Tracheal Intubation In Patients Research Articles

Radiotherapy Effects on Airway Management in Patients with Nasopharyngeal Cancer

Background: At present, there is a paucity of data in the literature pertaining to the impact of radiotherapy (RT) on the success of tracheal intubation in patients with nasopharyngeal cancer (NPC). The aim of this study is to investigate the frequency of difficult tracheal intubation in patients with NPC following RT. Methods: Patients with NPC who underwent RT followed by surgery between 2012 and April 2024 at the University Hospital Heidelberg were retrospectively analyzed. Results: Twenty-three patients, predominantly males (73.9%) with a mean age of 52.9 years, were enrolled. Overall, 65.2% of the patients had an American Society of Anesthesiologists (ASA) class of III. The mean total laryngeal dose was 53.5 Gy for the main and boost plan, and the maximum total laryngeal dose was 66.61 Gy. Direct laryngoscopy was performed in 69.6% of cases, followed by 26.1% videolaryngoscopy, and 4.2% required fiberoptic intubation. In total, 47.8% of the patients had a Cormack/Lehane grade of I, followed by 43.5% with grade II and 8.7% with grade III. Overall, 87% of patients were successfully intubated on the first attempt. Conclusions: It has been demonstrated by previous studies that RT has the potential to enhance complications and difficulties encountered during airway management. While the results must be interpreted with caution, our study provides no evidence of severe impairment in advanced airway management in patients with nasopharyngeal cancer who have undergone radiotherapy.

A Comparative Study Between Video Laryngoscope and Video Stylet for Tracheal Intubation in Patients With Simulated Cervical Fracture Injury: A Prospective Randomised Controlled Study.

Purpose Video laryngoscopes were being used more often in cases of potentially difficult airways. The Karl Storz video stylet offered clear advantages over conventional laryngoscopes for patients with cervical spine fractures. This study aimed to compare the performance of the C-MAC video laryngoscope with the new Karl Storz video stylet in patients with simulated cervical fracture injuries. Material and methods The study, approved by the Board of Studies and the Ethical Committee of Jawaharlal Nehru Medical College and Hospital in Aligarh, involved 50 patients undergoing operative procedures under general anaesthesia. It was a prospective randomised controlled study on patients aged 20-60, weighing 30-80 kg, and classified as American Society of Anesthesiologists (ASA) Grades I and II, admitted for elective operative procedures. Patients were randomly assigned to two groups for intubation using different devices: the control group (N = 25) was intubated with the C-MAC (Mac blade) video laryngoscope (CM), and the study group (N = 25) was intubated with the Karl Storz video stylet (VS). The anaesthetic procedure involved a detailed pre-anesthetic check-up for all patients, including a medical history review, physical examination, and necessary tests based on age. Standard monitoring and pre-medication were administered uniformly. Anesthesia was induced and intubation was attempted using appropriate devices, following manual stabilisation of the neck. Parameters such as intubation attempts, time taken, failures, hemodynamic changes, and complications were recorded throughout the procedure. If intubation was unsuccessful, alternative measures were taken, and the operative procedure proceeded. Results The intubation success rates were compared between the two groups, CM and VS. In the CM group, all 25 patients (100%) were successfully intubated on the first attempt, while in the VS group, 23 patients (92%) were successfully intubated on the first attempt, and two patients (8%) required two attempts. The difference in the distribution of the number of attempts between the two groups was not statistically significant (p = 0.4915). The mean intubation time in the CM group was 27.24 ± 2.16 seconds, while in the VS group, the mean intubation time was significantly longer at 30.84 ± 6.81 seconds, with a statistically significant difference (p = 0.0105). Adjustment manoeuvres were required in only 4% of patients in the CM group compared to 0% in the VS group, although this difference was not statistically significant. The occurrence of blood on the device during intubation was recorded, and the distribution of patients with blood on the device among the two groups did not show a statistically significant difference (p = 0.617). Conclusion This study compared the effectiveness of two intubation devices. The C-MAC video laryngoscope showed a significantly higher rate of first-attempt successful intubations and required fewer attempts compared to the Karl Storz video stylet. The C-MAC also had shorter intubation times compared to the Karl Storz device. However, the Karl Storz video stylet demonstrated comparable performance to the C-MAC video laryngoscope in clinical settings, with both devices having similar safety profiles and minimal complications.

