two screws (white arrow) on each side. The head is covered with a soft cushion that can support the angle of the jaw without discomfort, even in a conscious patient.The JSD has been used for fiberoptic intubation under general anesthesia, but it is also useful for conscious fiberoptic intubation. During fiberoptic intubation in patients with conscious sedation or deep sedation, a jaw thrust maneuver by an assistant is sometimes required (2) because pharyngeal and laryngeal structures tend to move posteriorly, which can obstruct the airway and fiberoptic view. In these sedated patients, the JSD facilitates laryngeal exposure and maintenance of airway patency without the need for an assistant. This device can be used without discomfort for conscious patients, but it should be used for a short duration to minimize the potential risk of local skin or nerve damage. We have used this device in several sedated patients who required awake fiberoptic intubation and found that it was valuable. Kazuyoshi Aoyama MD* Etsuko Nagaoka MD* Ichiro Takenaka MD† Tatsuo Kadoya MD†