Anaesthesia
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Comparative Study
Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.
Sixty patients with no clinical indicators of a difficult airway were selected to undergo a fibreoptic assessment after induction of general anaesthesia using both the Berman Intubating Airway and the Williams Airway Intubator. The bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation were studied. ⋯ The estimated odds ratio of obtaining an obstructed path was 3.06 times higher for the Berman than the Williams Airway. However, if the glottis could be reached with the bronchoscope, there was no significant difference in the degree of ease of intubation between the two airways.
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We report the management of a patient requiring surgical laryngoscopy with a view to laser resection of an epiglottic recurrence of laryngeal cancer. Previous attempts at tracheal intubation and awake nasal fibreoptic intubation had failed. During a previous anaesthetic the patient had been both 'impossible to intubate and to ventilate'. ⋯ This was achieved using the Aintree intubation catheter as an aid to nasal fibreoptic intubation and as a tube exchanger. Novel roles of the Aintree intubation catheter and LMA Proseal in this case are discussed. Complications of transtracheal jet ventilation as well as possible methods for avoiding them are also reviewed.
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This study examines the incidence and site of tracheal tube impingement during nasotracheal fibreoptic intubation, and the efficacy of anticlockwise tube rotation to overcome the problem. Forty-three patients underwent fibreoptic-assisted nasotracheal intubation using a preformed nasal tube, and a second fibrescope was used to observe any obstruction to passage of the tracheal tube. ⋯ Rotation resulted in successful intubation in all 10 cases, but proximal rotation did not always result in an equal degree of rotation at the tube tip. We conclude that the site of impingement for nasotracheal intubation with preformed nasal tubes is located at the posterior structures of the laryngeal inlet and that anticlockwise rotation is a simple and effective solution.