Continuous Positive-Pressure Oxygen Supply Improves Fiberoptic Intubation Efficacy and Safety in Patients With Simulated Cervical Spinal Injury: A Prospective Double-Blind Randomized Controlled Study.

Fiberoptic intubation is an important method for tracheal intubation in patients with cervical spine injury. How to effectively and safely complete fiberoptic intubation while maintaining the stability of the cervical spine is very important. This study compared the efficiency and safety of fiberoptic intubation after anesthesia induction under different types of air pressure in patients with simulated cervical spinal injury. In total, 59 adult patients who underwent fiberoptic intubation with a cervical collar for simulated cervical spinal injury were randomly allocated to continuous positive-pressure oxygen, normal-pressure, or intermittent negative-pressure suction groups. After the induction of anesthesia and adequate 100% oxygenation, which confirmed effective neuromuscular blockade, it was deemed appropriate to begin fiberoptic intubation. In the continuous positive-pressure oxygen group, the fiberoptic device was connected through the negative-pressure suction path with 5 L/min oxygen. In the intermittent negative-pressure suction group, the fiberoptic device was connected to the negative-pressure suction device. In the normal-pressure group, the flexible fiberoptic device was not connected to either the oxygen source or the negative-pressure suction device. The intubation time was recorded as the primary outcome measure. The intubation success rate, number of attempts, minimum SpO2, objective lens contamination rate, and incidence of complications were also compared among the groups. Compared with those in the other groups, the median (range) intubation time in the continuous positive-pressure group was 59 (36-181) seconds, which was significantly shorter than that in the normal-pressure group, 167 (46-181) seconds, and the intermittent negative-pressure suction group, 132.5 (38-181) seconds (P=0.04). The success rate of nasotracheal intubation was significantly greater in the continuous positive-pressure group (94.7%, 18/19) than in the normal-pressure group (50%, 10/20) and intermittent negative-pressure suction group (50%, 10/20) (P=0.004). There was a significant difference among the three groups (P=0.043). The median (range) minimum SpO2 during fiberoptic intubation was 100% (99-100%) in the continuous positive-pressure group, 100% (90-100%) in the normal-pressure group, and 99% (88-100%) in the intermittent negative-pressure suction group (P=0.029). However, no statistically significant difference was detected among the groups with complications. The continuous use of positive-pressure oxygen via the negative-pressure suction pathway can improve the efficiency and safety of fiberoptic intubation in patients with simulated cervical spinal injury after anesthesia induction.

First-attempt awake tracheal intubation success rate using a hyperangulated unchannelled videolaryngoscope vs. a channelled videolaryngoscope in patients with anticipated difficult airway: a randomised controlled trial.

There is uncertainty about the optimal videolaryngoscope for awake tracheal intubation in patients with anticipated difficult airway. The use of channelled and unchannelled videolaryngoscopy has been reported, but there is a lack of evidence on which is the best option. We conducted a randomised clinical trial to compare the efficacy of the C-MAC D-Blade® vs. Airtraq® in adult patients (aged ≥ 18 y) scheduled for elective or emergency surgery under general anaesthesia with anticipated difficult airway who required awake tracheal intubation under local anaesthesia and conscious sedation. The primary endpoint was the first-attempt tracheal intubation success rate. Secondary outcomes included the overall success rate; number of tracheal intubation attempts; Cormack and Lehane glottic view; level of difficulty (visual analogue score); patient discomfort (visual analogue score); and incidence of complications. Ninety patients (70/90 male (78%); mean (SD) age 65 (12) y) with anticipated difficult airways were randomly allocated to C-MAC D-Blade or Airtraq videolaryngoscopy. First-attempt successful tracheal intubation rate was higher in patients allocated to the C-MAC D-Blade group compared with those allocated to the Airtraq group (38/45 (84%) vs. 28/45 (62%), respectively; p = 0.006). The proportion of patients' tracheas that were intubated at the second and third attempt was 4/45 (9%) and 3/45 (7%) in those allocated to the C-MAC D-Blade group compared with 14/45 (31%) and 1/45 (2%) in those allocated to the Airtraq group (p = 0.006). There was no significant difference in overall tracheal intubation success rate (C-MAC D-Blade group 45/45 (100%) vs. Airtraq group 43/45 (96%), p = 0.494). In patients with anticipated difficult airway, first-attempt awake tracheal intubation success rate was higher with the C-MAC D-Blade compared with Airtraq laryngoscopy. No difference was found between the two videolaryngoscopes in overall tracheal intubation success rate.

