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Anesthesia Progress Sep 2022Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in...
OBJECTIVE
Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in nasotracheal intubation. In this retrospective study, we investigated the risk factors of postoperative sore throat in nasotracheal intubation.
METHODS
Anesthesia records of patients 16 to 80 years of age who underwent nasotracheal intubation were included. Patients underwent oral and maxillofacial surgery from February 2015 until September 2018. Airway device (Macintosh laryngoscope, Pentax-AWS, or McGRATH video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dose were investigated. Fisher exact test, Wilcoxon rank sum test, Welch t test, and Steel-Dwass multiple test were used, and a multivariable analysis was performed using stepwise logistic regression to determine the risk factors of postoperative sore throat.
RESULTS
A total of 169 cases were analyzed, and 126 patients (74.6%) had a postoperative sore throat. Based on the univariate analysis of the data, 12 factors were determined to be potentially related to the occurrence of a postoperative sore throat. However, after evaluation using stepwise logistic regression analysis, the 2 remaining variables that correlated with postoperative sore throat were airway device (P < .05) and intubation attempts (P = .04). In the model using logistic regression analysis, the fiberoptic scope had the strongest influence on the incidence of sore throat with reference to Pentax-AWS (odds ratio = 5.25; 95% CI = 1.54-17.92; P < .05).
CONCLUSION
Use of a fiberoptic scope was identified as an independent risk factor for postoperative throat discomfort. Compared with direct laryngoscopy and other video laryngoscopes, the use of a fiberoptic scope had a significantly higher incidence of sore throat.
Topics: Fentanyl; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Pharyngitis; Remifentanil; Retrospective Studies; Risk Factors; Steel
PubMed: 36223193
DOI: 10.2344/anpr-69-01-05 -
PloS One 2020Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of the MultiViewScope Stylet Scope and the direct laryngoscope with the Miller blade for the intubation in normal and difficult pediatric airways: A randomized, crossover, manikin study.
BACKGROUND
Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized crossover study, we compared the effectiveness of the MVS Stylet Scope to a standard direct laryngoscope with Miller #1 blade in simulated normal and difficult airways.
METHODS
Fifteen expert anesthesiologists and Fifteen anesthesiology residents participated in the study. Participants were asked to perform intubation with the Airsim Baby manikin first, and then with the Airsim Pierre Robin manikin. Participants in each group used the intubation devices in a randomized order. The primary outcome was the time of successful intubation. The secondary outcomes were the force exerted on the incisors during intubation, Cormack-Lehane scale, the difficulty of intubation.
RESULTS
There were no differences between MVS Stylet Scope and Direct laryngoscope in the time of successful intubation by the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved the force exerted on the incisors during intubation in the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved Cormack-Lehane scale, and the difficulty of intubation with difficult pediatric airway situation in both expert anesthesiologists and anesthesiology residents.
CONCLUSIONS
Although less forces on the incisors and improved view of glottis were observed with the MVS Stylet Scope, MVS Stylet Scope did not shorten the time of intubation. The results of this study mean that the MVS Stylet Scope may be a less invasive airway devise than the direct laryngoscope with the Miller blade in the pediatric airway management. For the next step, we need to evaluate the MVS Stylet Scope in the real patients as an observational study.
Topics: Airway Management; Anesthesiology; Child; Cross-Over Studies; Glottis; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Manikins; Respiratory System
PubMed: 32790734
DOI: 10.1371/journal.pone.0237593 -
Anales Del Sistema Sanitario de Navarra 2009Endotracheal intubation using direct laryngoscopy continues to be the "gold standard" amongst all the techniques for isolating the airway. Generally this is a secure... (Review)
Review
Endotracheal intubation using direct laryngoscopy continues to be the "gold standard" amongst all the techniques for isolating the airway. Generally this is a secure manoeuvre, but it might become a situation of extreme emergency when dealing with an unexpected difficult airway. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a new tool for use with the patient. The fact that it is easy to learn to use and simple to handle makes it a practical device in many situations where managing the airway is indicated. Its advantages over the Macintosh laryngoscope have been demonstrated in patients with an airway that it is difficult to manage and in adverse situations outside the surgical setting, when endotracheal intubation has been achieved in a simple way following unsuccessful attempts with conventional laryngoscopes. The greatest benefits in using the Airtraq laryngoscope have been shown in patients with a pronounced limitation of cervical mobility, and in those where the airway is distorted for anatomical reasons, such as pregnant women and obese patients.
