Making endotracheal intubation easy and successful, particularly in unexpected difficult airway

Abstract

Background:Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians.Purpose:We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study.Settings and Design:Operating room, emergency department, intensive care unit (ICU), retrospective observational study.Materials and Methods:A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise.Statistical Analysis:Descriptive.Results:Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists.Conclusions:The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed.

CuBr2‐induced charge screening on photoactive nanocolloidal polypyrrole:poly(styrene sulfonate) composite multilayer thin‐film counter electrodes for high‐efficiency dye‐sensitized solar cells

“…Due to the presence of 15 wt% PSS in the reaction mixture, the structure of PPy is continuously doped with higher PSS content. Hence, there is a sharp absorption peak at 295 nm corresponding to π–π * interband transition, which is seen for both PPyUt and PPyCB films as shown in Fig. .…”

Intubación de paciente despierto con diagnostico de tumor de células de Merckel

“…Según las intubaciones emergentes, el 10% de los pacientes tienen una vía aérea difícil, que es un predictor independiente de complicaciones de la vía aérea. Es por ello de suma importancia que el personal de salud tenga conocimiento de las diferentes escalas de evaluación de vía aérea , así como los médicos en formación tengan experiencia en el manejo de estos casos [11].…”