Difficult airway management in patients with laryngeal tumor: Case series and systematic review

Airway management in patients with laryngeal tumor presents significant challenges and risks. SEEKflex (Safe Easy Endotracheal Kit-flexible) is a modified introducer developed by our team for the intubation in severe COVID-19 patients. Here, we present 4 cases where SEEKflex facilitated tracheal intubation in patients with laryngeal tumors underwent surgeries and achieved a definitive airway. A systematic review of MEDLINE, EMBASE, CINAHL, and Web of Science databases was also performed using the keywords such as “laryngeal tumor”, “airway management” and “anesthesia” to identify the reports on airway management techniques for patients with laryngeal tumors. 14 papers involving 17 patients were retrieved. All the cases reported positive patient outcomes, though there were instances of intubation failure after general anesthesia. Despite increased availability of basic airway management techniques and various types of intubation tools, challenges persist, especially in patients with pre-existing severe airway obstruction. SEEKflex provides a simple and rapid solution for intubating patients with laryngeal tumors, which ensures a clear airway for patient safety.

Effect of Magnesium Sulfate with Propofol on Hemodynamic Stability during Tracheal Intubation in Patients Undergoing Coronary Artery Bypass Grafting: A Single-Center Study

Objectives: This study aimed to assess the hemodynamic response of magnesium sulfate (MGS) with propofol during tracheal intubation in patients undergoing coronary artery bypass grafting (CABG). Methodology: A cross-sectional study was conducted at a tertiary cardiac center in Pakistan, involving 100 patients undergoing elective CABG. Hemodynamic parameters were recorded before and after intubation, following the administration of MGS with propofol. Results: The mean systolic blood pressure was 114.9±9.4 mmHg, 120.3±3.4 mmHg and 111.1±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of <0.001. The mean diastolic blood pressure was 66.2±10.3 mmHg, 67.8±6.1 mmHg, and 62±7.2 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of <0.001. The mean arterial blood pressure was 82.5±9.2 mmHg, 85.3±4.5, mmHg and 78.4±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of <0.001. The mean heart rate was 65.1±8.8 bpm, 69.7±5.2 bpm and 71.3±4.6 bpm before intubation, after 2 minutes and 5minutes respectively, with p-value of <0.001. Conclusion: The study concludes that the addition of MGS to propofol contributes to hemodynamic stability during tracheal intubation in patients undergoing CABG. Further research is needed to validate these findings and explore optimal dosing regimens.

The performance of C-MAC videostylet versus D-Blade during tracheal intubation in patients with simulated cervical immobilization: A randomized comparative trial

ABSTRACT Background Concerning patients with suspected cervical spine (C-spine) fractures or other cervical pathologies, tracheal intubation must be done very carefully to avoid injury to the spinal cord. Methods Fifty-two patients within a range of 20–60 years old, and arranged for elective surgery, were indiscriminately allocated into two groups; Group S was intubated with the C MAC Videostylet (VS), whereas Group L was intubated by D blade Video Laryngoscope (VL) during cervical immobilization by Philadelphia collar. The first successful attempt duration, total number of intubation attempts, the total duration of the intubation, haemodynamic parameters, stress response of intubation, the degree of C-spine movement and complications were evaluated in both groups. Results Group L showed substantially shorter times for the first successful attempt (p-value <0.001) and the whole intubation procedure (p-value <0.001) compared to Group S. Group S had a significantly more total number of intubation attempts (p-value = 0.010). The haemodynamic parameters did not significantly differ throughout the measurements among groups. Regarding the blood cortisol measurements at different periods, there were statistically insignificant changes among the groups. Concerning the greatest alteration in C-spine angulation at the occiput-C1, C1-C2, and C2-C5 segments during laryngoscopy and intubation, there were statistically insignificant differences among groups. Conclusion The C MAC D-blade VL is superior to the VS in terms of the number and duration of intubation attempts during C-spine immobilization. Conversely, the VS showed comparable results to the D blade regarding C-spine motion and stress response.