Topics: Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy
PubMed: 19430513
DOI: No ID Found -
European Archives of... Dec 2020To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension.
PURPOSE
To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension.
METHODS
A consecutive series of patients who underwent percutaneous tracheostomy under laryngosuspension were reviewed for outcomes. The procedure is performed under general anesthesia and laryngosuspension. An 8.5 oral endotracheal tube is inserted and the cuff is inflated in the supraglottis, allowing access to the whole trachea and subglottis. The tube is taped to the laryngoscope. A rigid endoscope is inserted in the endotracheal tube through a swivel connector connected to the tube and the ventilation circuit. Percutaneous tracheostomy kit is used to perform dilatational tracheostomy at the desired level of the trachea under direct visual endoscopic control.
RESULTS
Forty-eight patients underwent percutaneous tracheostomy under laryngosuspension. Thirty-two cases were performed in an emergency after securing the airway with endotracheal intubation. In all other cases, tracheostomy was performed as a part of an elective procedure affecting the airway or in patients requiring prolonged ventilation. More than half of patients were considered high risk by virtue of one or more of the following: morbid obesity, prior neck surgery, prior neck radiotherapy, progressive head and neck cancer, or laryngotracheal stenosis. Complications occurred in seven cases.
CONCLUSION
Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of patient ventilation and hemostasis throughout the procedure. High-quality endoscopic vision and easy access to the airway under laryngosuspension allow tracheostomy to be performed with maximum safety.
Topics: Dilatation; Humans; Intubation, Intratracheal; Laryngoscopes; Trachea; Tracheostomy
PubMed: 32577900
DOI: 10.1007/s00405-020-06141-1 -
Anaesthesia Sep 1999The light from a battery-powered laryngoscope with a fibreoptic blade is limited by the 3-V battery and deteriorates with use, as the optic fibres break. A laryngoscope...
The light from a battery-powered laryngoscope with a fibreoptic blade is limited by the 3-V battery and deteriorates with use, as the optic fibres break. A laryngoscope handle is described in which the bulb is replaced by a fibreoptic cable connecting to a mains, halogen light source. This laryngoscope gives 6000 Cd.m(-2) light at the centre of the field compared with 800 Cd.m(-2) for the battery. The field of illumination is also improved from 1600 Cd.m(-2) 20 mm from the centre compared with 120 Cd.m(-2) for the battery handle. The fibre optic cable is attached at the side of the handle and does not interfere with intubation. The mains-powered light source has the advantages of being reliable with the ability to switch immediately to a second bulb; low running costs; improved light for intubation and it makes it possible to use a dental mirror for indirect laryngoscopy in difficult intubations.
Topics: Electricity; Fiber Optic Technology; Humans; Laryngoscopes; Lighting
PubMed: 10460559
DOI: 10.1046/j.1365-2044.1999.00950.x -
PloS One 2022Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle...
INTRODUCTION
Videolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of customized videolaryngoscope was proposed and studied for patient care in underprivileged areas however there were no distinct conclusions on its performances.
METHOD
The study follows PRISMA guidelines for systematic review and the protocol in International Prospective Register for Systematic Reviews. The primary aim was to assess the first attempt success of customized videolaryngoscope for endotracheal intubation. The secondary objective was to evaluate the number of attempts, laryngoscopic view in terms of Cormack Lehane score and Percentage of glottic opening, use of external laryngeal maneuver and stylet and, the airway injuries after the endotracheal intubation.
RESULT
Five studies were analyzed for risk of bias using the National Institute of Health Quality Assessment Tool for cross-sectional studies. Most of the studies had a poor to a fair level of evidence with only one study with a good level of evidence. Certainty of evidence was "very low" for all eligible studies when graded using the Grading of Recommendation, Assessment, Development and Evaluation approach for systematic review.
CONCLUSIONS
The certainty of the evidence regarding performance of custom-made videolaryngoscope compared to conventional laryngoscope was very low and the study was performed in small numbers with fair to the poor risk of bias. It was difficult to establish and do further analysis regarding whether the customized form of videolaryngoscope will improve the first attempt success rate for tracheal intubation, reduce the number of attempts, improve the laryngoscopic view, require fewer external aids and reduce the incidences of airway injury with the given low-grade evidence. Some properly conducted randomised clinical trials will be required to further analyze the outcome and make the strong recommendations.
