A simple method to facilitate difficult intubation

Smith, Martin M.; Buist, Robert J.; Mansour, N. Y.

doi:10.1007/bf03007497

Cited by 14 publications

(6 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the stylet inside tracheal tubes is used to temporarily change the tube to a hockey-stick shape so as to improve access to the ‘ anterior larynx ’. [30–32] Similarly, the augmented curved tip of DLTs is more likely to be aligned with the glottis in the anterior direction and with the left bronchus in the left direction. This is a probable reason for the shorter time and fewer attempts for intubation in the curved-tip group, especially in the patients with the laryngoscopic grade of 2 or 3.…”

Section: Discussionmentioning

confidence: 99%

“…However, the stylet can be broken or hardly removed from the tube when it is too angulated. [30, 35, 36] Moreover, the excessively bent tip may intensify contact and damage to airway tissues during intubation. We thus bent the DLT tip only to an angle of 135° (= 180° - 45°) and observed fewer right bronchial misplacement without aggravating airway injury.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Augmentation of curved tip of left-sided double-lumen tubes to reduce right bronchial misplacement: A randomized controlled trial

et al. 2019

View full text Add to dashboard Cite

BackgroundDuring intubation with a blind technique, a left-sided double-lumen tube (DLT) can be misdirected into the right bronchus even though its curved tip of the bronchial lumen turns to the left. This right bronchial misplacement may be associated with the tip angle of DLTs. We thus performed a randomized trial to test the hypothesis that the DLT with an acute tip angle enters the right bronchus less frequently than the tube with an obtuse tip angle.MethodsWe randomized surgical patients (n = 1427) receiving a polyvinyl chloride left-sided DLT. Before intubation, the curved tip was further bent to an angle of 135° and kept with a stylet inside in the curved-tip group, but not in the control group. After the tip was inserted into the glottis under direct or video laryngoscopy, the stylet was removed and the DLT was advanced into the bronchus with its tip turning to the left. We checked which bronchus was intubated, and the time and number of attempts for intubation. After surgery, we assessed airway injury, sore throat, and hoarseness. The primary outcome was the incidence of right bronchial misplacement of the DLT.ResultsDLTs were misdirected into the right bronchus more frequently in the control group than in the curved-tip group: 57/715 (8.0%) vs 17/712 (2.4%), risk ratio (95% CI) 3.3 (2.0–5.7), P < 0.001. The difference was significant in the use of 32 (P = 0.003), 35 (P = 0.007), and 37 (P = 0.012) Fr DLTs. Intubation required longer time (P < 0.001) and more attempts (P = 0.002) in the control group. No differences were found in postoperative airway injury, sore throat and hoarseness.ConclusionsBefore intubation of left-sided DLTs, augmentation of the curved DLT tip reduced the right bronchial misplacement and facilitated intubation without aggravating airway injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Augmentation of curved tip of left-sided double-lumen tubes to reduce right bronchial misplacement: A randomized controlled trial

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Even when the larynx can be visualised, it is sometimes difficult to pass the tracheal tube. Use of optimum shape of the tracheal tube, with [15][16][17][18][19] or without [20] a stylet, or passage of an introducer ('bougie') under vision ('visual bougie' technique) with subsequent 'railroading' of the tube into the trachea, are recommended [21].…”

Section: Methodsmentioning

confidence: 99%

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Henderson¹,

Popat²,

Latto³

et al. 2012

Anaesthesia

186

254

View full text Add to dashboard Cite

“…Even when the larynx can be visualised, it is sometimes difficult to pass the tracheal tube. Use of optimum shape of the tracheal tube, with [15–19] or without [20] a stylet, or passage of an introducer (‘bougie’) under vision (‘visual bougie’ technique) with subsequent ‘railroading’ of the tube into the trachea, are recommended [21].…”

Section: Methodsmentioning

confidence: 99%

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Henderson¹,

Popat²,

Latto³

et al. 2004

Anaesthesia

885

327

View full text Add to dashboard Cite

SummaryProblems with tracheal intubation are infrequent but are the most common cause of anaesthetic death or brain damage. The clinical situation is not always managed well. The Difficult Airway Society (DAS) has developed guidelines for management of the unanticipated difficult tracheal intubation in the non-obstetric adult patient without upper airway obstruction. These guidelines have been developed by consensus and are based on evidence and experience. We have produced flow-charts for three scenarios: routine induction; rapid sequence induction; and failed intubation, increasing hypoxaemia and difficult ventilation in the paralysed, anaesthetised patient. The flowcharts are simple, clear and definitive. They can be fully implemented only when the necessary equipment and training are available. The guidelines received overwhelming support from the membership of the DAS. Disclaimer: It is not intended that these guidelines should constitute a minimum standard of practice, nor are they to be regarded as a substitute for good clinical judgement.

show abstract

A simple method to facilitate difficult intubation

Cited by 14 publications

References 4 publications

Augmentation of curved tip of left-sided double-lumen tubes to reduce right bronchial misplacement: A randomized controlled trial

Augmentation of curved tip of left-sided double-lumen tubes to reduce right bronchial misplacement: A randomized controlled trial

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Contact Info

Product

Resources

About