Evolution of Tracheobronchial Colonization Following Tracheal Intubation in Patients With Neurologic Injury Who Are Ventilated: The INSPIRE Study

BackgroundCharacteristics and course of endotracheal secretions have scarcely been studied in patients under mechanical ventilation (MV) at risk of developing ventilator-associated pneumonia (VAP). Research questionExhaustive description of endotracheal secretions and determination of their predictive value for the diagnosis of VAP during MV. Study design and methodsSingle-center prospective study in neuro-injured patients requiring MV for at least 7 days. Patients with pulmonary and infectious diseases were ineligible. All endotracheal aspirates (ETA) collected between tracheal intubation and Day7 were analyzed. Macroscopic characteristics and microbiology were assessed. CPIS was calculated daily. A blinded adjudication committee validated all VAP events. ResultsForty-eight patients and 1544 ETAs were analyzed. Overall, 81% of the ETA were purulent and 50% were thick. Culture results showed high inter- and intra-individual variability. Ten patients (21%) developed an early VAP. Eight patients (80%) with VAP and 14 (37%) without had a CPIS>6. The day before VAP diagnosis, a 20-mL increase in ETA volume detected a VAP with a sensitivity of 67% and a specificity of 93%. InterpretationOur study provides new information on the course of respiratory colonization in mechanically ventilated patients and suggests that ETA color and aspect, and pathogens kinetics cannot predict VAP. Traditional VAP criteria (CPIS and bacterial load) had also a low diagnostic specificity. Contrariwise, an increase in secretion volume should alert for VAP development.

Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator.

Background: The main clinical manifestations of patients with Pierre Robin sequence (PRS) include micrognathia, the glossoptosis and dyspnoea. The difficulty of tracheal intubation (TI) in such patients is increased. Objective: The purpose of the study was to evaluate the reliability and efficacy of the PRS simulator. Methods: A PRS simulator was developed by using 3-dimensional (3D) printing technology under computer-aided design. A total of 12 anaesthesiologists each trained 5 times for TI on the PRS Training Simulator-1 and recorded the simulation time. After the training, they were randomly divided into three groups with a total of 12 nontrained anaesthesiologists, and the simulation was completed on PRS Simulator-2, 3 and 4. The simulation time was recorded, and the performance was evaluated by three chief anaesthesiologists. Then, all 24 anaesthesiologists completed the questionnaire. Results: A PRS simulator developed by 3D printing was used to simulate the important aspects of TI. The average number of years worked was 6.3 ± 3.1years, and 66.7% were female. The time for the 12 anaesthesiologists to complete the training gradually decreased (p < 0.01). Compared with the trained anaesthesiologists, the simulation time of TI in the nontrained anaesthesiologists was much longer (all p < 0.01). In addition, the simulation performance of the trained anaesthesiologists was relatively better (all p < 0.01). Conclusion: The reliability and efficacy of the PRS simulator is herein preliminarily validated, and it has potential to become a teaching and training tool for anaesthesiologists.

Feasibility of ProVu™ Video Stylet for awake intubation of patients with severe obesity: A pilot observational study