Topics: Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Video Recording
PubMed: 34990475
DOI: 10.1371/journal.pone.0261863 -
Minerva Anestesiologica 2022
Topics: Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Manikins; Video Recording
PubMed: 34527409
DOI: 10.23736/S0375-9393.21.15998-X -
Anaesthesia Nov 2015We compared the McGrath MAC(®) videolaryngoscope when used as both a direct and an indirect laryngoscope with a standard Macintosh laryngoscope in patients without... (Comparative Study)
Comparative Study
We compared the McGrath MAC(®) videolaryngoscope when used as both a direct and an indirect laryngoscope with a standard Macintosh laryngoscope in patients without predictors of a difficult tracheal intubation. We found higher median Intubation Difficulty Scores with the McGrath MAC as a direct laryngoscope, 1 (0-3 [0-5]) than when using it as an indirect videolaryngoscope, 0 (0-1 [0-5]) or when using the Macintosh laryngoscope, 0 (0-1 [0-5]), p = 0.04. This was mirrored in the subjective user reporting, scored out of 10, of difficulty for each method 3.0 (2.0-3.4 [0.5-80]); 2.0 (1.0-3.9 [0-70]) and 2.0 (1.0-3.3 [0-70]), respectively (p = 0.01). This difficulty is in part explained by the poorer laryngeal views recorded using the Cormack and Lehane classification system (p < 0.001) and reflected in the higher than normal operator force required (25%, 4%, 8% for each method, respectively, p < 0.001) and the increased use of rigid intubation aids (21%, 6%, 2%, respectively, p < 0.001). There was no difference between the groups in time taken to intubate or incidence of complications. There was no statistical difference in the performances as measured between the McGrath MAC used as an indirect videolaryngoscope and the Macintosh laryngoscope. We cannot recommend that the McGrath videolaryngoscope be used as a direct laryngscopic device in place of the Macintosh.
Topics: Equipment Design; Female; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Male; Middle Aged; Video Recording
PubMed: 26336853
DOI: 10.1111/anae.13209 -
British Journal of Anaesthesia Jan 2018
Topics: Anesthetics; Critical Care; Intubation; Laryngoscopes; Laryngoscopy
PubMed: 29397120
DOI: 10.1016/j.bja.2017.11.017 -
Medicine Feb 2023It is important to reduce the hemodynamic response during tracheal intubation. We performed a systematic review and meta-analysis of the Airway Scope and Macintosh... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is important to reduce the hemodynamic response during tracheal intubation. We performed a systematic review and meta-analysis of the Airway Scope and Macintosh laryngoscope to determine whether they reduce the hemodynamic responses of heart rate (HR) and mean blood pressure (MBP) after tracheal intubation under general anesthesia.
METHODS
We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim of our meta-analyst is to determine if the Airway Scope reduces hemodynamic responses (HR and mean MBP) 60 seconds after tracheal intubation compared to the Macintosh laryngoscope. We expressed pooled differences in hemodynamic responses between the 2 devices as weighted mean differences with 95% confidence intervals. We conducted trial sequential analysis. Secondarily, we investigated the ability of the Airway Scope and Macintosh laryngoscope to reduce hemodynamic responses at 120 seconds, 180 seconds, and 300 seconds after tracheal intubation.
RESULTS
We identified clinical trials comparing hemodynamic response via a comprehensive literature search. Of 185 articles found in the search, we selected 8. In comparison to the Macintosh laryngoscope, the Airway Scope significantly reduced HR and MBP at 60 seconds after tracheal intubation (HR; weighted mean difference = -7.29; 95% confidence interval, -10.9 to -3.62; P < .0001; I2 = 57%, MBP; weighted mean difference = -11.5; 95% confidence interval, -20.4 to -2.65; P = .01; I2 = 91%). At the secondary outcome, the Airway Scope significantly reduced the fluctuation of HR after 120 seconds and 180 seconds of tracheal intubation. However, the Airway Scope did not significantly reduce MBP 120 seconds, 180 seconds, and 300 seconds after tracheal intubation. Trial sequential analysis suggested that the total sample size reached the required information size for heart rate.
CONCLUSIONS
Our finding suggested that the Airway Scope attenuated hemodynamic responses at 60 seconds after tracheal intubation in comparison with that of the Macintosh laryngoscope. However, the MBP sample size is small and further research is needed.
Topics: Humans; Laryngoscopy; Laryngoscopes; Intubation, Intratracheal; Hemodynamics; Heart Rate
PubMed: 36827056
DOI: 10.1097/MD.0000000000033047