scholarly journals Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Linh T. Nguyen ◽  
Sudip D. Thakar ◽  
Angela T. Truong ◽  
Dam-Thuy Truong
Keyword(s):  
Tracheal Intubation ◽  
Adverse Events ◽  
Airway Management ◽  
Reliable Method ◽  
Orotracheal Intubation ◽  
Tube Placement ◽  
Dental Injury ◽  
Malpractice Litigation ◽  
Novel Approach ◽  
Anesthesia Providers

Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient.

scholarly journals Optical Devices in Tracheal Intubation—State of the Art in 2020

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 575
Author(s):  
Jan Matek ◽  
Frantisek Kolek ◽  
Olga Klementova ◽  
Pavel Michalek ◽  
Tomas Vymazal
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Mouth Opening ◽  
Optical Devices ◽  
Tube Placement ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Endotracheal Tube Placement ◽  
Supraglottic Airway Devices ◽  
Thoracic Anesthesia

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

scholarly journals Pecha Kucha with Part-Task Training Improves Airway Management in Fresh Frozen Cadavers: A Case-Control Observational Study

2020 ◽  
Vol 29 (6) ◽  
pp. 532-537
Author(s):  
Kemal Tolga Saracoglu ◽  
Mehmet Yilmaz ◽  
Ayse Zeynep Turan ◽  
Alparslan Kus ◽  
Tuncay Colak ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Tracheal Tube ◽  
Complication Rate ◽  
Task Group ◽  
Tube Placement ◽  
Fiberoptic Intubation ◽  
Fresh Frozen ◽  
Task Training

<b><i>Objective:</i></b> The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. <b><i>Subjects and Methods:</i></b> The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (<i>n</i> = 9) received part-task training and group 2 (<i>n</i> = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. <b><i>Results:</i></b> Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

scholarly journals Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess

2021 ◽  
Vol 14 (2) ◽  
pp. e238600
Author(s):  
Ming Kai Teah ◽  
Esther Huey Ring Liew ◽  
Melvin Teck Fui Wong ◽  
Tat Boon Yeap
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Patient Outcomes ◽  
Fibreoptic Intubation

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Comparison of three fixation methods for orotracheal intubation in 95 adults

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Ye Sun ◽  
Hua Fan ◽  
Xiao-Xia Song ◽  
Hua Zhang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Intubation ◽  
Older People ◽  
Endotracheal Intubation ◽  
Orotracheal Intubation ◽  
The Other ◽  
Fixation Methods ◽  
The Difference

Abstract Background The present study aimed to compare three fixation methods for orotracheal intubation. Methods Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape–fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared. Results The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant. Conclusion The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.

scholarly journals I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Chaoliang Tang ◽  
Xiaoqing Chai ◽  
Fang Kang ◽  
Xiang Huang ◽  
Tao Hou ◽  
...  
Keyword(s):  
Stress Response ◽  
Tracheal Intubation ◽  
Adverse Events ◽  
Endotracheal Tube ◽  
Posterior Fossa ◽  
Carbon Dioxide Tension ◽  
Uneventful Recovery ◽  
Posterior Fossa Surgery ◽  
Necrosis Factor Alpha ◽  
Respiratory Variables

Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients.Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared.Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasmaβ-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI.Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lindsay Johnston ◽  
Taylor Sawyer ◽  
Anne Ades ◽  
Ahmed Moussa ◽  
Jeanne Zenge ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Estimating Equation ◽  
Oxygen Desaturation ◽  
Physician Training ◽  
Training Level ◽  
Success Rates ◽  
Emergency Airway ◽  
Significant Difference

<b><i>Introduction:</i></b> Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. <b><i>Methods:</i></b> Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). <b><i>Results:</i></b> Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; <i>p</i> &#x3c; 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; <i>p</i> = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; <i>p</i> &#x3c; 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. <b><i>Conclusion:</i></b> Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

scholarly journals Submental method for orotracheal intubation in treating facial trauma

1998 ◽  
Vol 116 (5) ◽  
pp. 1829-1832 ◽  
Author(s):  
Luiz Carlos Manganello-Souza ◽  
Nicolas Tenorio-Cabezas ◽  
Luiz Piccinini Filho
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Surgical Intervention ◽  
Orotracheal Intubation ◽  
Facial Trauma ◽  
Facial Fractures ◽  
Surgical Team ◽  
Visible Scar ◽  
Alternative Method

OBJECTIVE: To demonstrate an alternative method for intubating patients with fractures of maxilla and nose, prior to surgery. DESIGN: Cases Report. PARTICIPANTS: We studied 10 patients with facial fractures that affected maxilla and nose. INTERVENTION: The patients were submitted to surgery under general anesthesia and submental oro-tracheal intubation. RESULTS: This type of intubation allowed the surgical team to work on the whole face of the patient and left no visible scar. CONCLUSION: This procedure is indicated for patients with fractures of maxilla and nose who need surgical intervention under general anesthesia.

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