BackgroundAirway management in the obese patient is known to be challenging as oxygenation may rapidly decrease after general anesthesia induction. Mask ventilation and tracheal intubation can be complicated due to obesity-related anatomical features. The reduced safe apnea time can put the patient at risk of severe and rapid desaturation. Recent guidelines recommend avoiding the suppression of spontaneous breathing in cases of predicted anatomically or physiologically difficult airway. Many different devices, such as video stylets and video laryngoscopes, have been proposed as alternatives to traditional gold standard flexible bronchoscope use for awake intubation. AimOur study reports the use of a new flexible ProVu™ Video Stylet (Flexicare Medical Ltd., Mountain Ash, UK) for awake intubations in 11 patients with severe obesity, who presented with at least one criterion for potentially difficult oxygenation (during ventilation and/or intubation attempts) after suppression of spontaneous breathing. MethodsIn total 11 consecutive patients with severe obesity and clinical indication for an awake tracheal intubation were enrolled over a 10-months period and intubated with the ProVu™ Video Stylet. ResultsAll 11 tracheal intubations were successfully performed. The procedures also highlighted potential limitations to consider while using the device in an awake intubation setting. ConclusionDespite the limitations of this small observational pilot study, our study showed that the ProVu™ Video Stylet may be a promising tool and a valid alternative for performing awake tracheal intubation in patients with severe obesity and predictors of difficult oxygenation. Future studies are needed to compare the performance of the ProVu™ Video Stylet with video laryngoscopy and flexible bronchoscopy, and to provide stronger evidence in favor or against the use of this new device. The possible availability of an alternative device, combined with the skill and confidence to use it, may provide the anesthesiologist an additional tool for managing awake intubation of at-risk airways, in accordance with recommendations from the most recent guidelines.

Pharmacological combination for awake tracheal intubation in patients with giant struma: A case report &amp;lrm;

Pharmacological combination for awake tracheal intubation in patients with giant struma: A case report &amp;lrm;

Comparison between high-flow nasal cannula and conventional oxygen therapy in COVID-19 patients: a systematic review and meta-analysis.

High-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) are important respiratory support strategies for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the results are conflicting for the risk of intubation with HFNC as compared to COT. We systematically synthesized the outcomes of HFNC relative to COT in COVID-19 patients with AHRF and evaluated these outcomes in relevant subpopulations. This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, medRxiv, BioRxiv, and the Cochrane Central Register of Controlled Trials for randomized controlled trials and observational studies that compared the efficacy of HFNC with COT in patients with COVID-19-related AHRF. Primary outcomes were intubation rate and mortality rate. Secondary outcomes were the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), respiratory rate, hospital length of stay, intensive care unit (ICU) length of stay, and days free from invasive mechanical ventilation. In total, 20 studies with 5732 patients were included. We found a decreased risk of requiring intubation in HFNC compared to COT [odds ratio (OR) = 0.61, 95% confidence interval (CI): 0.46-0.82, p = 0.0009, I2 = 75%]. Similarly, we found HFNC was associated with lower risk of intubation rate compared to COT in the subgroup of patients with baseline PaO2/FiO2 < 200 mmHg (OR = 0.69, 95% CI: 0.55-0.86, p = 0.0007, I2 = 45%), and who were in ICU settings at enrollment (OR = 0.57, 95% CI: 0.38-0.85, p = 0.005, I2 = 80%). HFNC was associated with an improvement of PaO2/FiO2 and respiratory rate compared to COT. The use of HFNC compared to COT did not reduce the mortality rate, days free from invasive mechanical ventilation, hospital length of stay, or ICU length of stay. Compared to COT, HFNC may decrease the need for tracheal intubation in patients with COVID-19-related AHRF, particularly among patients with baseline PaO2/FiO2 < 200 mmHg and those in ICU settings. This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022339072).

Pre-oxygenation with high-flow oxygen through the nasopharyngeal airway compared to facemask on carbon dioxide clearance in emergency adults: a prospective randomized non-blinded clinical trial

