Proximal End Of Tube Research Articles

A COMPARISON BETWEEN TWO METHODS OF FALLOPIAN TUBAL LIGATION FOR STERILIZATION OF WOMEN IN A LOW RESOURCE SETTING

Objective: To compare two methods of tubal sterilization; modied Pomeroy and a modication added to modied Pomeroy's method, in a low resource setting. In this prospective study conducted fromMethods: 2019 to 2021 in one thousand women, we compared Pomeroy's method with an other method in which a slight modication in the original modied Pomeroy's technique was introduced, in a very low resource rural community hospital with only basic operation theater facility. In modied Pomeroy's method, a loop of fallopian tube is resected and transxed with 2-0 chromic catgut surgical suture material. In our study we added another modication to the modied Pomeroy's method, wherein the proximal end of the fallopian tube was additionally ligated with a 2-0 silk suture. The patients were followed up from 6months-2 years. A failure rate of 0.4% was observed in women who underwent Modied Pomeroy's method in contrast to noResults: failure in women in whom the proximal end of the tube was additionally ligated. Additional modication to theConclusion: original modied Pomeroy's method of sterilization can be potentially promising in reduction of sterilization failure rate in parts of world where salpingectomy is less readily accepted.

Duration of stenting with Montgomery T-tubes in severe laryngotracheal stenosis: does it matter?

Laryngotracheal stenosis management remains largely discretionary in surgical practice. Duration of stenting remains variable following open reconstruction procedures in absence of clearly established differences. The current study evaluates successful decannulation after short-term periods compared with longer periods. A comparative study over 18 months evaluated differences in successful decannulation between short- and long-term stent groups. Patients with grade II, III or IV laryngotracheal stenosis were placed on Montgomery T-tube for a short-term period (n = 15), and decannulation rates were compared with age-, sex- and diagnosis-matched patients (n = 15) from historical cases with long-term stent placement. Thirty patients were included. There was no difference between the two groups at baseline. Nine patients (30 per cent) were successfully decannulated, and there was no difference in rates of decannulation between the two groups (p = 0.8). Granulations at the proximal end of tube (38.7 per cent), superior migration of tube (16.1 per cent) and dysphonia (12.9 per cent) were common complications. Decannulation was not more successful after placing Montgomery T-tubes for longer periods of time when compared with removal within the first three months. Early removal after proper case selection and planning may be considered for a successful outcome in laryngotracheal stenosis.

Converting a nasoendotracheal tube to orotracheal, following fibreoptic intubation under general anaesthesia in a paediatric patient with complete cleft palate.

Sir, Cleft lip and palate are commonly associated with retrognathia, micrognathia and glossoptosis,[1] and can be part of syndromes such as Pierre Robin syndrome, Treacher-Collin's syndrome or Goldenhar syndrome. The anaesthesiologists frequently face difficulty with airway maintenance, mask ventilation, laryngoscopy, and endotracheal intubation.[2] Many of these infants may require fibreoptic intubation when they come for surgery.[3] We are reporting a case of Pierre Robin syndrome posted for palatoplasty. The patient, 9-month-old male infant, was delivered normally and had a history of snoring and nasal regurgitation while feeding. On examination, mandible was markedly receding along with a complete cleft palate involving both soft and hard palates. After keeping the child nil per oral for 6 h, general anaesthesia was induced with 8% sevoflurane in oxygen using a Jackson Rees circuit. Following induction a nasopharyngeal airway was introduced through one nostril with an endotracheal tube connector attached to the proximal end. Anaesthesia was maintained with 4% sevoflurane in oxygen with Jackson Rees circuit connected to the airway. Electrocardiogram, non-invasive blood pressure, SpO2 and end-tidal CO2 (EtCO2) were monitored. A 4.0 mm internal diameter oral Ring-Adair-Elwyn (RAE) tube was loaded on to the paediatric bronchoscope and the child was intubated nasally through the opposite nostril. As the surgeons insisted on an oral tube, the nasal tube was pushed in till the proximal end was at the nostril [Figure 1]. Then the mouth was opened and the most proximal part of the endotracheal tube visible through the cleft was caught with a paediatric Magill's forceps and pulled into the oral cavity [Figure 2]. At the same time, the part of the tube in the pharynx was stabilised by pushing it posteriorly to the pharyngeal wall with the index finger of the left hand to prevent accidental extubation. Once the proximal end of tube was brought out through the oral cavity, endotracheal tube connector was attached and position confirmed with EtCO2 and auscultation. The tube was then fixed in the midline and surgery commenced after giving fentanyl 2 μg/kg and atracurium 0.5 mg/kg intravenously. Maintenance of anaesthesia was with O2 :N2O (1:2) with sevoflurane (1.5–2%). The child was extubated at end of surgery uneventfully after reversing the neuromuscular blockade and when fully awake.Figure 1: Nasal endotracheal tube being pushed in till the proximal end is at the nostrilFigure 2: Proximal end of endotracheal tube being pulled out through the oral cavityThough infants can be intubated orally with fibreoptic bronchoscope, technical ease is more with the nasal route. Fibreoptic intubation succeeds less frequently by oral route because of the greater angle between oral cavity and the laryngeal inlet and also since keeping the bronchoscope in the midline is more difficult with oral route.[4] Though a nasotracheal tube can be changed to orotracheal using a guide wire, in the presence of a complete cleft palate, the technique described by us can be safely and easily accomplished.

