Principles of Airway Management

Finucane, Brendon T.; Santora, Albert H.; Uppington, Jeffrey

doi:10.1097/00006534-199003000-00033

Cited by 6 publications

(10 citation statements)

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“…The quoted incidence ranges widely from 5-]00%. 21 With the use of a blade extender in selected patients (male and larger patients), there was no difficulty in lifting the epiglottis during intubation. Prior to tracheal intubation in this group of patients, it is important that the blade extender is properly placed at the tip of the BL blade by listening and feeling for a firm "snap".…”

Section: Discussionmentioning

confidence: 99%

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

MacQuarrie

Hung

Law

1999

Can J Anesth/J Can Anesth

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Purpose: To evaluate the utility and safety of orotracheal intubation in adult patients with simulated difficult airways using the Bullard Laryngoscope (BL). Methods: A rigid cervical collar was used to simulate the difficult airway. The study consisted of two phases. Phase I evaluated the BL used in conjunction with an independently styletted endotracheal tube (ISE-Vr) passed freehand into the trachea. Phase II evaluated the new Multifunctional Intubating Stylet (MFIS). Forty patients were studied in each phase. Following induction of anesthesia a rigid cervical collar was applied and the laryngoscopic grade assessed. Tracheal intubation was then performed using the BL with either an ISE-I-F or the MFIS. The total time to intubate, number of attempts, failures, hemodynamic changes during intubation were recorded. Results: The rigid collar effectively simulated a difficult laryngoscopy, 65~ of patients had a grade 3 view. The success rates for tracheal intubation using the ISE-i-I-and MFIS were 88% and 83% respectively. The average times to intubation were similar for both intubating techniques (45.4 +_ 26.8 sec for the ISE-I-I-and 41.2 • 25.2 sec for the MFIS). Although there were minor hemodynamic changes, mucosal bleeding and sore throat following intubation, there were no major complications in any of the study patients. Conclusions: The BL, used with either an ISETT or the MFIS, is an effective and safe intubating device for patients with simulated restricted cervical spine movement. Further studies are needed to compare the effectiveness and safety of these two techniques in managing patients with a difficult airway.Objeclif: I~valuer I'utilit6 et la s&urit6 de rintubation orotrach&le de patients adultes, chez qui on a simul6 une alt&ation des voies aEriennes, en utilisant un laryngoscope de Bullard (LB). M&hode : Un collier cervical rigide a 6tE utilisE pour simuler I'intubation difficile. Quarante patients ont particip~ chacune des deux phases de I'~tude : pendant la phase I, on a 6value le LB utilisE en conjonction avec un tube endotrach~al ~ stylet ind~pendant (TETSI) passe & main libre dans la trachEe; pendant la phase II, on a ~valuE le nouveau stylet d'intubation multifonctionnel (SIMF). Apr& rinduction de ranesthEsie, on a applique un collier cervical rigide et cote la laryngoscopie. On a procEdE ensuite ~ I'intubation en utilisant le LB soit avec le TETSI, soit avec le SIME Le temps total nEcessaire pour procEder ~ I'intubation, le nombre d'essais, les &hecs et les changements h~modynamiques qui se sont produits pendant rintubation ont Et6 notes. REsultats: Le collier rigide a efficacement simulE des difficultEs d'intubation, 65 % des patients pr&entant une classe 3. Les taux de rEussite de rintubation endotrachEale avec le TETSI ou le SIMF ont Et6 de 88 96 et 83 % respectivement. Les deux techniques d'intubation ont n&essitE des temps similaires (45,4 • 26,8 s avec le TETSI et 41,2 _ 25,2 s avec le SIMF). Des changements hEmodynamiques mineurs sont survenus, un saignement de la muqueuse et une ir...

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Section: Discussionmentioning

confidence: 99%

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

MacQuarrie

Hung

Law

1999

Can J Anesth/J Can Anesth

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“…Activation of the glossopharyngeal nerve results in spasmodic and uncoordinated muscle movements. 1 Physical stimuli may induce gagging in some patients, while psychological stimuli (e.g., anxiety) may induce gagging in others. Techniques to reduce gagging include relaxation, hypnotherapy, acupuncture and "hypnopuncture", all of which target the neural pathways between the gagging centre and cerebral cortex.…”

Section: Patient-controlled Oral Airway Insertion To Facilitate Awakementioning

confidence: 99%

Patient-controlled oral airway insertion to facilitate awake fibreoptic intubation

Tsui

Dillane

Yee

2008

Can J Anesth/J Can Anesth

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“…This can commonly be accomplished with direct laryngoscopy, however, there is a 0.3% incidence of failed intubations [1]. If airway management fails, the outcome can be catastrophic.…”

Section: Introductionmentioning

confidence: 99%

The GlideScope<sup>®</sup> Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

Ackermann¹,

Pott²,

Vaida³

et al. 2012

OJAnes

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Background: This study assesses the effectiveness of the GlideScope ® Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation attempts, number of adjustment maneuvers, and number of failed intubations.

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Principles of Airway Management

Cited by 6 publications

References 0 publications

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

Patient-controlled oral airway insertion to facilitate awake fibreoptic intubation

The GlideScope<sup>®</sup> Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

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Principles of Airway Management

Cited by 6 publications

References 0 publications

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

Patient-controlled oral airway insertion to facilitate awake fibreoptic intubation

The GlideScope&lt;sup&gt;&#174;&lt;/sup&gt; Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

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The GlideScope<sup>®</sup> Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study