IntroductionBefore tracheal intubation, it is essential to provide sufficient oxygen reserve for emergency patients with full stomachs. Recent studies have demonstrated that high-flow nasal oxygen (HFNO) effectively pre-oxygenates and prolongs apneic oxygenation during tracheal intubation. Despite its effectiveness, the use of HFNO remains controversial due to concerns regarding carbon dioxide clearance. The air leakage and unknown upper airway obstruction during HFNO therapy cause reduced oxygen flow above the vocal cords, possibly weaken the carbon dioxide clearance.MethodsPatients requiring emergency surgery who had fasted < 8 h and not drunk < 2 h were randomly assigned to the high-flow group, who received 100% oxygen at 30–60 L/min through nasopharyngeal airway (NPA), or the mask group, who received 100% oxygen at 8 L/min. PaO2 and PaCO2 were measured immediately before pre-oxygenation (T0), anesthesia induction (T1), tracheal intubation (T2), and mechanical ventilation (T3). The gastric antrum’s cross-sectional area (CSA) was measured using ultrasound technology at T0, T1, and T3. Details of complications, including hypoxemia, reflux, nasopharyngeal bleeding, postoperative pulmonary infection, postoperative nausea and vomiting (PONV), and postoperative nasopharyngeal pain, were recorded. The primary outcomes were PaCO2 measured at T1, T2, and T3. The secondary outcomes included PaO2 at T1, T2, and T3, CSA at T1 and T3, and complications happened during this trial.ResultsPre-oxygenation was administered by high-flow oxygen through NPA (n = 58) or facemask (n = 57) to 115 patients. The mean (SD) PaCO2 was 32.3 (6.7) mmHg in the high-flow group and 34.6 (5.2) mmHg in the mask group (P = 0.045) at T1, 45.0 (5.5) mmHg and 49.4 (4.6) mmHg (P < 0.001) at T2, and 47.9 (5.1) mmHg and 52.9 (4.6) mmHg (P < 0.001) at T3, respectively. The median ([IQR] [range]) PaO2 in the high-flow and mask groups was 404.5 (329.1–458.1 [159.8–552.9]) mmHg and 358.9 (274.0–413.3 [129.0–539.1]) mmHg (P = 0.007) at T1, 343.0 (251.6–428.7 [73.9–522.1]) mmHg and 258.3 (162.5–347.5 [56.0–481.0]) mmHg (P < 0.001) at T2, and 333.5 (229.9–411.4 [60.5–492.4]) mmHg and 149.8 (87.0–246.6 [51.2–447.5]) mmHg (P < 0.001) at T3, respectively. The CSA in the high-flow and mask groups was 371.9 (287.4–557.9 [129.0–991.2]) mm2 and 386.8 (292.0–537.3 [88.3–1651.7]) mm2 at T1 (P = 0.920) and 452.6 (343.7–618.4 [161.6–988.1]) mm2 and 385.6 (306.3–562.0 [105.5–922.9]) mm2 at T3 (P = 0.173), respectively. The number (proportion) of complications in the high-flow and mask groups is shown below: hypoxemia: 1 (1.7%) vs. 9 (15.8%, P = 0.019); reflux: 0 (0%) vs. 0 (0%); nasopharyngeal bleeding: 1 (1.7%) vs. 0 (0%, P = 1.000); pulmonary infection: 4 (6.9%) vs. 3 (5.3%, P = 1.000); PONV: 4 (6.9%) vs. 4 (7.0%, P = 1.000), and nasopharyngeal pain: 0 (0%) vs. 0 (0%).ConclusionsCompared to facemasks, pre-oxygenation with high-flow oxygen through NPA offers improved carbon dioxide clearance and enhanced oxygenation prior to tracheal intubation in patients undergoing emergency surgery, while the risk of gastric inflation had not been ruled out.Trial registrationThis trial was registered prospectively at the Chinese Clinical Research Registry on 26/4/2022 (Registration number: ChiCTR2200059192).

Combined Styletubation with Videolaryngoscopy for Tracheal Intubation in Patients Undergoing Thyroidectomy with Intraoperative Neuromonitoring

The purpose of this case series report is to demonstrate the current state of the art regarding tracheal intubation of an evoked electromyography-endotracheal tube (EMG-ET tube) for continuous intraoperative recurrent laryngeal nerve monitoring (IONM) in patients undergoing thyroid surgery. Both direct laryngoscopy (DL) and videolaryngoscopy (VL) are popular for routine tracheal intubation of an EMG-ET tube. A new intubating technique (styletubation), using a video-assisted intubating stylet (VS), provides less traumatic and swift intubation. Styletubation combined with VL ensures the precise placement of the EMG-ET tube. This novel intubation technique improves the outcome of intubating an EMG-ET tube for IONM.