Prevention of migration of endotracheal tubes used for aided nasogastric tube placement in anaesthetized patients.

Sir, During bariatric surgery procedures, the anaesthesiologists help facilitate proper placement of nasogastric tubes (NGTs) and bougies to size the gastric pouch. They help perform leak tests with saline, methylene blue or air to ensure staple-line or anastomotic integrity. They ensure complete removal of all gastric tubes before gastric division to avoid unplanned stapling and transection of these tubes. After the surgery is performed, they re-insert the NGT tube under vision watching the monitor carefully while the tube is advanced to avoid disruption of the anastomosis. NGT insertion in an anaesthetised patient is however a very cumbersome procedure for the anaesthesiologist with the need to burrow under sterile drapes to approach the oral cavity and the need to use a laryngoscope and Magill's forceps to advance the tube 1–2 cms at a time to avoid coiling in the oropharynx because of the flexibility and slippery nature of a lubricated NGT through the compromised lumen of the oesophagus secondary to the inflated endotracheal bulb.[1] Several techniques to simplify this procedure have been recommended in the literature.[2,3,4,5,6,7] Of these a quick and easy way often adopted intra-operatively by many anaesthesiologists is to pass a paediatric endotracheal tube (ETT) nasally and a NGT is passed down this tube directly to the oesophagus without coiling or trauma.[2,3,4] The ETT can be then be removed from around the NGT without displacement of the tube. Correct position of NGT is confirmed by injection of air and auscultation over the epigastrium, aspiration of gastric contents or direct visualisation/palpation at surgery. An ETT is preferred over a nasopharyngeal airway as guide for NGT insertion because of its length. We would like to share our experience of a possible undesired event associated with this manoeuvre to create awareness and for adoption of necessary precautions. We recently encountered three patients undergoing bariatric procedures for treatment of their morbid obesity spread over three different centres that were complicated by intra-operative migration of the guiding nasal ETT into the oesophagus after dislodgement of the tube from its connector by this manoeuvre [Figure ​[Figure1a1a and ​andb].b]. In all three cases unaware of tube dislodgment (as the connector was the only visible portion), the NGT was threaded pushing the tube further downwards. In all three cases, the tube could not be readily accessed for removal through the mouth and were managed by endoscopic retrieval in two and retrieval through a gastrostomy in one [Figure ​[Figure2a2a and ​andbb]. Figure 1 (a) Endoscopic image of the proximal end of migrated nasal endotracheal tube in the oesophagus after displacement of the tube connector, (b) Endoscopic image of the body of the migrated nasal endotracheal tube in the oesophagus after displacement of the ... Figure 2 (a) Endoscopic image of the visualization and grasping of the migrated nasal endotracheal tube in the oesophagus, (b) Endoscopic image of the retrieval of the migrated nasal endotracheal tube from the oesophagus Portex® ETT connectors easily get separated from the tube if attached shallowly resulting in dislodgement of the tube. The simplest precaution to prevent dislodgement is to encircle a 1-cm wide tape at the proximal end of tube and secure it to the connector or use a one-size larger tracheal tube connector, which can be easily and snugly fit into the proximal end of the tube.[8] Furthermore, the Portex® ETTs used should be larger than the NGT as a snugly fitting NGT can easily carry the ETT also with it. Precautionary measures should always be implemented to avoid this unnecessary intra-operative complication.