Evaluation of Ultrasound Guided Measurement of Tongue Thickness in Predicting Difficult Tracheal Intubation in Patients Undergoing Elective Surgery: A Cross Sectional Study

Background: Preoperative airway assessment is necessary to identify airway difficulties to the earliest, ensure adequate preparation to airway management before induction and to avoid airway related complications. Various Imaging techniques have been studied for prediction of the difficult airway. the ultrasound is a quick and simple technique. Aim of the study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in patients undergoing elective surgery.&#x0D; Methods: Sixty-one patients American Society of Anesthesiologist class I and II,18-65 years of age, either sex, were included. Tongue thickness was measured by ultrasound as the distance from the surface of tongue to the submental skin. Modified mallampatti score was also recorded.&#x0D; Results: Receiver operating characteristic (ROC) curve of tongue thickness showed an AUC of 0.879 for a cut off value of &gt;6 cm. This shows it has an excellent predictive value. Tongue thickness (&gt;6cm) was found to have 90.16% combined diagnostic accuracy with 75% sensitivity and 94.74% specificity for prediction of difficult intubation. No correlation between tongue thickness and modified mallampatti score. (Correlation coefficient was 0.013, p value 0.920).&#x0D; Conclusion: We conclude that ultrasound guided measurement of tongue thickness&gt; 6 cm can reliably predict difficult tracheal intubation in patients undergoing elective surgery.

Arterial partial pressure of oxygen and procalcitonin combined with ROX index predict the timing of tracheal intubation in patients with acute severe pancreatitis

To investigate the efficacy of arterial partial pressure of oxygen (PaO2), procalcitonin (PCT) combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis (SAP). A case-control study was conducted. A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects. According to whether endotracheal intubation was used after admission during hospitalization, the patients were divided into the intubation group (102 cases) and non-intubation group (46 cases). Gender, age, white blood cell count (WBC), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), hemoglobin (Hb), PCT, PaO2, arterial partial pressure of carbon dioxide (PaCO2), arterial bicarbonate ion (HCO3-) 1 day after admission, arterial lactic acid (Lac), lactate dehydrogenase (LDH), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2), blood pressure, worst ROX index (ROX index = SpO2/FiO2/RR) within 30 minutes of admission and 30 minutes before intubation of the two groups were measured. Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP. The receiver operator characteristic curve (ROC curve) was used to determine the optimal predictive cut-off value for endotracheal intubation. There were no significant differences in age, gender, WBC, LYM, CRP, Hb, LDH, HR and blood pressure at admission between the two groups. The PLT, Lac, PCT and RR in the intubation group were significantly higher than those in the un-intubation group, and HCO3-, PaO2, SpO2, PaO2/FiO2, the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group (all P < 0.05). Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in SAP patients [odds ratio (OR) = 0.723, 95% confidence interval (95%CI) was 0.568-0.896, P = 0.000], followed by PaO2 (OR = 0.872, 95%CI was 0.677-1.105, P < 0.001). PCT was the positive influencing factor (OR = 1.605, 95%CI was 1.240-2.089, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of PaO2, PCT, the worst ROX index within 30 minutes before intubation and the combination to evaluate the tracheal intubation time of patients with SAP were 0.715, 0.702, 0.722 and 0.808, the sensitivity was 78.1%, 75.0%, 81.5% and 89.3%, the specificity was 66.7%, 59.0%, 73.2% and 86.4%, and the best cut-off value was 60.23 mmHg (1 mmHg ≈ 0.133 kPa), 2.72 μg/L, 4.85, and 0.58, respectively. The AUC of the combination of PaO2, PCT and the worst ROX index within 30 minutes before intubation predicted the timing of tracheal intubation in patients with SAP was significantly greater than using each index alone (all P < 0.01). The worst ROX index within 30 minutes before intubation combined with PaO2 and PCT is helpful for clinicians to make a decision for tracheal intubation in patients with SAP.

The Heister jaw opener: a novel solution for tracheal intubation in patients with temporomandibular joint ankylosis

The Heister jaw opener: a novel solution for tracheal intubation in patients with temporomandibular joint ankylosis

Preoperative lignocaine nebulisation for attenuation of the pressor response of laryngoscopy and tracheal intubation in patients with severe preeclampsia undergoing caesarean section delivery: A randomised double-blind controlled trial.

Following induction of general anaesthesia, direct laryngoscopy and endotracheal intubation usually cause tachycardia and hypertension due to increased sympathetic activity. This response is generally exaggerated in hypertensive patients. This study aimed to evaluate the effectiveness of preoperative lignocaine nebulisation in attenuating the pressor response to laryngoscopy and endotracheal intubation in patients with severe preeclampsia undergoing caesarean delivery. After ethical approval, we conducted this randomised, double-blind study, which included 110 patients with severe preeclampsia who underwent caesarean delivery under general anaesthesia. These patients were randomly allocated into two groups to receive either preoperative nebulisation of lignocaine 2% in a dose of 4.5 mg/kg (not exceeding 400 mg) in the lignocaine group or nebulisation of an equivalent volume of 0.9% NaCl in the saline group. The primary objective was the systolic blood pressure after tracheal intubation. The secondary objectives included heart rate, maternal serum cortisol and blood glucose levels, grade of cough during emergence, postoperative sore throat and hoarseness of voice, neonatal Apgar score and umbilical blood gas. The systolic blood pressure was significantly lower in the lignocaine group compared to the saline group at 1, 3 and 5 min after endotracheal intubation and after delivery of the foetus (P = 0.001, 0.003, 0.002 and 0.019, respectively). Similarly, the heart rate was significantly lower in the lignocaine group versus saline group at 1 and 3 min after endotracheal intubation (P = 0.041 and 0.042, respectively). Preoperative lignocaine nebulisation in a dose of 4.5 mg/kg effectively attenuated the pressor response to laryngoscopy and endotracheal intubation in patients with severe preeclampsia undergoing caesarean delivery.

Comparison of Blockbuster LMA with Air Q LMA for Success of Blind Tracheal Intubation in Patients Undergoing General Anesthesia

Background: Blockbuster Laryngeal mask airway (LMA) is a device gaining popularity in airway management, and advantageous in ventilation and intubation. Air Q LMA is a supraglottic airway device with a shorter and wider breathing tube designed for ventilation as well as intubation in difficult airway. We aimed to evaluate the success of tracheal intubation using these devices. Methods: Overall 80 participants aged 18-60 years with ASA I and II were randomized into Group A (Air Q LMA) and Group B (Blockbuster LMA) using computer generated random numbers. The objectives of our study were to evaluate first pass successful intubation, ease, time and attempts taken for device insertion, oropharyngeal leak pressure, time for LMA removal and post operative complications. Association between variables were assessed with chi square test and unpaired t test. Result: There was a statistically significant difference in the first pass successful intubation between the groups which was higher in Group B (90%) than Group A (60%) (P&lt;0.001), the overall successful intubation was more in Group B 97.5% compared to Group A 85%. The device insertion was easy in 85% patients in Group A and 95% patients in Group B. The time taken for introduction of Air Q was longer (38.15±4.92sec) when compared with blockbuster LMA (26.25±4.44sec), (P&lt;0.001). Mean Oropharyngeal leak pressure of blockbuster LMA (32.40±3.99cmH2O) was greater than Air Q LMA (29.10±2.61cmH2O), (P&lt;0.001). Conclusion: Blockbuster LMA provides greater success of blind tracheal intubation when compared to air Q LMA.

Evaluation of oxygen saturation as an indicator for tracheal intubation in patients with COVID-19: a prospective cohort study

Background. Since the beginning of COVID-19 pandemic, the importance of clinical criteria for tracheal intubation in critically ill patients with respiratory failure became more noteworthy, especially in resource limitations. The objective was to evaluate the importance of hemoglobin oxygen saturation as a criterion for tracheal intubation in patients with COVID-19. Materials and methods. This is a multi-center, prospective, observational cohort study. We included 117 patients with COVID-19 who needed respiratory support between March to June 2021. Patients were intubated by the protocol of each institution participating in the study and the anesthesiologist’s clinical judgement. Signs of respiratory failure, methods of respiratory support and patient outcome were recorded. Results. Among 117 studied cases, 100 patients had hemoglobin oxygen saturation of 60–90 % in whom 58 were intubated. During hospitalization, 56 intubated patients and 14 non-intubated patients died (96.6 % Vs. 33.3 %). Conclusion. Arterial blood hemoglobin oxygen saturation of 60–90 could not be the correct key to unlock the problem of intubation decision in patients with COVID-19. Therefore, hemoglobin oxygen saturation should not be solely regarded as an indication for intubation in COVID-19.